Tag Archives: los angeles times

A painful picture of rare childhood mental illness

The Los Angeles Times’ Shari Roan tells the story of a 6-year-old girl suffering from a rare – perhaps even unique – case of early childhood schizophrenia. For months, even the most powerful medications her young body can handle don’t seem to phase her imaginary animal friends and almost-constant hallucinations. The mental illness is a serious threat to her health and that of those around her. In January she had to be moved from home to UCLA’s pysch ward. Roan uses the story, told with intense, wrenching detail and ending with a note of hope for the future, to illuminate the plight of America’s tiny population of mentally ill children.

About 1% of adults have schizophrenia; most become ill in their late teens or 20s. Approximately one in 10 will commit suicide.

Doctors and other mental health experts don’t fully understand the disease, which has no cure. Jani’s extreme early onset has left them almost helpless. The rate of onset in children 13 and under is about one in 30,000 to 50,000. In a national study of 110 children, only one was diagnosed as young as age 6.

“Child-onset schizophrenia is 20 to 30 times more severe than adult-onset schizophrenia,” says Dr. Nitin Gogtay, a neurologist at the National Institute of Mental Health who helps direct the children’s study, the largest such study in the world on the illness.

Calif. nonprofit’s conflicts of interest ‘inherent’

Los Angeles Times reporter Alan Zarembo found unusually high executive pay and a tangle of additional compensation (ranging from rent to legal fees) that make executives at Tarzana Treatment Center some of the best-paid nonprofit leaders around.

The $45-million-a-year business, which has aggressively pursued lucrative government contracts, paid out salaries as high as $428,057 for the chief operating officer, a number which does not take into account deferred compensation and other activities. Part of the property leased by the center is owned by four board members, in an arrangement which nets them $2.7 million in rental fees annually. The CEO earned $330,372 for 32 hours a work a week, not including his share of the rent or the $237,965 in legal fees he earned in 2007 as part of an ongoing contract.

Frances Hill, a professor at the University of Miami specializing in nonprofit tax law, said conflicts of interest were inherent at Tarzana because the chief executive wears so many other hats: chairman of the board, lawyer and landlord.

“My jaw is dropping over this,” she said.

All of this appears to be legal, though “anathema” to a nonprofit’s mission, Zaremba found. The IRS allows this sort of self-dealing as long as the nonprofit can show that it gets better rates than it would on the open market, and government caps on executive pay for its contractors don’t apply because much of the compensation comes from non-government revenues. The leader of a nonprofit watchdog group asks “If the executives weren’t paid so much, ‘how many more services could be provided to people who need them?'”

Numbers on the rehab center’s effectiveness remain elusive, as they do for many such organizations, but Zaremba quotes a patient praising its professionalism and a positive review from a local official.

Effectiveness debate over virtual colonscopies

Officials are considering whether or not Medicare will cover virtual colonoscopies, a technology that, while cheaper and far less invasive, may also be less reliable. Los Angeles Times reporter Noam N. Levey looked at how the debate over colorectal screening illuminates the difficulties inherent in the larger discussion about the Obama administration’s push for efficient health-care spending.

According to Levey, “Colorectal cancer is highly treatable if detected early, but it remains the nation’s second deadliest cancer, in large part because half of adults over 50 do not get screened.” Levey reported that patients avoid screening primarily because they wish to avoid the sedation or discomfort that accompany the procedure.

Doctors and researchers do not yet agree on the effectiveness of virtual scanning, and it still requires unpleasant preparations like colon-cleansing and the insertion of air into the intestine. Nonetheless, it promises to offer a relatively enticing alternative to the traditional colonoscopy.

Some studies have indicated that the procedure can detect most polyps as well as traditional colonoscopy. But others have suggested it is not be as good at detecting some smaller polyps.

Disputes over the cost-effectiveness of virtual colonoscopy further complicated the analysis.

The agency’s extensive year-long review of the efficacy of virtual colonoscopy shows just how much budgetary pressure Medicare is under during a period of increased scrutiny and reform.

Medicare, which will spend more than $500 billion this year, is under increasing pressure to contain spending that many experts say threatens the whole federal budget.

Of particular concern has been the rising cost of scans. Medicare spent more than $14 billion on imaging in 2006, double what it spent six years earlier, according to a 2008 report by the Government Accountability Office.

L.A. doctors go to barber shops to reach black men

Los Angeles Times reporter Mary Engel follows the Black Barbershop Health Outreach Program founded by Dr. Bill Releford in December 2007. According to Engel, “African Americans have the highest rates of diabetes and heart disease of any group, yet black men are among the least likely to see a doctor regularly. So if the men wouldn’t come to a doctor, he would bring a cadre of volunteer doctors and nurses to the barbershop.”

The response was so enthusiastic that Releford expanded the program to 50 other L.A. barbershops, and then to barbershops in other states. This year, at 750 shops in 50 cities across 13 states, men who ordinarily would go nowhere near a doctor’s office will be offered a health checkup in a setting so familiar that it will seem as routine as a haircut.

Engel found the problems addressed by the program to be both urgent and under-funded.

At almost every screening, at least one person’s blood pressure or blood sugar is so high he’s sent straight to a hospital emergency room.