Noteworthy News Articles on Mental Health Topics, November 17-21, 2003



Questions Rise Over Imprisoning Sex Offenders Past Their Terms
Laura Mansnerus, New York Times- 11/17/2003

KEARNY, N.J. — Robert Deavers, guilty of two rapes, has done his 20 years in prison. He still has not been freed. Instead, for five years, he has been locked up by state officials who are worried about what he might do. Mr. Deavers took another try at gaining his release in the fall of 2002 at a hearing, his third. The subject was his state of mind, and he quickly lost hope.
    A state psychiatrist who had interviewed him briefly told the closed, nearly empty courtroom that Mr. Deavers tended to self-righteousness and had been taken to task in group therapy for being overconfident. A psychologist who had never met him but had reviewed his records said he was egocentric. There was much testimony about an incident in which he had bumped into a female guard. By noon Mr. Deavers knew what would happen a month later: the judge would rule that he was too dangerous to be released.
    Back in his room, Mr. Deavers resumed his role in a fiercely debated but politically popular system of preventive detention used by New Jersey and 15 other states. In hearings here at the Northern Regional Unit at Kearny, a Department of Corrections center, men who have finished their prison terms are involuntarily committed as psychiatric patients and, with a handful of exceptions, are recommitted each year. Mr. Deavers is one of 287 "sexually violent predators" in two high-security psychiatric centers in the state. The law has long allowed the commitment of mentally ill people who pose an imminent danger to others. But the detention of these men, many legal experts say, is a striking departure from the principle that people who are not mentally ill may be confined only for their acts, not their thoughts.
    In yearly review hearings, the men are judged by their sexual tastes and fantasies — or what psychiatrists suppose to be their fantasies — as well as their performance on psychological tests, their attitudes toward authority and their willingness to acknowledge their crimes and disorders. Many are rapists or child molesters, and the fear that they might commit more of the same crimes is grave. In 1998 New Jersey — like other states reacting to murders by sex offenders with previous convictions — authorized the commitment of anyone who has served time for a sex crime and is found to have a "mental abnormality or personality disorder" that makes him likely to commit another crime. These men are to be given treatment, chiefly group therapy, until they are judged no longer dangerous.
    Five years later, only a handful have been released, and critics of the commitment process — psychiatrists, civil-liberties advocates and even some early supporters of the law — are concerned that it is merely an exercise rigged to keep sex offenders locked up for a lifetime. One Kearny resident, committed after five years in prison for having sex with a teenager, said, "I'd be better off if I'd killed him." The process is severe for a purpose: dealing with a type of criminal that society regards as dangerous, devious and manipulative.
    New Jersey's law is considered one of the strictest, prompted in part by the 1994 rape and murder of a 7-year-old, Megan Kanka, by a neighbor who had served two prison terms for sexually assaulting children. Supporters of the law note that most of those committed are repeat offenders, and say they warrant every effort to determine whether they might commit future crimes. As hard as it may be to predict behavior, they say, the alternative is waiting for another rape. Yet because of the secrecy surrounding the law, few of those supporters know how it has been put into practice.
    New Jersey, more than most states, seals the commitment process from public view. It is one of three states that do not have juries at the hearings, which are closed to protect patients' confidentiality. Patients' names never enter any public record. The decisions of the two Superior Court judges who handle all the cases are sealed. But in a half-dozen recent cases, a New York Times reporter was allowed, with the patients' permission, to attend hearings at Kearny. Those proceedings — along with interviews with lawyers who represent sex offenders, with some current and former state employees and with more than a dozen patients — offer a glimpse into the workings of the Sexually Violent Predator Act.
    The proceedings are a mix of psychiatry and law that according to many in both professions, blurs distinctions the system has long made between the mad and the bad. The hearings are roughly modeled on commitments for the mentally ill, but with a key difference. In a regular civil commitment, the focus is on the patient's current state of mind; crimes committed long ago are usually not considered relevant. In the hearings at Kearny, however, criminal records are considered critical evidence of the patient's thoughts, behavior and possibility of committing future crimes.
    Since the patient's state of mind is at issue, almost any information about him is admissible, including much that would be barred in a criminal proceeding, like hearsay evidence, evaluations written years ago by the police or psychiatrists, statements to therapists and the patient's own writings. Critics say the hearings deny offenders both the legal protections of a criminal prosecution and the sound medical grounding of a regular civil commitment case. They say the diagnoses — framed by lawmakers rather than doctors — are so vague they could apply to millions of people. By rummaging through a patient's past and psyche, they say, the state can always find a reason to keep him confined. Several people who have worked in the system told of prosecutors' shopping for psychiatric opinions and of exaggerated, even erroneous testimony and public defenders too overwhelmed to organize a proper defense.
    It is hard to find anyone working in the system to speak about the process. All the state agencies involved declined requests for interviews with officials; the public defender's office and the attorney general's office answered some written questions. John Kip Cornwell, a law professor at Seton Hall University who testified in support of the sexual predator bill and still backs it, said that it was difficult to draw distinctions between the truly dangerous and the merely criminal but that those judgments could and should be made. Psychiatry is an inexact science, he said, but the hearings do allow expert testimony from each side. Still, he is concerned that the process focuses on the patient's criminal record, "and then once you're in, it's tough to get out." Other backers of the law have similar qualms. Five years ago the New Jersey Psychiatric Association broke with its national parent organization and supported the predator law, to assure psychiatrists a role in the process.

Has the law worked as hoped?
"Let me put it this way," said Dr. David A. Reskof, chairman of the association's forensic psychiatry committee. "How many people have been committed to Kearny? And how many have come out?" Days Before Freedom The secret process begins, aptly, with a surprise. Days before they are to be released, inmates are notified that they will be sent to Kearny. Candidates for commitment are identified by the Department of Corrections shortly before their release dates. The attorney general's office screens the cases and seeks commitment of about 45 percent of those offenders, said Barbara Waugh, the assistant attorney general who supervises the cases. "This is not something we take lightly," Ms. Waugh said through a spokesman. But she said the office had no written guidelines for the screening process, which is under challenge in federal court. In a class-action suit, patients contend that it is unconstitutionally arbitrary; the state has not replied.
    To get a temporary commitment order from a judge, the state must present two medical recommendations. One psychiatrist who supplied them, Dr. Gerald Groves, said that sometimes, if he advised against committing someone, "the institution might go find another psychiatrist who would be willing to commit." The offender then awaits an initial commitment hearing. There, the state presents its diagnoses and usually argues that the offender has shown an inability to control his deviant impulses, which in turn shows a high likelihood of committing another crime. The state wins 95 percent of those cases, according to the attorney general's office, and even more of the annual review hearings that follow. In five years, 11 patients have been released out of 302 committed, according to the Department of Corrections, which would not say why. The state has recommended none for release.
    Courts around the nation have upheld violent-predator statutes since Washington State enacted the first in 1990, but have expressed concerns. The United States Supreme Court cautioned in 1997 that a commitment must have a psychiatric basis and cannot be a mere extension of punishment, and it held last year, in upholding the Kansas law, that states must establish an offender's "serious difficulty in controlling behavior" before committing him. The New Jersey Supreme Court ruled last year that the offender must be found "highly likely," not just more likely than not, to commit further sex crimes. But experts say none of those rulings have had much effect.
    Dr. Paul Appelbaum, a past president of the American Psychiatric Association and an authority on psychiatry and the law, said the United States Supreme Court had ratified a vague standard that gave wide discretion to prosecutors and judges. The association has called the predator statutes "a serious assault on the integrity of psychiatry," objecting to the use of statements made in psychotherapy as evidence against patients, and the use of the mental health system for people who are not mentally ill. (Like most states, New Jersey has a separate hospital for violent criminals who are mentally ill.) "It's hard to know where to start because the whole thing is so crazy," Dr. Appelbaum said.
    Many of those familiar with New Jersey's process say the diagnoses, which need not include specifically sexual disorders, are often highly debatable. Dr. Timothy P. Foley, a forensic psychologist who has testified for both sides in commitment hearings, said one common diagnosis — "personality disorder, not otherwise specified," or N.O.S. — could apply to "anybody who's interesting." "I would diagnose myself with personality disorder, N.O.S.," he said. Most psychiatrists and psychologists also say they can never reliably predict recidivism, which Justice Department analyses show is lower among sex offenders than in the general criminal population, though it varies greatly by offense. The state often cites patients' denials — or playing down — of offenses as evidence that further treatment is needed. But most forensic studies have found no link between denial or hostility to treatment and future crimes.
    Proponents of the sex-offender laws say it is the responsibility of the legal system to make that difficult prediction. "That's the way the law always works," said Richard Samp, the chief counsel of the Washington Legal Foundation, a conservative group that filed a friend-of-the court brief supporting the Kansas law. "When you're predicting the future, all you can do is ask a doctor to make his best medical judgment."

Brushing Against a Guard
Robert Deavers was the first person to be committed under New Jersey's sex-offender law. And at his last review hearing, he expected to become the first to be released. Mr. Deavers, a 53-year-old Vietnam veteran, has a dubious history: shortly after finishing a prison term for attempted rape, he raped two women. Yet he has been considered a success in treatment, and the state attorney general's office had tentatively endorsed a plan for his release.
    "I told them I'd wear a bracelet, a chip with a G.P.S. tracking device," Mr. Deavers said in an interview before the hearing. "I told them I'd urinate in a jar weekly. I'm the one who put myself in this position, so in order to make them feel comfortable I'm willing to give up some of my own civil liberties." But in the hearing, a new problem emerged: rushing through a doorway recently, he brushed up against a female guard. Sent to solitary confinement, he went on a hunger strike in protest and refused to speak to staff members.
    Mr. Deavers's public defender, Joan Van Pelt, said the incident had been an accident and not sexually motivated, and introduced the results of a polygraph test that backed him up. But the state's psychiatrist was skeptical. "That doesn't mean he didn't have those thoughts," said the psychiatrist, Dr. Charles Gnassi. "Brushing past a woman, a man — it's difficult, I would think, not to have some type of sexual thinking."
    But it was Mr. Deavers's reaction to the incident that most concerned the state's next witness, Dr. Merrill Berger. "He didn't get it," Dr. Berger said of the guard's complaint. "He was crushed that she would feel this way. This really speaks to his egocentric view of the world."
    The state contended that the incident showed a lack of self-control, which would make Mr. Deavers likely to commit another crime. The argument succeeded. The judge, Serena Perretti, found that he had been "acting against his best interest, asserting his entitlement, regardless of the rights of others."
    In some states, similar commitment hearings are full-fledged trials lasting weeks, but in New Jersey, they rarely take more than a day. In most cases, the state's experts have only recently met the patient. Therapists who have treated the patients do not normally testify, since that might interfere with the treatment. Patients often have no expert witnesses to dispute the state's findings. Many said the public defender's office had denied their requests for an independent evaluation, leaving them with no allies in court but a public defender who might have 40 other cases. Their complaints are hard to verify; the public defender's office would say only that "occasionally" it would refuse to hire an expert "where to do so would not be reasonably expected to advance the client's case." Most of the testimony is based on the patient's records, containing everything from juvenile charges to the notes of his therapists. Many of the evaluators' reports were written years ago and borrowed from yet older evaluations. The reports are often ambiguous or sketchy, even indecipherable.
    At a September hearing for Edward Gorcica, an exhibitionist who had exposed himself to children, the state's psychiatrist, Dr. Michael McAllister, said he would tentatively add fetishism to his list of diagnoses. He said he had just noticed a statement in a 1999 psychiatrist's report that Mr. Gorcica had mentioned fantasizing about feet. Patrick Madden, the public defender, said the handwritten report appeared to say that the patient "fantasized about women but not children." Dr. McAllister, he said, had probably mistaken the word "but" for "feet." Judge Perretti, squinting at the document, said that was the more logical interpretation and asked the doctor if he would withdraw his statement. Not necessarily, Dr. McAllister replied. He said he had seen other reports by that psychiatrist, who was foreign-born, and that "sometimes his syntax is a bit off."
    The record of a patient's crimes — usually called "the official version" — takes on an authority of its own, not just for its details, but also for the psychiatric interpretations it contains about those details. "This is so much like everything that was criticized in the Soviet Union," said Margaret Smith, a criminologist who works at the Prisoners' Self-Help Legal Clinic in Newark, and is one of the few outsiders who has attended hearings at Kearny. "There's no way to contest any part of the official record without it being spun in a way that makes you look sicker." She added, "If you say you didn't do it, that's just evidence of how much you need treatment."

A Piece of His Record
William Anderson, an amateur boxer and occasional drug dealer from Newark, pleaded guilty to two felonies — the rape of a 21-year-old woman and aggravated assault on a 12-year-old girl — and he served seven years in prison. But in July, at his latest review hearing, he was confronted with a piece of his record that he thought had been resolved: the specifics behind charges that were dropped when he accepted the plea bargains.
    Mr. Anderson, 34, maintains that from the start, he had denied some of the accusations in police reports. That was exactly the problem, said Dr. Stanley Kern, the state's psychiatrist, who argued that Mr. Anderson posed a risk of offending again in part because he "does not fully admit to sex offenses as documented in the official records." As Dr. Kern recounted the rape, Mr. Anderson, then 23, forced the woman to perform oral sex on him and submit to vaginal and anal sex, and then raped her anally with a flashlight. Mr. Anderson's public defender, Ms. Van Pelt, protested that there was no evidence of an assault with a flashlight and that that charge had been dropped. Ms. Van Pelt asked Dr. Kern if he had seen the report of the doctor who examined the victim; it noted that there was "no medical evidence of any lacerations or bleeding in the genital or rectal area." Dr. Kern said he had not.
    When Judge Perretti announced her decision, it was not clear what weight she had given the events of a decade ago. But she did note another detail from his record: Mr. Anderson had fathered five children by the age of 18, "only three in wedlock." "That does clearly indicate a maladaptive pattern of behavior," she said. She concluded, "I do not find any evidence that, given denials, rationalizations and blame-shifting, that the respondent's treatment has in any respect diminished his risk."



Experts on Both Sides Testify for Hinckley
Carol D. Leonnig, Washington Post- 11/17/2003

Attorneys for John W. Hinckley Jr. described him yesterday as a caring and changed man whose mental health has dramatically improved since he tried to assassinate President Ronald Reagan in 1981 and who would pose no danger if allowed to leave a Washington mental hospital for brief, unchaperoned visits with his family. The portrait was drawn at the start of a court hearing to decide whether Hinckley, 48, should get privileges that could move him along the path to eventual release. His legal team and chief therapist yesterday listed what they described as positive signs that Hinckley is ready to move beyond St. Elizabeths Hospital, where he has been confined since a jury found him not guilty by reason of insanity in 1982.
    His hobbies have evolved from reading about famous murderers to caring for a band of feral cats on the grounds of St. Elizabeths, they said. He has told doctors he is sorry for hurting the four shooting victims and their families and has volunteered to take preventive medication, they said. And finally, his doctor reported, Hinckley has not shown any symptoms of the psychosis and violent personality disorders that led him to think he could shoot a president to win the heart of actress Jodie Foster. "He's probably the least dangerous person on the planet," said Hinckley's attorney, Barry Wm. Levine, stressing that the Secret Service is expected to continue shadowing Hinckley as it does now whenever he leaves the hospital with staff supervision. Agents even watch him from a parked car when he walks alone at the gated Southeast Washington compound.
    "The proposal that is made here is not a bold one," Levine said. Even the prosecution's medical experts concur that Hinckley should be allowed to take unsupervised trips to see his family off hospital grounds. Hinckley's parents, John and Jo Ann, live in Williamsburg, where some of the proposed visits would take place. They were at the hearing yesterday. But government prosecutors, urged by Attorney General John D. Ashcroft's top deputies to oppose such outings, insisted yesterday that Hinckley cannot be trusted. Prosecutors said Hinckley has fooled his therapists in the past into thinking he is better. They contended that the medical opinions provide no guarantee of the public's safety. "He's had a history of deceptiveness," Assistant U.S. Attorney Robert Chapman told Hinckley's therapist. "Isn't it true he's withheld things from his doctors? He's withheld things from you?"
    U.S. District Judge Paul L. Friedman, who will weigh Hinckley's request at the conclusion of the three-day hearing, indicated that he wasn't automatically persuaded by the experts, even as Hinckley's therapist and other reports pointed out that Hinckley is no longer reading violence-themed books or exhibiting any signs of obsession with Foster. "Sometimes people are deceptive and aren't found out," the judge told the attorneys. "Maybe he's not reading books because he knows he's being watched. Maybe he's learned what to be deceptive about."
    Levine told the judge that all the psychiatrists and experts who have examined Hinckley are convinced that he is no longer a danger to himself and would not "snap" during one-day and overnight visits to his parents' home. But Friedman said he wasn't yet convinced, "and ultimately I'm the one who has to decide."
    The stakes are unusually high, and the outcome will be closely watched by many. Hinckley's family, attorneys, mental health advocates of national organizations -- even staff members at St. Elizabeths -- argue that Hinckley is being unfairly subjected to a stricter standard than other patients because of whom he attacked.
    Hinckley's assault, on March 30, 1981, came as Reagan left the Washington Hilton Hotel after a speech. The shooting seriously injured the president, press secretary James S. Brady, U.S. Secret Service agent Timothy J. McCarthy and D.C. police officer Thomas K. Delahanty. Hinckley was taken to the forensics ward at St. Elizabeths in 1982. Almost none of the people who were on that ward then are still there. For example, Hinckley's former girlfriend, Leslie deVeau, was also found not guilty by reason of insanity in 1982 for fatally shooting her 10-year-old daughter. DeVeau was released after four years at the hospital.
    Yesterday, Hinckley's main therapist, Sidney Bink, testified that Hinckley has agreed to take the drug Risperdal to control possible episodes, although the medication is not required. Bink said most patients are given privileges to walk around the hospital grounds as the final step before they are released, but Hinckley has had those privileges for several years. "This is an unusual situation," Bink explained.
    But many politicians in President Bush's administration and in Congress have hotly opposed any community release because they consider it an insult to the White House, Reagan, officers of the law, and crime victims in general. Chapman noted yesterday that Hinckley did not tell his doctors that deVeau bought him a book on Foster in summer 2000 -- while the same doctors had concluded that Hinckley had no more interest in the actress.
    Another federal judge turned down a similar request from Hinckley in 1997, relying largely on the concerns of Raymond F. Patterson. The former St. Elizabeths forensics chief determined that Hinckley had a disturbing infatuation with a hospital pharmacist who slightly resembled Foster. But during this hearing, Patterson is scheduled to testify that he would support gradual unsupervised visits for Hinckley with family -- as many as six overnight trips to his parents' home if all goes well. The government's other expert doctor agrees.



Schizophrenia Tied to Sense of Smell
David Kohn, Baltimore Sun- 11/17/2003

A study has found that a faulty sense of smell may predict precisely the risk of schizophrenia, months or years before obvious symptoms appear. Until now, doctors have had no reliable way to make an early diagnosis of the debilitating mental illness, which afflicts more than 2 million Americans. "This is the first time we've found a potential marker specifically for schizophrenia. It's a promising diagnostic tool," said University of Melbourne neuropsychologist Warrick Brewer, one of the study's co-authors. Early detection can be key, Brewer said, because schizophrenic patients who get prompt treatment generally do better in the long run. A psychotic episode can cause permanent brain damage, raising the chance of subsequent attacks.
    Published in The American Journal of Psychiatry, the study examined 81 people at high risk for developing schizophrenia. The subjects had all shown early subtle signs of the disease: genetic risk, disorganized thinking or subtle hallucinations or delusions. Brewer and his colleagues gave this group a standard 40-item scratch-and-sniff test, which asks subjects to smell an odor and then identify it. Twelve of the 81 subjects scored very low on the smell test. Over the next two years, only those 12 developed schizophrenia. Ten other patients also had psychotic episodes, but their symptoms were caused by other mental illnesses.
    Schizophrenia researchers praised the study. "It could provide an early warning system," said University of Pennsylvania psychiatrist Bruce Turetsky, who also has studied the connection between smell and schizophrenia. Turetsky has found that nasal cavities of schizophrenics are smaller than those of healthy subjects.
    Scientists have known for a decade that those with the disease have an impaired sense of smell. Most people with schizophrenia can perceive the presence of a strong odor but have trouble recognizing and naming it. They might mistake the scent of pizza for that of bubble gum, for instance. Scientists suspect that this olfactory deficiency arises from a quirk in neural circuitry--the area of the brain that interprets emotion and social signals also decodes aroma. In schizophrenics, this brain region, the limbic system, somehow malfunctions. Those with the disease are often detached and withdrawn and have trouble decoding social and emotional signals. This breakdown also damages the ability to label odor, and the impairment seems to precede other symptoms. "Even before the onset of schizophrenia, these people were showing a compromise of that neural pathway," Brewer said. He emphasized that not everyone with a poor sense of smell has a higher chance of getting schizophrenia. Only those who also show other symptoms are at greater risk, he said.
    The study adds to the growing awareness that studying smell can help researchers understand schizophrenia, said Columbia University psychiatry professor Dolores Malaspina. "Smell is something that we can look at so easily, and yet it tells us so much," she said.



Anti-Overdose Drug Given to San Francisco Addicts
Daniel Costello, Los Angeles Times- 11/17/2003

Marking a first for a public agency in California, the San Francisco health department began dispensing a controversial anti-overdose medication to heroin addicts Saturday at a city-sponsored needle exchange program. Despite criticism that it could encourage further addiction, San Francisco health officials say their plan to distribute the prescription medicine, known as naloxone, will save lives and possibly give addicts a chance to eventually go clean.
    A mix of health department staff and volunteers trained 11 drug users in a Tenderloin-area clinic. Officials hope to expand that number substantially over the next few weeks. "We know this saves lives and has almost no side effects. It's a miracle drug," said Dr. Josh Bamberger, who oversees the new program at the city Department of Public Health.
    A few other public agencies around the country have taken similar steps. In California, a private, nonprofit health group in Mendocino County two months ago began offering naloxone to a small group of clients. But officials say San Francisco is the first public agency in the state to distribute the medicine.
    The step is part of a 3-year-old initiative that seeks to reduce the harmful effects of drug use in San Francisco rather than solely trying to keep addicts from taking drugs. Other efforts include methadone treatments, needle-exchange programs to reduce the transmission of diseases and medical attention for complications from addiction, such as skin infections.
    The naloxone program requires people who receive the drug to be trained in how to administer it and how to perform other rescue techniques to assist overdose victims. The medicine is injected into an arm or leg and doctors say victims can recover in a matter of minutes. It is mainly used with heroin overdoses but is also effective with other opiates such as morphine and Oxycontin. Each addict in the training program this weekend received two syringes pre-filled with naloxone. Officials describe naloxone as a nonaddictive, non-mood-altering drug that doctors and paramedics have used to treat victims of opiate overdose for decades. The medication has no street value and the common generic version costs as little as a dollar a dose. The drug works by blocking opioid receptor sites in the brain.
    Critics, including some physicians, worry that dispensing naloxone to addicts may cause more harm than good. Some fear addicts may not call paramedics after they revive a friend, while others are concerned that public funding of such a program endorses addiction. "This is a huge mistake," says Dr. Eric Voth, a Kansas addiction specialist and spokesman for Drug Free America, a national group that targets drug abuse. "It just isn't safe to remove this from a medical setting and put it in the hands of addicts who are notoriously unreliable," he says. Voth adds he would rather see the money spent on treatment programs so addicts could get off the drugs.
    Health officials in Portland, Maine, scrapped plans to distribute overdose medication to heroin users last year after intense public pressure. Doctors say there is a possibility, although rare, that someone recovering from an overdose after being treated with naloxone may experience a dangerous seizure. And for those addicted to opiates, naloxone immediately pushes them into an agonizing withdrawal that often produces nausea, tremors and extreme sweats. Because of the discomfort, some addicts may want to shoot up again quickly, possibly setting themselves up for another overdose, critics say. Peter Warren, a spokesman for the California Medical Assn., says the organization agrees with efforts to reduce the harmful effects of addiction but is wary of any initiative that doesn't include efforts to get addicts into treatment and counseling. Many naloxone programs encourage users to enter such programs but don't require it.
    Last year, a six-month study by researchers at UC San Francisco, partially funded by the city Department of Public Health, tracked 24 addicts who were given naloxone, along with eight hours of training, latex gloves and alcohol swabs. In all, participants reported witnessing 20 overdoses and successfully used the medication on 14 occasions. For various reasons, the other six overdose victims were not given naloxone but survived.
    Alex Kral, director of Urban Health Studies at UC San Francisco and an author of the study, says that a large publicly funded naloxone program in San Francisco is needed and viable. He points out that groups in San Francisco have been providing naloxone underground for several years. "I think the medical establishment is slowly coming around to this and seeing it as a solution to a needless problem," he says.
    New Mexico currently is dispensing the drug in several locations throughout the state and both Baltimore and New York City are planning to start similar programs in the next few months. Some private doctors and community-based organizations have also recently started providing the medication. (Los Angeles health officials say they have no plans to distribute naloxone.) New Mexico and Connecticut have passed laws limiting liability for nonmedical people who administer naloxone, including law enforcement officers or friends who are trying to save an addict. In San Francisco, doctors say they don't need a liability law because they are prescribing a legal medication and are covered by patient-client relationship. But a friend who administers the drug to an addict could be held liable for any ill effects.
    Nationally, heroin use is climbing dramatically, aided by a plunge in the drug's price. The number of new heroin users during the last decade grew by more than 100,000 per year — a pace not seen since the early 1970s. It's estimated that 2% of all heroin addicts die each year. Although overdose deaths in San Francisco have eased in recent years, the city averages more than 120 annually. That often surpasses the city's homicide numbers.
    Health officials say that people who have gone through drug treatment and fall back into their old habits are at particularly high risk of overdose. They often don't decrease the amount of drug they use to match their newer, lower tolerance to the drug. That's why some programs around the country are dispensing the anti-overdose medication to addicts leaving jail after short terms. Contrary to popular belief, many addicts who overdose on opiates survive for up to an hour. That leaves a large window of time to treat an overdose victim, including the use of naloxone, doctors say. Research shows that most people overdose near someone else and that up to three quarters of all addicts don't call paramedics if a friend is overdosing. Dr. Karl Sporer, an emergency physician at San Francisco General Hospital, says many addicts instead rely on a slew of popular street remedies that are believed to revive overdose victims, like filling their pants with ice or injecting them with milk.
    Because the idea of dispensing naloxone to addicts is relatively new, there is little research proving the programs reduce mortality rates. Anecdotally, officials in New Mexico and Chicago say they've seen up to a 20% drop in overdose cases since they've started distributing naloxone. Bamberger, the San Francisco health official, expects that his department will train up to 600 users over the next year. Addicts interested in receiving naloxone must first go through an hourlong training on how to administer the drug as well as how to provide rescue breathing and other life-saving techniques.



Rush Limbaugh Shares Life's Tough Lessons
Jacques Steinberg, New York Times- 11/18/2003

Emerging from a self-imposed exile in which he was treated for an addiction to painkillers, Rush Limbaugh returned to the air yesterday. And listeners who tuned in during the first few minutes of his radio show would have been forgiven if they thought they were hearing an Oprah-style self-help session. "I have to admit that I am powerless over this addiction that I have," Mr. Limbaugh, speaking from a Manhattan studio, told his listeners, just after noon on the East Coast. "I used to think I could beat it with force of will."
    During a 16-minute opening monologue, Mr. Limbaugh, who has spoken in the past about the need to jail more drug abusers, instead borrowed liberally from the teachings of 12-step programs like Alcoholics Anonymous. Asking and then answering a question about what he had learned during a month inside a treatment center in Arizona, Mr. Limbaugh said, "You can boil it down to one real simple essence: I can't be responsible for anybody's happiness but my own." He added, "I have thought that I had to be this way or that way in order to be liked or appreciated or understood, and in the process I denied myself who I was."
    Mr. Limbaugh acknowledged that "a lot of people" had branded him a hypocrite for urging tough punishment for some drug users while not being forthcoming about his own addiction, which, he said yesterday, dates to the mid-1990's. He has said that he became addicted to painkillers after spinal surgery in the 1990's. "My behavior doesn't change right or wrong," he said. He acknowledged, however, that for nearly a decade he "avoided the subject of drugs on this program for the precise reason I was keeping a secret." At times, he said, he even pretended that he did not recognize the names of painkillers mentioned by callers.
    One of the first calls he took yesterday, from a woman identified only as Mary Jo of Montgomery, Ala., was about a friend in trouble. "You have a friend who's an addict?" Mr. Limbaugh asked. The caller responded that she did, and wanted to know "what strengthens someone?" "Are you ready to listen?" Mr. Limbaugh asked. "I want you to know something now. You are not responsible for what your friend does."
    Though the early segments of his three-hour show were devoted to what Mr. Limbaugh had learned about himself in treatment, he still took time to practice his stock in trade, advancing the message of the right and lambasting the left. He took swipes at familiar liberal targets like Senators Edward M. Kennedy and Hillary Rodham Clinton. And he took pains to assure his listeners that he had not been brainwashed while in treatment, during which, he acknowledged, he rarely read a newspaper and watched little on television other than football. "Many people feel and think that when you go to a rehabilitation center for addictions or other things, that the people in there turn you into a linguini-spined liberal, and that's not true," he said. Rather, he said, he tried to incorporate what he had learned about himself and use it to psychoanalyze his opponents. Among the problems with liberals, Mr. Limbaugh said he had discovered, is that "they don't like themselves." "You ever see liberals smile about anything?" he asked.
    Mr. Limbaugh said there was only one subject he would not talk about on the air: news reports suggesting that he had acquired drugs like the painkiller OxyContin without a prescription and that the matter was now the subject of an investigation. "This is something I am not able to be as blunt and open about now as I'd like to be," he said. "That day will come, and it will come soon."
    There was much riding on Mr. Limbaugh's return, which was broadcast over the 600 radio stations that carry his syndicated show. Though in a typical week he draws at least 14.5 million listeners — nearly 20 million by his estimate — industry analysts suggested that he might draw four to five times as many yesterday. His actual ratings, as compiled by Arbitron, will not be known for several weeks.

 

Government Mapping Out Strategy to Fight Autism
Jane Gross, New York Times- 11/19/2003

Propelled by the skyrocketing number of diagnoses of the perplexing brain disorder autism in children, federal officials have for the first time mapped out a long-term, interagency plan to deal with the problem. The plan includes objectives like the development of teaching methods that will allow 90 percent of autistic children to speak; the identification of genetic and nongenetic causes of the condition; and adequate services for all afflicted children in the next 7 to 10 years.
    The plan, which is to be unveiled at a major autism conference in Washington that begins today, signals the start of the push-pull process over financing. Such a plan was required by the Congressional appropriations committee that controls the budget for scientific and medical research and education programs of all kinds. Few of the nearly 150,000 autistic children and young adults now getting special education services under federal law will benefit significantly, experts say, since the most effective treatment involves early, intensive behavior therapy, which is poorly understood and in limited supply. The three-pronged plan sets goals for more coordinated biomedical research, earlier screening and diagnosis, and effective therapy. The plan demands, for the first time, collaboration between scientists, clinicians, educators and policymakers in an array of federal agencies.
    Autism is a disorder with a wide range of symptoms sometimes so mild as to let a child function in a regular classroom with special services and at other times so severe that a child is mute and institutionalized. "Millions of people need help," said Robert L. Beck, president of the Autism Society of America, the nation's oldest and largest autism advocacy group. "And this is a new opportunity and a very exciting one." The need is enormous. According to federal education officials, in 1992-93, fewer than 20,000 of the nation's nearly five million special-education students, ages 6 to 21, were considered autistic. Ten years later, nearly 120,000 of six million special-education students had autism. That does not count the 19,000 children 3 to 5 receiving autism services under federal law, or those younger whose numbers have not been tallied.
    Nobody knows the cause of the surge, although epidemiologists suspect it is largely a result of refined diagnosis and public awareness. That does not change the dimensions of a problem that strains schools, medical services and families. Nor does it affect forecasts of growing caseloads for decades to come.  Dr. Fred R. Volkmar of the Child Study Center at Yale University, a leading autism researchers and a member of the committee that drafted the 10-year plan, measures the crisis in more anecdotal ways. Twenty years ago, Dr. Volkmar said, when he told people he worked with autistic children, they often misheard him and thought he had said "artistic." They had never heard of the disorder, which typically affects the ability to communicate, form relationships with others and respond appropriately to the external world. By contrast, Dr. Volkmar said, it is rare these days not to know someone with an autistic child. He now sees children as young as 12 months, gets referrals from day-care centers and has a two-year waiting list. Were screening techniques to improve so that diagnoses could be made in infants, he would be hard-pressed to find schools, trained behavioral therapists or other services for them.
    The plan, which will be reviewed by the Interagency Autism Coordinating Council, established by the Child Health Act of 2000, is presented in broad brush strokes, with few details and no price tags. It was drafted by scientists to assess the state of autism research and identify the roadblocks that might be hindering progress in understanding the cause and the best treatment options. The plan lays out a timeline, in increments of 1 to 3 years, 4 to 6 years and 7 to 10 years and then ranks goals according to the likelihood of achieving them. Realistic goals in each of the three stages include the development, evaluation and institution of effective treatments, in collaboration with the Department of Education. More challenging goals, by contrast, include finding effective drugs for the symptoms of autism and identifying environmental factors that may contribute to the development of the disorder. "The idea is to be challenging everyone in the field to be reaching for the best we can possibly do," said Dr. Steve Foote, the director of neuroscience at the National Institute of Mental Health, which was designated the lead agency by the Child Health Act. The legislation, passed in the Clinton administration, addresses dozens of childhood disabilities.
    Some parents are likely to be frustrated by the plan's suggestion that it will take at least seven years to provide treatment for all who need it.  Mr. Beck of the Autism Society of America hoped that long-term research and improved services were not mutually exclusive. "There are good practices out there," he said, "just not enough of them." He added: "And there's no money on the services and treatment side. What do we do with the kids for the next 7 to 10 years? We have to do both. You cannot just throw away a generation of children."
    Many researchers and clinicians in the field credit the advocacy community with galvanizing the government, following in the footsteps of AIDS advocates in the 1980's. There are several such organizations, all included at the conference, that have shifted emphasis from looking for a cure to also fighting for a more systematic study of treatments and more services for children.
    There is wide agreement that intensive behavioral therapy, which can include breaking a simple task like hand washing into a dozen component parts, beginning at the earliest possible age, is highly effective for many children. What remains a mystery is which children benefit and why, which techniques work best and whether early improvement is sustained over time, said Dr. Catherine Lord, director of the Autism and Communications Disorder program at the University of Michigan and an author of the interagency plan. Parents of autistic children are stymied by how difficult it is to find properly trained behavioral therapists. Like others on the scientific side, Dr. Volkmar said that was because the Department of Education, under President Bush, had been "a real stumbling block." Mr. Beck agreed and said he was "quite excited to see them at the table." Education officials denied a lack of interest. Robert Pasternack, assistant secretary for special education, said Mr. Bush had been generous in his financing requests for educational services for the disabled. Mr. Pasternack acknowledged a "critical shortage of special education teachers" and said the government was eager to "help states recruit and train them."

 

Expert: Hinckley Not Ready for Unsupervised Visits
Sam Hananel, Associated Press- 11/19/2003

The man who shot President Reagan is not ready to leave a mental hospital for unsupervised visits with his parents, a forensic psychiatrist told a federal judge. Robert Phillips, an expert witness testifying for the government, said John Hinckley Jr. still suffers from the same narcissistic personality disorder that drove him to shoot Reagan and three others outside a Washington hotel in March 1981.  Phillips countered earlier testimony Tuesday from Hinckley's former psychiatrist and his mother, who claim Hinckley is no longer a danger to the public.  Hinckley has asked U.S. District Court Judge Paul L. Friedman to let him leave Washington's St. Elizabeths Hospital unescorted and visit his parents at their home in Williamsburg, Va. Five of the 10 proposed trips would be overnight visits.  Reagan's family and the government oppose the idea.
    On the second day of a three-day hearing, Phillips said Hinckley still shows troubling signs he is not being completely honest or forthright with his treating physicians and "a tendency to hide the ball, so to speak."  Phillips said he was concerned that Hinckley had not changed enough since he sought similar privileges three years ago. In 2000, prosecutors said Hinckley had a continued interest in violently themed books and music that he hid from treating physicians.
    Hinckley, 48, has lived at the hospital since a jury found him innocent by reason of insanity in 1982, when he said he shot the president to impress actress Jodie Foster. Earlier Tuesday, lawyers for Hinckley wrapped up their case after putting Hinckley's former therapist and his mother on the stand.  Robert Keisling, who treated Hinckley at St. Elizabeths Hospital in 1998 and 1999, said Hinckley's violent acts occurred only when he was in a psychotic episode, which hasn't occurred in 16 years.   Even if Hinckley suffered a relapse, Keisling said, such incidents occur over weeks or months, not during a day or two in which he would be outside hospital supervision.   "The risk of relapse is practically zero. You don't see people become acutely psychotic in 48 hours," Keisling said, maintaining that Hinckley should be allowed to visit his parents without supervision.
    Hinckley's mother said she believes her son is no longer mentally ill and does not pose threat to anyone.  "I believe he has recovered," Jo Ann Hinckley said. "There is no issue of dangerousness in John at all."   Government lawyer Thomas Zeno questioned whether Hinckley's parents really were prepared to deal with a situation in which Hinckley tried to run away or was confronted by someone hostile.  Jo Ann Hinckley said she would carry a cell phone and list of emergency numbers to call, including hospital staff and police, if necessary.
    Under a 1999 federal appeals court ruling, Hinckley has been able to take supervised day trips off hospital grounds.  Hinckley was at the hearing but sat quietly with his lawyers as witnesses testified.

 

Wayne County Community Mental Health Could Face Deficit
Laura Potts, Detroit Free Press- 11/19/2003

Wayne County says its mental health agency could have an almost $20-million deficit this year, but some agency officials are disputing the claim and placing the blame for the financial woes on the county.  In any case, both acknowledge that programs for the 75,000 residents who receive mental health or disability services from the agency could be at risk.
    Wayne County and the mental health agency disagree over how much the agency owes service providers and how much those service providers owe the agency for overcharges. It is up to the agency to clear that up and create a plan for fixing the financial shortcomings, said Carla Sledge, Wayne County's chief deputy financial officer.   "They have to incorporate better financial controls over there." The staff put in place by Wayne County Executive Robert Ficano will be "watching and monitoring the spending over there," Sledge said.
    On Monday, the county received an assessment of the agency's books. The auditor, Plante & Moran, had been asked to determine whether it could audit the agency separately from the county, Sledge said.  But without proper documentation from the agency's service providers, Plante & Moran advised against a full audit. Funds would be better spent on determining where there are outstanding bills, the report concluded.   "The agency doesn't have it together at this point to conduct a full audit," Sledge said.  But some agency officials said it is the county's responsibility to pinpoint an exact deficit amount through an independent audit.   "They want to talk about those millions and millions of dollars in deficits and I don't believe it," said Mohamed Okdie, a member of the CMH board.  Okdie said the county "controls the purse strings" of the agency, charging it $7 million for things such as legal services and administrative costs.
    The county's broad deficit estimates raise questions about whether there actually is a deficit, Okdie said. He said he believes the county is predicting a deficit in hopes of discrediting the agency and its ousted interim director, Patricia Kukula, who was placed on administrative leave last week. Kukula, who is one of the finalists for the permanent executive director position, will be in U.S. District Court this morning , asking Judge Bernard Friedman to reinstate her. Okdie said the agency's own attempts to clarify its budget situation have been blocked by the county.
    Both the county and the agency emphasize that people who receive mental health and disabilities services have not yet been affected by the possible deficit. But if the agency or the county has to eliminate the deficit, services will be affected, Okdie and Sledge said.  A state-mandated change in how Wayne County provides its mental health services makes it easier to track payments to and from service providers. Once the 2003 deficit question is cleared up, the agency's budget is in good shape, said Wayne County Commissioner Phil Cavanagh. "That air of uncertainty makes it hard to progress and move forward," Cavanagh said. "But it's not going to be problems that we'll be strapped with in future years."



Dr. Billy Taylor Comes Home
Jim Carty, Ann Arbor News- 11/21/2003

"Billy Taylor? He doesn't come around. Hasn't in years . . . ahhh . . .  there was some trouble." Anyone who followed Taylor's All-American football career at the University of Michigan and what happened afterward knows, of course, that there was some trouble. He was the getaway driver in a much-publicized armed robbery soon after he was cut from the NFL, followed by a private decades-long fight with substance abuse. A struggle so destructive, people around Michigan slowly let him go.
    They were more comfortable with the legend. With tales of Taylor's 21-yard touchdown in the 1971 game against Ohio State, which Michigan won, 10-7. With Bob Ufer's famous screaming radio call of "Touchdown Billy Taylor!" and an uncomplicated 20-year-old halfback, just 5-foot-10 and 195 pounds, a little bowling ball of hard-to-bring-down. Oh, people tried to help Taylor. His old coach, Bo Schembechler, worked it out so he could get his master's degree in prison. There was a job at General Motors. A little money here and there. But Taylor's slide into alcoholism only worsened, and some time in the 1980s, he just stopped coming around.
    What happened from there? Nobody at Michigan seemed to know, not as recently as this week. But a fan had a phone number, so you call it and a man picks up. "Hello," the voice says. "Dr. Bill Taylor."

A passion for school
Yes, it's the same Billy Taylor Only it's not the same Billy Taylor at all. Not the young football star who thrilled tens of thousands at Michigan Stadium and once had brunch with President Richard Nixon at the White House. Not the older man who lost just about everything. This is Dr. William Taylor, has been ever since May 17, when the University of Nevada-Las Vegas granted him a doctorate in educational leadership after three and a half years of class work.
    Taylor works at the 35,000-student Community College of Southern Nevada, and works is the operative word. He's been at the college for five years, beginning as an adjunct professor of English and, while he still teaches some classes, his official position these days is National Junior College Athletic Association compliance officer and student advisor. He also was recently asked to serve as the interim director of student retention. His life is the school, says Tim Chambers, who coached the college's baseball team to last year's junior college national championship and serves as athletics director. "I know Bill Taylor as a guy with a lot of energy and a passion for athletics," Chambers says. "Just a relentless and super guy. A guy who said, 'Hey, I'll run study hall for you,' when we were starting our athletics program. Doing things he wasn't asked to do, that weren't in his job description."
    Chambers, like most of the people in Taylor's life now, admits he doesn't know much about what happened before Taylor got to Nevada, both the good and the bad. They've seen some football highlight films and hear a lot about Michigan and Ohio State every November. They know he's had some trouble. But they don't really know. Nobody does, because Taylor doesn't like to talk about the past. He doesn't seem comfortable talking about it now, really. There are times he worries about what'll happen if people focus on the armed robbery again or hear how far he fell when he was drinking. "I'm nervous about how this comes out," he admits. Then he tells the story. Maybe not the whole story, but the closest he's been able to come.

Working with 'Sis'
It starts Aug. 17, 1997, the last day he had a drink. The day he met Sheryl Carson. A different person would have kept walking, maybe even been a little scared and walked a little faster. They were on the east side of Detroit, and here was this man, this raggedy, beat-up man, telling her he'd just quit drinking and asking for a job. "He was thin. He looked like a street person," Carson says. "He approached me and he said to me, 'God told me to talk to the lady with the red van."' "Well," Carson asked, "what did he say to you?" "He told me today you would hire me." "OK," Carson said. "OK what?" Taylor asked. "Well," Carson said, "You said God said so, so let's go." Just like that? "Well, I'm in the caring-for-people business," says Carson, who runs her own adult foster care business in Detroit. "Usually it's for a person who needs my services for in-home care, not a job, but it's what I do. He said the magic words. He said God sent me. You have my attention if you tell me God sent you. I have to weigh that out."
    She put Taylor to work doing yard chores, but noticed how he talked. He was articulate, clearly educated. She asked if he had a high school diploma and was told he had a master's in continuing education from Michigan. "Well come over here and tell me why you're digging in that dirt?" she said. Over the next year, Taylor became her right-hand man at Family Ties. He was, she remarks without any irony, good at taking care of people. There was no hour he wouldn't work. They handled emergencies together and forged a friendship so tight Taylor now calls Carson "Sis."
    In 1998, Carson took her employees on a vacation out West, including Las Vegas, where Taylor read in the local paper that the booming city was desperate for teachers on the high school and junior college level. When they got back to Detroit, he told Carson he'd always wanted to finish the doctorate he started at Michigan and thought maybe he could get a teaching job and pursue the degree in Nevada. But he didn't want to leave without her permission. "I said, 'Bill, absolutely,"' Carson remembers. "That was late August, and by September he was on his way to Vegas."

A battle with depression
Before going any further, you should know this isn't Billy Taylor's first comeback. The clippings are in a musty, yellowed envelope labeled, "Taylor, Billy, FOOTBALL, '69." From Aug. 8, 1976, headlined "Future's All to Billy Taylor," is an Ann Arbor News story of Taylor being interviewed in prison, talking about learning his lesson, working on the master's and solving his problems through God. In another printed March 14, 1979 and headlined "Go straight, Billy Taylor tells young inmates," Taylor is visiting the Maxey Boys Training School and cautioning against going to real prison. "After you leave this place," Taylor is quoted in the 1979 story, "You have to find your own niche, grab hold of something and develop it. You've got to believe in yourself."
    It was easier advice to give than live. On the surface, Taylor had built a good life. He was married, had two sons and was working in personnel and labor relations for General Motors. He'd also been battling depression ever since his mother, Mariah Marie Taylor, died unexpectedly on Jan. 4, 1971, three days after Michigan lost to Stanford in Taylor's final game as a Wolverine. Within the next six months, his 20-year-old girlfriend, Valerie, was stabbed to death in Detroit and his favorite uncle, Eugene Wells, murdered his aunt, Hattie Lee, and then killed himself. He blames the deaths, especially his mother's, for his inability to get serious about football again and, more importantly, for the depression that led to a steadily increasing drinking problem. "My dad passed when I was 5," Taylor says. "She was my mother and father. I've never been closer to anyone. At 61, she was gone, right when I was a senior and I hoped to buy her a new home. She'd never had that. Or nice clothes, nice things. She sacrificed to keep food on the table. "I never really got over it. I just had a lot of years of just real depression."
    It came to a head in 1980 or 1981 - Taylor's not sure of the year - when General Motors asked him to transfer to a Southern state. He took unemployment instead and, in his own words, just drank and drank and drank. Drank until he lost his marriage. Drank until he was living from house to house in the slums of Detroit with other alcoholics. He was smoking marijuana, too. Fighting and staying up two, three nights at a time. Taylor tries not to tell this part, worries when pressed on it. Asked if he ever stole from his family and friends, he draws a line. "I don't want to go all the way there," Taylor says, pausing to pick his words carefully. "But I will say my lifestyle was not a good one. And if I wronged anybody, I hope they can forgive me. But the things I used to do, I don't do any more."

A student again
Taylor drifted away from all of his former teammates during those dark Detroit days, but Thom Darden still heard stories, even in Cedar Rapids, Iowa, where he now works in sales. He wondered if he'd get a call one day telling him Taylor was dead. "I don't think about that any more," Darden says. Because this time, Darden tells you, it's for real. He's been in touch with Taylor for a few years now, visited him in Las Vegas and seen for himself. So has Glenn Doughty, another one of the "Mellow Men", as Taylor, Darden, Doughty, Mike Taylor, Alden "Butch" Carpenter and Reggie McKenzie used to call each other when they lived together in an off-campus house during their playing days. "Nobody gives you a doctorate," says Doughty, who now lives in St. Louis and owns his own company. "You are screened. You are grilled."
    And it was harder for Taylor than most, says Dr. Paul Meacham. Meacham was the first person Taylor spoke to when he called for information on UNLV's doctoral program in educational leadership. The then-chair of UNLV's education program also happened to have received a master's in music from Michigan in 1961, becoming a casual Wolverine fan in the process. "Bill Taylor?" he asked on the phone. "As in Billy Taylor?"
    Most of the students in Taylor's doctoral program already were working in education, Meacham said. They were familiar with the terminology of the trade, while Taylor's writings were rougher. He had to learn to become a student again. "He will tell you it wasn't a walk in the park for him," Meacham said. "A dissertation it has to be a scholarly work. You have to do it over and over and over again. Proper terminology. Proper presentation. Conducting validation studies."Some people persist at it, some people don't. He showed an amazing persistence. I'm happy we were able to be a part of his resurrection, as it were."

'Good and positive' work
The doctorate wasn't really that hard, Taylor says. It was work, but good work. You want hard? Try living on the streets. But resurrection is a description he likes, both because it gives credit to the God he credits with rescuing him from the depths of alcoholism and because he does feel reborn. He's back in contact with his children. His sons, William Taylor III and Alden James Butch Taylor - named for his former teammate, Alden "Butch" Carpenter, who died of a heart attack during a pickup basketball at the Michigan intramural building - are 23 and 22 now and both in college. Daughter Mariah Marie Taylor is 11 and lives in Detroit with her mother.
    Now that his doctorate is complete, Tim Chambers thinks it's only a matter of time before a bigger college or university hires Taylor away from the Community College of Southern Nevada, either to teach or to work in athletics. If he leaves, he'll go with Chambers' blessing, just like he left Detroit with Sheryl Carson's. "I know he loves his job here," Chambers said, "but he also has goals. I think he wants to be at the Division I level. He wanted his doctorate, and he got it. Who am I to say he has to stay here?" Like dozens of other former Michigan football players, he'll be back in Ann Arbor for the Ohio State game on Saturday. The man who stopped telling people he was Billy Taylor, who was too ashamed to visit Schembechler Hall for years, returns for the first time as Dr. Billy Taylor. He's a little nervous, but hopeful that people will forgive any wrongs. For the first time in years, he wants to answer that question.

Whatever happened to Billy Taylor?
In the end, he thinks he's done the program proud. "I made mistakes," Taylor says. "I made a lot of bad choices. But today, I try to do the right thing and help people. That's my philosophy -- who can I help? From any student at the college to the president. I have a message to young people: If you should ever fall, get back up. "It's this simple to me, I know what I'm doing is good and positive."
    At 54, he's young enough to write an even happier ending to an autobiography he's been working on for more than 20 years. Young enough, a skeptic might point out, to find trouble again. Taylor knows that better than anybody, just like he knows some will wonder whether he could possibly choose the wrong road again. "I would tell them don't bet on it," Taylor said. "Life's itinerary is just a mystery. Everybody has to go through what they have to go through. Only God knows why. Why an All-American? Why getting in trouble? Why do I get to move from Detroit to Las Vegas and pursue the doctorate? "I don't have the answers. But I would say this: Don't bet on it."