Divorce Online: Faster, Cheaper and Lawyer-Free
Kim Campbell, Christian Science Monitor- 6/23/2003

Until a few months ago, business cards were the only thing Valentino Agundez had bought online. But in March, she decided to use the Internet to purchase something more permanent: a divorce. The kindergarten teacher and her husband were already separated, but had put off making their split official because of the legal fees. Then a friend suggested a Web site that offered to prepare the paperwork for $249. "I kind of felt weird about it, because it was over the Internet. But when I went online, it was really easy," says Agundez, who is in her early 20s and lives in Hollywood, Calif.
    Agundez is one of a growing number of Americans who use the Internet to help with their divorces, bypassing attorneys to prepare documents on their own. Many go online to save money and forgo the emotional clashes that can play out in lawyers' offices. But as states move toward allowing divorces to be actually filed online, critics say it could make the process of breaking up as easy as ordering movie tickets — and push up the already high number of divorces in the United States. "People are going to enter into marriage much more casually with something like this available," says Jan LaRue, chief counsel of the conservative group Concerned Women for America. "The idea of divorce becoming faster and cheaper — to me, that doesn't help the idea of marriage."

May Take Some Time
   It may be a year or more before filing for divorce online is truly possible, but using the Internet to help with the process has already caught on — pushed ahead by two other trends: more people representing themselves in legal matters and growing comfort with handling paperwork, such as taxes, online. For Agundez, who used a site called LegalZoom.com, the Internet changed her perception of how much time and drama were involved in the divorce process. "The Internet responds to you right away, and that's not the way I pictured divorce," she says.
    LegalZoom and CompleteCase.com, another national site that helps with uncontested divorces, say that since they launched in 2001, they've served approximately 30,000 and 20,000 divorce customers respectively. In May, the number of divorce packages sold by LegalZoom — which also handles other legal documents, like wills — was up by 43 percent over May of 2002, according to the company's CEO, Brian Liu. CompleteCase, which only handles divorces, has also grown significantly — and has spawned a bevy of copycats.
    Do-it-yourself divorcing may be a boon for online companies — which offer document preparation and services that range from under $50 to $1,000 or more — but it can complicate things for state and local courts, which is one reason so many of them have also entered the Internet fray. By offering online access to information and forms, courts in states such as California, Arizona, Utah, and Maryland hope to cut down on the backlog created by do-it-yourselfers who file incorrect paperwork and to better serve low-income users. A few include programs that walk people through the forms, similar to the way online tax-preparer TurboTax does.
    "Our real goal is to make sure that people do a good job of self-diagnosing their problem," says Ayn Crawley, director of the Maryland Legal Assistance Network in Baltimore. She notes that people often set out to represent themselves, not realizing they should ask a few more questions. "People may trade off pension rights for custody, and you should know what you're giving up," she says. In California's San Mateo County, almost 10,000 people dealing with family-law matters have completed their forms online in the past 12 months. The county's next big project, to be completed next year, will allow people to file their completed paperwork directly to the court online.

Marriage Advocates Opposed
That, say marriage advocates, is a bad idea. If online filing catches on, they argue, it could give the perception that getting unhitched is as easy as clicking a mouse. Already alarmed by the rise in divorces from the widespread adoption of no-fault divorce laws in the 1970s, a number of family-values groups are opposed to measures that diminish the seriousness of divorce.
    "The message from online filing ... is that marriage really is just a piece of paper," says Diane Sollee, founder of the Coalition for Marriage, Family and Couples Education. She is less concerned about using online services to save money on legal fees, but worries that the number of unnecessary divorces will grow if people can impulsively file for divorce in the middle of the night. "If there's an online divorce available, and you're in the mood, you can go ahead and file," she says.
    For now, instant divorce is still a ways off — and may never be quite that simple. State laws vary, but many require couples to appear in court and file further paperwork after the initial filing. Those who have gone the online route say the Internet didn't simplify their decision, only the mechanics of carrying it out. "It really doesn't take away all the emotional issues. But it does make the process easier," says Al Hernandez, a salesman from Concord, Calif., who spent about $500 for his divorce.
    The California-only provider he used, DivorceWizards.com, both helped him prepare his documents and took them to court and filed them for him in 2001. He tried to reconcile with his wife for a year after his initial filing, but eventually continued the process. He went the online route both to keep costs down — simply retaining a lawyer would have cost him between $1,500 and $3,500 — and to keep things as amicable as possible. Like many Americans, he chose to leave lawyers out of it. "I really think it creates more animosity between the parties," he says. "It ends up making you bicker over little things."

Drug Addiction as a Developmental Disorder
John O’Neil, New York Times- 6/24/2003

A new study from Yale suggests that drug addiction should be thought of as a developmental disorder, because the changing circuitry of teenagers' brains appears to leave them especially vulnerable to the effects of drugs and alcohol. Dr. R. Andrew Chambers of the Yale School of Medicine, lead author of the article, said addictive drugs worked by stimulating parts of the brain that are changing rapidly in adolescence.
    In particular, Dr. Chambers said, the drugs tap into a neural imbalance that may underlie teenagers' affinity for impulsive and risky behavior. The circuitry that releases chemicals that associate novel experiences with the motivation to repeat them develops far more quickly in adolescence than the mechanisms that inhibit urges and impulses. As a result, he said, teenagers are not only more likely to experiment with drugs than other groups, but the experience also has more profound effects on the brain — and sometimes permanent ones.
    The article, published in the June issue of The American Journal of Psychiatry, was based on a review of 140 earlier studies. Dr. Chambers wrote that although it had long been known that most addicts began using drugs in adolescence, most research into the mechanisms of addictions or treatment focused on adults. Shifting to a model that links vulnerability to normal developmental changes in the brain could lead to new methods of prevention or ways of singling out teenagers at higher risk for drug use, he said.
    Dr. Chambers acknowledged that social factors appeared to play a role in drug addiction but said they did not account entirely for greater levels of drug use among adolescents. His analysis covered three aspects of teenage behavior and their basis in brain functioning — attraction to novelty, less than adult levels of judgment and an overriding interest in sex. Teenagers are drawn to new activities and experiences, a process that Dr. Chambers referred to as "the expansion of their motivational repertory." "That's a good thing," he said, "because adolescents have to learn how to be adults." But to aid the process, the motivational circuitry of the brain — the complex of chemical reactions that make certain experiences more desirable than others — is also rapidly expanding. It is this circuitry, centered on the chemical dopamine, that is at the heart of the addictive effects of a wide range of drugs as different as cocaine and alcohol, Dr. Chambers said.
    At the same time, the parts of the frontal cortex that are activated by adults when they weigh risks and rewards lag developmentally. "You have a situation where the motivational brain areas are particularly active," Dr. Chambers said, "and the part of the brain that is supposed to inhibit impulses is not working well, because it is sort of under construction."
    The other part of the equation lies in a number of brain regions that are reshaped in adolescence as they respond to soaring levels of sex hormones. Dr. Chambers said that rapid change seemed to leave young people unusually attuned to all sorts of new social and sexual stimulation, which in turn appeared to make the brain more open to the addictive effect of drugs.

For Depression, the Family Doctor May Be the First Choice but Not the Best
Susan Gilbert, New York Times- 6/24/2003

For most of his life, John Smythe of Glen Rock, N.J., struggled with a hot temper during day and insomnia at night. He thought of these problems as family traits; his parents had them, too. But two years ago his internist told him that they were signs of clinical depression. "A chill went down my spine," recalled Mr. Smythe, 60, who runs a small business. "Depression to me was somebody walking around moping, sort of withdrawn. It never occurred to me that there could be other symptoms." His internist, Dr. Rick Cohen of nearby Midland Park, prescribed an antidepressant. It did not take Mr. Smythe long to start feeling better. "I could stay rational without getting annoyed and slamming the phone down," he said. "It turned me around."
    Mr. Smythe is in a lucky minority. Only about 40 percent of people in treatment for depression get adequate care, according to a survey of more than 9,000 Americans that was sponsored by the National Institute of Mental Health and released last week. The study defined "adequate treatment" as a course of at least 30 days on an antidepressant or a mood stabilizer, along with four visits to a doctor or at least eight 30-minute psychotherapy sessions with a mental health professional.
    Dr. Ronald Kessler, a professor of health care policy at Harvard who was the lead author of the study, says a crucial problem is that general medical doctors tend to be the first line of defense against mental disorders as well as physical ones. Because they are not as well informed about depression as mental health specialists, he said, they are more likely to undertreat it — prescribing either too little medication or an inappropriate one, like an anti-anxiety drug.
    These general practitioners, typically family doctors and internists, treat 70 percent of the people who seek help for depression, according to other research. And more of them are treating depression now than a decade ago, Dr. Kessler said, because the newer antidepressants — selective serotonin reuptake inhibitors — are safer and easier to prescribe than older drugs. "The companies that make these drugs are providing more educational material to general medical doctors," he said.
    Psychiatrists say the new findings should not be interpreted to mean that primary-care physicians are unqualified to treat depression. "The notion that everybody with depression should be treated by a mental health professional is ridiculous," said Dr. John Greden, a psychiatrist who is director of the Depression Center at the University of Michigan. Dr. Greden said many general practitioners could effectively treat people with mild to moderate depression. But he added that mental health professionals agreed that severe or intractable depression should be referred to a psychiatrist or a psychologist. "Just as you wouldn't want a primary-care physician to do coronary bypass surgery, you wouldn't want one to treat severe or complicated depression," said Dr. Greden, who works with primary-care doctors in Michigan on ways to improve the diagnosis and treatment of depression.
    But there are many obstacles to receiving adequate care from a general practitioner, even for mild or moderate depression, experts say. For one thing, Dr. Greden says, primary-care physicians do not receive enough training on how to recognize the condition. "Most patients don't come in and say, `I feel sad or depressed,' " he said. "They emphasize complaints like fatigue or insomnia or other physical manifestations of depression." So their doctors tend to treat the physical symptoms, Dr. Greden added, by prescribing sleeping pills for insomnia, for example, instead of looking for the underlying causes.
    Another obstacle is that many general practitioners are uncomfortable talking about depression, said Dr. David Kupfer, chairman of psychiatry at the University of Pittsburgh Medical Center, who has studied trends in treating depression. "If a patient talks about his sleep problems, the doctor won't ask about other possible depression symptoms," he said.
    Yet another obstacle is time. Doctors in managed-care plans have a financial incentive to see as many patients as possible each day. Dr. Cohen, the internist, said the time pressure discouraged many of his colleagues from asking the necessary questions to find out whether patients are depressed. "One colleague said to me, `I see so many patients a day, I don't want to open up a can of worms,' " he said.
    When they do diagnose depression, primary-care doctors often fail to provide enough information on drugs' side effects, patients say. Yet unpleasant side effects like anxiousness, weight gain and loss of sexual desire are among the main reasons that patients stop taking antidepressants. "I've rarely heard any patient say, `My family doctor explained it all to me,' " said Howard Smith, director of operations for the Mood Disorders Support Group, an organization in New York City that operates support groups for people with depression and bipolar disorder.
    Mr. Smith says the side effects can start within a day of two of beginning an antidepressant, but the benefits often take a few weeks to show up. "So patients call their doctors and complain that they feel sicker, and the doctors tell them to stop the medication or they prescribe something else," he said. If doctors took the time to explain to their patients that the side effects were often temporary, he said, many more would continue treatment and have their depression effectively managed.
    Dr. Cohen said most primary-care doctors did not know about the nuances of the many antidepressants — which ones are best for particular symptoms and what to do if the lowest dose does not work. "Internists are grilled on how to use multiple medications for diabetes or hypertension and how to switch medications if the first one doesn't work," he said. "But there's not as much education geared to internists on dosing and switching antidepressants." Further, research has shown that medication and psychotherapy together are more effective for treating depression than either approach alone.
    If general practitioners lack the time and expertise to treat depression properly — and if they are not compensated enough for it under managed care — why do they provide most of the treatment for depression? "Many of my patients want me to treat them because they trust me as their family doctor," said Dr. Jim Martin, a family physician in San Antonio. "Some of my patients don't want to see a specialist because of the stigma of depression." But growing numbers of patients no longer have the choice, he added, because some managed-care plans have begun reducing or even eliminating coverage for general practitioners for treating depression.
    Psychiatrists say it is unrealistic to think that mental health professionals can do the job themselves because there are not enough of them to treat the estimated 35 million Americans with depression, only about half of whom receive treatment now. "Without primary-care physicians, we won't make a dent in treating more people with depression," Dr. Greden said.
    His research shows that primary-care physicians improve their ability to diagnose and treat depression when they forge relationships with psychiatrists and psychologists, consulting with them about particular patients. Under this model, primary-care doctors do the medical treatment, but check with the specialists about drug choice and dosing and refer patients to them for talk therapy. "If general practitioners don't have the wiggle room from managed care to spend more time with patients who are suffering from depression," Dr. Kupfer said, "society will pay a large price in suicides and in high levels of impairment."

Management or Medicine?
Eileen McNamara, Boston Globe- 6/25/2003

Children's Hospital says Amy Meeker's son is capable of ''physically aggressive and unsafe behavior.''  Children's Hospital says 7-year-old Will ''requires continuous one to one observation as an inpatient.''  Children's Hospital says he ''requires an intense level of service that can accommodate episodic impulsive, unpredictable aggressive activity.'' Those details were in a June 13 letter. To his family's horror and frustration, Children's Hospital told Meeker in a subsequent meeting she had better be prepared to take this violent little boy home.
    Meeker's son was admitted to Children's psychiatric ward on May 30 after he tried to strangle her during a visit to his neurologist's office. The violent behavior was thought to be linked to Will's rare seizure disorder, which has led the Newton school system to declare the red-haired first-grader a danger to himself and to others.  In the locked ward, he has been safe but has failed to respond to medical interventions. What he needs, the Countryside School, his parents, and Children's Hospital agree, is a hard-to-find bed in a residential treatment facility. Until she and the school can find one, his clinical team told Meeker, she had better plan on taking her son home. If he gets violent, she could always call 911, Meeker says she was told. If Meeker worries about the safety of Will's twin brother, she could send her healthy child to live with a friend or relative.
    Ironically, this advice came from a world-class hospital that has led the way in calling attention to the needs of children stuck in inappropriate care settings because of the dearth of both acute psychiatry beds and residential treatment beds. Dr. William Beardslee, Children's psychiatrist-in-chief, co-chairs the so-called Stuck Children Commission, which has been trying to document the need and urging the state to commit the resources to solve the problem. Yesterday, the panel said it would meet next month with state officials on what the secretary of human services, Ronald Preston, called an urgent issue.
    Meeker appreciates that Children's has a much broader problem but she was incredulous that its doctors would consider the release of a violent child preferable to holding him until a safe, appropriate placement could be found. ''His clinicians have advised me that a discharge is imminent, although I have repeatedly told them that I cannot meet the criteria they have outlined in writing as necessary to the safety of Will and those around him,'' Meeker wrote on Monday in a letter faxed to Dr. James Mandell, the hospital's president and CEO. ''If he is discharged it is likely that serious harm will result either to him, his twin brother, or others. Surely, Children's Hospital does not wish to have that occur as a result of its action.''
    John Auerbach is director of the Boston Public Health Commission and a friend of Meeker. ''It has been heart-wrenching to watch her fight to protect this child and her family,'' he says. ''Do we have to wait for a tragedy to realize the risk of sending a violent child home? Children's does wonderful work, has dedicated, caring clinicians; but too often the decision-making of hospital administrators is based on the bottom line, not the best interests of the patient.''
    Asked by the Globe yesterday about the hospital's plans for Meeker's son, Children's Hospital reversed positions, while claiming that nothing had ever been set in stone. Will won't be discharged until a suitable placement is found, promised Dr. Robert A. Lobis, medical director of the psychiatry service. It was surprising news and a great relief to a persistent but deeply distraught mother, struggling to cope with a larger, more poignant reality -- the invisible disorder that is slowly, relentlessly robbing her family of the freckle-faced boy who has no memory of trying to choke his mother to death.

OxyContin Network Believed Extensive
Josh White, Washington Post- 6/25/2003

Federal prosecutors yesterday outlined for the first time the scope of their investigation into the illegal distribution of OxyContin, writing in court papers that they have already snared 41 dealers in an ongoing probe of doctors, pharmacists and patients who formed a conspiracy to sell the drugs in a black market. In court documents associated with pleas and sentencing hearings in U.S. District Court in Alexandria, prosecutors said that "Operation Cotton Candy" has been focusing on 60 to 80 people in Northern Virginia, most notably two pain doctors who are "major targets" of the investigation. A federal organized crime and drug enforcement task force has been working for more than two years to trace the network of dealers, who prosecutors claim have received prescriptions for "obscene" amounts of the painkiller drug from the doctors.
    Prosecutors wrote that many of the 41 dealers were patients or otherwise affiliated with the two doctors and their separate offices in McLean and Centreville. The doctors have previously been identified in court papers as William E. Hurwitz and Joseph K. Statkus. Both have acknowledged that they are targets of the investigation but have denied any wrongdoing.
    Assistant U.S. Attorney Gene Rossi wrote in the papers that the doctors were prescribing pills after "perfunctory exams" and would "rubber stamp and oftentimes encourage the patients' insatiable demand for Oxy and other pills." The patients would then fill their prescriptions at pharmacies and sell the pills or hand them over to "recruiters and organizers" for later sale at huge markups. Prosecutors said the pills were often taken to southwest Virginia, Tennessee and Kentucky, where some conspirators have likened the market among rural addicts to "selling water in the desert," the court papers say.
    OxyContin is a form of synthetic morphine that has been called a miracle drug for cancer patients and others with intractable pain. A long-acting, FDA-approved time-release pill, it enables some bedridden patients to return to their normal lives. But its potency has made it alluring to abusers, who crush it and snort it or inject it for a heroin-like high.
    The documents released yesterday show that the federal grand jury is still hearing testimony and is examining about five patients "who died from receiving and taking obscene amounts of Oxy and other pills." The information became public in documents relating to a sentencing hearing yesterday for Rita Faye Carlin, a former patient of one of the doctors, and at a plea and sentencing hearing for Kelly Kathleen Latimer, a former Prince William County prosecutor and defense attorney who was a patient of both doctors. Latimer was sentenced to 50 months in federal prison for taking part in a conspiracy to distribute crack cocaine and for obstructing justice and tampering with a federal witness. Latimer traded her pain medications to a friend in exchange for crack they shared. "I know what I've done is wrong and that I've made a complete mess of my life," Latimer said in court. Rossi called the case a "Greek tragedy," while Judge Leonard E. Wexler called it one of the most mind-boggling cases he has seen: "You're a lady who had the ability, had the brains, had the background, had the family background . . . and did what you damned pleased."
    Latimer's case led, in part, to the resignation of another Prince William County prosecutor. John V. Notarianni resigned in April after FBI agents raided his office and took his computer as part of the investigation. Federal prosecutors said in court that a former Prince William prosecutor helped Latimer get her husband to lie about where Latimer had been living after her release on bond. Though they did not name Notarianni, Latimer's husband, Merle Snider, said in interviews that he signed a document he knew was false when Notarianni asked him to.
    Rossi said in court that Latimer called her husband and a "known conspirator" from the Alexandria jail April 9 to dictate a letter, aimed at influencing the court, that Latimer knew was misleading. Snider said in interviews that Notarianni met him in a church parking lot in Manassas on April 10, handed him a pen and urged him to sign the letter. "I was looking at it thinking . . . 'He handles cases and puts people's lives on the line, and he knew it was a lie,' " Snider said in an April interview. "It was weird, because we both knew it was a lie." The letter never made it into court files because Latimer's attorney wouldn't accept it. The attorney then recused himself.
    Notarianni, who is now a defense attorney, has not been charged with a crime. Prosecutors said yesterday in court that Snider is scheduled to plead guilty in August to obstruction charges, and the U.S. attorney's office is weighing charges against the other known conspirator. Notarianni did not return calls to his office and his Manassas home yesterday. Carlin was sentenced to 14 months in prison. Prosecutors said she has been helpful in the investigation and that she has testified before the grand jury.

Supreme Court Reverses Gay Sex Ban
Lyle Denniston, Boston Globe- 6/27/2003

WASHINGTON -- In a sweeping advance for gay rights, the Supreme Court ruled for the first time yesterday that gays and lesbians have a constitutional right to form intimate relationships, including sexual activity. The court, in a 6-3 decision that showed signs of a deep emotional rift among the justices, overruled a 1986 decision that had allowed criminal prosecution of same-sex couples when they engage in sex in private and by mutual consent. Five of the nine justices supported that part of the ruling.  That 1986 decision, Bowers v. Hardwick, ''should be and now is overruled,'' Justice Anthony M. Kennedy wrote for the majority. The ruling ''was not correct when it was decided, and it is not correct today,'' he said.  The broad ruling, issued on the last day of the court's term, stands as its most significant decision on gay rights since the Bowers case nearly a generation ago. The new decision in Lawrence v. Texas could potentially affect the outcome of legal challenges to many forms of laws or regulations aimed at gays and lesbians.
    Describing the constitutional basis of the gay rights decision, Kennedy declared that the liberty guaranteed by the due process clause in the Constitution ''allows homosexuals the right to make the choice'' to express their personal bond to each other through intimate conduct. ''Freedom presumes an autonomy of self that includes freedom of thought, belief, expression, and certain intimate conduct.'' The government, he said, ''cannot demean the existence or control the destiny'' of gays and lesbians ''by making their private sexual conduct a crime.''
    As the justice read portions of the opinion from the bench in a quiet but firm voice, a leader of the gay rights movement, Georgetown law professor Chai Feldblum, sat in the lawyers' section of the courtroom, wiping away tears. Just in front of her, Harvard law professor Laurence H. Tribe, who had argued and lost the Bowers case, listened attentively but without expression.
    When Kennedy finished, Justice Antonin Scalia, who wrote the main dissenting opinion, steadily raised his voice as he condemned the ruling. He said that it ''decrees the end of all morals legislation'' and ''dismantles the structure of constitutional law permitting a distinction between homosexual and heterosexual conduct.''   Scalia called the majority opinion ''the product of a court that has largely signed on to the so-called homosexual agenda.'' The Kennedy opinion said at one point that the case did not involve the issue of government power to ban same-sex marriages, but Scalia said that the logic and the principle behind the decision would protect such marriages. ''What justification,'' the dissenting justice said, ''could there possibly be for denying the benefits of marriage to homosexual couples exercising `the liberty protected by the Constitution'?''
    The ruling struck down, by a 6-3 vote, a Texas law that makes sodomy a crime only if engaged in by same-sex couples. The Bowers case did not differentiate between heterosexual and gay couples. Justice Sandra Day O'Connor provided the sixth vote for nullifying the Texas law, but did not endorse the overruling of the Bowers decision.
    As they reviewed the Texas law, the justices had faced two constitutional approaches to a decision -- one narrow, one broad. The five-justice majority led by Kennedy chose the broad approach involving the Constitution's guarantee of ''due process,'' which the court has interpreted to encompass a broad right of privacy against government regulation and punishment. That right underlay the Supreme Court's abortion rights decision in Roe v. Wade, and such decisions as those upholding married and unmarried couples' right to use birth control devices, and married couples' decisions about how to raise their children.  The narrower argument for striking down the Texas law -- the approach taken by O'Connor -- was that the Texas law violates the Constitution's guarantee of equality because it outlaws sodomy only when engaged in by same-sex couples, not by all couples.
    The equality basis for a decision would have nullified only the Texas law, and the laws of three other states that also apply the sodomy ban only to same-sex partners -- Kansas, Missouri, and Oklahoma. Nine other states have sodomy laws that apply to anyone engaging in that form of conduct. Those laws are likely to fall, too, under the decision. By contrast, the ''due process'' foundation of the decision gives it a much wider sweep. The decision is sure to embolden the attempt by gay rights' lawyers to get the courts to strike down bans imposed across the nation on gay marriage, and could lead to challenges to the military policy of discharging individuals who identify themselves as gays and lesbians.
The court's main opinion, while embracing a broad right to engage in homosexual sex by adults in private, also specified some limitations. It does not apply to minors, public acts, or prostitution, Kennedy made clear. Nor does it cover situations where someone is harmed or coerced by same-sex conduct, and ''does not involve whether the government must give formal recognition to any relationship that homosexual persons seek to enter.''
    No state allows a gay relationship to become a marriage, and only one state -- Vermont -- allows gays and lesbians to enter into ''civil unions'' with many of the same legal benefits as marriage conveys. In Canada, the province of Ontario has sanctioned gay marriage, and the nation is moving toward the same recognition.
    The Texas case, Kennedy said, ''does involve two adults who, with full and mutual consent from each other, engaged in sexual practices common to a homosexual lifestyle.'' The case involved two Houston men, John Geddes Lawrence and Tyron Garner, who were prosecuted for same-sex sodomy after police acting on a false tip about an armed man in an apartment complex, entered Lawrence's apartment and found the two engaging in intimate conduct.
    The court's main opinion was sharply critical of the Bowers decision 17 years ago, saying the court back then was wrong in viewing the constitutional issue as only a question of whether there is a gay right to engage in sodomy. That ''discloses the court's own failure to appreciate the extent of the liberty at stake. To say that the issue in Bowers was simply the right to engage in certain sexual conduct demeans the claim the individual in that case put forward, just as it would demean a married couple were it to be said marriage is simply about the right to have sexual intercourse.''
    Kennedy's opinion was joined in full by Justices Stephen G. Breyer, Ruth Bader Ginsburg, David H. Souter, and John Paul Stevens. Scalia's dissent said that the ruling ''will have far-reaching implications beyond this case.''

Change Ahead For Houston Drug Cases
Rachel Graves, Houston Chronicle- 6/27/2003

Thousands of low-level drug offenders in Texas will now go to treatment programs instead of state jails, a fundamental change in prosecution that was sparked by inequities in sentencing in Harris County. The Houston Chronicle reported in December that local prosecutors sent 35,000 small-time drug offenders to state jails or prisons in the past five years, a wildly disproportionate number for the county's population.  During hearings in Austin this spring, state lawmakers grilled a Harris County prosecutor over the imbalance.
    The bill, one of 1,300 that Gov. Rick Perry signed into law after the close of the legislative session earlier this month, mandates probation and substance-abuse treatment instead of jail for first-time felons caught with less than a gram of most drugs. It was sponsored by Rep. Ray Allen, R-Grand Prairie. The law, which goes into effect Sept. 1, is predicted to lower the state jail population by 2,500 people and save the state $30 million over the next five years.
    Local officials applauded the law, even as they realized it would leave them scrambling to establish more treatment facilities. Supporters said it will keep drug addicts from turning into hardened criminals. "You can save money, save lives, ensure public safety," said state Sen. John Whitmire, D-Houston. "It's a great investment and return on the dollar to keep people from becoming permanent problems for the state of Texas." Whitmire said he is working with the Texas Department of Criminal Justice to find money to establish a residential substance-abuse treatment facility in Harris County. The Legislature also has mandated that Harris County open a drug court.
    Federal grant money is available to help local governments provide treatment programs, and the state will help them track down those funds, supporters said. "The governor's criminal justice division anticipates using grant dollars from the federal level to fund substance-abuse treatment programs around the state," said Gene Acuna, a spokesman for Perry. "There will be options."
    State District Judge Michael T. McSpadden, who advocates making low-level drug offenses misdemeanors instead of felonies, said the change is "a step in the right direction." Under current law, felons sometimes have the option of a six-month jail sentence or a longer probation term. Frustrated judges say the convicts often opt for the jail time, viewing it as the easier way out. McSpadden praised the new law for putting a stop to that, allowing judges the latitude to give stiff probation sentences that convicts cannot turn down in favor of jail time.
    A Chronicle investigation found that nearly half of the 15,000 inmates in the state jail system -- lower-security jails established in 1994 to house nonviolent felons -- were there for drug crimes involving less than 1 gram. Forty-nine percent of those offenders were from Harris County. The county accounts for 16 percent of Texas' total population.
    The change in law comes as the state is slashing money for drug-treatment programs in the prison system, a move many called contradictory. A six-month drug treatment program in the state jails has been eliminated, and the state's Substance Abuse Felony Punishment Program was reduced from nine to six months as part of massive state budget cuts. Larry Todd, prison system spokesman, said the state had no choice but to reduce programs because of budget constraints, but he acknowledged that drugs and alcohol are a major problem among inmates. "The majority of the offenders coming into our system have admitted to some sort of substance abuse," he said. Many were convicted of crimes directly involving drugs, he added, and others committed theft or burglary in an attempt to get money for drugs.  Will Harrell, executive director of the American Civil Liberties Union of Texas, said the cuts are disappointing but will ultimately be offset by the change in law. "Treatment works and incarceration doesn't," Harrell said. "It's just better public policy."

Man Was Unstable Months Before Slaying, Psychiatrist Says
Jenifer Ragland, Los Angeles Times – 6/27/2003

A Simi Valley serial rapist on trial in the death of a 20-year-old college student was mentally disturbed, homicidal and suicidal when he was released from a mental hospital months before the slaying, a psychiatrist testified Thursday. Dr. John Liebert, a former employee of the Ventura County Behavioral Health Department, was the first defense witness in the trial of 32-year-old Vincent Sanchez, who faces charges of first-degree murder, kidnapping and attempted rape in connection with the July 5, 2001, killing of Moorpark College student Megan Barroso. Sanchez already has pleaded guilty to sexual assault charges involving a dozen women. If convicted of all charges he could face the death penalty.
    On the witness stand Thursday, Liebert said he had diagnosed Sanchez with a number of potential psychiatric disorders, including "intermittent explosive disorder" and "adjustment disorder" in January 2001 before Sanchez opted to leave the hospital against the doctor's advice. He had entered the hospital expecting to stay only three days, but was held an additional period after making threats. Liebert said he had no authority to keep Sanchez in the facility. A court ordered that Sanchez be released on Jan. 16. "There's nothing you can do," Liebert testified. "It's against the law to ask him to stay another five minutes. When they want to leave, you let them go." While being treated in the hospital, Liebert said, Sanchez "made a robust threat ... that he was going to kill his girlfriend and himself and that he had a viable weapon to do it."
    As a result, Liebert said he was forced to invoke a legal procedure holding himself responsible to warn potential victims that Sanchez was being released and could pose a danger to them. Liebert issued the warning to police and Sanchez's former girlfriend, Luz LaFarga. Liebert said it was clear at the time that Sanchez had no insight as to why his threats against LaFarga and himself were serious. Sanchez had formed an intense bond with LaFarga and her children and believed he could reconcile their relationship, he said. "I was trying to get him to accept that this relationship was dead and that he needed to grieve," Liebert said.
    On direct examination, defense attorney Neil Quinn went through Liebert's notations on Sanchez's discharge report, which included several possible diagnoses. Liebert described "adjustment disorder" as an inappropriate reaction to stress and a sign of an underlying personality disorder. He said "intermittent explosive disorder" describes someone who exhibits violent or verbal explosions without provocation. Sanchez also could have been diagnosed with post-traumatic stress disorder, Liebert testified, stemming from a 1997 industrial accident in which Sanchez suffered a severe head injury.
    On cross-examination, Deputy Dist. Atty. Dee Corona asked if someone with "intermittent explosive disorder" would plan ahead before committing violent acts. Liebert said they would not. Corona then listed several actions Sanchez had taken after making the threat against LaFarga, including stealing a shotgun from his roommate, sawing off the barrel of the gun and preparing a duffel bag with handcuffs, a ski mask, duct tape and ammunition before asking LaFarga to meet him.
    Liebert then said he would have needed at least six months to definitively diagnose Sanchez, rather than the eight days he had in January 2001. "Is it correct to say you were not confident in the diagnoses at the time Mr. Sanchez was released?" Corona asked. Liebert replied, "Yes, that's correct." Testimony continues today.

How Light Became a Therapy
Joshua Tompkins, Los Angeles Times- 6/27/2003

The quest to understand light's effect on biological rhythms dates back to the 1930s, when scientists first discovered a circadian system in plants. Mounting evidence of the human body clock's tendency to synchronize with the day-night cycle attracted more researchers to the budding field of chronobiology during the next several decades. But the research was largely abandoned in the 1970s after experiments in Germany indicated that social cues such as work schedules — not sunrise and sunset — were the chief pacemakers of a person's sleep schedule.
    In 1980, still convinced that light was the body's core metronome, scientists at the National Institute of Mental Health discovered a link between light exposure and the suppression of melatonin, suggesting a biochemical basis for the waking effect of bright light. The results put the light-dark theory back in vogue. "It influenced a lot of people to reconsider the role of the light-dark cycle and also the use of bright light to experimentally and perhaps therapeutically manipulate biological rhythms," says Dr. Al Lewy, senior vice chairman of the department of psychiatry at Oregon Health and Science University, and one of the NIH scientists involved in the 1980 study.
    The relationship between light, melatonin and a person's sleep habits is orchestrated by a cluster of small structures in the brain called the suprachiasmatic nuclei, or SCN, located behind the eyes near the optic nerve. The onset or absence of light, relayed from the retinas via neurotransmitters, causes the firing rate of certain neurons in the SCN to change, which in turn affects the release of melatonin by the pineal gland. " Thus, even the most dutiful midday sunbather may suffer from DSPS, Lewy says. "The key is to get the light as soon as you awaken. If you wait a few hours, it's not going to be effective. There are a lot of people who dilly-dally around the house before they go outside."

Study: Nicotine Inhalers Effective
New York Times, 6/27/2003

A recent study suggests an eyebrow-raising approach to fighting smoking. The government, the study says, should consider allowing smokers to buy inhalers that will give them pure shots of nicotine. The inhalers might reduce the damage to public health caused by smoking tobacco, says the study, which appears in the current issue of Tobacco Control.  The author of the report, Dr. Walton Sumner II of the Washington University School of Medicine in St. Louis, says most of the harm that smokers suffer comes from the thousands of chemicals, including toxins and carcinogens, that accompany the nicotine in cigarettes. None of those satisfies the smokers' addiction.
    "Obviously, nicotine is a huge reason people use tobacco products," Sumner said. "That's what they're trying to get, the nicotine. Although nicotine is not harmless, it just doesn't have that much effect on people's health when you use pure formulations."  While other nicotine methods are available for smokers who want to quit, including gum and patches, some have side effects, and smokers do not seem to find the alternatives as satisfying as cigarettes, the study added.

U.S. BuSpar Users Could Get a Refund
Detroit Free Press, 6/27/2003

Thousands of U.S. patients who took the medication BuSpar or its generic version (buspirone HCl) for anxiety problems in the last eight years may be eligible to file claims in a multi-million dollar settlement.  Consumers could get $200-300, according to Sage Eastman, assistant Michigan attorney general.  Only those who paid for the medicine themselves, or whose insurance required them to purchase the two medicines, in a time period from Jan. 1, 1998, and Jan. 31 this year, are eligible for compensation.
    The settlement follows a class-action suit by attorneys general in 50 states and U.S. territories and the District of Columbia, against Bristol-Myers Squibb, manufacturer of the drug. The lawsuit charged that Bristol-Myers conspired to prevent other generic competitors. As a result, consumers paid $65.29 for the drug, compared to $19.33 for generic equivalents. Bristol-Myers has denied any wrongdoing.  Michigan stands to receive $2.5 million in the settlements. Part of the money would go to the state of Michigan, for reimbursement of Medicaid patients who received the drug. The rest would be paid to consumers who have proofs of purchase for Buspar. Claims must be filed by October 10.

Canada Plans Injection Site for Addicts
Jeremy Hainsworth, Associated Press- 6/27/2003

VANCOUVER, British Columbia -- Canada will open North America's first legal safe-injection site for drug addicts later this year, a decision that drew swift criticism from White House drug czar John Walters. The so-called "shooting gallery" will be federally funded, a 12-seat facility where addicts will be given the equipment they need to inject safely under the supervision of nurses, said Viviana Zanocco, spokeswoman for the Vancouver Coastal Health Authority, which will run the program. It will open in September in Vancouver's Downtown Eastside, an impoverished neighborhood known for crime and drug use, under funding the federal government announced this week. "They would shoot up under supervision," Zanocco said Thursday. After injecting, the users will be monitored in a "chill-out" room to check for overdoses, she said.
    The site will be exempt from federal drug laws to allow heroin and cocaine users to use it without fear of arrest. "It makes us the first health authority in Canada to have this exception that hopefully will allow us to establish scientifically whether supervised injection sites can improve health outcomes and reduce harm to drug users," Zanocco said. Similar safe-injection programs have been set up in the Netherlands, Switzerland, Australia and Germany. While the sites are credited with reducing overdose deaths and the spread of disease, specialists say the effect on addiction rates is unclear.
    Walters, the White House Director of National Drug Control Policy, said in a telephone interview Thursday the program shows an appalling indifference to addiction. "Drug abuse is a deadly disease," Walters said. "It's immoral to allow people to suffer and die from a disease we know how to treat." He also called the concept "a lie," saying "there are no safe injection sites."
    Canada already has irritated Walters and U.S. security officials with a proposal to decriminalize possession of small amounts of marijuana. Asa Hutchinson, undersecretary for border and transportation security in the Department of Homeland Security, warned Thursday that such moves will bring tighter border controls against drug trafficking from Canada. "We're concerned about the increased drug activity coming from Canada," Hutchinson said during a visit to Seattle. The United States is "adjusting as necessary our border inspections to address those concerns that we have," Hutchinson said. That means longer lines that slow the flow of commerce between the North American neighbors that share the world's largest trade relationship, worth more than $1 billion a day.
    Zanocco called the safe-injection program a way to help addicts begin rehabilitation. The federal funding of $900,000 requires a government research program on drug use. Ann Livingston of the Vancouver Area Network of Drug Users said allowing addicts to inject at supervised sites will reduce the spread of HIV/AIDS and hepatitis, while protecting them from arrest on the streets. "It is simply a public health initiative to do what's logical and compassionate and effective," she said. About 4,000 addicts live in the 15-square-block Downtown Eastside, which has one of the highest HIV infection rates in the world.
    Mayor Larry Campbell, a former police office and coroner, won election last year on a platform that promised safe injection sites as part of a "four pillar" drug policy involving treatment, prevention, harm reduction and enforcement. Vancouver's police department was criticized by Human Rights Watch in April for a crackdown on drug dealers in the area. Police denied targeting users, saying they focused on dealers, but critics said the crackdown would alienate drug users from social services, leading to an increase in disease and death.
    Livingston said creating safe-injection sites was a positive step, rather than going soft on drug use. She worries that opponents will create obstacles to its proper establishment. "We'll be watching to make sure that it isn't put forward as a program that's designed to fail, that it isn't so restrictive that the people who you want to come in don't come in," she said.

Mental Ailments in Children Being Linked to Strep
Carey Goldberg, Boston Globe- 6/28/2003

KENNEBUNKPORT, Maine -- Sammy Jelin, math whiz and natural comedian, sailed through fifth grade, a school enthusiast eager for the bus each morning. By the start of sixth grade last fall, he could barely make it to school at all: In just weeks, his world had turned into a minefield of germ phobias, invisible walls, and constant tics -- hallmarks of obsessive compulsive disorder and Tourette's syndrome. By this May, Sammy's mother, Beth Jelin, was nearing her wits' end. Then an acquaintance mentioned that her son had contracted similar mental ailments through a streptococcus infection. The idea sounded wild, especially because Sammy had never had strep throat. But a prompt blood test did turn up unusually high levels of strep, and Sammy went on antibiotics. Within days, Sammy got so much better that Beth Jelin is convinced that undiagnosed strep was the culprit, and a growing body of research, though still controversial, suggests she might be right.
    It could be that at least one child in every 1,000 suffers from obsessive compulsive disorder linked to strep, say federally financed researchers who have been exploring the connection for several years. Garden-variety strep, bacteria best known for attacking the throat, is far more common than that; virtually every child catches it once or twice a winter. And strep sometimes infects a child without bringing noticeable symptoms.  In contrast to strep, a child has only a small chance of developing strep-related obsessive compulsive disorder, or OCD. But among children who do have OCD, up to one-half of those cases could be strep-related, said one specialist, Dr. Tanya Murphy of the University of Florida.
    Skeptics say strep is so common in schoolchildren that simple chance could dictate that it would sometimes coincide with the onset of OCD or Tourette's. But evidence is accumulating. Researchers in Rochester, N.Y., reported last year that over four years in one pediatric practice, they had linked 25 cases of children with OCD and tics to strep. And when those children at Elmwood Pediatric Group were quickly given antibiotics, both the strep and the psychiatric symptoms went away, Drs. Michael Pichichero and Marie Lynd Murphy reported at conferences and in the Archives of Pediatrics & Adolescent Medicine.
    While no one advocates prescribing antibiotics more broadly as a precaution against OCD, some specialists say the link is now established enough that pediatricians should order a strep test when a child comes in with sudden-onset OCD or tics.  The connection remains little known among pediatricians, even though it is recognized enough to have a name: PANDAS, for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection. And dozens of studies have focused on it recently. Several points about PANDAS are already quite clear, said Dr. Susan Swedo, who helped discover the syndrome in the early 1990s and now leads the National Institute of Mental Health PANDAS research team. There is no question, she said, that a there is a group of children with a ''fairly unique clinical presentation'': abrupt onset of OCD or tics along with other unusual behaviors, from frequent urination to high separation anxiety.
    Normally, OCD develops gradually, often over years; but with sudden onset, parents often say their child seemed to get ill overnight, or can name the date when the symptoms started. Typical OCD involves obsessions, often with cleanliness or fears about safety, and can include compulsions, like repeated hand-washing.  With PANDAS, Swedo said, it is also clear that the children's psychiatric symptoms get worse with subsequent strep infections but fade when the strep does. Also, she and others said, this is not the first time that infections have been connected to psychiatric disorders. In its advanced stages, syphilis can lead to insanity. Lyme disease has been known to bring on psychiatric problems, and some researchers have reported that strep may also be connected to anorexia.
    There is broad agreement, Swedo said, on a possible mechanism for PANDAS: It could be that in some children, strep triggers antibodies that mistakenly attack the basal ganglia, a part of the brain that helps control movement, much as antibodies mistakenly attack the heart in rheumatic fever. But researchers have a ways to go before they really understand what happens, and why it happens only in certain children, Swedo said. There seems to be a genetic element involved as well, she noted; PANDAS children seem to have immune systems predisposed to the disorder.
    Other researchers are working to try to find biological markers or highly objective measures to distinguish PANDAS children from those with garden-variety OCD or Tourette's. Still others are focusing on how best to prevent and fight PANDAS using antibiotics. If specialists' estimates are correct, tens of thousands of children between the toddler years and puberty may be affected.
    For the past month, Jelin has been doing a great deal of research on PANDAS and using the information to try to help Sammy. Most recently, she has been looking into the best ways to fight strep, and found a new study favoring amoxicillin. ''We're approaching this like a military operation,'' she said in an e-mail describing the antibiotics her son is now taking. ''First, we dropped massive amounts of penicillin. Next we're sending in the ground troops -- Keflex and amoxicillin.''
    Before his improvement, Sammy had suffered through a wide range of OCD and Tourette's symptoms.  He developed bruises on his arms and legs from using them, rather than his fingers, to flick light switches. He felt compelled to hop and clear his throat at the same time. At one point, he needed to eat with his eyes closed. This month, Beth Jelin said, many of those behaviors have faded, though some remain in a less pronounced and less frequent form. During a 20-minute conversation last week at his kitchen table, Sammy seemed just slightly more squirmy than the average boy and was quietly hilarious as he discussed his surfeit of self-confidence and his economic suggestions for President Bush. He did not want to talk about his OCD and recent improvement, but his mother said he recently told her, ''Mom, I'm a boy full of hope.''
    She is left wondering, she said, ''How many children are there out there with mental health diagnoses where we're not really looking for the physical cause?'' Swedo cautions parents of children diagnosed with OCD not to get their hopes up. She has heard from many parents who were crushed when their children's strep tests turned up nothing. Still, she said, if a child fits the PANDAS profile, ''it's really worth it to look for an asymptomatic strep infection.'' Prompt antibiotic treatment, she said, ''can cause a pretty dramatic improvement in the symptoms. It's not very often, but it is worth it.'' Or as Sammy put it when asked what he would tell other children who run into problems like his: ''It's very good to test this kind of thing out because, frankly, it's not very fun to have.'' ''It's exhausting,'' he said. ''Something you have to keep in mind is, don't worry, it's not just you.''

Ruling Seen as Precursor to Same-Sex Marriages
David G. Savage, Los Angeles Times- 6/28/2003

WASHINGTON — The Supreme Court's decision upholding gay civil rights leads logically — and some say, inevitably — to same-sex marriages in the United States, say both gay rights supporters and advocates of traditional family structures. The two sides in this "culture war" find themselves in agreement on what Thursday's decision means.
    By a 6-3 vote, the court struck down laws criminalizing sex between gays and described their relationships as a "personal bond" that is protected by the Constitution. If so, some of these people say, it is only a small step further to say that gays who establish such personal bonds should be permitted to marry, just like heterosexual couples. "If you extend the logic and the reasoning of that decision, that's where we are headed," says Richard Lessner of the Family Research Council. "We're convinced this case was brought to provide the foundation for same-sex marriages. Gay-rights advocates were looking for a precedent, and now they have it."
    The lawyers who brought the Texas case before the high court agree it leads logically to recognition of same-sex marriages. "I think it is inevitable now. In what time frame, we don't know," said Patricia Logue, a lawyer for Lambda Legal Defense and Education Fund in New York and co-counsel in the Lawrence vs. Texas case decided Thursday. "It's happening in Canada and in Europe, and the Lawrence decision obviously helps here. Most of anti-gay discrimination comes down to, 'We don't approve of you, and we don't like you.' But the court has held that is not an acceptable reason for discrimination."
State courts in Massachusetts and New Jersey are considering cases brought by gay couples seeking the right to marry. If they win in one state, lawyers for gay civil rights hope to set a precedent that will eventually allow for same-sex marriages nationwide. "It's not going to happen this year or next, but in the next decade, I think it's likely," said Georgetown University law professor Chai Feldblum, who teaches gay rights law. "The state lawyers in the pending cases have a hard time proving that allowing gays to marry will harm the institution of marriage."
    In one way, the Supreme Court went out of its way to make clear it was not giving gays a right to marry under state law. In his majority opinion, Justice Anthony M. Kennedy said the Texas case "does not involve whether the government must give formal recognition to any relationship homosexual persons seek to enter." In her concurring opinion, Justice Sandra Day O'Connor added that the "traditional institution of marriage" is not at issue. But other parts of the court's opinion stressed the "moral disapproval" of gays did not justify a state's discrimination against them.
    The justices "are not ready to open up marriage to gay people. They think the public isn't quite ready for it," said Feldblum, a former clerk at the court. "But as a matter of logic and principle, there is no reason not to provide the institution of marriage for gay people. The court is leaving that open for the future."
Lessner, whose group has been pressing for state laws that say marriage is reserved for a man and a woman, believes the court's decision poses a major threat. "We find ourselves strangely in agreement with the people on the gay rights side," he said.
    In 1996, Congress passed the Defense of Marriage Act to try to block a state-by-state drive toward same-sex marriages. Proponents of that law feared that state courts in Hawaii or Vermont would accord gays and lesbians a right to marry. And after marrying there, gay couples could seek recognition of their legal unions in other states under the "full faith and credit" clause of the Constitution. This provision requires courts in one state to honor legal agreements made in another state. Although the Defense of Marriage Act creates one barrier to same-sex marriages, opponents say it would not prevent the Supreme Court from striking down as unconstitutional all the state laws excluding same-sex marriage.

Psychiatrist's Qualifications Questioned in Child Drowning Trial
Associated Press, 6/30/2003

TROY, N.Y. --Prosecutors seeking the conviction of a woman for the drowning of her 4-year-old son challenged Monday the qualifications of a psychiatrist who testified the defendant was unable to tell right from wrong at the time of the killing. Stephen Price, a psychiatrist who specializes in schizophrenia, said he disagreed with earlier psychiatric testimony on the defendant, Christine Wilhelm, and judged her delusional when she drowned her son Luke in the bathtub of their Hoosick Falls home and attempted to do the same to her other son Peter, then 5. Wilhelm, 39, is charged with second-degree murder and attempted murder. She has pleaded not guilty by reason of insanity.
    Forensic psychiatrist Park Dietz, who did a 10-hour videotaped evaluation of Wilhelm that was played for jurors last week, determined Wilhelm was able to tell right from wrong at the time of the April 2002 drowning. Assistant Rensselaer County District Attorney Joel Abelove noted that while Dietz is a recognized expert in forensic psychiatry who has testified in many well-known cases, including those of Andrea Yates and Jeffrey Dahmer, Price has little experience in the area, The Record of Troy reported in Tuesday's editions.
    Abelove said Price based his determination on a four-hour session he had with Wilhelm days after the death, and two more sessions that were conducted this April, a year later. Price was hired by the defense at an estimated price of $16,000 to evaluate Wilhelm's mental capacity. Price said he handled the evaluation properly, adding that it was necessary to take time to establish a rapport with Wilhelm and review all the other information related to the case. ''She trusted Mr. Frost and (defense attorney) John Turi and held them in very high regard,'' Price said. ''She told me more than what she told Dr. Dietz.''
    Price's sessions were not recorded, and all the jury had to go by were Price's ''incomplete'' notes, Abelove said. The prosecutor suggested that Wilhelm manipulated the interviews because she knew their purpose.  Abelove also said Wilhelm hid delusions in the past to get released from psychiatric facilities.  Price stood by his diagnosis. ''Most people who are severely mentally ill can appear to be logical but when they are in the center of their delusions it all falls apart for them,'' Price said. ''If it wasn't for the delusions that she experienced that night, we wouldn't be here today.''

N.J. Youths Linger in Psychiatric Wards
Associated Press, 6/30/2003

TRENTON, N.J.--Some emotionally troubled children and teenagers linger in juvenile psychiatric wards in New Jersey for far longer than their intended emergency stays, The New York Times reported. The youths, including some in the custody of the New Jersey Division of Youth and Family Services, are brought to nine crisis units in hospitals across the state for 8-day stays. But some stay for weeks after being declared fit for release, The Times reported.
    ''The situation now is horrific,'' Kathy Wright, executive director of the New Jersey Parents Caucus, told The Times for Monday's editions. The federally funded, nonprofit group offers support to parents of children with psychiatric disorders. ''DYFS workers bring them there (the wards) if they have failed in a foster placement,'' Wright was quoted as saying. ''Once a kid has a mental past or a violent past, no one wants them.''
    Joe Delmar, a spokesman for DYFS, told The Associated Press that children under the agency's care who are brought to the units remain under DYFS supervision during and after their stays. Delmar said 30-40 youths a year recommended for placement in group homes after initially entering a crisis unit remain for prolonged periods, which he said average one month. The longest stay in such a unit for any youth in ''the past couple of years,'' was 120 days. Children are kept in the units for that time, Delmar said, while officials seek ''the right fit'' in the state's highly specialized residential programs, where often there are no immediate openings.
    He said 90 percent of all children who entered crisis units had come from their own homes, while the rest were DYFS children from foster homes. However, Delmar said Monday that virtually all children recommended for group homes are first placed in DYFS custody, a step necessary for Medicaid to pay the bill. ''It does take a long time,'' Delmar said Monday. ''But we're talking about 30-40 children a year, less than 1 percent of the children who go into these crisis units.''  Delmar acknowledged that some children other than those awaiting placement in group homes may linger in the crisis units, but they are not in DYFS custody, and the state has no control over them, he said.   State officials have been working to address the problem, which has become more formidable in recent years. They are optimistic that a program the Partnership for Children will help more children receive treatment in their homes or foster homes.
   ''If we can assure that children, whatever their family circumstances, get services earlier and closer to their home, we hope we can prevent the escalation in behavior that leads people to the hospitals,'' said Julie Caliwan, the director of the partnership.