Well: The Fallout of a Chance Medical Finding

An incidental finding — I was convinced of it. My patient had undergone a CT scan of the abdomen at another hospital because of stomach pains and “incidentally noted” was a 2-centimeter mass in her adrenal gland. She brought in the report for me to see, nervous that she might have cancer.

I reassured her that it was exceedingly unlikely that she had cancer. Benign masses in the adrenal gland are nearly as common as birthmarks. They almost never cause symptoms and we stumble across them only because we do so many scans for other reasons. They’ve even earned their own appellation: incidentalomas, and that’s what I was sure she had.

Of course a tiny fraction — 1 to 2 percent — of these adrenal masses can wreak havoc by churning out an excess of adrenal hormones or by being cancerous. Luckily, the mass on my patient’s scan possessed all the reassuring characteristics of benignity: it was small, low-attenuating, well circumscribed, with smooth borders. And she had no symptoms to suggest adrenal hyperactivity or cancer. It was most likely a benign adrenal adenoma that would never cause her harm.

Nevertheless, once the incidentaloma had been given life, so to speak, it was no longer incidental. We were now obliged to run some highly complicated — and expensive — lab tests. I winced as I ordered urinary metanephrines to test the adrenaline-producing capacity of the adrenal. The computer warned me with exclamation points and asterisks that this was a “greater-than-$100-send-out test.” Explaining how to correctly collect a 24-hour urine sample was its own involved discussion. Then I had to explain the even more complicated logistics of the overnight dexamethasone-suppression test to evaluate the cortisol-producing capacity of the adrenal.

After that, I considered the follow-up CT scans, recommended at six months, one year and two years, to ensure that the mass wasn’t growing. What about all that radiation? One group of endocrinologists estimated that the chance of uncovering a malignant cancer in patients like mine was roughly equal to the chance of causing a fatal cancer from the radiation of these follow-up CT scans. And might these CT scans pick up other incidental findings, opening yet more Pandora’s boxes of medical evaluation?

And what about the issue of skyrocketing medical costs? The evaluation of this incidentaloma was going to cost more than a thousand dollars. Tens of millions of CT scans are done every year in the United States. It doesn’t take many back-of-the-envelope calculations to see how quickly the costs of incidental findings, and their subsequent evaluations, add up. How much should the societal obligation weigh into the decisions for my patient?

My thoughts flitted back to the doctor who had ordered this CT in the first place. Perhaps if the doctor had had more time to spend on the history and physical, the CT would not have been necessary. From my 15 years with this patient, I knew that her symptoms could be voluminous in quantity and quality. This wasn’t to say that something serious couldn’t squeak in, but over the years I have learned that it takes immense perseverance and patience to tease out the significance of each symptom. Otherwise we’d be doing a CT every week for her.

But I could understand how a doctor in a busy ER on a weekend might have been overwhelmed by the plethora of symptoms and simply ordered a CT “to be on the safe side.” I wished that doctor had tried to call me before ordering the scan, but what’s done was done. The fallout of that decision was now in my lap.

By now we had run well over our allotted time and my patient was utterly overwhelmed by the complex testing procedures and schedules. The adrenal mass was an incidental finding, after all, but it had completely steamrolled our visit. My patient’s diabetes, obesity, depression, arthritis and elevated cholesterol all ended up with the short end of the clinical stick — an outcome that surely is not incidental to her health.


Danielle Ofri is an associate professor of medicine at New York University School of Medicine and editor in chief of the Bellevue Literary Review. Her most recent book is “Medicine in Translation: Journeys With My Patients.”

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Boeing faces battles: fixing Dreamliner and winning back fliers









Marian Burkhart was looking forward to traveling on Boeing's 787 Dreamliner. She and her husband settled into their seats, picked a movie and waited for what she called the "Taj Mahal plane" to take them from Houston to Los Angeles.


Then the pilot came on the intercom with surprising news: All passengers had to get off the plane because federal regulators had grounded the so-called aircraft of the future, concerned by fires caused by its electronics system.


Burkhart, 48, now isn't sure whether she'll fly on a 787.





"It's a beautiful plane…but I would wait awhile," she said, moments after arriving in Los Angeles on an older airplane. "I want to make sure there aren't any additional incidents."


Boeing Co. is now battling on two fronts: fixing the source of the problem and regaining the trust of the flying public. This is not what the aerospace giant had planned for the 787, which the company promoted as "defining 21st century flight."


FULL COVERAGE: Boeing's troubled Dreamliner


The last time the Federal Aviation Administration grounded a large commercial jet was 36 years ago when a DC-10 crashed at Chicago O'Hare International Airport, killing all 271 aboard.


The FAA's move to ground the Dreamliner has shaken confidence among travelers and the aviation community at large as regulators around the world took similar action against the 787.


In the latest 787 incident, smoke was seen coming from the right side of a plane belonging to Japanese carrier All Nippon Airways shortly after an emergency landing. All 137 passengers and crew were evacuated from the aircraft and slid down the Dreamliner's emergency slides. Video of the event was captured by an onboard passenger and has been broadcast worldwide.


"Welcome to the era of social media, Boeing," said Michel Merluzeau, managing partner of aerospace consultant G2 Solutions in Kirkland, Wash. "That sort of thing is going to be seen by millions of people. As much as Boeing says it's 'teething issues' with a new plane, they're running out of time."


New planes, in general, have growing pains. But the FAA's examination into the 787's power system is incredibly rare for a plane in service more than a year.


At issue is the Dreamliner's electrical system and power-distribution panels, which involve pervasive use of lithium-ion batteries. The technology, also found in cellphones and electric automobiles, has a history of being involved in fires. The Dreamliner is the first large commercial aircraft to use the technology on such a large scale.


Oliver McGee, a former deputy assistant secretary at the Department of Transportation, said he believes the FAA acted appropriately in grounding the Dreamliner fleet.


"The worst thing we could have is a massive fire 30,000 feet in the air," McGee said. "I think the grounding and improvements are essential. That said, the Boeing 787 is a safe airplane.... Any time you're doing mass engineering you have to be patient as you take out the glitches."


Boeing said in a statement that it believes the 787 is safe and is working with its airline customers and regulators to resolve the issue.


"The safety of passengers and crew members who fly aboard all Boeing airplanes is our highest priority," Boeing said in the statement. "We are confident the 787 is safe, and we stand behind its overall integrity. Our customers are also standing behind the 787 and understand the value it brings to them and their passengers."


Correcting the problem is only part of Boeing's battle. It must repair the Dreamliner's image with airlines as well as passengers.


"The longer it drags on, it obviously isn't great for Boeing's reputation or credibility," said J.B. Groh, an aerospace analyst who covers Boeing for D.A. Davidson & Co. "Boeing unfortunately lives in a fish bowl, so every issue with the 787 is analyzed ad nauseam. I don't think there's a lot you can do to fix that."


Boeing should be open with the public as it finds a solution, said Prashant Malaviya, a marketing professor at Georgetown University.


"In the mind of the customer, the brand has eroded already," Malaviya said. "Fixing the real problem is not enough. The biggest thing they can do is have some transparency in the process of fixing it and then publicize that."





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U.S. finalizes rules for financial firms to avoid foreclosures









In a major effort to heal the $10-trillion U.S. mortgage market, the Consumer Financial Protection Bureau has finalized rules designed to ensure financial firms offer every available option to keep delinquent borrowers in their homes.


The regulations, to be announced Thursday, address widespread complaints that loan servicers — the companies that collect mortgage payments and repossess homes — were woefully unprepared to help borrowers during the tsunami of foreclosures after the housing bust.


They are designed to complement previous settlements by major banks over allegations of widespread servicing and foreclosure abuses. But unlike earlier settlements, they will apply to all large mortgage servicers, not just banks, in all states.





Still, the rules drew immediate criticism from a prominent consumer group, which said they don't do enough to force servicers to consider easing the terms of mortgages and expressed fears that the rules might preempt stronger existing provisions.


"While the establishment of industrywide standards is important, the failure to require meaningful loan modification protections is a retreat from current safeguards under the soon-to-expire [Obama administration] loan modification program," said Alys Cohen, an attorney with the National Consumer Law Center.


The consumer bureau was created when Congress passed the sweeping Dodd-Frank financial reform act in reaction to the mortgage meltdown and the global economic crisis that ensued. The law also required lenders to ensure that they only make loans that borrowers can reasonably be expected to repay.


Last week, the bureau issued major regulations providing a "safe harbor" from lawsuits under that new requirement for lenders who make certain types of presumably sound home loans. A key requirement is that total debt payments for borrowers — including principal, interest, taxes and insurance on home loans — be no more than 43% of gross income.


The rules to be released Thursday, which take effect in a year, bar lenders from pursuing foreclosure proceedings against borrowers while applications for loan modifications are pending — the much-criticized practice of "dual tracking."


The consumer bureau said banks also must provide "direct, easy, ongoing access" to employees who are required to alert borrowers to missing information, provide status reports on modification requests and ensure documents don't get lost.


Banks also are required to inform borrowers who miss two monthly payments about options to avoid foreclosure and to wait until loans go 120 days delinquent before beginning a foreclosure — a provision that would preempt a 90-day requirement under California law.


Richard Cordray, the consumer bureau's director, said distressed borrowers had not gotten the help and support they deserved, such as "timely and accurate information about their options for saving their homes."


"Servicers failed to answer phone calls, routinely lost paperwork and mishandled accounts," Cordray said in remarks to be delivered at an industry conference Thursday.


"Communication and coordination were poor, leading many to think they were on their way to a solution, only to find that their homes had been foreclosed on and sold," he said. "At times, people arrived home to find they had been unexpectedly locked out."


The new rules don't apply to most small banks and credit unions. Bureau officials said they have had few complaints about these small institutions, which are more likely to keep loans on their books, rather than sell them, and generally devote more attention to individual customers.


Servicers often are collecting payments on behalf of loan owners, who may be the banks themselves but more often are trusts created on behalf of mortgage investors. The investors have mandated a wide range of relief programs for troubled borrowers in addition to government-sponsored programs such as the Obama administration's Home Affordable Modification Program.


In the past, servicers would sometimes not inform troubled borrowers about all the options, instead steering them into foreclosure or programs that provided the servicers with greater financial rewards, bureau officials said.


The servicers are now supposed to clearly explain all alternatives to borrowers so they can pick the best one. The new rules also establish clearer opportunities for borrowers to appeal servicers' denials of loan modifications.


In addition to worries that the bureau has not cracked down hard enough on servicers, consumer advocates expressed concern that the new rules will not take effect for a year.


"While we understand that servicers need time to implement complex procedures, we're still in the middle of a foreclosure crisis," Cohen said. "Many people will unnecessarily lose their homes if we wait a year."


scott.reckard@latimes.com





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Commentary: Background Checks? Yes, but Leave Video Games Alone






COMMENTARY | I have mixed feelings toward the White House‘s gun violence response. I agree that background checks should be required before people are allowed to buy a firearm and that an assault weapon ban should be reinstated into law. While limiting the number of bullets in a weapon’s magazine will decrease the number of deaths in a mass shooting, the public does not need high-capacity magazines. Therefore any weapon using high-capacity magazines should be banned from public use, not just capping the magazines to 10 bullets.


But violent video games and other media images and scenes real-life violence? These media do not kill people. The shooters kill the people. Those who are mentally unstable may not understand that violent video games are not real life and should not be duplicated in real life. As long as gamers understand the difference between video games and real life, that shouldn’t be touched.






– Edmond, Okla.


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Obama calls for research on media in gun violence


NEW YORK (AP) — Hollywood and the video game industry received scant attention Wednesday when President Barack Obama unveiled sweeping proposals for curbing gun violence in the wake of the Newtown, Conn., school shooting.


The White House pressed most forcefully for a reluctant Congress to pass universal background checks and bans on military-style assault weapons and high-capacity ammunition magazines like the ones used in the Sandy Hook Elementary massacre.


No connection was suggested between bloody entertainment fictions and real-life violence. Instead, the White House is calling on research on the effect of media and video games on gun violence.


Among the 23 executive measures signed Wednesday by Obama is a directive to the Centers for Disease Control and Prevention and scientific agencies to conduct research into the causes and prevention of gun violence. The order specifically cited "investigating the relationship between video games, media images and violence."


The measure meant that media would not be exempt from conversations about violence, but it also suggested the White House would not make Hollywood, television networks and video game makers a central part of the discussion. It's a relative footnote in the White House's broad, multi-point plan, and Obama did not mention violence in entertainment in his remarks Wednesday.


The White House plan did mention media, but suggested that any effort would be related to ratings systems or technology: "The entertainment and video game industries have a responsibility to give parents tools and choices about the movies and programs their children watch and the games their children play."


The administration is calling on Congress to provide $10 million for the CDC research.


The CDC has been barred by Congress to use funds to "advocate or promote gun control," but the White House order claims that "research on gun violence is not advocacy" and that providing information to Americans on the issue is "critical public health research."


Since 26 were killed by a gunman at Sandy Hook in December, some have called for changes in the entertainment industry, which regularly churns out first-person shooter video games, grisly primetime dramas and casually violent blockbusters.


The Motion Picture Association of America, the National Association of Broadcasters, National Cable & Telecommunications Association and the Independent Film & Television Alliance responded to Wednesday's proposal in a joint statement:


"We support the president's goal of reducing gun violence in this country. It is a complex problem, and as we have said, we stand ready to be a part of the conversation and welcome further academic examination and consideration on these issues as the president has proposed."


After the Newtown massacre, Wayne Pierre, vice-president of the National Rifle Association, attacked the entertainment industry, calling it "a callous, corrupt and corrupting shadow industry that sells and sows violence against its own people." He cited a number of video games and films, most of them many years old, like the movies "American Psycho" and "Natural Born Killers," and the video games "Mortal Kombat" and "Grand Theft Auto."


President Obama's adviser, David Axelrod, had tweeted that he's in favor of gun control, "but shouldn't we also question marketing murder as a game?"


Others have countered that the same video games and movies are played and watched around the world, but that the tragedies of gun violence are for other reasons endemic to the U.S.


The Entertainment Software Association, which represents video game publishers, referenced that argument Wednesday in a statement that embraced Obama's proposal.


"The same entertainment is enjoyed across all cultures and nations, but tragic levels of gun violence remain unique to our country," said the ESA. "Scientific research an international and domestic crime data point toward the same conclusion: Entertainment does not cause violent behavior in the real world."


Several R-rated films released after Newton have been swept into the debate. Arnold Schwarzenegger, the former California governor and action film star, recently told USA Today in discussing his new shoot-em-up film "The Last Stand": "It's entertainment. People know the difference."


Quentin Tarantino, whose new film "Django Unchained" is a cartoonish, bloody spaghetti western set in the slavery-era South, has often grown testy when questioned about movie violence and real-life violence. Speaking to NPR, Tarantino said it was disrespectful to the memory of the victims to talk about movies: "I don't think one has to do with the other."


In 2011, the Supreme Court rejected a California law banning the sale of violent video games to children. The decision claimed that video games, like other media, are protected by the First Amendment. In dissent, Justice Stephen G. Breyer claimed previous studies showed the link between violence and video games, concluding "the video games in question are particularly likely to harm children."


In the majority, Justice Antonin Scalia wrote that the government can't regulate depictions of violence, which he said were age-old, anyway: "Grimm's Fairy Tales, for example, are grim indeed."


___


AP Entertainment Writer Derrik J. Lang contributed to this report from Los Angeles


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Some With Autism Diagnosis Can Recover, Study Finds


Doctors have long believed that disabling autistic disorders last a lifetime, but a new study has found that some children who exhibit signature symptoms of the disorder recover completely.


The study, posted online on Wednesday by the Journal of Child Psychology and Psychiatry, is the largest to date of such extraordinary cases and is likely to alter the way that scientists and parents think and talk about autism, experts said.


Researchers on Wednesday cautioned against false hope. The findings suggest that the so-called autism spectrum contains a small but significant group who make big improvements in behavioral therapy for unknown, perhaps biological reasons, but that most children show much smaller gains. Doctors have no way to predict which children will do well.


Researchers have long known that between 1 and 20 percent of children given an autism diagnosis no longer qualify for one a few years or more later. They have suspected that in most cases the diagnosis was mistaken; the rate of autism diagnosis has ballooned over the past two decades, and some research suggests that it has been loosely applied.


The new study should put some of that skepticism to rest.


“This is the first solid science to address this question of possible recovery, and I think it has big implications,” said Sally Ozonoff of the MIND Institute at the University of California, Davis, who was not involved in the research. “I know many of us as would rather have had our tooth pulled than use the word ‘recover,’ it was so unscientific. Now we can use it, though I think we need to stress that it’s rare.”


She and other experts said the findings strongly supported the value of early diagnosis and treatment.


In the study, a team led by Deborah Fein of the University of Connecticut at Storrs recruited 34 people who had been diagnosed before the age of 5 and no longer had any symptoms. They ranged in age from 8 to 21 years old and early in their development were in the higher-than-average range of the autism spectrum. The team conducted extensive testing of its own, including interviews with parents in some cases, to gauge current social and communication skills.


The debate over whether recovery is possible has simmered for decades and peaked in 1987, when the pioneering autism researcher O. Ivar Lovaas reported that 47 percent of children with the diagnosis showed full recovery after undergoing a therapy he had devised. This therapy, a behavioral approach in which increments of learned skills garner small rewards, is the basis for the most effective approach used today; still, many were skeptical and questioned his definition of recovery.


Dr. Fein and her team used standardized, widely used measures and found no differences between the group of 34 formerly diagnosed people and a group of 34 matched control subjects who had never had a diagnosis.


“They no longer qualified for the diagnosis,” said Dr. Fein, whose co-authors include researchers from Queens University in Kingston, Ontario; Children’s Hospital of Philadelphia; the Institute of Living in Hartford; and the Child Mind Institute in New York. “I want to stress to parents that it’s a minority of kids who are able to do this, and no one should think they somehow missed the boat if they don’t get this outcome.”


On measures of social and communication skills, the recovered group scored significantly better than 44 peers who had a diagnosis of high-functioning autism or Asperger’s syndrome.


Dr. Fein emphasized the importance of behavioral therapy. “These people did not just grow out of their autism,” she said. “I have been treating children for 40 years and never seen improvements like this unless therapists and parents put in years of work.”


The team plans further research to learn more about those who are able to recover. No one knows which ingredients or therapies are most effective, if any, or if there are patterns of behavior or biological markers that predict such success.


“Some children who do well become quite independent as adults but have significant anxiety and depression and are sometimes suicidal,” said Dr. Fred Volkmar, the director of the Child Study Center at the Yale University School of Medicine. There are no studies of this group, he said.


That, because of the new study, is about to change.


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FAA grounds entire fleet of Boeing 787s

Federal officials say they are temporarily grounding Boeing's 787 Dreamliners until the risk of possible battery fires is addressed.









Federal regulators have grounded all U.S. Boeing 787 Dreamliner passenger jets, a potentially devastating setback for the company's troubled new flagship airliner.


The move Wednesday by the Federal Aviation Administration left airlines reeling, seeking ways to accommodate delayed passengers. Boeing Co. stock fell on the news in after-hours trading.


The order came Wednesday after a 787 operated by a Japanese carrier, All Nippon Airways, made an emergency landing in southwestern Japan. The crew reported an unusual smell in the cabin, and indicators in the cockpit told pilots there was a problem related to an onboard lithium-ion battery.








FAA statement on Boeing 787 grounding 


Such batteries were also involved in a fire last week aboard a parked 787 in Boston operated by Japan Airlines.


The Japanese carriers — which own 24 of the 50 Dreamliners flying today — decided to remove all of their 787s from service indefinitely out of safety concerns. That move led to the FAA's extraordinary grounding order.


The plane is assembled at Boeing's Everett, Wash., factory, but the bulk of the large components arrive from suppliers around the world pre-assembled. There are about 50 suppliers in California alone.


"This is clearly a black eye and hiccup for Boeing," said Richard Phillips, managing director at Janes Capital Partners, an Irvine-based aerospace and defense investment bank. "It's clearly related to the batteries.... It could mean significant reengineering work that … could take a long time."


Boeing Chief Executive Jim McNerney said in a statement that the company is working with the FAA to "find answers as quickly as possible."


"The company is working around the clock with its customers and the various regulatory and investigative authorities," he said. "We are confident the 787 is safe, and we stand behind its overall integrity."


The FAA's decision came less than a week after U.S. Transportation Secretary Ray LaHood and FAA chief Michael Huerta deemed the plane safe to fly. The 787 has experienced a series of mishaps including a fuel leak and the Boston fire. However, the FAA had allowed the planes to continue to operate while it launched an unusual and sweeping evaluation of the way Boeing designs, manufactures and assembles the aircraft.


At issue is the Dreamliner's electrical systems and power-distribution panels, which involves pervasive use of lithium-ion batteries, which have been involved in fires and can also be found in cellphones and electric automobiles. The Dreamliner is the first large commercial aircraft to use the technology on such a large scale.


In a statement, the FAA said that the grounding order is aimed to "address a potential battery fire risk in the 787 and require operators to temporarily cease operations. Before further flight, operators of U.S.-registered Boeing 787 aircraft must demonstrate to the Federal Aviation Administration that the batteries are safe."


The FAA order is expected to be followed by carriers worldwide.


Boeing's use of lithium-ion batteries, made by Kyoto, Japan-based GS Yuasa Corp., were called into question when a smoldering fire was discovered last week on the underbelly of a Dreamliner operated by Japan Airlines after the 173 passengers and 11 crew members had deplaned at the gate.


In the latest incident involving All Nippon Airways, smoke was seen swirling from the right side of the cockpit. All 137 passengers and crew were evacuated from the aircraft and slid down the Dreamliner's emergency slides. Video of the event was captured by an onboard passenger and has been broadcast worldwide.


The FAA has been aware of the flammability of lithium-ion batteries for years. Still when the agency was certifying the Dreamliner for flight operation, it issued special conditions for lithium-ion battery installations on the Dreamliner because regulations don't cover this technology.


"At present, there is limited experience with use of rechargeable lithium-ion batteries in applications involving commercial aviation. However, other users of this technology, ranging from wireless telephone manufacturing to the electric vehicle industry, have noted safety problems with lithium ion batteries. These problems include overcharging, over-discharging, and flammability of cell components," the FAA wrote at the time.


The FAA has issued scathing assessments of lithium-ion batteries for starting fires.


In October 2011, the FAA issued an airworthiness directive to owners of Cessna Aircraft Co.'s Model 525C airplanes that required them to swap out the lithium-ion batteries with other batteries.





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Family of man killed by Santa Ana police disputes city's explanation









The family of a man killed by police in Santa Ana disputed the official chain of events leading to his shooting, saying the 39-year-old had fallen asleep in his parked car and was startled when officers began banging on his vehicle.


The death of Binh Van Nguyen has stirred protests and rumors, fanned by coverage on Vietnamese radio and conversation at local coffeehouses.


In a public outreach effort Monday, Santa Ana city leaders — including Mayor Miguel Pulido and interim Police Chief Carlos Rojas — held a town hall meeting to respond to the rumors and offer reassurance that the shooting is being investigated.





"We hope to show the community we are listening," Cpl. Anthony Bertagna said.


Police said they were forced to open fire with semiautomatic handguns when Nguyen tried to drive his white Toyota toward them in the early hours of last Friday.


Patrol officers cruising through a west Santa Ana neighborhood reported that they first spotted Nguyen sitting in the back seat of his parked car in the 200 block of Maxine Street. As two uniformed men approached, he jumped into the front seat, police said.


The officers said they asked him to exit the car, but instead he gunned it toward them, Bertagna said.


The area where the 12:45 a.m. incident unfolded is a haven for gang activity and drugs, police said.


But family members countered the official version of what happened.


"The crime scene photos show Binh's car in a stationary position curbside, with little or no room to maneuver," the Nguyens said in a statement released by their attorney, Michael Guisti.


The family asserted that the officers were not wearing uniforms and that Nguyen — startled from his sleep — had no way of knowing they were policemen.


"We are grief-stricken beyond words. Binh was a gentle and kind man with a warm personality," the family said.


Supporters staged a peaceful protest Sunday at the scene where Nguyen, who worked in a dry-cleaning shop, was shot. He is survived by his wife and two sons, ages 13 and 7.


"They need to show the greater community that this is a tragedy and police have questions to answer," Guisti said.


Both officers involved in the fatality, one a veteran and the other described as "experienced" but new to the department, are on leave but expected to return to duty.


Police found drug paraphernalia in Nguyen's car, Bertagna said.


anh.do@latimes.com





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Chicago rapper facing jail for parole violation


CHICAGO (AP) — Chicago rapper Chief Keef has been taken into custody after a juvenile court judge decided a video of him firing a semiautomatic rifle at a New York gun range was a violation of probation.


The artist, real name Keith Cozart, was sentenced last year to 18 months' probation after his conviction on aggravated unlawful use of a weapon charges for pointing a gun at police officers.


The Chicago Sun-Times reports (http://bit.ly/VJ1YUt) Judge Carl Anthony Walker said the video showed a disregard for the court's authority. Walker scheduled a Thursday sentencing hearing for the 17-year-old Cozart.


Defense attorney Dennis Berkson told Walker his client never took the gun outside of the range and the target practice was supervised.


Chief Keef's first album, "Finally Rich," was released last year to mixed reviews.


___


Information from: Chicago Sun-Times, http://www.suntimes.com/index


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Breaking Link of Violence and Mental Illness





No one but a deeply disturbed individual marches into an elementary school or a movie theater and guns down random, innocent people.




That hard fact drives the public longing for a mental health system that produces clear warning signals and can somehow stop the violence. And it is now fueling a surge in legislative activity, in Washington and New York.


But these proposed changes and others like them may backfire and only reveal how broken the system is, experts said.


“Anytime you have one of these tragic cases like Newtown, it’s going to expose deficiencies in the mental health system, and provide some opportunity for reform,” said Richard J. Bonnie, a professor of public policy at the University of Virginia’s law school who led a state commission that overhauled policies after the 2007 Virginia Tech shootings that left 33 people dead. “But you have to be very careful not to overreact.”


New York State legislators on Tuesday passed a gun bill that would require therapists to report to the authorities any client thought to be “likely to engage in” violent behavior; under the law, the police would confiscate any weapons the person had.


And in Washington, lawmakers said that President Obama was considering a range of actions as part of a plan to reduce gun violence, including more sharing of records between mental health and law enforcement agencies.


The White House plan to make use of mental health data was still taking shape late Tuesday. But several ideas being discussed — including the reporting provision in the New York gun law — are deeply contentious and transcend political differences.


Some advocates favored the reporting provision as having the potential to prevent a massacre. Among them was D. J. Jaffe, founder of the Mental Illness Policy Org., which pushes for more aggressive treatment policies. Some mass killers “were seen by mental health professionals who did not have to report their illness or that they were becoming dangerous and they went on to kill,” he said.


Yet many patient advocates and therapists strongly disagreed, saying it would intrude into the doctor-patient relationship in a way that could dissuade troubled people from speaking their minds, and complicate the many judgment calls therapists already have to make.


The New York statute requires doctors and other mental health professionals to report any person who “is likely to engage in conduct that would result in serious harm to self or others.”


Under current ethical guidelines, only involuntary hospitalizations (and direct threats made by patients) are reported to the authorities. These reports then appear on a federal background-check database. The new laws would go further.


“The way I read the new law, it means I have to report voluntary as well as involuntary hospitalizations, as well as many people being treated for suicidal thinking, for instance, as outpatients,” said Dr. Paul S. Appelbaum, director of the Division of Law, Ethics, and Psychiatry at Columbia University’s medical school. “That is a much larger group of people than before, and most of whom will never be a serious threat to anyone.”


One fundamental problem with looking for “warning signs” is that it is more art than science. People with serious mental disorders, while more likely to commit aggressive acts than the average person, account for only about 4 percent of violent crimes over all.


The rate is higher when it comes to rampage or serial killings, closer to 20 percent, according to Dr. Michael Stone, a New York forensic psychiatrist who has a database of about 200 mass and serial killers. He has concluded from the records that about 40 were likely to have had paranoid schizophrenia or severe depression or were psychopathic, meaning they were impulsive and remorseless.


“But most mass murders are done by working-class men who’ve been jilted, fired, or otherwise humiliated — and who then undergo a crisis of rage and get out one of the 300 million guns in our country and do their thing,” Dr. Stone said.


The sort of young, troubled males who seem to psychiatrists most likely to commit school shootings — identified because they have made credible threats — often do not qualify for any diagnosis, experts said. They might have elements of paranoia, of deep resentment, or of narcissism, a grandiose self-regard, that are noticeable but do not add up to any specific “disorder” according to strict criteria.


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