U.S. Judges Offer Addicts a Way to Avoid Prison

Todd Heisler/The New York Times

Emily Leitch of Brooklyn, with her son, Nazir, 4, was arrested for importing cocaine but went to “drug court” to avoid prison.

Federal judges around the country are teaming up with prosecutors to create special treatment programs for drug-addicted defendants who would otherwise face significant prison time, an effort intended to sidestep drug laws widely seen as inflexible and overly punitive.

The Justice Department has tentatively embraced the new approach, allowing United States attorneys to reduce or even dismiss charges in some drug cases.

The effort follows decades of success for “drug courts” at the state level, which legal experts have long cited as a less expensive and more effective alternative to prison for dealing with many low-level repeat offenders.

But it is striking that the model is spreading at the federal level, where judges have increasingly pushed back against rules that restrict their ability to make their own determination of appropriate sentences.

So far, federal judges have instituted programs in California, Connecticut, Illinois, New Hampshire, New York, South Carolina, Virginia and Washington. About 400 defendants have been involved nationwide.

In Federal District Court in Brooklyn on Thursday, Judge John Gleeson issued an opinion praising the new approach as a way to address swelling prison costs and disproportionate sentences for drug trafficking.

“Presentence programs like ours and those in other districts mean that a growing number of courts are no longer reflexively sentencing federal defendants who do not belong in prison to the costly prison terms recommended by the sentencing guidelines,” Judge Gleeson wrote.

The opinion came a year after Judge Gleeson, with the federal agency known as Pretrial Services, started a program that made achieving sobriety an incentive for drug-addicted defendants to avoid prison. The program had its first graduate this year: Emily Leitch, a Brooklyn woman with a long history of substance abuse who was arrested entering the country at Kennedy International Airport with over 13 kilograms of cocaine, about 30 pounds, in her luggage.

“I want to thank the federal government for giving me a chance,” Ms. Leitch said. “I always wanted to stand up as a sober person.”

The new approach is being prompted in part by the Obama administration, which previously supported legislation that scaled back sentences for crimes involving crack cocaine. The Justice Department has supported additional changes to the federal sentencing guidelines to permit the use of drug or mental health treatment as an alternative to incarceration for certain low-level offenders and changed its own policies to make those options more available.

“We recognize that imprisonment alone is not a complete strategy for reducing crime,” James M. Cole, the deputy attorney general, said in a statement. “Drug courts, re-entry courts and other related programs along with enforcement are all part of the solution.”

For nearly 30 years, the United States Sentencing Commission has established guidelines for sentencing, a role it was given in 1984 after studies found that federal judges were giving defendants widely varying sentences for similar crimes. The commission’s recommendations are approved by Congress, causing judges to bristle at what they consider interference with their judicial independence.

“When you impose a sentence that you believe is unjust, it is a very difficult thing to do,” Stefan R. Underhill, a federal judge in Connecticut, said in an interview. “It feels wrong.”

The development of drug courts may meet resistance from some Republicans in Congress.

“It is important that courts give deference to Congressional authority over sentencing,” Representative F. James Sensenbrenner Jr., Republican of Wisconsin, a member and former chairman of the Judiciary Committee, said in a statement. He said sentencing should not depend “on what judge happens to decide the case or what judicial circuit the defendant happens to be in.”

At the state level, pretrial drug courts have benefited from bipartisan support, with liberals supporting the programs as more focused on rehabilitation, and conservatives supporting them as a way to cut spending.

Under the model being used in state and federal courts, defendants must accept responsibility for their crimes and agree to receive drug treatment and other social services and attend regular meetings with judges who monitor their progress. In return for successful participation, they receive a reduced sentence or no jail time at all. If they fail, they are sent to prison.

The drug court option is not available to those facing more serious charges, like people accused of being high-level dealers or traffickers, or accused of a violent crime. (These programs differ from re-entry drug courts, which federal judges have long used to help offenders integrate into society after prison.)

In interviews, the federal judges who run the other programs pointed to a mix of reasons for their involvement.

Read More..

Pro sports leagues aim to put workers' comp out of play

One would think that we've learned from bitter experience not to trust a word uttered by our major professional sports leagues.

Yet here they are trying to put another howler over on us. This is their assertion that retired pro athletes — many of them from outside the state — are ripping off California's workers' compensation system for hundreds of millions of dollars.

The state Legislature is setting itself up to swallow this one whole: A bill to close this supposed loophole has been introduced by Assembly Insurance Committee Chairman Henry Perea (D-Fresno).

Let's start with the bottom line: This bill would be a total sellout to the major pro sports leagues and their billionaire team owners, who pay the workers' compensation claims won by their workers. Its victims would be athletes whose limbs, joints, backs and craniums were pounded relentlessly on the field of play and who were left with inadequate treatment or support after they retired.

Let's also home in on whose interests are most at stake: It's the National Football League, which is facing a tidal wave of legal claims related to long-term neurological damage suffered by players. Claims from more than 4,000 players and their families have been consolidated in a single immense lawsuit in Philadelphia federal court, where pretrial maneuvering has been lumbering on for months.

Among their allegations is that the NFL suppressed evidence that the concussions caused by its style of play could have long-term health consequences. The league has consistently denied that it tried to mislead players.

Perea's bill serves the NFL and the pro sports leagues and teams in basball, basketball, hockey and soccer. (Apparently lacrosse, rugby and softball leagues didn't have the juice to get their way in Sacramento.) It's purportedly a response to the upsurge in workers' comp claims filed by pro athletes, including many who never played for California teams, that started around 2007.

There were several reasons for the increase. Under state law, you can file a claim if you can argue that you suffered an injury in California, even if your employer was located elsewhere; it's a rare pro athlete who doesn't occasionally play an away game against a California team.

More important, California is one of nine states that allow workers' compensation for "cumulative trauma" injuries, those that build up over time. The most familiar of these are carpal tunnel injuries suffered by typists. But they also encompass knee or back damage from years of blocking and tackling, or neurological damage from repeated concussions.

"The NFL is not terribly worried about cumulative knee trauma," says Frank Neuhauser, a social insurance expert at UC Berkeley. "They understand what they're going to pay for that. But they're terrified of brain injuries, which can cost millions and result in complete disability." The NFL didn't reply to my request for comment on the workers' comp issue.

It's hardly shocking that the NFL and other major leagues would want to shut down this avenue of compensation. Nor is it very surprising that they would resort to disinformation.

"The NFL knows this could be detrimental to their bottom line," says attorney Mel Owens, who played nine years for the Los Angeles Rams in the 1980s and now represents athletes in workers' comp cases. "So they couch it in terms of players abusing the system."

The leagues' bid for sympathy depends on most laypersons having no idea about how workers' compensation works. So here's a primer. To begin with, taxpayers don't pay for workers' comp; employers do, either by buying commercial workers' comp insurance or (if they're big enough) self-insuring. Their premiums are overwhelmingly based on their type of business and their claims record. The premium paid by the employer of file clerks will be very different from that of a skyscraper builder.

Therefore, if California workers'-comp judges take a more liberal view of long-term brain injuries for football players (and as yet there's no evidence that they do), that may drive up premiums paid by sports teams, but it won't affect the premium paid by grocery stores.

The leagues "are trying to make it look like these are costs that will fall on all employers," Neuhauser says. "But it has nothing to do with current rates. Sports teams' premiums will go up, but not those for construction companies or anyone else."

Then there's the notion, also happily peddled by the leagues, that the athletes are getting away like bandits, abetted by aggressive lawyers. A 2012 analysis done for the NFL and the professional baseball, basketball and hockey major leagues by the benefits consulting firm Milliman Inc. estimated the cost of already-filed California cumulative trauma claims by athletes at $747 million.

That sounds like a lot, until you realize that it covers 4,500 players, for an average of $166,000 each, which includes the cost of medical treatment. Is that a lot for injuries that may be crippling for life and include Alzheimer's or other neurological syndromes? For a player judged partially but permanently disabled, the maximum benefit is $270 a week for up to 320 weeks. Long story short: No player is getting rich off these payments.

Nor are the players typically coasting into retirement with superstar nest eggs. Consider Reggie Williams. A standout linebacker who played 14 seasons for the Cincinnati Bengals, including two Super Bowls, he made $45,000 in his rookie year, 1976, and topped out at $445,000 after 14 seasons.

Now 58, Williams has suffered through 24 operations on his right knee, leaving the knee looking like hamburger and that leg 3 inches shorter than his left. "I never played a game where I didn't get hurt," he told me. That includes 14 games in California against the Rams, Raiders, 49ers and Chargers. "Now I wake up every day in extreme pain." Five years ago he had to leave a job with Walt Disney Co. because he could barely stand on his feet.

In 2008, Williams filed for workers' compensation in California, but the Bengals have blocked that claim, for now, arguing that under his employment contract he was required to file in Ohio. If the team wins, he may be out of luck, for the statute of limitations on Ohio workers' comp claims has long passed, and the state doesn't cover cumulative trauma.

"The NFL doesn't want to be liable for any of this," says Williams' lawyer, Owens. He points out that taxpayers bear the ultimate cost if the leagues skate on their obligations. "If the players can't get workers' comp benefits and they can't get health insurance, they end up on Social Security disability and Medicare," Owens said.

Why California legislators should bend over backward to help out franchise-owning plutocrats is a mystery. That's especially true since the reason athletes have to resort to workers' comp in the first place is that the owners have abdicated their responsibility to care for the injured players who have made them rich. Sure, they'll pay lip service to player health, but talk is cheap. It looks even cheaper in light of the NFL's new broadcast contracts, which are worth more than $40 billion over the next decade.

If the leagues want their California problem to go away, that would be easy: reach deals with the players' unions providing lifetime injury coverage superior to what they can get from workers' compensation. That's a very low bar, even when you're trying to clear it while carrying bagfuls of money.

Michael Hiltzik's column appears Sundays and Wednesdays. Reach him at mhiltzik@latimes.com, read past columns at latimes.com/hiltzik, check out facebook.com/hiltzik and follow @latimeshiltzik on Twitter.

Read More..

Jury in Bell corruption trial may be deadlocked

A court spokeswoman said Thursday the jury in the Bell corruption case appears to be deadlocked.

“The jurors may be at an impasse,” said Patricia Kelly, a spokeswoman for L.A. County Superior Court.

Jurors sent a note to the judge Thursday morning, and all the attorneys in the case were called in.

Six former Bell City Council members are accused of stealing public money by paying themselves extraordinary salaries in one of Los Angeles County’s poorest cities.

Luis Artiga, Victor Bello, George Cole, Oscar Hernandez, Teresa Jacobo and George Mirabal are accused of misappropriation of public funds, felony counts that could bring prison terms.

They were arrested in September 2010 and have been free on bail.

The nearly $100,000 salaries drawn by most of the former elected officials are part of a much larger municipal corruption case in the southeast Los Angeles County city in which prosecutors allege that money from the city’s modest general fund flowed freely to top officials.

The three defendants who testified painted a picture of a city as a place led by a controlling, manipulative administrator who handed out enormous salaries, loaned city money and padded future pensions. Robert Rizzo, the former adminstrator, and ex-assistant city manager Angela Spaccia are also awaiting trial.

The four-week trial of the former council members turned on extremes.

Deputy Dist. Atty. Edward Miller said the council members were little more than common thieves who were consumed with fattening their paychecks at the expense of the city’s largely immigrant, working-poor residents.

Miller said the accused represented the “one-percenters" of Bell who had “apparently forgotten who they are and where they live."

Defense attorneys said the former city leaders -- one a pastor, another a mom-and-pop grocery store owner, another a funeral director -- were dedicated public servants who put in long hours and tirelessly responded to the needs of their constituents.

Jacobo testified that Rizzo informed her she could quit her job as a real estate agent and receive a full-time salary as a council member. She said she asked City Attorney Edward Lee if that was possible and he nodded his head.

"I thought I was doing a very good job to be able to earn that, yes," Jacobo said.

Cole said Rizzo was so intimidating that the former councilman voted for a 12% annual pay raise out of fear the city programs he established would be gutted by Rizzo in retaliation if he opposed the pay hikes.

The defense argued that the prosecution failed to prove criminal negligence -- that their clients knew what they were doing was wrong or that a reasonable person would know it was wrong.

The attorney for Hernandez, the city’s mayor at the time of the arrests, said his client had only a grade-school education, was known more for his heart than his intellect and was, perhaps, not overly “scholarly.”

Prosecutors argued that the council members pushed up their salaries by serving on city boards that rarely met and, in one case, existed only as a means for paying them even more money.

Jurors were also left to deal with the question of whether council members were protected by a City Charter that was approved in a special election that drew fewer than 400 voters.

Defense attorneys say the charter allowed council members to be paid for serving on the authorities.

But the prosecutor argued that the charter -- a quasi-constitution for a city -- set salaries at what councils in similar-sized cities were receiving under state law: $8,076 a year. Because council members automatically serve on boards and commissions, the district attorney said the total compensation for all of each council member's work was included in that figure.

Read More..

George Lopez to host Playboy Jazz Festival

LOS ANGELES (AP) — George Lopez is taking over as master of ceremonies of the annual Playboy Jazz Festival.

The comedian was announced as the festival's new host Thursday at an event at the Playboy Mansion.

"This is iconic," said the former star of the ABC sitcom "George Lopez" and the TBS talk show "Lopez Tonight." ''I've never been here before. I was married for 17 years. I couldn't even have a Playboy air freshener."

Bill Cosby previously served as the festival's host for more than 30 years. Cosby was a fixture at the gathering of jazz luminaries since the first festival was held in 1979.

Lopez said Cosby called him to give him advice on the gig. His tips included not letting musicians in his dressing room "because they'll eat all your food and drink all your drink," joked Lopez.

This year's show will feature such artists as Herbie Hancock, Jeffrey Osborne, Sheila E. and Grace Kelly, who were on hand at Thursday's event.

The Playboy Jazz Festival is scheduled for June 15 and 16 at the Hollywood Bowl.

___

Follow AP Entertainment Writer Derrik J. Lang at http://www.twitter.com/derrikjlang .

___

Online:

http://www.playboyjazzfestival.com

Read More..

Jane C. Wright, Pioneering Oncologist, Dies at 93

Dr. Jane C. Wright, a pioneering oncologist who helped elevate chemotherapy from a last resort for cancer patients to an often viable treatment option, died on Feb. 19 at her home in Guttenberg, N.J. She was 93.

Her death was confirmed by her daughter Jane Jones, who said her mother had dementia.

Dr. Wright descended from a distinguished medical family that defied racial barriers in a profession long dominated by white men. Her father, Dr. Louis T. Wright, was among the first blacks to graduate from Harvard Medical School and was reported to be the first black doctor appointed to the staff of a New York City hospital. His father was an early graduate of what became the Meharry Medical College, the first medical school in the South for African-Americans, founded in Nashville in 1876.

Dr. Jane Wright began her career as a researcher working alongside her father at a cancer center he established at Harlem Hospital in New York.

Together, they and others studied the effects of a variety of drugs on tumors, experimented with chemotherapeutic agents on leukemia in mice and eventually treated patients, with some success, with new anticancer drugs, including triethylene melamine.

After her father died in 1952, Dr. Wright took over as director of the center, which was known as the Harlem Hospital Cancer Research Foundation. In 1955, she joined the faculty of the New York University Medical Center as director of cancer research, where her work focused on correlating the responses of tissue cultures to anticancer drugs with the responses of patients.

In 1964, working as part of a team at the N.Y.U. School of Medicine, Dr. Wright developed a nonsurgical method, using a catheter system, to deliver heavy doses of anticancer drugs to previously hard-to-reach tumor areas in the kidneys, spleen and elsewhere.

That same year, Dr. Wright was the only woman among seven physicians who, recognizing the unique needs of doctors caring for cancer patients, founded the American Society of Clinical Oncologists, known as ASCO. She was also appointed by President Lyndon B. Johnson to the President’s Commission on Heart Disease, Cancer and Stroke, led by the heart surgeon Dr. Michael E. DeBakey. Its recommendations emphasized better communication among doctors, hospitals and research institutions and resulted in a national network of treatment centers.

In 1967, Dr. Wright became head of the chemotherapy department and associate dean at New York Medical College. News reports at the time said it was the first time a black woman had held so high a post at an American medical school.

“Not only was her work scientific, but it was visionary for the whole science of oncology,” Dr. Sandra Swain, the current president of ASCO, said in a telephone interview. “She was part of the group that first realized we needed a separate organization to deal with the providers who care for cancer patients. But beyond that it’s amazing to me that a black woman, in her day and age, was able to do what she did.”

Jane Cooke Wright was born in Manhattan on Nov. 30, 1919. Her mother, the former Corinne Cooke, was a substitute teacher in the New York City schools.

Ms. Wright attended the Ethical Culture school in Manhattan and the Fieldston School in the Bronx (now collectively known Ethical Culture Fieldston School) and graduated from Smith College, where she studied art before turning to medicine. She received a full scholarship to New York Medical College, earning her medical degree in 1945. Before beginning research with her father, she worked as a doctor in the city schools.

Dr. Wright’s marriage, in 1947, to David D. Jones, a lawyer, ended with his death in 1976. She is survived by their two daughters, Jane and Alison Jones, and a sister, Barbara Wright Pierce, who is also a doctor.

As both a student and a doctor, Dr. Wright said in interviews, she was always aware that as a black woman she was an unusual presence in medical institutions. But she never felt she was a victim of racial prejudice, she said.

“I know I’m a member of two minority groups,” she said in an interview with The New York Post in 1967, “but I don’t think of myself that way. Sure, a woman has to try twice as hard. But — racial prejudice? I’ve met very little of it.”

She added, “It could be I met it — and wasn’t intelligent enough to recognize it.”

Read More..

Airports big and small may feel effects of federal budget feud

Get ready for longer lines at Los Angeles International Airport, slower delivery of packages and the possible shutdown of small Southern California airport control towers if a resolution isn't reached on federal budget cuts.

The good news is that the biggest effects probably will not take hold until April, giving President Obama and congressional leaders time to hammer out a deal to resolve the budget feud.

But if no agreement is reached, the Federal Aviation Administration will be forced to cut its budget about $600 million. That could force the FAA to close more than 100 air traffic control towers across the country, primarily at smaller regional airports, including in Santa Monica, Victorville and Oxnard.

The night shift for air traffic controllers could also be eliminated at about 70 larger airports, including LA/Ontario International.

The federal agency has also put out the option of furloughing FAA employees for one or two days per two-week pay period, beginning in mid-April.

At Los Angeles International Airport, officials say it is too early to gauge how much of an effect the budget cuts would have on the average air traveler.

But Transportation Security Administration head John Pistole said lines at security gates at major airports across the country could grow longer during the peak spring and summer travel seasons if he is forced to cut overtime pay, which would reduce the number of screening officers.

"The longer it goes, the greater the potential impact," he said of the budget battle.

The National Air Traffic Controllers Assn. expects the cuts to lead to fewer flights and increased delays of as long as 90 minutes during peak hours.

"Safety will remain the top priority, but in order to maintain the appropriate level of safety with fewer controllers, fewer planes will be allowed in the sky, as well as in and out of airports," the group said in a statement.

The FAA has announced plans to shut down towers at airports with fewer than 150,000 landings and takeoffs a year. Santa Monica Airport, which is on the FAA closure list, operates about 105,000 landings and takeoffs a year. Van Nuys Airport, which is not on the list, has more than 250,000 landings and takeoffs.

Still, the effect on smaller airports on the FAA cut list may not be severe because pilots can land and depart without the help of an air traffic controller by keeping track of each other through radio communications.

Joe Justice, who operates Justice Aviation, a company that offers flying lessons at Santa Monica Airport, said he doesn't expect his business to face major changes if the tower is closed.

"We would continue to give flying lessons," he said. "There would be no reason not to. We would depart here and practice at a place where there is an open tower."

Private jet charter companies said they may even get more business if sequestration increases delays on commercial airlines, forcing passengers to charter a jet.

"People who are sitting on the fence about wanting to hire a private jet may spend the extra money so they won't be caught in a situation where they have no idea how long their delays will be," said Ben Schusterman, founder of Los Angeles-based ElJet.

The closure of overnight shifts at the control tower in Ontario could eliminate 12 passenger flights, or 9% of operations, but a bigger effect would be the loss of 73 cargo flights, or 36% of all cargo operations.

Cargo operators at Ontario said they were still unsure of the effect of budget cuts on their businesses.

"UPS is closely monitoring the sequestration proceedings," United Parcel Service Inc. spokesman Mike Mangeot said. "And while we are in communications with the FAA regarding the effects of the possible cuts, it is premature to speculate at this time."

hugo.martin@latimes.com

Read More..

Santa Cruz hit hard by officers' deaths

SANTA CRUZ — Flags throughout this sparkling beach town flew at half-staff Wednesday. The entire Police Department was meeting with grief counselors. Handmade signs cropped up, sympathy cards to a stunned city.

"Thank you for your service Santa Cruz Police Department. RIP Detective Baker. RIP Detective Butler." That's what Mary Gregg wrote in neat black letters on yellow construction paper, hanging her message in the window of the downtown check-cashing store where she works.

"Something," she felt, "had to be said today."

Best known for its surfing museum and a roller coaster that Bay Area newspaper columnist Herb Caen described as "one long shriek," Santa Cruz is not used to the kind of pain that rippled through town the day after a gunfight left two veteran officers — and the man they were investigating — dead.

The city's Police Department, which has less than 100 sworn officers, had operated for 150 years without losing a single one in the line of duty. Until Tuesday afternoon, when two veteran detectives in plainclothes walked up to Jeremy Goulet's house as part of a misdemeanor sexual assault investigation.

Sgt. Loran "Butch" Baker, 51, and Det. Elizabeth Butler, 38, were killed on Goulet's doorstep, Santa Cruz County Sheriff Phil Wowak said during a news conference near an impromptu memorial at police headquarters.

"We don't know all that happened when they came into contact with Goulet," said Wowak, whose department is leading the investigation so Santa Cruz police can mourn. "We do know what was left in the aftermath."

The 35-year-old Goulet, who had a long history of run-ins with the law, killed and disarmed the detectives before fleeing in Baker's car, Wowak said. Law enforcement officers from throughout the region began a sweep of the Santa Cruz neighborhood where Baker and Butler were slain. A short time later, Goulet ditched the car and tried to flee on foot.

In the ensuing gun battle, Wowak said, Goulet shot up a firetruck, sending firefighters, medical personnel and passersby scrambling. After killing the suspect, authorities discovered Goulet had been wearing body armor and had three guns.

"It is our belief that two of the three weapons belonged to the Santa Cruz Police Department, but we haven't confirmed it," said Wowak, adding that it was still unclear whether Goulet had taken the body armor from Baker's car or had it on before the shooting broke out.

"We know now that he was distraught," the sheriff said. "We know now that he had the intention of harming himself and possibly the police.… There's no doubt in anyone's mind that the officers who engaged Goulet stopped an imminent threat to the community."

Goulet had been arrested Friday on suspicion of disorderly conduct. Local news accounts said he had broken into the home of a co-worker and been fired from his job at The Kind Grind coffeehouse Saturday. A manager at the beachfront shop declined to comment Wednesday.

According to Goulet's father, the barista — who recently had moved from Berkeley to Santa Cruz — was a ticking time bomb who held police and the justice system in deep contempt. Ronald Goulet, 64, told the Associated Press that his son had had numerous run-ins with the law and had sworn he would never go back to jail.

But the elder Goulet said he never thought his troubled son would turn to such violence.

Goulet said his son undermined any success in the military (he reportedly was a member of the Marine Corps Reserves and later the Army) or college because of an insatiable desire to peep in the windows of women as they showered or dressed.

"He's got one problem, peeping in windows," his father said. "I asked him, 'Why don't you just go to a strip club?' He said he wants a good girl that doesn't know she's being spied on, and said he couldn't stop doing it."

In 2008, a Portland, Ore., jury convicted Jeremy Goulet on misdemeanor counts of unlawful possession of a firearm and invasion of personal privacy after he peeked into a woman's bathroom as she showered, said Don Rees, a chief deputy district attorney in Multnomah County.

Goulet faced additional charges, including attempted murder, after he allegedly fired a gun at the woman's boyfriend. The two had fought after Goulet was spotted outside the woman's condo, but a jury acquitted him of those charges, Rees said.

During the trial, Goulet admitted that he liked to use his cellphone to record unsuspecting women undressing, according to the Oregonian newspaper. Prosecutors alleged he had peeped at women "hundreds of times" without getting caught.

Goulet was given three years' probation, Rees said, but spent time in jail after his probation was revoked.

Read More..

Well: Think Like a Doctor: The Man Who Wobbled

The Challenge: Can you solve the medical mystery of a man who suddenly becomes too dizzy to walk?

Every month, the Diagnosis column of The New York Times Magazine asks Well readers to try their hand at solving a medical mystery. Below you will find the story of a 56-year-old factory worker with dizziness and panic attacks. I have provided records from his two hospital visits that will give you all the information available to the doctor who finally made the diagnosis.

The first reader to offer the correct diagnosis gets a signed copy of my book, “Every Patient Tells a Story,” and the satisfaction of solving a case that stumped a roomful of specialists.

The Patient’s Story:

The middle-aged man clicked his way through the multiple reruns of late-late-night television. He should have been in bed hours ago, but lately he hadn’t been able to get to sleep. Suddenly his legs took on a life of their own. Stretched out halfway to the center of the room, they began to shake and twitch and jump around. The man watched helplessly as his legs disobeyed his mental orders to stop moving. He had no control over them. He felt nauseous, sweaty and out of breath, as if he had been running some kind of race. He called out to his wife. She hurried out of bed, took one look at him and called 911.

The Patient’s History:

By the time the man arrived at Huntsville Hospital, in Alabama, the twitching in his legs had subsided and his breathing had returned to normal. Still, he had been discharged from that same hospital for similar symptoms just two weeks earlier. They hadn’t figured out what was going on then, so they weren’t going to send him home now.

The patient considered himself pretty healthy, but the past year or so had been tough. In 2011, at the age of 54, he had had a mild stroke. He had no medical problems that put him at risk for stroke — no high blood pressure, no high cholesterol, no diabetes. A work-up at that time showed that he had a hole in his heart that allowed a tiny clot from somewhere in his body to travel to the brain and cause the stroke. He was discharged on a couple of blood thinners to keep his blood from making more clots. He hadn’t really felt completely well, though, ever since. His balance seemed a little off, and he was subject to these weird panic attacks, in which his heart would pound and he would feel short of breath whenever he got too stressed. Mostly he could manage them by just walking away and focusing on his breathing. Still, he never felt as if he was the kind of guy to panic.

And he had always been quick on his feet. The first half of his career he had been in the steel business — building huge metal trusses and supports. He and his team put together 60-plus tons of steel structures every day. For the past decade he had been machining car parts. After his stroke, work seemed to get a lot harder.

The Dizziness:

A few weeks ago, he stood up and wham — suddenly the whole world went off-kilter. He felt as if he was constantly about to fall over in a world that no longer lay down flat. His first thought was that he was having another stroke. He went straight to his doctor’s office. The doctor wasn’t sure what was going on and sent him to that same emergency room at Huntsville Hospital. After three days of testing and being evaluated by lots of specialists, his doctors still were not sure what was going on. He hadn’t had a heart attack; he hadn’t had a stroke. There was no sign of infection. All the tests they could think of were normal.

The only abnormal finding was that when he stood up, his blood pressure dropped. Why this happened wasn’t clear, but the doctors in the hospital gave him compression stockings and a pill — both could help keep his blood pressure in the normal range. Then they sent him home. He was also started on an antidepressant to help with the panic attacks he continued to have from time to time.

You can read the report from that hospital admission below.

You can also read the consultation and discharge notes from that hospital visit here.

He had been home for nearly two weeks and still he felt no better. He tried to go back to work after a week or so at home, but after driving for less than five miles, he felt he had to turn around. He wasn’t sure what was wrong; he just knew he didn’t feel right. Then his legs started jumping around, and he ended up back in the hospital.

The Doctor’s Exam:

It was nearly dawn by the time Dr. Jeremy Thompson, the first-year resident on duty that night, saw the patient. Awake but tired, the patient told his story one more time. He had been at home, watching TV, when his legs started jumping on their own and he started feeling short of breath. His wife sat at the bedside. She looked just as worried and exhausted as he did. She told the resident that when he spoke that night at home, his speech was slurred. And when the ambulance came, he could barely walk. He has never missed this much work, she told the young doctor. It’s not like him. Can’t you figure out what’s wrong?

The resident had already reviewed the records from the patient’s previous hospital admissions. He asked a few more questions: the patient had never smoked and rarely drank; his father died at age 80; his mother was still alive and well. The patient exam was normal, as were the studies done in the E.R.

The first E.R. doctor thought that his symptoms were a result of anxiety, culminating in a full-blown panic attack. The resident thought that was probably right. In any case he would discuss the case with the attending in a couple of hours during rounds on the new patients. Till then, he told the worried couple, they should just try to get a little sleep.

An Important Clue:

Dr. Robert Centor was definitely a morning person. His cheerful enthusiasm about teaching and taking care of patients made him a favorite among residents. At 7:30 that morning, he stood outside the patient’s door as Dr. Thompson relayed the somewhat frustrating case of the middle-aged man with worsening dizziness and panic attacks. Then they went into the room to meet the patient. He was a big guy, tall and muscular with the first signs of middle-aged thickening around his middle. His complexion had the look of someone who spent a lot of time outdoors. Dr. Centor introduced himself and pulled up a chair as the rest of the team watched. He asked the patient what brought him to the hospital.

“Every time I get up, I get dizzy,” the man replied. Sure, he had had some balance problems ever since his stroke, he explained, but this felt different – somehow worse. He could hardly walk, he told the doctor. He just felt too unstable.

“Can you get up and show us how you walk?” Dr. Centor asked.

“Don’t let me fall,” the patient responded. He carefully swung his legs over the side of the bed. The resident and intern stood on either side as he slowly rose. He stood with his feet far apart. When asked to close his eyes as he stood there, he wobbled and nearly fell over. When he took a few steps, his heel and toes hit the ground at the same time, making a strange slapping sound.

Seeing that, Dr. Centor knew where the problem lay and ordered a few tests to confirm his diagnosis.

You can see the review report and notes for the patient’s second hospital visit below.

Solving the Mystery:

What tests did Dr. Centor order? Do you know what is making this middle-aged man wobble? Enter your guesses below. I’ll post the answer tomorrow.

---

Rules and Regulations: Post your questions and diagnosis in the Comments section below. The correct answer will appear tomorrow on Well. The winner will be contacted. Reader comments may also appear in a coming issue of The New York Times Magazine.

.

Read More..

Island Air is Ellison's latest buy

How do you follow the purchase of an island in Hawaii?

If you're Oracle Chief Executive Larry Ellison, you buy an airline so you can hop to and from your tropical paradise.

Ellison has been on a shopping spree lately, buying 98% of the island of Lanai in June from Los Angeles billionaire David Murdock and then, in November, buying a beachfront Malibu home from film and TV producer Jerry Bruckheimer.

Ellison's most risky acquisition may be Island Air, which he bought Wednesday through a holding company.

The exact purchase prices of Ellison's recent deals have not been disclosed, but local observers value the 141-square-mile island at more than $500 million and the three-bedroom, three-bath Malibu pad at more than $3.65 million. The details of the airline deal were not announced.

Island Air, a regional carrier serving airports on all major Hawaiian islands, has 245 employees and three turboprop planes, with 224 weekly flights between the islands of Oahu, Maui, Molokai, Lanai and Kauai.

Lanai, the sixth-largest Hawaiian island, was once a pineapple plantation and is still sparsely inhabited. It includes two resort hotels and two golf courses with clubhouses, according to Hawaii's Public Utilities Commission.

But Ellison did not buy the airline just to get to and from his island, airline officials say.

He hopes to expand the businesses to serve locals visiting relatives on the islands and to fly mainland and foreign tourists throughout the island state, airline officials said. The airline plans to retire two 1980s-era planes and expand to four or five new ATR 72 turboprops by the end of the year.

But Ellison should not get his hopes up about pocketing big profits, said Ray Neidl, an aviation analyst for Nexa Capital Partners in Washington, D.C.

"It's a high-risk situation with no significant margins, at least initially," he said of owning an airline.

And if Ellison hopes to expand the business, he should expect to get some resistance from the big carrier on the island, Hawaiian Airlines, Neidl added. "It really depends on what Hawaiian does."

Island Air began in 1980 as Princeville Airways, carrying passengers from Kauai to Honolulu. The history of the carrier has not always been blue skies and soft landings.

"In our 30-plus years, we had our ups and downs, pardon the pun," said Michael Rodyniuk, a senior consultant to the airline.

Like most airlines across the country, he said, Island Air struggled during the economic turmoil between 2008 and 2012 but expects to thrive with a surge in tourism that Hawaii has been enjoying in the past year or so.

The state welcomed a record 8 million visitors in 2012, surpassing the previous high of 7.6 million visitors in 2006.

"All major markets are up," Rodyniuk said.

The previous owner of the airline, California businessman Charles Willis IV, had been looking for a buyer for the airline and had put all 245 employees on notice that layoffs could begin as soon as March 11 if a buyer was not found, he said. "So Mr. Ellison saved 245 jobs," Rodyniuk said.

Forbes ranks Ellison as the third-richest American, with a net worth of $36 billion. He has cut big checks in the past on high-priced properties in Malibu, Lake Tahoe, Rancho Mirage and other locations.

But unlike real estate, air carriers are an investment that can give investors nightmares.

Virgin America, a California-based airline partly owned by millionaire Richard Branson, has been operating for more than five years without recording a profitable year.

California Pacific Airlines is the brainchild of Encinitas businessman Ted Vallas, who has already invested more than $6 million of his own money but has spent the last year trying to clear federal red tape so he can begin selling tickets.

And then there are the 11 other airlines — including American, Delta, United and US Airways — that have filed for bankruptcy since 2000.

"The profit margins on airlines, even though they are improving, are not that attractive," Neidl said.

hugo.martin@latimes.com

Read More..

Tribune Co. hires advisors to explore sale of newspaper unit

Tribune Co. has hired investment bankers to advise the media company on the potential sale of its newspaper publishing unit.

The company announced that it has retained JPMorgan Chase & Co. and Evercore Partners to assess whether to sell the division that includes the Los Angeles Times, Chicago Tribune and six other daily newspapers.

The bankers will analyze bids from suitors, but their hiring does not necessarily mean that the assets would be sold.

"There is a lot of interest in our newspapers, which we haven't solicited," Gary Weitman, a Tribune spokesman, said in a statement. "Hiring outside financial advisors will help us determine whether that interest is credible, allow us to consider all of our options, and fulfill our fiduciary responsibility to our shareholders and employees."

Tribune hopes to sell the newspaper group intact instead of selling each paper individually, according to a person familiar with the matter.

The Chicago company has a healthy balance sheet and doesn't feel financial pressure to sell the properties, according to the person. It's unclear how long the process could take.

There has been widespread speculation that Tribune would attempt to unload the newspaper business to focus on its more promising television operations. Rupert Murdoch's News Corp. is among the possible bidders for the newspaper assets.

Tribune emerged from its four-year bankruptcy at the end of 2012 and appointed broadcasting veteran Peter Liguori as chief executive in January.

JPMorgan Chase holds an ownership stake in Tribune.

Evercore Partners, a boutique investment bank, also is working for the parent company of the New York Times on its planned divestiture of the Boston Globe.

walter.hamilton@latimes.com

andrew.tangel@latimes.com

Read More..