St. John's in court fight over failed nurse recruitment effort









Short of hospital nurses in recent years, St. John's Health Center in Santa Monica hired a recruiter in England and flew one of its top executives to London to interview job candidates.


The recruiter's firm, Stateside Nursing, found 105 nurses and the hospital paid the company nearly $700,000 in recruiting fees and for providing "acculturation services" to help the foreigners adjust to life in Southern California.


Despite all those payments, none of the nurses ever arrived in Santa Monica.





Now the hospital is pursuing a court fight over this costly failure, saying it was the victim of fraud, bribery and unfair business practices. But the legal battle may also yield unflattering details about the inner workings of one of the area's best-known hospitals, which recently saw a high-profile management shake-up.


In the case headed to trial next month, St. John's accuses the recruiter, Lisa Taylor, of paying about $128,000 in bribes to Victor Melendez, the hospital's former vice president of human resources. The hospital is suing the pair in Los Angeles County Superior Court.


Both Melendez, through his lawyer, and Taylor deny the allegations, and they say the payments to Melendez were not bribes. He was paid for previous recruiting work unrelated to the hospital contracts, they said. Taylor says changes in U.S. immigration rules prevented the nurses from coming to work.


There's no indication that this nurse-recruitment saga prompted the recent dismissals of St. John's former chief executive, Lou Lazatin, and her chief operating officer, Eleanor Ramirez, by the hospital's owner, the Sisters of Charity of Leavenworth Health System in Denver. In November, the Catholic nonprofit escorted Lazatin and Ramirez off the hospital premises one morning and fired 15 of the hospital's 17 board members by email.


Taylor wants the two former executives to testify in this case and explain their departure. "We want to know why they aren't there anymore," she said. "It goes to their credibility." Neither Lazatin nor Ramirez could be reached for comment.


Michael Slubowski, chief executive of the Sisters of Charity, has declined to comment on the specific reasons for the St. John's dismissals, and he said the hospital "doesn't publicly discuss legal matters."


There have been discussions in recent months about selling the 266-bed hospital, which has tended to celebrities and politicians over the years. St. John's reported a loss of $13 million for 2011, the latest state data show, and patient revenue slipped 8% to $891 million.


The nursing shortage at St. John's was a common problem for many hospitals across California.


In 2006, Melendez, the hospital's newly hired human resources executive, set out to remedy that problem. He recommended three recruiting firms to the hospital, including Taylor's Stateside Nursing, according to his lawyer, Vincent S. Ammirato. In a contract that year, St. John's agreed to pay Stateside an $8,000 recruitment fee for each nurse it found.


The hospital sent Melendez to London, where he and Taylor interviewed dozens of nurses and 52 of them accepted job offers, according to the hospital's lawsuit. Stateside billed Saint John's for about $200,000 in initial fees.


Stateside then offered to provide "acculturation services" for the 52 nurses at $2,000 per nurse to help them acclimate to life in the U.S. because many were originally from the Philippines, India and other countries. In court filings, the hospital contends that Melendez didn't have the authority to approve those additional expenses because they weren't included in the contract. Rather, the hospital said, those payments were just a way for Taylor to pocket extra money for the alleged bribes.


By August 2007, even though no nurses had arrived, St. John's agreed to pay Stateside even more. The hospital boosted Stateside's recruitment fee to $13,000 per nurse from $8,000 earlier.


The hospital says Melendez wasn't authorized to sign the new contract. Ammirato, Melendez's lawyer, said that his client did not act alone and that Melendez's boss, the former chief operating officer, was involved in negotiating Stateside's agreements and approving its invoices.


In mid-2007, Melendez left St. John's for another job, so the hospital sent other human resource officials to London to interview nurses. Stateside found 53 more nurses and it billed for additional fees. Overall, according to court documents, the hospital paid Stateside $669,550 in upfront fees in 2007 and 2008.


St. John's said it became suspicious later in 2008 when Stateside's director of sales sent a letter to the hospital alleging that the recruitment firm was overcharging St. John's and paying bribes to Melendez. Based on this tip, St. John's sought to recoup its money and subpoenaed Melendez's bank records.


Stateside wired Melendez $51,843 in February 2007 and sent him an additional $51,943 the next month, according to the hospital's lawsuit. Those wire transfers took place shortly after Melendez authorized two payments of $52,000 apiece to Stateside. Later in 2007, Taylor wrote him another check, for $25,000. Taylor and Melendez don't dispute those payments.


In October 2010, an arbitrator found that Stateside engaged in "unlawful and fraudulent business practices" by paying Melendez to gain improper advantages in its contracts. The arbitrator awarded the hospital $1 million in damages, interest and legal fees.


Stateside went through liquidation in England, Taylor said, and she couldn't defend herself at the arbitration hearing. The hospital hasn't collected any portion of the arbitration award since her company shut down.


Taylor said she had satisfied her obligations by finding the nurses and getting them licensed to work at St. John's. The U.S. had adopted a policy in 2006 that made it more difficult for some foreign nurses to obtain work visas. St. John's said in its suit that Taylor misrepresented that she could handle those immigration issues.


"We got the nurses as far as we could get them when the U.S. government ran out of visa numbers," said Taylor, 47, who now lives in Colorado. "I'm looking forward to telling my story at trial."


chad.terhune@latimes.com





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Man With 4th Amendment Written on Chest Wins Trial Over Airport Arrest



A Virginia man who wrote an abbreviated version of the Fourth Amendment on his body and stripped to his shorts at an airport security screening area won a trial Friday in his lawsuit seeking $250,000 in damages for being detained on a disorderly conduct charge.


Aaron Tobey claimed in a civil rights lawsuit (.pdf) that in 2010 he was handcuffed and held for about 90 minutes by the Transportation Security Administration at the Richmond International Airport after he began removing his clothing to display on his chest a magic-marker protest of airport security measures.


“Amendment 4: The right of the people to be secure against unreasonable searches and seizures shall not be violated,” his chest and gut read.


In sending the case to trial, unless there’s a settlement, the 4th U.S. Circuit Court of Appeals ruled 2-1 and reversed a lower court judge and invoked Benjamin Franklin in the process. According to the opinion by Judge Roger Gregory:


Here, Mr. Tobey engaged in a silent, peaceful protest using the text of our Constitution—he was well within the ambit of First Amendment protections. And while it is tempting to hold that First Amendment rights should acquiesce to national security in this instance, our Forefather Benjamin Franklin warned against such a temptation by opining that those ‘who can give up essential liberty to obtain a little temporary safety, deserve neither liberty nor safety.’ We take heed of his warning and are therefore unwilling to relinquish our First Amendment protections—even in an airport.


Tobey didn’t want to go through the advanced imaging technology X-ray machines, or so-called nude body scanners, that were cropping up at airports nationwide. Instead, when it was his turn to be screened, he was going to opt for an intrusive pat-down, and removed most of his clothing in the process.


Among other things, the federal lawsuit claimed wrongful detention and a breach of the First Amendment and Fourth Amendment. Tobey was on his way to Wisconsin for his grandmother’s funeral. Despite his detainment, he made his flight.


According to the suit, while under interrogation, the authorities wanted to know “about his affiliation with, or knowledge of, any terrorist organizations, if he had been asked to do what he did by any third party, and what his intentions and goals were.”


Two weeks later, Henrico County prosecutors dropped the misdemeanor charge against him, and he sued the Transportation Security Administration and others.


In dissent, Judge J. Harvie Wilkinson wrote:


Had this protest been launched somewhere other than in the security-screening area, we would have a much different case. But Tobey’s antics diverted defendants from their passenger-screening duties for a period, a diversion that nefarious actors could have exploited to dangerous effect. Defendants responded as any passenger would hope they would, summoning local law enforcement to remove Tobey—and the distraction he was creating — from the scene.


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Brooke Shields signs up for a hitch on Lifetime’s “Army Wives”






LOS ANGELES (TheWrap.com) – Brooke Shields has signed up for the Air Force – or at least the Air Force as it’s portrayed on “Army Wives.”


“Pretty Baby” star Shields will join the cast of the Lifetime series for its seventh season, the network said Thursday.






Shields will play Katherine “Kat” Young, a brash, brilliant Air Force colonel and crack C-17 pilot who clashes with Gen. Michael Holden (Brian McNamara) shortly after arriving at Joint Base Marshall Bring.


But after Young and Holden’s Air Force-Army rivalry gets underway, Holden discovers that Young has a tragic past — and more in common with him than he first thought.


The ABC Studios-produced “Army Wives” returns for its seventh season March 10 at 9 p.m. with a drastically revamped cast. In addition to Shields, singer/actress Ashanti, Torrey DeVitto of “Pretty Little Liars,” Bring It On” alum Elle McLemore and singer Jesse McCartney have joined the cast. Meanwhile, Kim Delaney has departed the series, and former series regular Sally Pressman will only appear “in several episodes” of the new 13-episode season.


“We’re all very excited about season seven, in which a new tribe emerges from the shadow of tragedy,” executive producer Jeff Melvoin said of the upcoming season on Wednesday.


TV News Headlines – Yahoo! News





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40 Years After Roe v. Wade, Thousands March to Oppose Abortion


Drew Angerer/The New York Times


Pro-life activists made their way down Constitution Avenue toward the Supreme Court during the March for Life in Washington on Friday.







WASHINGTON — Three days after the 40th anniversary of the decision in Roe v. Wade, the landmark Supreme Court case that legalized abortion, tens of thousands of abortion opponents from around the country came to the National Mall on Friday for the annual March for Life rally, which culminated in a demonstration in front of the Supreme Court building.




On a gray morning when the temperature was well below freezing, the crowd pressed in close against the stage to hear more than a dozen speakers, who included Tony Perkins, the president of the Family Research Council; Representative Diane Black, Republican of Tennessee, who recently introduced legislation to withhold financing from Planned Parenthood, and Senator Rand Paul, Republican of Kentucky; Cardinal Seán Patrick O’Malley of Boston; and Rick Santorum, the former senator from Pennsylvania and Republican presidential candidate.


Mr. Santorum spoke of his wife’s decision not to have an abortion after they learned that their child — their daughter Bella, now 4 — had a rare genetic disorder called Trisomy 18.


“We all know that death is never better, never better,” Mr. Santorum said. “Bella is better for us, and we are better because of Bella.”


Jeanne Monahan, the president of the March for Life Education and Defense Fund, said that the march was both somber and hopeful.


“We’ve lost 55 million Americans to abortion,” she said. “At the same time, I think we’re starting to win. We’re winning in the court of public opinion, we’re winning in the states with legislation.”


Though the main event officially started at noon, the day began much earlier for the participants, with groups in matching scarves engaged in excited chatter on the subway and gaggles of schoolchildren wearing name tags around their necks. Arriving on the Mall, attendees were greeted with free signs (“Defund Planned Parenthood” and “Personhood for Everyone”) and a man barking into a megaphone, “Ireland is on the brink of legalizing abortion, which is not good.”


The march came two months after the 2012 campaign season, in which social issues like abortion largely took a back seat to the focus on the economy. But the issue did come up in Congressional races in which Republican candidates made controversial statements about rape or abortion. In Indiana, Richard E. Mourdock, a Republican candidate for the Senate, said in a debate that he believed that pregnancies resulting from rape were something that “God intended,” and in Illinois, Representative Joe Walsh said in a debate that abortion was never necessary to save the life of the mother because of “advances in science and technology.” Both men lost, hurt by a backlash from female voters.


Recent polls show that while a majority of Americans do not want Roe v. Wade to be overturned entirely, many favor some restrictions. In a Gallup poll released this week, 52 percent of those surveyed said that abortions should be legal only under certain circumstances, while 28 percent said they should be legal under all circumstances, and 18 percent said they should be illegal under all circumstances. In a Pew poll this month, 63 percent of respondents said they did not want Roe v. Wade to be overturned completely, and 29 percent said they did — views largely consistent with surveys taken over the past two decades.


“Most Americans want some restrictions on abortion,” Ms. Monahan said. “We see abortion as the human rights abuse of today.”


Speaker John A. Boehner of Ohio, who spoke via a recorded video, called on the protest group, particularly the young people, to make abortion “a relic of the past.”


“Human life is not an economic or political commodity, and no government on earth has the right to treat it that way,” he said.


The crowd was dotted with large banners, many bearing the names of the attendees’ home states and churches and colleges. Gary Storey, 36, stood holding a handmade sign that read “I was adopted. Thanks Mom for my life.” Next to him stood his adoptive mother, Ellen Storey, 66, who held her own handmade sign with a picture of her six children and the words “To the mothers of our four adopted children, ‘Thank You’ for their lives.”


Mr. Storey said he was grateful for the decision by his biological mother to carry through with her pregnancy. “Beats the alternative,” he joked.


Last week, the Planned Parenthood Federation of America started a new Web site, and on Tuesday, its president, Cecile Richards, released a statement supporting abortion rights.


“Planned Parenthood understands that abortion is a deeply personal and often complex decision for a woman to consider, if and when she needs it,” she said. “A woman should have accurate information about all of her options around her pregnancy. To protect her health and the health of her family, a woman must have access to safe, legal abortion without interference from politicians, as protected by the Supreme Court for the last 40 years.”


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Johnson & Johnson Hid Flaw in Artificial Hip, Documents Show





Johnson & Johnson executives knew years before they recalled a troubled artificial hip in 2010 that it had a critical design flaw, but the company concealed that information from physicians and patients, according to internal company documents disclosed Friday during a trial over the device’s failure.




The medical device giant had received complaints from doctors about the device, the Articular Surface Replacement, or A.S.R., even as it started marketing a version of it in 2005 in the United States. The A.S.R.’s flaw caused it to shed large quantities of metallic debris after implant and the model failed an internal 2007 test in which engineers compared its performance to another company hip implant, the documents show.


Still, executives of the company’s DePuy Orthaepedics unit kept selling the A.S.R. even as it was being abandoned by an increasing number of surgeons who were working as consultants to the company. DePuy executives discussed ways of fixing the defect but apparently never did so, the records suggest.


The documents were introduced Friday in Los Angeles Superior Court by plaintiffs’ lawyers during opening arguments in the first A.S.R.-related lawsuit to go to trial. The company faces more than 10,000 lawsuits in the United States in connection with the device. An estimated 93,000 patients worldwide received an A.S.R., about one-third of them in the United States.


For their part, DePuy executives insisted before the A.S.R.’s recall in mid-2010 that the implant was working well despite years of complaints from doctors that it was failing early. In late 2009, the company announced plans to phase out the model but said it was doing so because of slowing sales, not safety concerns.


In opening arguments, a lawyer for DePuy, Alexander Calfo, reiterated those positions, telling jurors that DePuy had acted ethically throughout the entire A.S.R. episode.


“The evidence will show that DePuy acted as an extremely responsible manufacturer,” Mr. Calfo said.


But a lawyer for Loren Kransky, the plaintiff in the case, painted a far different picture of DePuy’s behavior for jurors in his opening arguments.


The lawyer, Michael Kelly, also introduced a number of internal records which suggested that the concern of company executives for profits might have exceeded their worries about patients. For example, Mr. Kelly said, DePuy officials never told doctors that the A.S.R. had failed an internal performance test against another company hip.


“They did not report the data to American doctors,” said Mr. Kelly. “They changed the test and tested it against other things until they found one it could beat.”


The A.S.R. represents one of the biggest medical device failures in recent decades. According to DePuy’s internal estimates, it will fail within five years in about 40 percent of patients who got one. That figure is eight times the failure rate of most orthopedic implants.


The A.S.R. belonged to a once-popular class of hip implants introduced about a decade ago as a way of trying to address problems associated with hips made from traditional materials like metal and plastic. But surgeons have largely abandoned them because their components can grind together, releasing metallic debris that damages a patient’s tissue and bone.


The A.S.R. was sold in two versions, one used in an alternative hip replacement called resurfacing and one used in standard hip replacement. Only the version used in standard replacements was sold in the United States.


In 2003, DePuy began selling the resurfacing version of the A.S.R. outside the United States in an effort to catch up with a competing device known as the Birmingham hip. But by 2005, some doctors began telling DePuy that the A.S.R. was failing quickly after implant and company consultants soon stopped using it, records show.


The problem, internal DePuy records indicate, was the design of the cup component that fit into a patient’s hip socket. The cup, which was used in both the resurfacing and standard versions of the A.S.R., had an inside groove against which a surgeon pressed a tool in order to implant the component.


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787 Dreamliner's safety systems failed, NTSB says









After investigating a fire that broke out on Boeing Co.'s 787 Dreamliner passenger jet, the National Transportation Safety Board said that backup protections in the aircraft's lithium-ion batteries and electronics systems failed.


But the safety agency hasn't reached a conclusion on the cause of the fire that occurred in Boston on Jan. 7 and partly led to last week's grounding of Dreamliners worldwide that remains in effect.


Speaking to reporters Thursday from Washington, NTSB Chairwoman Deborah Hersman said the agency hadn't determined what happened, but she added that the redundant safety systems installed by Boeing did not work.





The Federal Aviation Administration grounded the jet Jan. 16 after an emergency landing by All Nippon Airways in Japan because of a second fire believed to involve the plane's onboard lithium-ion batteries. Shortly after the FAA's decision, countries around the world prohibited the new plane from flying.


"These events should not happen," said the safety board's chairwoman. "As far as design of the aircraft, there are multiple systems to protect against a battery event like this. Those systems did not work as intended."


The decision on whether 787s should continue to be grounded in the U.S. belongs to the FAA. The independent safety board is responsible for collecting forensic evidence and conducting tests to determine what happened.


There is no timeline to when tests will be completed, but Hersman said the agency has "all hands on deck" looking into the problem. Investigators around the world are disassembling and scanning the batteries.


In its search for the exact cause of the fires, the NTSB has said it is looking for possible contaminants or manufacturing defects. The agency is also working with officials from Boeing, the FAA and the Navy, as well as investigators in France and Japan.


Japan, where the second fire occurred, is also where Boeing's lithium-ion batteries are made by Kyoto-based GS Yuasa Corp. The Japan Transport Safety Board, the country's version of the FAA, is heading up the investigation into All Nippon's emergency landing and reported fire.


So far, the NTSB's investigators in the Boston fire have found that overheating was caused by short circuits and "thermal runaway," a chain reaction in which heat spreads rapidly from cell to cell, Hersman said. "The significance of these events cannot be understated."


Boeing said in a statement that it is working with its airline customers and the regulatory agencies to get the matter resolved but that it is not permitted to comment directly on the ongoing investigations.


"The company has formed teams consisting of hundreds of engineering and technical experts who are working around the clock with the sole focus of resolving the issue and returning the 787 fleet to flight status," Boeing said. "The safety of passengers and crew members who fly aboard Boeing airplanes is our highest priority."


The 787's battery systems were called into question on Jan. 7 when a smoldering fire was discovered on the underbelly of the plane operated by Japan Airlines after the 183 passengers and 11 crew members had deplaned at the gate.


In the second incident, which involved All Nippon Airways, smoke was seen swirling from the right side of the cockpit after an emergency landing related to the plane's electrical systems. All 137 passengers and crew members were evacuated from the aircraft and slid down the 787's emergency slides. Video of the event was captured by an onboard passenger and has been broadcast worldwide.


No one has been reported hurt or injured. But the recent events have become a public relations nightmare for the Chicago company, which has long heralded the Dreamliner as a representation of 21st century air travel.


Boeing has taken 848 orders for 787s from airlines and aircraft leasing firms around the world. Depending on the version ordered, the price ranges from $206.8 million to $243.6 million per jet.


The company has delivered 50 787s to eight airlines worldwide. Six are owned by Chicago-based United Airlines — the only U.S. carrier that currently has 787s in its fleet.


In an earnings conference call on Thursday, United Continental Holdings Inc. Chief Executive Jeff Smisek defended the plane.


"History teaches us that all new aircraft types have issues, and the 787 is no different," Smisek said. "We continue to have confidence in the aircraft and in Boeing's ability to fix the issues, just as they have done on every other new aircraft model they've produced."


In trading Thursday, Boeing's stock closed up more than 1%, or $1.03, to 75.32. But the stock fell in after-hours trading, at one point dropping 30 cents, or 0.4%, to $75.02.


Problems are expected with any new plane — especially one as complicated and sophisticated as the 787. But the last time the FAA grounded a large commercial jet out of safety concerns was almost 34 years ago after a DC-10 crashed at Chicago O'Hare International Airport, killing all 271 aboard.


The 787, a twin-aisle aircraft that can seat 210 to 290 passengers, is the first large commercial jet with more than half its structure made of composite materials (carbon fibers meshed together with epoxy) rather than aluminum sheets. It's also the first large commercial aircraft that extensively uses electrically powered systems involving lithium-ion batteries.


william.hennigan@latimes.com





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J.J. Abrams Will Reportedly Direct the Next <em>Star Wars</em> Movie











Gird your loins Star Wars fans – reports are surfacing that J.J. Abrams has been tapped to direct the next Star Wars.


Disney, which recently acquired Lucasfilm for $4 billion, is currently closing a deal with Abrams to helm the first film in the new Star Wars series, according to reports from The Wrap and Entertainment Weekly. No other major details were released, but back when the Mouse House acquisition was announced, Disney said it planned to release Episode VII in 2015.


“For the past 35 years, one of my greatest pleasures has been to see Star Wars passed from one generation to the next,” George Lucas said in a press release announcing the acquisition last October. “It’s now time for me to pass Star Wars on to a new generation of filmmakers.”


Abrams, who is set to release his latest directorial effort Star Trek Into Darkness May 17, had previously seemed uninterested in the Star Wars directing gig, telling Entertainment Weekly that he HollywoodLife.com that he believed he would be seeing the film “as a paying moviegoer!”


Representatives for Disney and Abrams had not returned calls seeking comment at press time.






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GLAAD protests Nat Geo’s collaboration with Boy Scouts






LOS ANGELES (TheWrap.com) – The advocacy group backed a Change.org petition started by Will Oliver, a 20-year-old gay Eagle Scout, that calls on Nat Geo to air a disclaimer clarifying the network’s views before each episode of its new series, “Are You Tougher than a Boy Scout.” It debuts this spring.


“That National Geographic would brush aside countless gay teens suffering at the hands of the BSA, shrugging off injustice as just another ‘point of view,’ is irresponsible,” GLAAD president Herndon Graddick said in a statement. “By airing this program, National Geographic is providing support and publicity to an organization that harms young people simply because of who they are. If the network is truly committed to standing by its non-discrimination practices, it should have no problem airing a disclaimer to that effect.”






Nat Geo did not immediately respond to calls from TheWrap requesting comment.


But in a statement to GLAAD, the network said the show has “nothing to do with this debate” over the Boy Scouts’ LGBT policies.


“As it relates to our upcoming show with the Boy Scouts, we certainly appreciate all points of view on the topic,” Nat Geo said in the statement, “but when people see our show they will realize it has nothing to do with this debate, and is in fact a competition series between individual scouts and civilians.”


GLADD pointed to the Boy Scouts’ October 2012 Progress Report of its National Council Strategic Plan 2011-2015. It cites the Nat Geo series as a “strategic partnership” aimed at promoting the idea that “scouting is ‘cool’ with youth.”


The report states that the Scouts will begin working on marketing plans with National Geographic for “leveraging the show with Scouting audiences and audiences outside of scouting.”


“It’s all too clear that this show is just a marketing ploy, crafted by the BSA to boost dwindling membership and distract Americans from the Scouts’ long history of discrimination,” Graddick said. “National Geographic Channel is the means to that end and must therefore make it clear where the network stands.”


TV News Headlines – Yahoo! News





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The New Old Age Blog: Grief Over New Depression Diagnosis

When the American Psychiatric Association unveils a proposed new version of its Diagnostic and Statistical Manual of Mental Disorders, the bible of psychiatric diagnoses, it expects controversy. Illnesses get added or deleted, acquire new definitions or lists of symptoms. Everyone from advocacy groups to insurance companies to litigators — all have an interest in what’s defined as mental illness — pays close attention. Invariably, complaints ensue.

“We asked for commentary,” said David Kupfer, the University of Pittsburgh psychiatrist who has spent six years as chairman of the task force that is updating the handbook. He sounded unruffled. “We asked for it and we got it. This was not going to be done in a dark room somewhere.”

But the D.S.M. 5, to be published in May, has generated an unusual amount of heat. Two changes, in particular, could have considerable impact on older people and their families.

First, the new volume revises some of the criteria for major depressive disorder. The D.S.M. IV (among other changes, the new manual swaps Roman numerals for Arabic ones) set out a list of symptoms that over a two-week period would trigger a diagnosis of major depression: either feelings of sadness or emptiness, or a loss of interest or pleasure in most daily activities, plus sleep disturbances, weight loss, fatigue, distraction or other problems, to the extent that they impair someone’s functioning.

Traditionally, depression has been underdiagnosed in older adults. When people’s health suffers and they lose friends and loved ones, the sentiment went, why wouldn’t they be depressed? A few decades back, Dr. Kupfer said, “what was striking to me was the lack of anyone getting a depression diagnosis, because that was ‘normal aging.’” We don’t find depression in old age normal any longer.

But critics of the D.S.M. 5 now argue that depression may become overdiagnosed, because this version removes the so-called “bereavement exclusion.” That was a paragraph that cautioned against diagnosing depression in someone for at least two months after loss of a loved one, unless that patient had severe symptoms like suicidal thoughts.

Without that exception, you could be diagnosed with this disorder if you are feeling empty, listless or distracted, a month after your parent or spouse dies.

“D.S.M. 5 is medicalizing the expected and probably necessary process of mourning that people go through,” said Allen Frances, a professor emeritus at Duke who chaired the D.S.M. IV task force and has denounced several of the changes in the new edition. “Most people get better with time and natural healing and resilience.”

If they are diagnosed with major depression before that can happen, he fears, they will be given antidepressants they may not need. “It gives the drug companies the right to peddle pills for grief,” he said.

An advisory committee to the Association for Death Education and Counseling also argued that bereaved people “will receive antidepressant medication because it is cheaper and ‘easier’ to medicate than to be involved therapeutically,” and noted that antidepressants, like all medications, have side effects.

“I can’t help but see this as a broad overreach by the APA,” Eric Widera, a geriatrician at the University of California, San Francisco, wrote on the GeriPal blog. “Grief is not a disorder and should be considered normal even if it is accompanied by some of the same symptoms seen in depression.”

But Dr. Kupfer said the panel worried that with the exclusion, too many cases of depression could be overlooked and go untreated. “If these things go on and get worse over time and begin to impair someone’s day to day function, we don’t want to use the excuse, ‘It’s bereavement — they’ll get over it,’” he said.

The new entry for major depressive disorder will include a note — the wording isn’t final — pointing out that while grief may be “understandable or appropriate” after a loss, professionals should also consider the possibility of a major depressive episode. Making that distinction, Dr. Kupfer said, will require “good solid clinical judgment.”

Initial field trials testing the reliability of D.S.M. 5 diagnoses, recently published in The American Journal of Psychiatry, don’t bolster confidence, however. An editorial remarked that “the end results are mixed, with both positive and disappointing findings.” Major depressive disorder, for instance, showed “questionable reliability.”

In an upcoming post, I’ll talk more about how patients might respond to the D.S.M. 5, and to a new diagnosis that might also affect a lot of older people — mild neurocognitive disorder.

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”


This post has been revised to reflect the following correction:

Correction: January 24, 2013

An earlier version of this post misspelled the surname of a professor emeritus at Duke who chaired the D.S.M. IV task force. He is Allen Frances, not Francis.

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DealBook: S.E.C. Pick Is Ex-Prosecutor, in Signal to Wall Street

3:30 p.m. | Updated

President Obama announced Thursday his nomination of Mary Jo White, a former federal prosecutor turned white-collar defense lawyer, to be the next chairwoman of the Securities and Exchange Commission.

In a short ceremony at the White House, Mr. Obama also said he was renominating Richard Cordray as director of the Consumer Financial Protection Bureau, a post Mr. Cordray has held under a temporary recess appointment without Senate approval for the past year. The president portrayed both selections as a way of preventing a financial crash like the one he inherited four years ago.

“It’s not enough to change the law,” Mr. Obama said. “We also need cops on the beat to enforce the law.”

Mr. Obama noted that Ms. White was a childhood fan of “The Hardy Boys,” just as he was. He added that as the United States attorney in New York in the 1990s she “built a career the Hardy Boys could only dream of.”

He noted that she prosecuted money launderers, mobsters and terrorists. “I’d say that’s a pretty good run,” he said. “You don’t want to mess with Mary Jo. As one former S.E.C. chairman said, Mary Jo does not intimidate easily.”

Mr. Obama likewise pressed the Senate to finally confirm Mr. Cordray to the leadership of the consumer agency created by the Wall Street regulation law passed in 2010. The president installed Mr. Cordray as director last January without Senate approval using his recess appointment power, but his term will expire at the end of the year unless he wins approval from the upper chamber of Congress.

“Financial institutions have plenty of lobbyists looking out for their interests,” Mr. Obama said. “The American people need Richard to keep standing up for them. And there’s absolutely no excuse for the Senate to wait any longer to confirm him.”

Ms. White and Mr. Cordray spoke only briefly. Ms. White said if confirmed she would work “to protect investors and to ensure the strength, efficiency and the transparency of our capital markets.” Mr. Cordray said that during his short tenure he has “been focused on making consumer finance markets work better for the American people” and approached it “with open minds, open ears and great determination.”

Regulatory chiefs are often market experts or academics. But Ms. White spent nearly a decade as the United States attorney in New York, the first woman named to this post. Among her prominent cases, she oversaw the prosecution of the mafia boss John Gotti as well as the people responsible for the 1993 World Trade Center bombing. She is now working the other side, defending Wall Street firms and executives as a partner at Debevoise & Plimpton.

As the attorney general of Ohio, Mr. Cordray made a name for himself suing Wall Street companies in the wake of the financial crisis. He undertook a series of prominent lawsuits against big names in the finance world, including Bank of America and the American International Group.

The White House expects Ms. White, 65, and Mr. Cordray, 53, to draw on their prosecutorial backgrounds while carrying out a broad regulatory agenda under the Dodd-Frank Act. Congress enacted the law, which mandates a regulatory overhaul, in response to the 2008 financial crisis.

Jay Carney, the White House press secretary, said Ms. White has “an incredibly impressive resume” and that her appointment along with the renomination of Mr. Cordray sends an important signal.

“The president believes that appointment and the renomination he’s making today demonstrate the commitment he has to carrying out Wall Street reform, making sure we have the rules of the road that are necessary and that are being enforced in a way” to avoid a crisis like that of 2008, Mr. Carney said.

Another White House official added that Ms. White and Mr. Cordray will “serve in top enforcement roles” in part so that “Wall Street is held accountable and middle-class Americans never again are harmed by the abuses of a few.”

Ms. White will succeed Elisse B. Walter, a longtime S.E.C. official, who took over as chairwoman after Mary L. Schapiro stepped down as the agency’s leader in December. Mr. Cordray joined the consumer bureau in 2011 as its enforcement director.

The nominations could face a mixed reception in Congress. Republicans had previously vowed to block any candidate for the consumer bureau, leading to the recess appointment. It is unclear whether the White House and Mr. Cordray will face another standoff the second time around.

Mr. Carney argued that there were no substantive objections to Mr. Cordray’s confirmation, only political ones. “He is absolutely the right person for the job,” Mr. Carney said.

Ms. White is expected to receive broader support on Capitol Hill. Senator Charles E. Schumer, a New York Democrat, declared that Ms. White was a “tough-as-nails prosecutor” who “will not shy away from enforcing the laws to ensure that markets operate fairly.”

But she could face questions about her command of arcane financial minutiae. She was a director of the Nasdaq stock market, but has otherwise built her career on the law-and-order side of the securities industry.

People close to the S.E.C. note, however, that her husband, John W. White, is a veteran of the agency. From 2006 through 2008, he was head of the S.E.C.’s division of corporation finance, which oversees public companies’ disclosures and reporting.

Some Democrats also might question her path through the revolving door, in and out of government. While seen as a strong enforcer as a United States attorney, she went on in private practice to defend some of Wall Street’s biggest names, including Kenneth D. Lewis, a former head of Bank of America. She also represented JPMorgan Chase and the board of Morgan Stanley. Last year, the N.F.L. hired her to investigate allegations that the New Orleans Saints carried out a bounty system for hurting opponents.

Consumer advocates generally praised her appointment on Thursday. “Mary Jo White was a tough, smart, no-nonsense, broadly experienced and highly accomplished prosecutor,” said Dennis Kelleher, head of Better Markets, the nonprofit advocacy group. “She knew who the bad guys were, went after them and put them in prison when they broke the law.”

The appointment comes after the departure of Ms. Schapiro, who announced she would step down from the S.E.C. in late 2012. In a four-year tenure, she overhauled the agency after it was blamed for missing the warning signs of the crisis.

Since her exit, Washington and Wall Street have been abuzz with speculation about the next S.E.C. chief. President Obama quickly named Ms. Walter, then a Democratic commissioner at the agency, but her appointment was seen as a short-term solution. It is unclear if she will shift back to the commissioner role if Ms. White is confirmed.

In the wake of Ms. Schapiro’s exit, several other contenders surfaced, including Sallie L. Krawcheck, a longtime Wall Street executive. Richard G. Ketchum, chairman and chief executive of the Financial Industry Regulatory Authority, Wall Street’s internal policing organization, was also briefly mentioned as a long-shot contender.

Kitty Bennett contributed reporting.

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