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DHMH Daily News Clippings
Thursday, February 5, 2009


Maryland / Regional
Insurance commissioner unveils four bills to aid consumers (Daily Record)
Maryland family grateful for SCHIP help (CNN)
Obama views children's health bill as step one (Baltimore Sun)
The bill is H.R. 2. (Associated Press)
Patients at Salisbury facility found malnourished (Daily Record)
Surgical Fires Not Often Talked About (WBAL-TV.com)
Governor O'Malley gets an earful (Baltimore Sun)
Economy on minds of many at governor’s town hall (Cumberland Times-News)
Prostate patients monitoring, not treating, cancer (Baltimore Examiner)
County police join frontlines in mental health (Montgomery County Gazette)
Virginia restaurant smoking ban proposal moves forward (Baltimore Sun)
National / International
FDA defends how it handled salmonella outbreak (Baltimore Sun)
Lawmakers to press for food safety overhaul as peanut recall surpasses 1,000 Products (Washington Post)
Home of man linked to 1982 Tylenol deaths searched (Frederick News-Post)
Health care for all (Baltimore Sun  Editorial)
Good medicine (Baltimore Sun Editorial)
Maryland / Regional
Insurance commissioner unveils four bills to aid consumers
By Danielle Ulman
Daily Record Business Writer
Thursday, February 5, 2009
ANNAPOLIS — The state’s insurance commissioner unveiled a group of legislative proposals Wednesday to reform insurance industry health care practices that he said would benefit citizens without affecting Maryland’s heavily burdened budget.
The most prominent of the bills would require insurers to spend more money on actual health care costs through a mandated increase in the medical loss ratio, or the percentage of each premium dollar that an insurance carrier spends on paying health care claims, said Insurance Commissioner Ralph S. Tyler.
An increase in the medical loss ratio would improve conditions for doctors, who are struggling to cover their own costs in Maryland under their contracts with insurers, said Stephen J. Rockower, an orthopedic surgeon in Rockville and a board member of MedChi, the state’s medical society.
“The biggest problem is that doctors are small-business people, too,” he said. “When insurance companies are not paying for certain services, doctors are forced to leave insurance plans or leave the state.”
Insurers pay 75 cents out of every dollar for small group insurance policies, and Tyler is seeking a bump to 85 cents per dollar, or a ratio of 85 percent; individual policies have a 60 percent loss ratio and would increase to 80 percent under this legislation. The ratio has not been updated in more than 15 years.
“It is a question of striking a balance between the legitimate needs of the insurance carriers to have sufficient expenses and motivation to earn money to have operations work, but at the same time being sure that the maximum amount of dollars possible are going out in the form of health care coverage,” said John Colmers, secretary of the Department of Health and Mental Hygiene.
The bill, sponsored by Del. Heather Mizeur, D-Montgomery, would phase in the ratio increases, starting at 80 percent in 2010. If an insurer does not meet the mandated increase, Tyler can require the insurer to file lower rates for consumers in the following year.
Another proposal would limit the amount of time an insurer can exclude a person’s pre-existing condition from coverage. Insurers can ask for a health history of up to seven years and refuse coverage of a pre-existing condition for two years; the new law would limit exclusion to one year.
The bill would still protect insurers from those who only pick up a policy after they get sick, but would shorten the amount of time a person would have to wait to get coverage.
Tyler also proposed a law that would put the burden on insurers to resolve any questions on a policyholder’s medical history before approving coverage. If a person fails to answer a question on an application and the insurer does not request the information, the law would cancel the insurer’s ability to drop the policy. Insurers would still have the right to rescind coverage for anyone who lied on an application.
The final proposal would target association health care plans that require members to join a group in order to get coverage and are not subject to Maryland laws for benefits. The law would require three firms — Golden Rule Insurance Co., Mega Life Insurance Co. and Time Insurance Co. — to tell consumers that they are not protected under state law and offer other options that would give them the same protections and benefits.
Michael Sullivan, a spokesman for the state’s largest insurer, CareFirst BlueCross BlueShield, said in a statement: “We’re reviewing the legislation to determine how it might affect CareFirst and its members.”
The House Health and Government Operations Committee and the Senate Finance Committee are both expected to meet for hearings on the legislation next week.
Copyright 2009 Daily Record.

Maryland family grateful for SCHIP help
By Rachel Streitfeld
Thursday, February 5, 2009
PIKESVILLE, Maryland (CNN) -- Isaiah Partlow helps his parents with his little sister Maya, flipping to her favorite TV channel and sharing bites of his ham and cheese Hot Pocket.
Robert and Kia Partlow use Maryland's Children's Health Insurance Plan.
 But when Maya came down with an ear infection, her parents weren't sure how they'd take care of her. They struggled to pay for the 2-year-old's health insurance coverage.
"No matter what happens to me, they're my No. 1 concern, making sure they go to bed healthy every night, waking up healthy every morning," said Robert Partlow, who lost his job, along with his health care benefits, last year.
Partlow soon found a new job, but it pays less and doesn't offer benefits. So he and his wife, Kia, applied for their two children to be covered by MCHIP, Maryland's version of the State Children's Health Insurance Plan (SCHIP).
President Obama signed changes to SCHIP into law late Wednesday afternoon, hours after the House of Representatives voted to pass the bill 290 to 135. Supporters say the program expansion, which was twice vetoed by President Bush for being too costly and unwieldy, will cover almost 11 million children who don't qualify for Medicaid but whose parents cannot afford private health insurance.
The bill expands SCHIP by more than $32 billion over five years.
"The help is definitely needed. At this day and time, with the economy the way it is, this takes a burden off of you knowing that at least your kids are covered," Robert Partlow said. "No matter what happens, they're covered."
On a busy school morning, Robert and Kia gather in the living room to share breakfast with the kids. Robert has just returned home from his job working a security detail overnight, and Kia is dressed for work.
The family makes about $50,000 a year -- $15,000 less than Robert was making before -- forcing the Partlows to make some tough decisions.
"That would have been a tossup of would we take them to the doctor or put gas in the car then go to work. And we really needed for me to go to work and everything," Kia said. "But that was the choice, the tossup."
When Isaiah, 7, and Maya were accepted into the MCHIP program in November, the notice didn't come a minute too soon. Maya, who suffers from frequent ear infections, had been complaining her ear hurt. Her parents were worried about how they'd pay a doctor's bill without insurance.
"So it was really a blessing to have. It came right on time," Kia said. "Because we wouldn't know what to do if we hadn't been able to afford to take her to the doctor."
Robert applauded lawmakers who voted for the SCHIP expansion.
"I sleep easier knowing that my kids are covered by insurance," Robert said. "And luckily I heard that we had this kind of program that we could turn to for help. It actually took a lot of weight off my shoulders, because I didn't know what I was going to do."
Copyright 2009 CNN.

Obama views children's health bill as step one
Associated Press
By Kevin Freking
Baltimore Sun
Thursday, February 5, 2009
WASHINGTON -- President Barack Obama sees expansion of government health insurance to millions of lower-income children as a first step of several to come in providing coverage for all Americans.
Ending a two-year effort by Democrats, Obama signed legislation Wednesday that will allow about 7 million children to continue coverage through the State Children's Health Insurance Program and allow an additional 4 million to sign up.
"The way I see it, providing coverage to 11 million children through CHIP is a down payment on my commitment to cover every single American," Obama said at a White House bill-signing ceremony.
The measure was similar to two bills vetoed by former President George W. Bush. It was pushed through both the House and Senate by Democrats eager to give Obama an early victory on health care.
Most lawmakers and advocacy groups in the health reform debate acknowledge that the next steps toward reform will be harder than expanding SCHIP, given the increasing federal deficit.
More ambitious changes envisioned by Obama will face entrenched interests in the health care community and Republicans who oppose expanding government-funded insurance.
"Republicans are committed to making health care more affordable, more accessible and offer more options to American families," said Rep. Roy Blunt, R-Mo. "Unfortunately, the only options we've seen so far this Congress would push us to a one-size-fits all government-run system."
And not all Democrats are on the same page with Obama. Montana Sen. Max Baucus, who chairs the Senate Finance Committee, plans to put together a bill that differs from the president's goal of universal coverage.
Obama acknowledged the difficulties of reforming health care at Wednesday's bill-signing ceremony "It won't be easy; it won't happen all at once," the president said. "But this bill that I'm about to sign, that wasn't easy either."
Since August 2007, the House voted seven times to expand the children's health insurance program. Opposition from Bush helped stiffen Republican resolve and helped block passage of the measures.
During final debate Wednesday before the bill passed the House, 290-135, Republicans criticized the cost of the measure. They also criticized allowing into the program an estimated 2.4 million children who otherwise might have access to private insurance.
"This debate is about, do we want a children's health insurance program that covers every child in America with state and federal dollars regardless of their ability to pay?" said Rep. Joe Barton, R-Texas. "Do we want to freeze out the private sector for health insurance?"
But supporters said that ensuring children had access to adequate health care was a matter of priorities. Rep. Frank Pallone, D-N.J., said an estimated 4 million people have lost employer-sponsored insurance in the past year.
"Do they keep their families' health insurance or do they put food on the table at night? During this economic recession, these kinds of decisions are unfortunately becoming more common," Pallone said.
Copyright 2009 Baltimore Sun.

The bill is H.R. 2.
Details from children's health insurance bill
By The Associated Press
Associated Press
Thursday, February 5, 2009
Key details from the legislation signed into law Wednesday expanding the State Children's Health Insurance Program:
*Continues coverage through 2013 for 7 million lower income children.
*Expands coverage for another 4.1 million uninsured children.
* Makes 2.4 million children eligible for the program who otherwise might have access to private insurance.
* Provides an additional $32.8 billion through Sept. 30, 2013, by increasing federal excise taxes on tobacco products. The tax on cigarettes will go up 62 cents to $1.01 a pack.
* Provides $100 million in grants for states, local governments, schools and others to enroll more eligible children.
* Requires states to offer a dental benefit.
* Allows states to offer SCHIP dental coverage to children whose private medical insurance does not cover dentist visits.
* Allows states to extend SCHIP and Medicaid to newly arrived legal immigrant children and pregnant women.
* Allows states to use Social Security numbers to verify an applicant's citizenship, making it easier to prove eligibility and enroll in the program.
Copyright 2009 Associated Press.

Patients at Salisbury facility found malnourished
Associated Press
Daily Record
Thursday, February 5, 2009
SALISBURY — Officials at a Salisbury facility for people with developmental disabilities say they have corrected problems that caused patients on feeding tubes to become malnourished.
A routine survey by the Maryland Office of Health Care Quality uncovered the problems last fall. Director Wendy Kronmiller says the findings "were extraordinarily serious."
The facility, the Holly Center, continues to be closely monitored by state officials and patient advocates.
The Holly Center was not penalized and Kronmiller says it is not at risk of losing federal funding.
Copyright 2009 Daily Record.

Surgical Fires Not Often Talked About
By Kerry Cavanaugh
Tuesday, February 3, 2009
BALTIMORE -- WBAL TV 11 News has learned that surgical fires in which patients actually catch fire in the operating room are incidents that are rarely talked about -- but do happen.
Cathy Reuter Lake became a crusader to make people aware of surgical fires after her mother, Catherine Darahano Reuter, underwent a tracheotomy on New Year's Eve in 2002.
Lake said her mother signed the release forms that explained everything that could go wrong during the procedure -- bleeding, a heart attack, infection and death -- but there was one frightening possibility those papers did not include.
"She went into an operating room, trusting that they would make things better for her, and instead she came out burned," Lake told 11 News reporter Kerry Cavanaugh.
Lake said her mother was disfigured by the surgical fire.
"My mom had second- and third-degree burns to the right side of her face. Both of her eyes were burned, inside her nose and her mouth and down her back," Lake said.
Reuter, a diabetic heart patient, declined rapidly, according to her daughter.
"She couldn't walk. She couldn't eat. She couldn't talk. Her vision was impaired further. So, I became literally her voice, eyes, and ears to help her," Lake said.
Lake had never heard of surgical fires. Sinai Hospital anesthesiologist Dr. James Pepple told 11 News that most accidents happen when oxygen is flowing and a surgical tool, such as a laser, creates a spark that ignites the flammable items surrounding a patient, including alcohol-based antiseptics, paper and surgical drapes. Even a person's hair can catch fire, Pepple said.
Catherine Darahano Reuter underwent a tracheotomy on New Year's Eve in 2002.
"Once that happens, it can go to the mask or the nasal canal and then it becomes a blowtorch, because you've got this flammable plastic with oxygen flowing through it," said Pepple said.
Pepple said he has never seen a fire in his 30-year career but has testified as an expert in a number of lawsuits.
"People joke about anesthesia being 99 percent boredom and 1 percent stark terror. The reality is that there are those moments where we have those awful things happen, and that's got to be one of the worst," he said.
The Emergency Care Research Institute estimated there are about 600 surgical fires in the U.S. annually -- a tiny percentage of the 50 million operations performed every year. The actual number could be considerably higher because many states don't require hospitals to report fires in the operating room, Cavanaugh reported.
"I hear this, 'Oh, they're rare, they rarely happen.' Well, you know, that may be true. But I never in my wildest dreams thought it would be my mother that was set on fire. That's how rare they are -- until it's you," Lake said.
Surgical fires are most common in head and neck surgeries because all three fire elements -- air, heat and fuel -- are in close proximity, according to Pepple.
There are simple ways to cut your risk. The Emergency Care Research Institute recommends that you talk with your doctor about fire prevention, which may include using less oxygen or no oxygen during the procedure. You can also request a non-alcohol-based skin prep, like betadyne.
"The more informed you are, the better off you are. If you can raise the awareness of the physicians and the nurses in the room, that's your best prevention," Pepple said.
"I didn't have the knowledge to ask those questions, and had I asked, maybe somebody in the OR would have said, 'Oh, wait. Let's make sure and double check this,'" Lake said. "People joke about anesthesia being 99 percent boredom and 1 percent stark terror. The reality is that there are those moments where we have those awful things happen, and that's got to be one of the worst."
- Sinai Hospital anesthesiologist Dr. James Pepple
Reuter died two years after her ordeal began. Her daughter reached a legal settlement with the D.C. hospital involved and launched surgicalfire.org to raise awareness in memory of her mother, Cavanaugh reported.
"This is just something that nobody wanted to talk about. And to me, personally, it's a dirty little secret that people don't want to talk about," Lake said.
11 News asked more than a dozen local hospitals if their surgical consent forms alert patients to the possibility of a fire. The only facility that responded did not include that information. Pepple said it would be too time consuming to detail every potential side effect in the pre-operative paperwork.
Maryland requires hospitals to report serious surgical fires; however, Wendy Kronmiller, director of the Maryland Office of Health Care Quality, told 11 News she believes they are under reported.
To learn more about surgical fires and to watch extended portions of our interviews with Pepple and Lake, click on the links above.
Copyright 2009 by wbaltv.com. All rights reserved.

Governor O'Malley gets an earful
Marylanders share their troubles — and their grievances
By Laura Smitherman
Baltimore Sun
Thursday, February 5, 2009
FROSTBURG – Cheryl Haberkam became despondent after losing her job as a dispatcher for a moving company late last year. The Baltimore resident had no income and no savings, and unemployment benefits had not kicked in. She didn't know where to turn.
So she e-mailed Gov. Martin O'Malley.
"I know you probably can't help me," she wrote, "but I think just saying this might help. Thank you for your time."
As the economy slid into recession, an increasing number of residents have apparently wanted to share their troubles - and their grievances - with the governor. In turn, O'Malley has shown a willingness to give them a greater forum, not only via the Internet but also through a series of town hall meetings, the first of which was held in Frostburg last night.
O'Malley, a Democrat, has said he wants to hear directly from Maryland's families, and he plans to take his Cabinet to the forums so residents can learn about state services. But the roadshow could also have political benefits by giving the governor the chance to interact with voters as he pushes his agenda in the General Assembly and gears up for re-election next year.
"It's good governance because he should be out there listening to what voters have to say," said Michael Cain, chairman of the political science department at St. Mary's College. "But there's certainly a political dimension to this as we're starting to get into the next season of elections."
Several hundred people attended the town hall at Mountain Ridge High School in Frostburg last night. O'Malley compared the event to a shareholders meeting, gesturing to Lt. Gov. Anthony G. Brown and department secretaries and calling them "your state government."
Wendy Atkinson and her daughter Ali, a sophomore at the school, attended the forum. Wendy, a Democrat, said she was inspired to get involved in politics after President Barack Obama's election and that she rarely hears much about O'Malley in the Republican stronghold of Western Maryland.
"I wanted to know more about what's going on with him," she said, adding that another draw was the governor's status as "a hottie."
Trips outside Annapolis ensure that O'Malley "breaks out of the bubble," said Herbert C. Smith, a political science professor at McDaniel College in Westminster, adding that face-to-face interactions with voters are invariably beneficial. "It puts a personal face on the object of talk-radio scorn."
O'Malley has much to explain to voters, political observers say. His approval rating took a hit last year after he pushed to raise taxes by $1.3 billion during a special session of the General Assembly. And though his rating has risen to 49 percent in a January poll from Gonzales Research & Marketing Strategies from a low of 37 percent last year, the governor still faces a $2 billion budget shortfall, and he has proposed cutting local aid and laying off state workers.
As governor, O'Malley has traveled around the state to places he has dubbed "capital for a day," and as Baltimore mayor he held "mayor's night out" forums. Former Gov. Robert L. Ehrlich Jr., a Republican, made similar trips. The coming town hall meetings, though, are expected to elicit a deeper level of anxiety from those who attend as the economy has worsened.
That distress has increasingly come across in e-mails, aides said. The governor typically receives hundreds a week, a sampling of which are periodically included in reading materials prepared for him. His administration has also launched the "problem solver" Web site that directs needy families to state services, and his campaign Web site has been revamped to ask for feedback on the current legislative session.
The e-mails, some of which were provided to The Baltimore Sun, frequently refer to financial struggles. Some writers urged O'Malley not to cut funding for programs that help the elderly and poor; others offered suggestions for tackling the budget shortfall. And some were critical of his policies. One woman wrote that "the economic crisis has ruined me, in case he wants to know."
Haberkam, for one, was happy that she e-mailed the governor after getting angry that her unemployment check had not arrived. She said she received a phone call from a state supervisor within hours and that her check came a few days later. She also received a letter from Labor Secretary Thomas E. Perez.
"I never expected a response because I'm sure they get thousands of e-mails, but I did it anyway because I got upset and I wanted to tell someone how I felt," said Haberkam, who is still looking for employment. "I was really overwhelmed that they called me, and they seemed concerned about me."
Copyright 2009 Baltimore Sun.

Economy on minds of many at governor’s town hall
By Kevin Spradlin
Cumberland Times-News
Thursday, February 5, 2009
FROSTBURG — Maryland Gov. Martin O’Malley had dinner at the Princess Restaurant and met with members of the current Leadership Allegany class at Mountain Ridge High School before kicking off a series of town hall meetings to discuss education and economics.
The visit to Frostburg was the first stop in an effort, O’Malley said, to relate statewide how issues decided in Annapolis relate to everyone in the state. The initiative is billed as the Governor’s Town Hall on Public Education and Our Economy and began on Wednesday in Frostburg.
O’Malley presented a condensed version of last week’s State of the State address in Annapolis, during which he touted the state public school system’s No. 1 ranking by a national industry publication. He called the night’s event “a report to the bosses,” referring to the residents and officials from Maryland’s four westernmost counties of Garrett, Allegany, Washington and Frederick in attendance.
Before digging into more serious matters, O’Malley paid tribute to the Pittsburgh Steelers’ Super Bowl victory on Sunday and noted there’s “black and gold in the Maryland flag, too.” Steelers fans, donning black and gold in an extended victory celebration, cheered.
O’Malley said his administration is raising education funding to historic levels and that investing in education and secondary education guarantees a “highly skilled work force.”
It’s not merely an investment in people now, O’Malley said, but ensures “better job opportunities for the future.”
One former Frostburg resident indicated she hoped the future arrives sooner rather than later. A senior at Randolph-Macon College in Ashland, Va., the political science major said she hoped to secure a job working in state or local government. But current economic conditions leave government entities with slim pickings for job seekers.
Throughout the evening, O’Malley seemed to rest hope on President Barack Obama’s economic stimulus plan. The $900 billion plan could bring nearly $3.5 billion to Maryland and open up immediate job opportunities in and out of government.
One man asked O’Malley what it would take for him to reconsider laying off some 700 state employees.
He questioned O’Malley’s capital expense of some $11 million for a vocational rehabilitation facility at a state prison complex.
“Take that $11 million and put it where people could use it most,” the man said, referring to the 700 jobs.
O’Malley said the budget issues weren’t capital project-related but operations-related. Again, he deferred to Obama’s plan.
If Obama’s economic stimulus package passes, “one of the very first announcements I’ll make will be, ‘we’re not laying off 700 people in the middle ... of a recession,’” O’Malley said.
A number of people spoke in an attempt to curry favor of the governor or to get the attention of the state cabinet members, all of whom were in attendance. DeCorsey Bolden, of Garrett Citizens for Smart Growth, left his turn at the podium very pleased.
“We want to defer and delete funding for the (U.S. Route) 219 bypass” through Oakland, Bolden said, citing a projection of increased traffic around Deep Creek Lake.
O’Malley was able to say that funding already has been deleted and “we don’t have plans to restore” monies to that project.
While Bolden was happy, “I just lost 20 other votes,” O’Malley said.
Contact Kevin Spradlin at kspradlin@times-news.com.
Copyright 2009 Cumberland Times-News.

Prostate patients monitoring, not treating, cancer
By Sara Michael
Baltimore Examiner
Thursday, February 5, 2009
A prostate cancer diagnosis should immediately be treated with surgery or chemotherapy, right?
Wrong, according to doctors at Johns Hopkins who say some patients are better off not treating the disease.
"It's cancer, so either you cut it out or you cook it -- that has been the dogma," said Dr. Alan Partin, a professor and director of the Brady Urological Institute at Johns Hopkins School of Medicine.
However, between 15 percent and 40 percent of the nearly 250,000 men diagnosed each year with prostate cancer won't feel any side effects from the disease, he said.
Now, Partin and colleague Dr. H. Ballentine Carter are offering men an option called active surveillance, also known as watchful waiting, where the cancer is closely monitored for changes and left alone for as long as possible.
The approach has been gaining support in the past several years and proving men can live longer without the side effects of treatment, such as impotence and urinary problems.
"The practice is still far from traditional, because patients and physicians fear losing that window of opportunity to treat the cancer," said Carter, a professor of urology and oncology at Johns Hopkins Medicine.
Unlike other cancers such as ovarian or lung, prostate cancer is slow-growing. More advanced and widespread screening has prompted more diagnoses, but as many as half of the patients would never have known they had cancer, Carter said.
Yet more than 90 percent of American men who are diagnosed undergo treatment, he said.
"A proportion of people who get detected are overdiagnosed and overtreated," Carter said.
In the past decade, Hopkins doctors have cared for about 700 men who have opted for active surveillance -- some for a year, others for 10, Partin said.
The surveillance approach is only appropriate for a select group of men, such as those over 65 who have smaller and less aggressive cancers, as determined by tests and biopsies.
The men are monitored closely with blood tests and exams every six months and annual biopsies.
No men in the program have died of prostate cancer, Carter said, suggesting that for those who do opt for treatment, it wasn't too late.
"They did not miss that window of treatment," Partin said.
One patient, who asked to be only identified as Phillip D., said he has a "sliver of reservation," about waiting too long, but feels comfortable with the decision to monitor his prostate.
Five years after his first biopsy revealed cancer, he said he is relieved he didn't have his prostate removed.
Although the program has gained support, the treatment approach goes against conventional wisdom for dealing with cancer.
"It flies in the face of the 'Big C' cancer response," said Dr. Howard Sandler, a prostate specialist at Cedars-Sinai Medical Center in California and a spokesman for the American Society of Clinical Oncology.
"For those who are good candidates, who are very sanguine and ready to come in for periodic checkups, I think it's a reasonable option," he said.
Sandler said there is still a slight possibility that doctors could miss the window, so patients must be carefully selected.
"This is not something that is done casually," said Howard Soule, executive vice president and chief science officer of the Prostate Cancer Foundation.
"What we will learn is who needs to be treated and when, and who doesn't."
Copyright 2009 Baltimore Examiner.

County police join frontlines in mental health
With reduced access to treatment, more calls to officers are over psychiatric issues
By Andrew Ujifusa
Montgomery County Gazette
Wednesday, February 4, 2009
On New Year's Day 2008, 19-year-old Maxwell Crocker was awakened by seven Montgomery County police officers at his parents' Kensington home who handcuffed him and drove him to Suburban Hospital.
Crocker had committed no crime. But based on statements from his ex-girlfriend and postings on his personal Web page, authorities were worried he might. So, using a state law that allows police intervention in cases of possible danger, they took him into custody and delivered him to the Bethesda hospital for psychiatric evaluations.
Crocker, who has a history of mental illness, was released 24 hours later with a hefty bill. He was never charged by police.
What happened to Crocker, observers say, is happening more and more as access to mental health treatment is dwindling in the face of rising costs and government budget cuts, forcing police officers to join frontline health care workers in dealing with mental illness.
Esther Kaleko-Kravitz, executive director of the National Alliance on Mental Illness (NAMI) in Montgomery County, said lack of affordable housing and higher prescription costs mean more mental health patients are living with relatives instead of at facilities, and are unable to get the treatment they need, precipitating many crises.
"There are more calls to police from families who say, ‘I can't control my loved one,'" she said.
In 1995, there were 3,494 beds in Maryland for the state's mental health patients at acute-care hospitals, private psychiatric facilities and state hospitals, with 303 of them in Montgomery County, according to Pam Barclay, director of the Center for Hospital Services at the Maryland Health Care Commission. In 2008, the statewide number had dropped to 2,404 beds, with Montgomery County's total decreasing to 186.
Holy Cross Hospital in Silver Spring closed its psychiatric unit in 1999, while Chestnut Lodge, a private psychiatric facility in Rockville, shut its doors in 2000.
Kaleko-Kravitz said the jail has become one of the county's largest providers of mental health services.
About 35 percent of Montgomery County Police's patrol officers have undergone extra training in dealing with people with mental illness, according to Officer Joan Logan, the department's crisis intervention coordinator. The 40-hour training involves visits with mental health patients, and testing officers' ability to recognize certain mental illnesses and deal with mental health scenarios.
It also involves having officers wear iPods for extended periods, listening to tracks that simulate the voices that some schizophrenics deal with on a daily basis.
"They learn what it's like to do routine things when you're suffering from a thought disorder, when you're hearing voices," Logan said.
The training, which officers volunteer to take, began in 2000.
Mental illness was cited in about 3,500 calls to police for assistance last year, up nearly 1,000 in two years, according to county police records.
Logan said 1,850 of the calls resulted in a formal police report, with a majority requiring transport to a mental health facility. That number was 1,550 in 2007 and 1,200 in 2006. Suicides or attempted suicides are not included in those counts.
Suicides in the county peaked in 2007at 64, and were down by a few last year at 61.
Logan said the higher number of mental health calls has put more stress on members of the police's Mobile Crisis Team, which is specifically assigned to deal with mental health crises.
"I don't know who would do it if we didn't do it," she said.
The Montgomery County Crisis Center, located in Rockville, deals with 5,000 people face-to-face and 50,000 calls annually and tries to stabilize people with mental health crises in the short-term and release them within 60 hours, according to the center's director Dudley Warner.
"In other jurisdictions, without Montgomery County's resources, it would just be the police," Warner said.
But Logan said in general, the process for getting mental health patients connected to resources to help can be confusing.
"If I had a mental illness, I don't think I would find this system easy to navigate. I would find it very frustrating," Logan said.
Crocker was the subject of a Maryland Emergency Petition, which allows an individual with a mental disorder who "presents a danger to the life or safety of the individual or of others" to be admitted for evaluation with or without consent. Law enforcement officials and mental health professionals can petition for emergency evaluations without the approval of a judge, although any interested person can petition for an evaluation through a District Court judge.
Crocker, allegedly made threats against his ex-girlfriend's new boyfriend at the end of 2007, according to a police incident report obtained through the Maryland Public Information Act. At the time, Crocker had been diagnosed with a bipolar disorder and was taking the prescription drugs Lexapro and lithium.
A subsequent police search of his MySpace and Facebook accounts turned up violent language and general references to a school shooting, prompting the police intervention, according to the report.
The emergency petition law was loosened in 2003, dropping language that required an individual present an "imminent" danger. State Sen. Jennie M. Forehand (D-Dist. 17) of Rockville said the change was made at the request of families and mental health advocacy groups who were worried about ongoing situations where the threat was not immediate or absolutely clear.
Kaleko-Kravitz also said the change has allowed more people who truly need psychiatric evaluations to get them, and that generally she thinks emergency petitions are a useful tool.
Logan said the change has made police officers' job easier, because it eliminates the need for a subjective judgment of "imminent" danger.
Crocker, who said he was on probation from Albert Einstein High School in Kensington for mental health issues when he was taken to Suburban, explained in a December interview that his 2007 writings were artistic and not directed at anyone.
But he also said his reference to a school shooting "crossed the line."
No weapons were found when police searched his parents' home on Jan. 1, 2008.
"Maxwell's a volatile personality," said his father Steve Crocker, "but I never thought he was remotely dangerous."
Crocker said after roughly 24 hours of evaluation and observation by a physician and mental health professionals, he was discharged and told only that he should be given a lower dose of his medication.
"I was distraught that I was there," he said in December. "I felt like a criminal. I looked like a criminal."
He also said he was awakened to sign a form stating he had been admitted voluntarily, which he did, though now he says he would have never agreed to do so if he had been thinking clearly.
Individuals brought to hospitals on emergency petitions are asked to declare whether they are there voluntarily or involuntarily. The answer can change who is responsible for paying the bill.
Representatives of Suburban Hospital declined to discuss the specifics of Crocker's case citing privacy laws, but said a patient would not have been asked to sign paperwork in the manner Crocker described.
Maryland law says the state will provide reimbursement for involuntary admissions from emergency petitions. Voluntary admissions are not specifically mentioned in the law.
Since he was on a probationary period for mental health expenses at the time, Crocker's insurance company will not pay his $2,000 bill from Suburban Hospital.
Problems associated with paying the bills for evaluations done by emergency petitions are not uncommon, according to Lynn Albizo, executive director of the Maryland chapter of NAMI. But she said there is often little people can do.
"I feel for them, and I think there's unfairness. You shouldn't have to go bankrupt over health care costs," she said.
Crocker lives with his mother in Silver Spring after his parents divorced, and works at a pizza restaurant in Washington, D.C. He said his credit has been wrecked by the process of fighting the hospital bill. He said he believes he should not pay for something he believes was ultimately involuntary on his part, and is preparing to file a grievance with the Maryland Attorney General's office about the bill.
"I absolutely will not pay for it. I will not pay for it given the principle of the matter," he said.
Copyright 2009 The Gazette.

Virginia restaurant smoking ban proposal moves forward
Associated Press
By Bob Lewis
Baltimore Sun
Thursday, February 5, 2009
RICHMOND, Va. - Gov. Tim Kaine and House Speaker Bill Howell have announced a deal on a bill curbing smoking in Virginia restaurants and bars.
The compromise announced today blends the Democratic governor's support for an outright ban on smoking in bars and opposition among Republicans to any mandatory restrictions.
It would ban smoking except in private clubs and in areas of restaurants walled off from nonsmoking areas with separate ventilation systems.
The measure will be taken up this afternoon in a House committee and is expected to reach the floor for a vote.
Copyright 2009 Baltimore Sun.

National / International
FDA defends how it handled salmonella outbreak
Associated Press
By Ricardo Alonso-Zaldivar and Brett J. Blackledge
Baltimore Sun
Thursday, February 5, 2009
WASHINGTON - Federal health officials are defending their handling of the nationwide salmonella outbreak, telling Congress they had been hot on the trail of a Georgia processor even before they were certain that peanuts were to blame for hundreds of illnesses.
The Food and Drug Administration "began its investigation prior to having a strong epidemiological link to a particular food," Stephen Sundlof, head of the agency's food safety center, said in testimony prepared for delivery to the Senate Agriculture Committee.
The first signs of the outbreak were detected in November by the Centers for Disease Control and Prevention. But disease detectives initially suspected chicken was the culprit in clusters of salmonella infections that states were reporting.
On Jan. 7 and 8, after discussions between federal and Minnesota authorities, peanut butter was added to the short list of suspects when some people who had gotten sick reported eating peanut butter in nursing homes and at an elementary school. On Jan. 8, the FDA visited an Ohio distributor for Peanut Corp. of America.
The next day federal inspectors were at the company's Blakely, Ga. facility, which ultimately was identified as the source of the food poisoning. That same day, Jan. 9, Minnesota health officials found salmonella in an open container of peanut butter made at the plant. On Jan. 10, Minnesota made a positive match to the salmonella strain that caused the outbreak.
Lawmakers, however, may not be reassured. They are concerned about the state of the national food safety system, a collaboration between the FDA, CDC and authorities in each state. As the list of recalled items containing peanut products surpasses 1,000, lawmakers are vowing to press for stronger food safety laws and more money for inspections.
"To say that food safety in this country is a patchwork system is giving it too much credit. It is a hit or miss gamble, and that is truly frightening," said Agriculture Committee Chairman Sen. Tom Harkin, D-Iowa. "It's time to find the gaps in the system and remedy them."
The salmonella outbreak has sickened at least 550 people in 43 states, eight of whom have died. New cases are being reported, although the outbreak is slowing.
The Peanut Corp. plant in Blakely, Ga., which produces a tiny share of U.S. peanut products, is being blamed. Authorities say the facility shipped peanut butter, paste and other products that had tested positive for salmonella. The company retested, got a negative reading, and shipped the products.
A criminal investigation is under way. The company has denied any wrongdoing and said Wednesday that its Blakely plant had received regular visits and inspections from state and federal authorities in 2008 and had gotten a "superior" rating from an independent inspection.
As the list of recall list grows, Assistant Surgeon General Ali Khan said it's a textbook example of an ingredient-driven outbreak.
"The event illustrates how a large and widespread outbreak can occur from distribution of a single item to hundreds of foods," Khan said in his prepared testimony.
Meanwhile, lawmakers are dusting off food safety legislation that went nowhere under administration of former President George W. Bush and are hoping for better luck under President Barack Obama, who has criticized the FDA's handling of the outbreak.
But it remains unclear whether Congress can deliver major improvements in food safety this year, given the press of critical issues such as the shaky economy and a ballooning federal deficit.
All the reform proposals would give the FDA authority to order recalls, which are now voluntary.
Reformers also agree that food processing plants should be required to have a safety plan and document their compliance. And there is widespread agreement that standards for imported foods must be upgraded.
There's also consensus that inspections should be carried out according to common requirements, but legislators differ on how frequently checks should be performed.
There's agreement on the need for standards for fresh produce, but there are differences over setting up a tracking system to find foods implicated in an outbreak.
One of the bills calls for taking food safety away from the FDA, where it is sometimes seen as a bureaucratic stepchild, and setting up a new Food Safety Administration within the Health and Human Services Department.
William Hubbard, a former FDA associate commissioner, said no reforms can succeed without more money. He says Congress must double the FDA's food safety budget to about $1 billion a year.
But even with that, Hubbard warned, the agency would not be able to regularly inspect some 150,000 facilities that produce, ship and store foods. He says the answer is a food safety system in which the FDA sets rules that all players in the food industry must comply with and that states help to enforce.
Copyright 2009 Baltimore Sun.

Lawmakers to press for food safety overhaul as peanut recall surpasses 1,000 products
Associated Press
By Ricardo Alonso-Zaldivar and Brett J. Blackledge
Washington Post
Thursday, February 5, 2009
WASHINGTON (AP) — Lawmakers are looking into the national salmonella outbreak and vowing to press for stronger food safety laws and more money for inspections.
"To say that food safety in this country is a patchwork system is giving it too much credit. It is a hit or miss gamble, and that is truly frightening," said Sen. Tom Harkin, D-Iowa, chairman of the Senate Agriculture Committee, which was holding a hearing on the outbreak Thursday. "It's time to find the gaps in the system and remedy them."
Meanwhile, more peanut products are being added to a recall list that surpasses 1,000 items — from ice cream to crackers to granola bars. Independent experts say it appears to be a record number of products for a recall involving foods consumed by humans.
In Congress, lawmakers are dusting off legislation that went nowhere under the previous administration and hoping for better luck under President Barack Obama, who has criticized the Food and Drug Administration's handling of the outbreak.
But it remains unclear whether Congress can deliver major improvements in food safety this year, given the press of critical issues such as the shaky economy and a ballooning federal deficit.
The salmonella outbreak has sickened at least 550 people, eight of whom have died. A Blakely, Ga., peanut-processing plant that produces just 1 percent of U.S. peanut products is being blamed.
Authorities say Peanut Corp. of America shipped peanut butter, paste and other products that had tested positive for salmonella. The company retested, got a negative reading, and shipped the products. A criminal investigation is under way. The Lynchburg, Va.-based company denies any wrongdoing and said Wednesday that the Blakely plant received regular visits and inspections from state and federal authorities in 2008.
"Independent audit and food safety firms also conducted customary unannounced inspections of the Blakely facility in 2008. One gave the plant an overall 'superior' rating, and the other rated the plant as 'meet or exceeds audit expectations (acceptable-excellent)' ratings," the company said in a statement.
In the House, Reps. John Dingell, D-Mich., Diana DeGette, D-Colo., and Rosa DeLauro, D-Conn., are pursuing reform bills that have many similarities and some key differences.
In the Senate, Illinois Democrat Dick Durbin is preparing to reintroduce a bipartisan bill.
All the reform proposals would give the FDA authority to order recalls, which are now voluntary.
Reformers also agree that food processing plants should be required to have a safety plan and document their compliance. And there is widespread agreement that standards for imported foods must be upgraded.
There's also consensus that inspections should be carried out according to common requirements, but legislators differ on how frequently checks should be performed.
There's agreement on the need for standards for fresh produce, but there are differences over setting up a tracking system to find foods implicated in an outbreak.
DeLauro's bill calls for taking food safety away from the FDA, where it is sometimes seen as a bureaucratic stepchild, and setting up a new Food Safety Administration within the Health and Human Services Department.
William Hubbard, a former FDA associate commissioner, said no reforms can succeed without more money. He says Congress must double the FDA's food safety budget to about $1 billion a year.
But even with that, Hubbard warned, the agency would not be able to regularly inspect some 150,000 facilities that produce, ship and store foods. He says the answer is a food safety system in which the FDA sets rules that all players in the food industry must comply with and that states help to enforce.
"I think there is so much public anxiety about food safety that there is a good chance for action," Hubbard said.
But he quickly added a cautionary note: "Congress," he said, "is a slow-moving beast."
On the Net:
The FDA's recall page: http://tinyurl.com/8srctw
Copyright 2009 Washington Post.

Home of man linked to 1982 Tylenol deaths searched
Associated Press
By Russell Contreras
Frederick News-Post
Thursday, February 5, 2009
CAMBRIDGE, Mass. (AP) -- Federal agents taking a second look at the murders of seven people who swallowed tainted Tylenol capsules in 1982 have searched the home of a one-time leading suspect in the still-unsolved case.
FBI agents from Boston and Chicago were seen Wednesday removing boxes and a computer from the condominium owned by James W. Lewis, who served more than 12 years in prison for trying to extort $1 million from the painkiller's manufacturers.
No one was ever charged with the deaths of the seven people who took cyanide-laced drugs in the Chicago area 26 years ago, leading to dramatic changes in the way food and medical products are packaged.
The FBI's Chicago office cited "advances in forensic technology" in a statement Wednesday announcing that it, along with Illinois State Police and local departments, was conducting a "complete review of all evidence developed in connection with the 1982 Tylenol murders."
The review began in part because of publicity and tips that arrived after the 25th anniversary of the deaths in 2007, according to the FBI. It has not resulted in any criminal charges.
"All of these tips have been or will be thoroughly investigated in an effort to solve this crime and bring some measure of closure to the families of the victims," the statement said.
The FBI would not confirm that searches at both Lewis' apartment and at a storage facility in Cambridge were related to the Tylenol case, only that it was part of an ongoing investigation.
In a space of three days beginning Sept. 29, 1982, seven people who took cyanide-laced Tylenol in Chicago and four suburbs died. That triggered a national scare, prompting an untold number of people to throw medicine away and stores nationwide to pull Tylenol from their shelves.
Lewis served more than 12 years in prison for sending an extortion note to Johnson & Johnson demanding $1 million to "stop the killing."
Lewis was arrested in December 1982 after a nationwide manhunt. At the time, he gave investigators a detailed account of how the killer might have operated and described how someone could buy medicine, use a special method to add cyanide to the capsules and return them to store shelves.
Lewis later admitted sending the extortion letter but said he never intended to collect it. He said he wanted to embarrass his wife's former employer by having the money sent to the employer's bank account.
In a 1992 interview with The Associated Press, Lewis explained that the account he gave authorities was simply his way of explaining the killer's actions.
"I was doing like I would have done for a corporate client, making a list of possible scenarios," said Lewis, who maintained his innocence. He called the killer "a heinous, cold-blooded killer, a cruel monster."
Lewis also served two years of a 10-year sentence for tax fraud. In 1978, he was charged in Kansas City with the dismemberment murder of Raymond West, 72, who had hired Lewis as an accountant. The charges were dismissed because West's cause of death was not determined and some evidence had been illegally obtained.
In 2004, Lewis was charged with rape, kidnapping and other offenses for an alleged attack on a woman in Cambridge. He was jailed for three years while awaiting trial, but prosecutors dismissed the charges on the day his trial was scheduled to begin after the victim refused to testify, according to the office of Middlesex District Attorney Gerry Leone.
In 2007, Lewis was interviewed on a local-access television show, "The Cambridge Rag," by host Roger Nicholson. In segments available online, Lewis asserted his innocence in the Tylenol and West cases. He turned aside Nicholson's suggestion that he take a lie-detector test, saying they are unreliable and unscientific.
Lewis moved to the Boston area after getting out of prison in 1995 and is listed as a partner in a Web design and programming company called Cyberlewis. On its Web site, which lists the location searched Wednesday as the company's address, there is a tab labeled "Tylenol" with a written message and audio link in which a voice refers to himself as "Tylenol Man" and complains about "the curse of being labeled the Tylenol Man."
Messages left at phone numbers listed to Lewis' wife, Leanne, and the company were not immediately returned. There was no answer Wednesday night at an accounting business listing Leanne Lewis as director and no immediate response to an e-mail to the business.
The 1982 poisonings led to the introduction of tamperproof packaging that is now standard. Bottles of the pain reliever were triple-sealed and warnings against taking capsules from damaged packages prominently displayed. Johnson & Johnson also sealed the bottle caps to the neck with a tight, plastic band and stretched a tough foil membrane over the bottle's mouth.
In 2007, 25 years after the deaths, survivors of the victims said they remained haunted by what happened and frustrated that nobody was convicted.
"I will never get past this because this guy is out there, living his life, however miserable it might be," said Michelle Rosen, who was 8 when her mother, Mary Reiner, collapsed in front of her after taking Tylenol for post-labor pains.
Associated Press writers Denise Lavoie in Boston, Mike Robinson, Don Babwin and Karen Hawkins in Chicago and Devlin Barrett in Washington contributed to this report.
© 2009 The Associated Press. All rights reserved.

Health care for all
Our view: Governor O'Malley's move to cover same-sex partners is a smart change in policy
Baltimore Sun Editorial
Thursday, February 5, 2009
Cost shouldn't be the primary consideration when deciding whether Maryland should extend health insurance benefits to same-sex domestic partners. Fairness should be, and so should self-interest: If the public sector wants to attract the best and the brightest employees, it's wise not to discriminate against millions of Americans.
Gov. Martin O'Malley's recent decision to push for this broadening of health insurance coverage is a bit overdue, but welcome news nonetheless. He made the same regulatory change for city employees when he was mayor. At least 15 states, including Maine and Montana, provide health insurance for same-sex domestic partners, as do a majority of Fortune 500 companies.
This isn't a free perk. It will likely cost about $3 million at a time when state government is cutting jobs and spending in the face of a serious economic recession. But if the state needs to trim employee health care costs, this isn't the place to start.
Efforts to promote equality for gay and lesbian couples in this country suffered a real setback last year when Californians voted to eliminate the rights of same-sex couples to marry, a highly controversial proposition now under review by the state's highest court. Maryland has such a law on the books, and prospects for overturning the ban in the General Assembly are not good.
Under these circumstances, the least that lawmakers can do is not stand in the way of this opportunity to reassure the gay community that it is respected and valued. It may help only a modest number of families, but the symbolic value is just as important.
Providing full health care benefits to only heterosexual couples amounts to a form of workplace discrimination. Taxpayer dollars are far too valuable to underwrite such inequities or to keep state government from attracting and retaining the best possible work force.
Copyright 2009 Baltimore Sun..

Good medicine
Our view: New SCHIP law is a prescription for better health care for kids
Baltimore Sun Editorial
Thursday, February 5, 2009
Monday was a particularly embarrassing day for President Barack Obama. His nominee for health care czar, Tom Daschle, withdrew from consideration after a tax problem, a dust-up that forced a first presidential "I messed up."
Yesterday, President Obama had the chance to improve the lives of millions of low-income children in this country. He signed into law a bill that will extend health care insurance to kids whose families can't afford it. That should count as a particularly satisfying day.
The State Children's Health Insurance Program (SCHIP) was twice vetoed by President George W. Bush. As a senator, Mr. Obama supported the bill, which will fund health care for an additional 4 million children who are not now enrolled in the program. It's a tangible example of how a change in the White House has brought about meaningful change for America's most vulnerable citizens.
Maryland children - about 110,000 enrolled in the state's version of the program and an additional 42,800 who will now be eligible - can be assured of health care.
Reform of the nation's health care system will be a long, arduous endeavor. In the interim, however, the children's health program will be one way to bridge the gap for many in need.
Copyright 2009 Baltimore Sun.