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From the Los Angeles Times

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Survey notes illegal-texting tendencies

Officers count up how many drivers are breaking the law with their phones.

by Veronica Rocha

Standing on a downtown street corner, Glendale Police Officer Mathew Bolton spotted at least 12 motorists illegally using a cell phone — and all within 60 seconds.

The count was part of an undercover survey Wednesday on Brand Boulevard and California Avenue of distracted drivers, in which roughly 10% of motorists were spotted doing something illegal while at the wheel.

Dressed in regular clothes, Bolton stood on the corner and yelled out "texting," "phone" and "talking" at a rapid pace as another officer noted the results.

"I just look for the hands. The big thing is the hands," Bolton said.

Bolton pointed out a motorist who was using an earpiece to talk on the phone while driving.

"That's what we want people to do is to use their Bluetooths," he said.

Offenders weren't cited as part of the survey that will help assess Glendale's traffic safety issues.

That day, Bolton and three other traffic officers counted 800 vehicles in two surveys, of which 61 motorists were illegally talking on a cell phone and 24 were texting.

Another driver was seen with a dog on her lap.

The surveys were covered by a $254,795 grant from the California Office of Traffic Safety.

Distracted-driving surveys in December produced similar results.

To clamp down on the number of distracted-driving-related collisions in the city, the Police Department launched its public education campaign Driven 2 Distraction in November.

The campaign has been focused on educating residents about traffic safety, city engineering and targeted enforcement operations in collision-prone areas.

Police officials hope the surveys provide them with a better understanding of local driving habits, Glendale Police Lt. Gary Montecuollo said.

"Obviously, the public safety of the people in our community is very, very important," he said.

http://www.glendalenewspress.com/news/tn-gnp-texting-20110122,0,6555915,print.story

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OPINION

The doctor can't see you now

By 2025, the U.S. may be short 130,600 physicians, half in primary care.

by Bradley Wertheim

January 24, 2011

Three months ago, I finished my last 30-hour shift as a medical student. Although I'll be starting my residency soon, it's unlikely I'll ever again work such a marathon shift.

Last fall, the American Council for Graduate Medical Education released new standards governing the nation's 111,000 physicians in training. In the most controversial reform in the recent history of medical education, these celebrated overnight rites of passage for rookie docs will soon join the ranks of bloodletting and barber surgeons in medical antiquity.

In an attempt to decrease errors and improve patient safety, the new standards restrict the consecutive hours a first-year resident may work without sleep, from the customary 30 to 16. Meanwhile, experienced residents are limited to 24-hour shifts, with a recommendation to pursue "strategic napping" in downtime.

The measures are well intentioned but controversial. Critics fear that shortened shifts will increase the number of physician-to-physician handoffs that occur as residents change shifts, resulting in lost details and miscommunication that could cause errors and harm patients. Continuity of care is desirable because of the advantages of having a single physician caring for the same patient over time. Others charge that 16-hour shifts are insufficient for educational purposes.

Surprisingly, research evidence supporting duty-hour regulations is lacking. Even the council concedes that the 80-hour limit on the resident physician workweek, instituted in 2002, failed to yield conclusive effects — positive or negative — on patient outcomes, though researchers acknowledge this is a challenging metric to assess. Both sides of the debate offer compelling, albeit unproven, arguments championing patient safety.

Although I share concerns regarding the effect on patient care of more frequent handoffs, I certainly did not labor through medical school only to end up harming a patient because of my fatigue.

However, this impassioned debate overlooks a more insidious issue that may pose an even greater threat to patient well-being. Although young doctors work long hours for traditional and educational reasons, staffing requirements further underpin the argument for 30-hour shifts and 80-hour workweeks. The problem is simple: We have too many patients and too few doctors.

Provided it survives legal and legislative challenges, the healthcare reform law extends insurance coverage to 30 million Americans. And aging baby boomers are expected to double the population of elderly by 2030. Will we have enough doctors to accommodate them?

A June 2010 report issued by the American Assn. of Medical Colleges says no. In a model that accounts for the influx of newly insured patients, increasing utilization of doctor visits, decreases in physician working hours, modest growth of the resident workforce and greater use of nurse practitioners and physician assistants, a 130,600-physician shortage is anticipated by 2025, half of which will be primary-care doctors.

Even now, it can be challenging to find a primary-care doctor accepting new patients, and the current estimated shortage is only 7,400. Imagine the task in 2025.

Resuscitating the physician workforce requires collaboration between medical schools, professional organizations and government. Medical schools now are kindling interest in primary care and aiming to boost enrollment by 30% before 2018. For the first time since the 1960s and 1970s, new medicals schools are being built. However, these new graduates will need residency programs to complete their training.

Few realize that these residency programs are mostly funded through Medicare and other government programs, and since 1997, the number of federally supported positions — and thus the annual number of freshly credentialed doctors — has been capped by Congress.

The health reform package includes admirable efforts to address physician shortages: improved funding for the National Health Services Corps, which trades student loan repayment for care rendered in underserved areas; payment incentives and training opportunities for primary-care doctors; and grants to medical schools to develop rural training programs.

However, lawmakers failed to increase the number of federally funded residency positions. Instead, they redistributed the number of unused slots in less-desirable training programs to more deserving hospitals that promise to train mostly primary-care and general surgery residents. A reasonable first step but one that amounts to a temporizing measure, not a cure.

Congress must lift the cap on residency funding to avert an imminent compromise of our physician workforce. The coming shortage will overwork doctors, both young and old; delay necessary patient care; and negate any potential safety gains afforded by new training regulations and future reforms. Medical school and residency training can last seven to 11 years, so prompt intervention is required to augment next decade's workforce.

Universal healthcare will succeed only if there are enough physicians to render it.

Bradley Wertheim, a student at Harvard Medical School, will begin his residency in internal medicine in July.

http://www.latimes.com/news/opinion/commentary/la-oe-wertheim-mdshortage-20110124,0,2420341,print.story

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From the New York Times

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4 Detroit Police Injured in Shootout

by NICK BUNKLEY

DETROIT — Four police officers were slightly wounded and their assailant killed on Sunday after a man walked into a police precinct and “began shooting indiscriminately,” a spokeswoman for the mayor said.

Karen Dumas, who is spokeswoman for Mayor Dave Bing, said the incident began about 4:30 p.m. when the man walked into the 6th Precinct in the northwestern part of the city and opened fire with a pistol grip shotgun. The man was able to shoot four officers before one or more officers returned fire, killing him.

The most seriously injured police officer was the precinct’s commander, Brian Davis, who was hit in the lower back, Ms. Dumas said. He underwent surgery at the nearby Sinai Grace Hospital on Sunday evening.

“His condition is critical but he is expected to pull through,” Ms. Dumas said.

Two other male officers were hospitalized but expected to be released on Monday. A female officer was hit in the chest but the bulletproof vest she was wearing prevented her from being injured. All four officers were expected to survive, according to a police official at the department’s headquarters who was not authorized to speak to the media.

The police chief, Ralph Godbee, said that the police know the gunman’s identify but did not release that information Sunday as they began to investigate his background and possible motive. It was unclear whether the gunman had previous contact with the precinct or was targeting any specific officers.

Chief Godbee described the scene as one of “utter chaos and pandemonium.” But he said the response by other officers prevented the outcome from being worse.

“They did all the things that they’re trained to do under pressure. We’re very blessed to stand before you with the belief that all four of the officers will be OK,” he said at a news conference.

The police station is one of the Detroit Police Department’s eight district offices. Members of the public who enter the station do not pass through metal detectors or otherwise undergo a security screening.

In light of Sunday’s events and the Jan. 8 shooting in Tucson, Ariz., that killed six people and wounded Representative Gabrielle Giffords and others, Chief Godbee said, “We have to take a step back and reassess security procedures at each one of our facilities. Incidents like this are very sobering and remind us how vulnerable we all are.”

The shooting came at the end of a weekend in which at least 10 people were shot in Detroit in three separate incidents. Three men were found murdered in a house on Friday night, and three people were hospitalized Sunday morning after being shot outside a strip club.

Last Monday, a police officer in a Detroit suburb was killed by a suspect in a home burglary. The officer shot and the suspect each died after exchanged fire.

http://www.nytimes.com/2011/01/24/us/24detroit.html?ref=us&pagewanted=print

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Wal-Mart Shooting Leaves 2 Dead

by THE ASSOCIATED PRESS

January 24, 2011

PORT ORCHARD, Wash. (AP) — Detectives are investigating why a man ran from deputies and then opened fire in a Walmart parking lot, sparking a shootout that left him and the woman he apparently was with dead and two law officers wounded.

Sunday's violence came after the Kitsap County Sheriff's deputies answered a call about a suspicious person at the store in Port Orchard.

Two deputies located the man and tried to talk to him but he began running, pursued by the officers.

"For reasons not yet known, the suspect turned and fired multiple shots," sheriff's spokesman Scott Wilson said.

Both men were hit and unable to return gunfire, but a female officer arriving on the scene shot and killed the gunman, Wilson said.

The two deputies were reported to be in satisfactory condition Sunday night.

Authorities said it wasn't immediately known who shot the woman, who died later at a Tacoma hospital.

The woman, believed to be in her late teens, appeared to be with the gunman.

"We believe that she and the deceased gunman knew each other, that they were together. We just have not yet established what that relationship" was Wilson told The Associated Press.

The identities of the dead as well as the three deputies haven't been released.

Witness Destany Droge, 22, of Bremerton said the two appeared to be a couple.

"As soon as she saw him get shot, she ran for him," she told the News Tribune of Tacoma. "She put herself in the line of fire."

Wilson said detectives are still trying to answer some key questions. The investigation "is real basic right now... The big question of why is unanswered."

Few other details of the violence that erupted about 3:45 p.m. were released, but shoppers described how they saw events unfold.

Droge also spoke with The Seattle Times. She and Emmili Jones, of Federal Way, 20, told the paper that they noticed two deputies confronting a heavyset man in the parking log. They said the man began running and pulled out a gun and fired behind his back without turning.

The officers were about 30 to 40 feet behind the suspect when he started firing, Ray Bourge told KOMO-TV. "Five or six shots were fired. ... I just went and took cover," he said.

Victor Meyers told the station that he heard the first shot, then six more in rapid succession.

"I heard one shot, which I thought was a car backfiring, and then several more reported back, which I knew to be gunfire," Meyers said.

He said he saw a female deputy running toward a victim on the ground before he and other witnesses were hustled from the scene.

The store was immediately locked down. Customers in the store were allowed to leave after investigators questioned them, and the store closed for the night, Wilson said.

Tacoma police said the deputies were both shot in the torso and were in satisfactory condition.

"I've seen just the one deputy, he's in one of the rooms talking with family and co-workers," said Mark Fulghum of the Tacoma police. "Both of the deputies are going to be fine. They're going to be kept overnight for observation."

Port Orchard, the county seat with about 8,250 residents, is about 15 miles west of Seattle across Puget Sound.

The last time a Kitsap County sheriff's deputy was shot in the line of duty was in April 1978, according to the Tacoma News Tribune. Deputy Dennis Allred stopped to help what he believed to be a stranded driver towing another vehicle. The vehicle turned out to be stolen, and Allred was shot and killed by the suspects.

http://www.nytimes.com/aponline/2011/01/23/us/AP-US-Wal-Mart-Shooting.html?ref=us&pagewanted=print

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From Google News

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Loughner's attorney gets juries to see other side

Clarke's list of clients includes Theodore Kaczynski, known as the Unabomber; Eric Rudolph, the 1996 Olympics bomber in Atlanta; Susan Smith, the South Carolina woman who drowned her children; and Zacarias Moussaoui, a conspirator in the 9/11 terrorist attacks.

In each of those cases, Clarke's mission was not to win acquittal but to stave off a death sentence for a client who was despised by the public. In each case, she and her fellow lawyers succeeded.

Colleagues, family members and legal foes describe Clarke as a workhorse with an encyclopedic knowledge of the law and uncanny litigation skills. Her forte, they say, is gaining the trust of clients who may be mentally ill, then helping jurors understand why they committed seemingly inexplicable crimes.

Those talents are expected to be tested in the case of Loughner, a 22-year-old accused of killing six people, including U.S. District Judge John Roll, and wounding 13 others, including Rep. Perry Mason and win all the time."Those talents are expected to be tested in the case of Loughner, a 22-year-old accused of killing six people, including U.S. District Judge John Roll, and wounding 13 others, including Rep. Gabrielle Giffords , D-Ariz., in a Jan. 8 rampage near Tucson.

Loughner was captured at the scene, and prosecutors have videotapes, boxes of evidence and scores of witnesses. They also have records suggesting that he suffers from mental-health problems.

Jon Sands, the chief federal public defender in Arizona who recruited Clarke as Loughner's counsel, said courthouse drama will not hinge on what happened but on whether the defendant is competent and whether he gets sentenced to death.

"The whole case is going to revolve around the mental issue. I mean, it's not a whodunit," said Sands, who has known Clarke for years and taught legal seminars with her. "Judy is extremely well-respected.. .. She's made a career of defending high-profile cases. She's the one you would want to represent you if you committed a crime."

Background in law

Clarke was born in Asheville, N.C., one of four children raised in a conservative home. Her father was a consultant for companies trying to prevent unionization. Her mother was a homemaker who performed in community theaters.

Candy Clarke, an older sister, said family meals often turned into debates.

"Our parents were staunch Republicans," she said. "But they raised us to know we could have our own opinions, and we could disagree — even with adults."

In a rare interview with the San Antonio Express-News , Judy Clarke said she wanted to be a lawyer from the time she was 12 years old, explaining, "I thought it would be neat to be Perry Mason and win all the time."

Candy Clarke has a different memory, dating to when her sister became student-body president at Asheville's T.C. Roberson High School and got into a disagreement with Principal Charles "Tommy" Koontz.

"He started telling her, 'You should be a lawyer because you can argue for or against anything,' " Candy Clarke recalled.

Judy Clarke followed her sister to Furman University in South Carolina. After graduating, she went to the University of South Carolina School of Law.

Judy Clarke has worked most of the past three decades as a public defender at offices in San Diego and in Spokane, Wash. She is also a law professor, the former president of the National Association of Criminal Defense Lawyers and a expert who advises other lawyers on capital cases.

Almost every news profile contains the same sentence: Judy Clarke did not respond to interview requests. That was the case for this story as well.

Friends and family say she is not motivated by publicity or money but is driven by a devotion to the law. As chief federal defender in San Diego, she was renowned for working 80-hour weeks and requiring staffers to put in at least 60.

She has appeared before the U.S. Supreme Court at least twice, assailed mandatory federal sentences imposed by Congress and mentored other death-penalty lawyers nationwide.

Today, Clarke and her husband, Thomas H. "Speedy" Rice, have a private firm in San Diego and teach law at William and Lee University in Virginia. Those who know her say Clarke is a loyal and humorous friend who enjoys running on the beach, visiting family and looking after her blind, deaf pug named Jack. Still, she pours most of her time and energy into law.

"If you ask 25 lawyers across the U.S. who would be the best attorney for Jared, every single one would say Judy Clarke," said Laurie Shanks, a New York friend and lawyer who has taught with Clarke for two decades at the National Criminal Defense College.

"She is extremely empathetic, zealous to the point of obsessiveness, dedicated to her client, to the Constitution, to the criminal-justice system and the highest ideals of our country."

Shanks said Clarke gets inside clients' heads, learning what makes them tick — and what made them explode in violence. Having solved that riddle, she excels at making jurors understand.

"By the end of the case, she will probably know more about Jared than his parents — perhaps even more about him than he does," Shanks said.

Susan Smith's trial

Acquaintances point to the case of Susan Smith as an example of Clarke's legal prowess.

In defending the mother who drove her two children into a lake and blamed a fictitious black man for their murders, Clarke offered explanations for what seemed inexplicable. She described Smith's abusive childhood, depression and failures, then said: "This is not a case about evil. This is a case about despair and sadness. We're not trying to gain your sympathy. We're trying to gain your understanding."

Candy Clarke, who attended the closing arguments, recalled being overwhelmed. "I would have let (Smith) go after listening to my sister," she said. "I have never seen anybody in my whole life so dedicated, so passionate."

Tommy Pope, who prosecuted Smith, said Clarke persuaded jurors and a TV audience to change their view of a defendant who was reviled.

"She was diligent and hard-working," Pope said of Clarke. "Where the defense was really effective was in turning the image from Susan the monster to Susan the victim."

Colleagues stress that Clarke seems almost egoless. They say her zeal is not just courtroom posturing but honest care for clients and disdain for executions. After the Smith case, Clarke donated her fee of nearly $83,000 to a fund for capital cases. Later, she paid a Christmas visit to Smith in prison.

"She doesn't go looking for these high-profile cases; they go looking for her," said David Bruck, a law-school friend who enlisted Clarke's help in defending Smith. "She's just naturally driven to stick up for the underdog.. .. And she doesn't have blinders about the tragedy and the suffering. She sees and feels what everybody's experiencing."

Officials fear bath salts are growing drug problem

From the Deep South to California, emergency calls are being reported over exposure to the stimulants the powders often contain: mephedrone and methylenedioxypyrovalerone, also known as MDPV.

Sold under such names as Ivory Wave, Bliss, White Lightning and Hurricane Charlie, the chemicals can cause hallucinations, paranoia, rapid heart rates and suicidal thoughts, authorities say. The chemicals are in bath salts and even plant foods that are sold legally at convenience stores and on the Internet. However, they aren't necessarily being used for the purposes on the label.

Mississippi lawmakers this week began considering a proposal to ban the sale of the powders, and a similar step is being sought in Kentucky. In Louisiana, the bath salts were outlawed by an emergency order after the state's poison center received more than 125 calls in the last three months of 2010 involving exposure to the chemicals.

In Brown's case, he said he had tried every drug from heroin to crack and was so shaken by terrifying hallucinations that he wrote one Mississippi paper urging people to stay away from the bath salts.

"I couldn't tell you why I did it," Brown said, pointing to his scars. "The psychological effects are still there."

While Brown survived, sheriff's authorities in one Mississippi county say they believe one woman overdosed on bath salts there. In southern Louisiana, the family of a 21-year-old man says he cut his throat and ended his life with a gunshot. Authorities are investigating whether a man charged with capital murder in the December death of a Tippah County, Miss., sheriff's deputy was under the influence of the bath salts.

The stimulants aren't regulated by the U.S. Drug Enforcement Administration, but are facing federal scrutiny. Law officers say some of the substances are being shipped from Europe, but origins are still unclear.

Gary Boggs, an executive assistant at the DEA, said there's a lengthy process to restrict these types of designer chemicals, including reviewing the abuse data. But it's a process that can take years.

Dr. Mark Ryan, director of Louisiana's poison control center, said he thinks state bans on the chemicals can be effective. He said calls about the salts have dropped sharply since Louisiana banned their sale in January.

Ryan said cathinone, the parent substance of the drugs, comes from a plant grown in Africa and is regulated. He said MDPV and mephedrone are made in a lab, and they aren't regulated because they're not marketed for human consumption. The stimulants affect neurotransmitters in the brain, he said.

"It causes intense cravings for it. They'll binge on it three or four days before they show up in an ER. Even though it's a horrible trip, they want to do it again and again," Ryan said.

Ryan said at least 25 states have received calls about exposure, including Nevada and California. He said Louisiana leads with the greatest number of cases at 165, or 48% of the U.S. total, followed by Florida with at least 38 calls to its poison center.

Dr. Rick Gellar, medical director for the California Poison Control System, said the first call about the substances came in Oct. 5, and a handful of calls have followed since. But he warned: "The only way this won't become a problem in California is if federal regulatory agencies get ahead of the curve. This is a brand new thing."

In the Midwest, the Missouri Poison Center at Cardinal Glennon Children's Medical Center received at least 12 calls in the first two weeks of January about teenagers and young adults abusing such chemicals, said Julie Weber, the center's director. The center received eight calls about the powders all of last year.

Dr. Richard Sanders, a general practitioner working in Covington, La., said his son, Dickie, snorted some of the bath salts and endured three days of intermittent delirium. Dickie Sanders missed major arteries when he cut his throat. As he continued to have visions, his physician father tried to calm him. But the elder Sanders said that as he slept, his son went into another room and shot himself.

"If you could see the contortions on his face. It just made him crazy," said Sanders. He added that the coroner's office confirmed the chemicals were detected in his son's blood and urine.

Sanders warns the bath salts are far more dangerous than some of their names imply.

"I think everybody is taking this extremely lightly. As much as we outlawed it in Louisiana, all these kids cross over to Mississippi and buy whatever they want," he said.

A small packet of the chemicals typically costs as little as $20.

In northern Mississippi's Itawamba County, Sheriff Chris Dickinson said his office has handled about 30 encounters with bath salt users in the past two months alone. He said the problem grew last year in his rural area after a Mississippi law began restricting the sale of pseudoephedrine, a key ingredient in making methamphetamine.

Dickinson said most of the bath salt users there have been meth addicts and can be dangerous when using them.

"We had a deputy injured a week ago. They were fighting with a guy who thought they were two devils. That's what makes this drug so dangerous," he said.

But Dickinson said the chemicals are legal for now, leaving him no choice but to slap users with a charge of disorderly conduct, a misdemeanor.

Kentucky state lawmaker John Tilley said he's moving to block the drug's sale there, preparing a bill for consideration when his legislature convenes shortly. Angry that the powders can be bought legally, he said: "If my 12-year-old can go in a store and buy it, that concerns me."

http://www.usatoday.com/news/nation/2011-01-22-bath-salts_N.htm?csp=obinsite

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