Taking aim at the gun industry








We've all heard the saw about California being hostile to industry. Here's an industry that indisputably has grounds for complaint: the gun industry.


Finally, the Legislature is getting something right.


According to many experts, California's firearms regulations are the toughest in the nation. (New York's recently enacted rules may be tougher, but they're still being rolled out.) California may soon get even tougher: a slate of proposals outlined this month by legislative leaders in Sacramento would add new regulations and close a few loopholes in the old.






"There's a lot for folks here to be proud of," Ben Van Houten, managing attorney at the San Francisco-based Law Center to Prevent Gun Violence, told me. "But there's still a lot of work to do. Federal law is astonishingly weak, so it's incumbent on the states to do as much as they can."


Taken together, the state's firearms laws are a model for regulating sales and possession of a dangerous product without banning it entirely — or even necessarily cutting much into the commercial market. More than 600,000 handguns, rifles and shotguns were sold in California in 2011, the latest year for which statistics are available from the attorney general's office. All required background checks, which resulted in denials of fewer than 1% of applications. California remains one of the nation's major gun markets — only Texas and Kentucky (go figure) generated more background checks last year, according to FBI figures.


This dynamic places California in a familiar position, as a bellwether on social and economic change. On issues such as auto emissions, greenhouse gases and tax policy, California has led the country across a Rubicon. Will gun safety be the next frontier?


Consider the most important statistic related to California's gun laws. In 1981, before the most stringent rules were adopted, California's rate of 16.5 firearms-related deaths per 100,000 population was 31st worst in the nation and higher than the national average; by 2000, a decade after the laws started getting tightened, the state ranked 20th, with a rate of 9.18, below the national average. In 2010, the latest year for which the Centers for Disease Control and Prevention offers figures, the state ranked ninth, with a rate of only 7.9.


And this is a big, diverse state with not inconsiderable pockets of gang lawlessness and drug abuse, and sizable populations of hunters, target shooters and other gun fanciers. Many factors may have contributed to the downward trend in firearm deaths since 1990, but the numbers strongly indicate that regulation works.


California's hostility to guns is focused mainly on assault weapons, which are outlawed — all others are legal, but regulated. The assault weapons ban is being extended to the makers of these dangerous products. The state's two largest public pension funds have reviewed their holdings of those manufacturers at the urging of state Treasurer Bill Lockyer, who argues that the funds shouldn't be investing in companies that make guns that can't be legally sold in the state.


The California State Teachers' Retirement System, or CalSTRS, voted in January to sell its holdings in three gun makers — Smith & Wesson and Sturm-Ruger, which are publicly traded companies, and Freedom Group. The latter landed in the CalSTRS portfolio through its investment in Cerberus Capital Management, a private equity firm that owns the gun maker, which made the assault rifle used in the Newtown school massacre in December. Soon after the massacre, Cerberus said it would put Freedom up for sale.


The board of the California Public Employees' Retirement System, or CalPERS, may vote on divestment of its holdings in Smith & Wesson and Sturm-Ruger as early as this week. (CalPERS doesn't own an interest in Freedom.) Lockyer, who sits on the boards of both pension funds, acknowledged that the divestment would be "largely symbolic" — the gun investments are negligible portions of both portfolios. But he's correct that it's important to make a statement that there are investments public agencies devoted to the health and welfare of their beneficiaries shouldn't be making.


It's even more important in this case, since CalPERS and CalSTRS are the two largest state pension funds in the country.


California's history with gun regulation is instructive for the nation. This is the state where the National Rifle Assn. tested its anti-regulation tactics before taking them on the road.


That happened in 1982, when a freeze on handgun sales appeared on the November ballot as Proposition 15. Aware that passage might spread the idea of a freeze on handguns nationwide, the NRA loaded up.


The organization provided roughly half of the $5.8 million spent to defeat the measure (a near record for an initiative campaign at the time), with gun manufacturers accounting for the rest. A key television ad depicted an elderly woman cowering in bed as a faceless interloper turns her doorknob and her 911 call returns a busy signal.


This was a mild foretaste of the organization's modern paranoid approach, which involves portraying daily life as a gantlet to be run dodging bloodthirsty Latin American drug gangs, looters, kidnappers, rioters and terrorists, as paranoia poster child Wayne LaPierre of the NRA wrote in an essay last week.


"When people realized Proposition 15 would affect their capacity to protect themselves," relates Rick Manning, who helped manage the campaign as an NRA consultant, "it was overwhelmingly rejected."


It didn't hurt that the NRA staged an aggressive voter registration drive among gun owners and supporters. The measure lost by a 2-1 margin, an outcome that is widely thought to have helped bring about Los Angeles Mayor Thomas Bradley's narrow loss in his race for governor against George Deukmejian.


That was the low-water mark for gun regulation in the state. In 1989 and 1990, however, state regulations got much tighter. The inspiration was a precursor to the Newtown massacre — the murder of five children and wounding of 29 others in a Stockton schoolyard by a deranged gunman who reloaded his assault rifle twice in the course of firing 105 rounds.


The post-Stockton era yielded an assault weapons ban. The state also extended to hunting rifles and shotguns its waiting period in effect for handguns; the wait is currently 10 days. At the time, an NRA lobbyist scoffed that "people don't follow California in any knee-jerk reaction." But the state's assault weapon ban became the model for the federal ban sponsored by Sen. Dianne Feinstein (D-Calif.) in 1994. The federal measure expired in 2004, and a renewal may be on the table as Congress ponders new regulations in the wake of Newtown.


Today, California law requires that almost all transfers of firearms, including private deals and gun show sales, be made through a licensed dealer and completed after a waiting period. High-capacity magazines are illegal except for those owned before 2000. There's a long list of people prohibited to possess firearms, including felons and people judged to be a danger to themselves or others.


The new proposals include measures to close a loophole in the ban on assault weapons and high-capacity magazines, and to require a background check and a permit to buy ammunition. The package reflects the cat-and-mouse game that unfolds any time an entrenched industry confronts a new regulatory paradigm.


"The gun industry has been very adept at finding loopholes to our existing laws," says Darrell Steinberg, the state Senate president pro tem, who will be spearheading the legislative effort in his chamber. He says the assumption that the bills will pass easily is misplaced: "It's not going to be easy or simple. There's going to be huge pushback certainly from the industry and a very vocal minority that doesn't believe in any law to reduce gun violence."


Indeed, gun-rights advocates sound as if they're already girding for a court fight. "It's just a matter of time before a California case gets out of the 9th Circuit," says Manning, referring to the liberal-leaning federal appellate court with jurisdiction over California. In the Supreme Court, which appeared to strengthen individual gun-possession rights with decisions in 2008 and 2010, "these laws will have some real problems."


It's true that the new proposals won't eradicate gun violence in California, any more than the post-1989 reforms eradicated school shootings in the state. The biggest loophole in California regulations can't be closed by the state — it's the porous regulations in nearby states such as Arizona that leach across the border.


But until and unless federal reforms close that gap, we're on our own.


Michael Hiltzik's column appears Sundays and Wednesdays. Reach him at mhiltzik@latimes.com, read past columns at latimes.com/hiltzik, check out facebook.com/hiltzik and follow @latimeshiltzik on Twitter.






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'Blade Runner' Oscar Pistorius weeps as he faces murder charge









JOHANNESBURG, South Africa -- Olympic sprinter Oscar Pistorius, the double-amputee revered in South Africa for overcoming his disability to compete in the London Games last year, wept in court Friday as he faced a murder charge in connection with the fatal shooting of his girlfriend.

During the proceedings in Pretoria, Gerrie Nel, one of the National Prosecuting Authority’s most senior advocates, said he would argue the killing of model and law graduate Reeva Steenkamp was premeditated murder, the most serious category of offense under South African law.


Nel is known for prosecuting high-profile cases, including winning the conviction of former police chief and Interpol boss Jackie Selebi on corruption charges.


Pistorius, nicknamed the "Blade Runner" because of the carbon-fiber prosthetic legs he uses to compete, did not enter a formal plea and was remanded into custody at Brooklyn police station in Pretoria until Tuesday, when his bail application is to be heard.








Under South African law, a suspect charged with such a high-level offense would have to prove exceptional circumstances to be granted bail.


In a packed courtroom, members of Pistorius' family struggled to pass through a media scrum and to find seats. The hearing coincided with "Black Friday," a day when people were being urged to wear black to protest rapes and violence against women.


[Updated, 8:35 a.m. Feb. 15: The family and Pistorius' management company later issued a statement denying that the athlete had murdered his girlfriend, saying: "The alleged murder is disputed in the strongest possible terms."


Some details of Pistorius' argument and the state's case are expected Tuesday.]

The famed athlete's court appearance came as South African media reported that he shot Steenkamp, his girlfriend of several months, four times through a bathroom door.


Under South African law, a person who fatally shoots an intruder has to prove he or she had a reasonable fear that the intruder posed a real threat to his or her life.

South Africa has one of the highest rates of gun homicides in the world, with killings of women by intimate partners the leading cause of female homicide in the country. About 57% of female homicide victims were killed by their partners in 2009, according to a report last year by the Medical Research Council.


One-third of female homicides were committed by partners with a history of prior violence against their partners, according to the report.

Friends of Steenkamp and Pistorius mourned the incident on social media.

"Drained, confused, I just can't wrap my head around things," one of Pistorius’ close friends, Alex Pilakoutas, posted on Twitter.


Darren Fresco, who described himself as one of Steenkamp’s best friends said he was hoping to wake from a nightmare and hear her infectious laughter again.

"We were just goofing off the other day talking to each other in only the way that we could to each other. My heart is on the verge of exploding with the pain of such a sudden loss of one of my best friends," Fresco, who said he was one of the last people to exchange tweets with Steenkamp, posted on Facebook.

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robyn.dixon@latimes.com





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Judge sets May trial date for Kardashian divorce


LOS ANGELES (AP) — Kim Kardashian has a due date for her baby and now a trial date for her divorce from NBA player Kris Humphries.


A judge on Friday set a May 6 trial for the reality TV star who wants to end her marriage before July, when her child with Kanye West is due.


Kardashian filed for divorce on Oct. 31, 2011, after she and Humphries had been married just 72 days. Their lavish, star-studded nuptials were recorded and broadcast by E! Entertainment Television.


The trial is expected to last three to five days and could reveal details about Kardashian's reality show empire, which includes "Keeping Up With the Kardashians" and several spinoffs.


Two judges determined Friday that Humphries' lawyers had adequate time to prepare for the trial.


Humphries wants the marriage annulled based on his claim that Kardashian only married him for the sake of her show.


She denies that allegation and says the case should be resolved through what would be her second divorce.


Humphries' attorney Marshall Waller asked for a delay until basketball season is over.


But Superior Court Judge Scott Gordon refused, saying firefighters, police officers, truck drivers and others have to miss work for trials, and Humphries must do the same if necessary.


Waller filed paperwork Thursday to withdraw from the case but didn't mention that development in court and refused to answer any questions about the document on Friday.


Waller said he was still hoping to obtain and review 13,000 hours of footage from Kardashian's reality shows to try to prove the fraud claim but noted he does not yet have an agreement to receive the footage.


Kardashian's lawyer said her client was ready for trial.


"Let's get this case dispensed with," attorney Laura Wasser said.


Humphries has provided a deposition in the case, as have West and Kardashian family matriarch Kris Jenner.


___


Anthony McCartney can be reached at http://twitter.com/mccartneyAP


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Fat Dad: Baking for Love

Fat Dad

Dawn Lerman writes about growing up with a fat dad.

My grandmother Beauty always told me that the way to a man’s heart was through his stomach, and by the look of pure delight on my dad’s face when he ate a piece of warm, homemade chocolate cake, or bit into a just-baked crispy cookie, I grew to believe this was true. I had no doubt that when the time came, and I liked a boy, that a batch of my gooey, rich, chocolatey brownies would cast him under a magic spell, and we would live happily ever.

But when Hank Thomas walked into Miss Seawall’s ninth grade algebra class on a rainy, September day and smiled at me with his amazing grin, long brown hair, big green eyes and Jimi Hendrix T-shirt, I was completely unprepared for the avalanche of emotions that invaded every fiber of my being. Shivers, a pounding heart, and heat overcame me when he asked if I knew the value of 1,000 to the 25th power. The only answer I could think of, as I fumbled over my words, was “love me, love me,” but I managed to blurt out “1E+75.” I wanted to come across as smart and aloof, but every time he looked at me, I started stuttering and sweating as my face turned bright red. No one had ever looked at me like that: as if he knew me, as if he knew how lost I was and how badly I needed to be loved.

Hank, who was a year older than me, was very popular and accomplished. Unlike other boys who were popular for their looks or athletic skills, Hank was smart and talented. He played piano and guitar, and composed the most beautiful classical and rock concertos that left both teachers and students in awe.

Unlike Hank, I had not quite come into my own yet. I was shy, had raggedy messy hair that I tied back into braids, and my clothes were far from stylish. My mother and sister had been on the road touring for the past year with the Broadway show “Annie.” My sister had been cast as a principal orphan, and I stayed home with my dad to attend high school. My dad was always busy with work and martini dinners that lasted late into the night. I spent most of my evenings at home alone baking and making care packages for my sister instead of coercing my parents to buy me the latest selection of Gloria Vanderbilt jeans — the rich colored bluejeans with the swan stitched on the back pocket that you had to lie on your bed to zip up. It was the icon of cool for the popular and pretty girls. I was neither, but Hank picked me to be his math partner anyway.

With every equation we solved, my love for Hank became more desperate. After several months of exchanging smiles, I decided to make Hank a batch of my chocolate brownies for Valentine’s Day — the brownies that my dad said were like his own personal nirvana. My dad named them “closet” brownies, because when I was a little girl and used to make them for the family, he said that as soon as he smelled them coming out of the oven, he could imagine dashing away with them into the closet and devouring the whole batch.

After debating for hours if I should make the brownies with walnuts or chips, or fill the centers with peanut butter or caramel, I got to work. I had made brownies hundreds of times before, but this time felt different. With each ingredient I carefully stirred into the bowl, my heart began beating harder. I felt like I was going to burst from excitement. Surely, after Hank tasted these, he would love me as much as I loved him. I was not just making him brownies. I was showing him who I was, and what mattered to me. After the brownies cooled, I sprinkled them with a touch of powdered sugar and wrapped them with foil and red tissue paper. The next day I placed them in Hank’s locker, with a note saying, “Call me.”

After seven excruciating days with no call, some smiles and the usual small talk in math class, I conjured up the nerve to ask Hank if he liked my brownies.

“The brownies were from you?” he asked. “They were delicious.”

Then Hank invited me to a party at his house the following weekend. Without hesitation, I responded that I would love to come. I pleaded with my friend Sarah to accompany me.

As the day grew closer, I made my grandmother Beauty’s homemade fudge — the chocolate fudge she made for Papa the night before he proposed to her. Stirring the milk, butter and sugar together eased my nerves. I had never been to a high school party before, and I didn’t know what to expect. Sarah advised me to ditch the braids as she styled my hair, used a violet eyeliner and lent me her favorite V-neck sweater and a pair of her best Gloria Vanderbilt jeans.

When we walked in the door, fudge in hand, Hank was nowhere to be found. Thinking I had made a mistake for coming and getting ready to leave, I felt a hand on my back. It was Hank’s. He hugged me and told me he was glad I finally arrived. When Hank put his arm around me, nothing else existed. With a little help from Cupid or the magic of Beauty’s recipes, I found love.


Fat Dad’s ‘Closet’ Brownies

These brownies are more like fudge than cake and contain a fraction of the flour found in traditional brownie recipes. My father called them “closet” brownies, because when he smelled them coming out of the oven he could imagine hiding in the closet to eat the whole batch. I baked them in the ninth grade for a boy that I had a crush on, and they were more effective than Cupid’s arrow at winning his heart.

6 tablespoons unsalted butter, plus extra for greasing the pan
8 ounces bittersweet chocolate, chopped, or semisweet chocolate chips
3/4 cup brown sugar
2 eggs at room temperature, beaten
1 teaspoon vanilla extract
1/4 cup flour
1/2 cup chopped walnuts (optional)
Fresh berries or powdered sugar for garnish (optional)

1. Preheat oven to 350 degrees.

2. Grease an 8-inch square baking dish.

3. In a double boiler, melt chocolate. Then add butter, melt and stir to blend. Remove from heat and pour into a mixing bowl. Stir in sugar, eggs and vanilla and mix well.

4. Add flour. Mix well until very smooth. Add chopped walnuts if desired. Pour batter into greased baking pan.

5. Bake for 35 minutes, or until set and barely firm in the middle. Allow to cool on a rack before removing from pan. Optional: garnish with powdered sugar, or berries, or both.

Yield: 16 brownies


Dawn Lerman is a New York-based health and nutrition consultant and founder of Magnificent Mommies, which provides school lectures, cooking classes and workshops. Her series on growing up with a fat father appears occasionally on Well.

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At G-20 meeting, officials seek to quell talk of 'currency war'









WASHINGTON -- Top finance officials and central bankers representing the Group of 20 largest economies are gathering in Moscow, and one of their chief concerns this weekend is how to defuse a brewing currency war, or at least the increasing talk of one.


Since Japan’s Shinzo Abe government began jawboning last fall about the yen being too expensive and pressuring its central bank to pursue more stimulative monetary policy, the Japanese currency has fallen sharply against the dollar and some other major currencies. That has triggered a fresh round of debate about currency manipulation and competitive devaluation. A cheaper currency tends to help a country’s exporters sell their goods abroad.


For years the U.S. and some other developed nations complained about China's currency policy. Beijing tightly controls the yuan, whereas the yen, dollar and euro are traded freely in international markets. More recently, though, the tables have turned somewhat at the G-20, made up of the largest developed and developing countries in the world.





As the Federal Reserve and some other central banks of struggling advanced economies have pumped more money into their financial systems, the result has been a weakening of their currencies. That hasn’t sat well with countries such as Brazil seeing jumps in their currencies' values and inflationary pressures from cheaper imported goods.


Fed Chairman Ben S. Bernanke, in brief remarks at a meeting Friday in Moscow, didn’t wade into the currency debate. But his comments made clear he sees a difference between a deliberate attempt to weaken one’s currency and a byproduct of actions taken to help one’s domestic economy. The Fed is now engaged in its third round of major asset purchases, buying $85 billion worth of Treasury and mortgage-backed securities a month, in addition to keeping short-term rates near zero.


“With unemployment at almost 8%, we are still far from the fully healthy and vibrant conditions that we would like to see,” Bernanke said, according to Bloomberg News. “The United States is using domestic policy tools to advance domestic objectives.” The Fed chief added: “We believe that by strengthening the U.S. economy we are helping to strengthen the global economy as well.”


At the G-20 meeting this weekend, top finance officials are expected to issue a joint statement addressing currency policies as well as concerns about excessive tightening of fiscal budgets.


“G-20 members will have to bring their exchange rate frameworks into alignment so that we grow together and avoid a downward spiral or beggar-thy-neighbor policies," said Lael Brainard, the Treasury Department’s undersecretary for international affairs.


Analysts, though, doubted that the G-20 could come up with rules that have teeth. More likely, they said, the statement will probably affirm that monetary policy should be aimed at domestic economic growth and inflation considerations, not targeted at exchange rates.


“Everybody is in one way or another complicit in this,” said Guy de Jonquieres, a senior fellow at the European Center for International Political Economy, referring to sovereign nations undertaking monetary policies to support their domestic economies and interests. “What I don’t see happening here is a real attempt to coordinate policy here.”


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Oscar Pistorius remains in jail facing murder charge









JOHANNESBURG, South Africa -- South African athlete Oscar Pistorius, who made history last year as the first double amputee runner to compete in the Olympics using prosthetic blades, will spend the night in jail Thursday after he was charged with murder in the death of his girlfriend at his house, prosecutors said.


The National Prosecuting Authority said Pistorius would remain in custody until his hearing Friday, when police intend to oppose bail.


Reeva Steenkamp, a 30-year-old model, died after being shot several times in the head and arm in Pistorius’ house in an upscale suburb in Pretoria.








PHOTOS: Pistorius in the London Olympics


Pistorius was ushered from the home by police Thursday morning with a gray hoodie covering his head and obscuring most of his face.


South Africans were in shock about the accusation against Pistorius, who became a hero during his long battle for the right to compete in the Olympics. After a controversy on whether the blades he uses to walk and run gave him an advantage in races, Pistorius was granted the right to compete in the London 2012 Olympic Games.


South Africa has one of the world's highest rates of murder and violent crime, and many South Africans keep guns at home to guard against intruders.


The Afrikaans-language newspaper Beeld suggested that Pistorius mistook his girlfriend for a burglar and killed her accidentally.


However, a police spokeswoman, Brig. Denise Beukes, said police were “surprised” at reports the killing was accidental, adding that that version hadn’t come from police, according to the South African Press Assn.


"I confirm there had been previous incidents of a domestic nature at his place,” said Beukes, adding that police couldn’t comment on the decision to oppose bail.


Beukes said police had interviewed neighbors who heard sounds at Pistorius’ home earlier in the evening, and also at the time the incident reportedly took place.


Pistorius’ father, Henke Pistorius, said his son was sad. But the older Pistorius said he didn’t know the facts.


“I don’t know nothing. It will be extremely obnoxious and rude to speculate,” he said in a radio interview. “If anyone makes a statement, it will have to be Oscar.”


An advertisement for Nike, one of Pistorius’ major sponsors, was removed from his official website Thursday. It had shown the athlete in a green lycra athletic suit and the slogan, “I am the bullet in the chamber."


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'Melrose' actress gets 3 years for deadly NJ crash


SOMERVILLE, N.J. (AP) — A former "Melrose Place" actress who was drunk when her SUV plowed into a car and killed a woman was sentenced Thursday to three years in prison, infuriating the victim's family who had hoped for the 10-year maximum.


"What a travesty!" the victim's husband, Fred Seeman, yelled after the sentence was read.


"This is not justice," the victim's 26-year-old son, Ford Seeman, told the judge before he stormed out of the courtroom.


A jury in November convicted Amy Locane-Bovenizer of vehicular homicide in the 2010 death of 60-year-old Helene Seeman in Montgomery Township.


Locane-Bovenizer will be eligible for parole after 2 1/2 years and will be credited the 81 days she has already served. She also had her license suspended for five years and will be on probation for three years after her release. She must pay several thousand dollars in fines.


Locane-Bovenizer, who didn't testify at the trial, appeared in 13 episodes of TV's "Melrose Place" and in movies including "Cry-Baby," ''School Ties" and "Secretary."


Prosecutors say she was driving with a blood-alcohol level nearly three times the legal limit when her SUV slammed into a Mercury Milan driven by Fred Seeman as he was turning into his driveway. Fred Seeman's wife, Helene, was killed, and he was seriously injured.


During the trial, the defense argued that Fred Seeman was making a slow turn, which contributed to the crash. They maintained that it was an accident, not a crime.


The defense also shifted blame to a third motorist who they say distracted the actress by honking at her and chasing her after being rear-ended. They said the chase led Locane-Bovenizer to drive 20 miles over the speed limit on a dark two-lane road.


The judge lowered the maximum sentence citing the hardship on Locane-Bovenizer's two young children. One has a serious medical and mental disability. The defense went into detail about how her sick child was deteriorating physically and psychologically since the actress' incarceration and about how a prolonged sentence would make it worse.


"I'm just glad her little girls will have their mother back soon," Locane-Bovenizer's mother, Helen Locane, said as she walked out of the courtroom.


In an emotionally charged statement, Fred Seeman told the court that the defense contention that his vehicle was turning slowly added "salt on the wound," and he said he was appalled that Locane-Bovenizer took no responsibility for killing his wife.


The actress, in turn, apologized to Seeman's family and said she did take full responsibility.


"I am truly sorry for all of the pain I have caused," she said, struggling to get through her statement, as she looked toward the family that packed one side of the courtroom while her friends and family packed the other. "My own suffering will never go away."


Judge Robert Reed said that he had no sympathy for the actress but that the children should not suffer even more because of her actions.


The Seeman family said after the sentencing that the decision was a "mockery" and only added to the suffering they've endured since the accident.


"What's one more punch in the gut?" Ford Seeman said.


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Doctor and Patient: Afraid to Speak Up to Medical Power

The slender, weather-beaten, elderly Polish immigrant had been diagnosed with lung cancer nearly a year earlier and was receiving chemotherapy as part of a clinical trial. I was a surgical consultant, called in to help control the fluid that kept accumulating in his lungs.

During one visit, he motioned for me to come closer. His voice was hoarse from a tumor that spread, and the constant hissing from his humidified oxygen mask meant I had to press my face nearly against his to understand his words.

“This is getting harder, doctor,” he rasped. “I’m not sure I’m up to anymore chemo.”

I was not the only doctor that he confided to. But what I quickly learned was that none of us was eager to broach the topic of stopping treatment with his primary cancer doctor.

That doctor was a rising superstar in the world of oncology, a brilliant physician-researcher who had helped discover treatments for other cancers and who had been recruited to lead our hospital’s then lackluster cancer center. Within a few months of the doctor’s arrival, the once sleepy department began offering a dazzling array of experimental drugs. Calls came in from outside doctors eager to send their patients in for treatment, and every patient who was seen was promptly enrolled in one of more than a dozen well-documented treatment protocols.

But now, no doctors felt comfortable suggesting anything but the most cutting-edge, aggressive treatments.

Even the No. 2 doctor in the cancer center, Robin to the chief’s cancer-battling Batman, was momentarily taken aback when I suggested we reconsider the patient’s chemotherapy plan. “I don’t want to tell him,” he said, eyes widening. He reeled off his chief’s vast accomplishments. “I mean, who am I to tell him what to do?”

We stood for a moment in silence before he pointed his index finger at me. “You tell him,” he said with a smile. “You tell him to consider stopping treatment.”

Memories of this conversation came flooding back last week when I read an essay on the problems posed by hierarchies within the medical profession.

For several decades, medical educators and sociologists have documented the existence of hierarchies and an intense awareness of rank among doctors. The bulk of studies have focused on medical education, a process often likened to military and religious training, with elder patriarchs imposing the hair shirt of shame on acolytes unable to incorporate a profession’s accepted values and behaviors. Aspiring doctors quickly learn whose opinions, experiences and voices count, and it is rarely their own. Ask a group of interns who’ve been on the wards for but a week, and they will quickly raise their hands up to the level of their heads to indicate their teachers’ status and importance, then lower them toward their feet to demonstrate their own.

It turns out that this keen awareness of ranking is not limited to students and interns. Other research has shown that fully trained physicians are acutely aware of a tacit professional hierarchy based on specialties, like primary care versus neurosurgery, or even on diseases different specialists might treat, like hemorrhoids and constipation versus heart attacks and certain cancers.

But while such professional preoccupation with privilege can make for interesting sociological fodder, the real issue, warns the author of a courageous essay published recently in The New England Journal of Medicine, is that such an overly developed sense of hierarchy comes at an unacceptable price: good patient care.

Dr. Ranjana Srivastava, a medical oncologist at the Monash Medical Centre in Melbourne, Australia, recalls a patient she helped to care for who died after an operation. Before the surgery, Dr. Srivastava had been hesitant to voice her concerns, assuming that the patient’s surgeon must be “unequivocally right, unassailable, or simply not worth antagonizing.” When she confesses her earlier uncertainty to the surgeon after the patient’s death, Dr. Srivastava learns that the surgeon had been just as loath to question her expertise and had assumed that her silence before the surgery meant she agreed with his plan to operate.

“Each of us was trying our best to help a patient, but we were also respecting the boundaries and hierarchy imposed by our professional culture,” Dr. Srivastava said. “The tragedy was that the patient died, when speaking up would have made all the difference.”

Compounding the problem is an increasing sense of self-doubt among many doctors. With rapid advances in treatment, there is often no single correct “answer” for a patient’s problem, and doctors, struggling to stay up-to-date in their own particular specialty niches, are more tentative about making suggestions that cross over to other doctors’ “turf.” Even as some clinicians attempt to compensate by organizing multidisciplinary meetings, inviting doctors from all specialties to discuss a patient’s therapeutic options, “there will inevitably be a hierarchy at those meetings of who is speaking,” Dr. Srivastava noted. “And it won’t always be the ones who know the most about the patient who will be taking the lead.”

It is the potentially disastrous repercussions for patients that make this overly developed awareness of rank and boundaries a critical issue in medicine. Recent efforts to raise safety standards and improve patient care have shown that teams are a critical ingredient for success. But simply organizing multidisciplinary lineups of clinicians isn’t enough. What is required are teams that recognize the importance of all voices and encourage active and open debate.

Since their patient’s death, Dr. Srivastava and the surgeon have worked together to discuss patient cases, articulate questions and describe their own uncertainties to each other and in patients’ notes. “We have tried to remain cognizant of the fact that we are susceptible to thinking about hierarchy,” Dr. Srivastava said. “We have tried to remember that sometimes, despite our best intentions, we do not speak up for our patients because we are fearful of the consequences.”

That was certainly true for my lung cancer patient. Like all the other doctors involved in his care, I hesitated to talk to the chief medical oncologist. I questioned my own credentials, my lack of expertise in this particular area of oncology and even my own clinical judgment. When the patient appeared to fare better, requiring less oxygen and joking and laughing more than I had ever seen in the past, I took his improvement to be yet another sign that my attempt to talk about holding back chemotherapy was surely some surgical folly.

But a couple of days later, the humidified oxygen mask came back on. And not long after that, the patient again asked for me to come close.

This time he said: “I’m tired. I want to stop the chemo.”

Just before he died, a little over a week later, he was off all treatment except for what might make him comfortable. He thanked me and the other doctors for our care, but really, we should have thanked him and apologized. Because he had pushed us out of our comfortable, well-delineated professional zones. He had prodded us to talk to one another. And he showed us how to work as a team in order to do, at last, what we should have done weeks earlier.

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Dorner manhunt: Investigators work to ID charred human remains









After what LAPD Chief Charlie Beck called "a bittersweet night," investigators Wednesday were in the process of identifying the human remains found in the charred cabin where fugitive ex-cop Christopher Dorner was believed to have been holed up after trading gunfire with officers, authorities said.


If the body is identified as Dorner’s, the standoff would end a weeklong manhunt for the ex-LAPD officer and Navy Reserve lieutenant suspected in a string of shootings following his firing by the Los Angeles Police Department several years ago. Four people have died in the case, allegedly at Dorner’s hands.


Beck said he would not consider the manhunt over until the body was identified as Dorner. Police remained on tactical alert and were conducting themselves as if nothing had changed in the case, officials said.








PHOTOS: Manhunt for ex-LAPD officer


The latest burst of gunfire came Tuesday after the suspect, attempting to flee law enforcement officials, fatally shot a San Bernardino County sheriff’s deputy and seriously injured another, officials said. He then barricaded himself in a wooden cabin outside Big Bear, not far from ski resorts in the snow-capped San Bernardino Mountains east of Los Angeles, according to police.


"This could have ended much better, it could have ended worse," said Beck as he drove to the hospital where the injured deputy was located. "I feel for the family of the deputy who lost his life."


The injured deputy is expected to survive but it is anticipated he will need several surgeries. The names of the two deputies have not been released.


TIMELINE: Manhunt for ex-LAPD officer


Just before 5 p.m., authorities smashed the cabin's windows, pumped in tear gas and called for the suspect to surrender, officials said. They got no response. Then, using a demolition vehicle, they tore down the cabin's walls one by one. When they reached the last wall, they heard a gunshot. Then the cabin burst into flames, officials said.


Last week, authorities said they had tracked Dorner to a wooded area near Big Bear Lake. They found his torched gray Nissan Titan with several weapons inside, the said, and the only trace of Dorner was a short trail of footprints in newly fallen snow.


According to a manifesto that officials say Dorner posted on Facebook, he felt the LAPD unjustly fired him several years ago, when a disciplinary panel determined that he lied in accusing his training officer of kicking a mentally ill man during an arrest. Beck has promised to review the case.

DOCUMENT: Read the manifesto


The manifesto vows "unconventional and asymmetrical warfare" against law enforcement officers and their families. "Self-preservation is no longer important to me. I do not fear death as I died long ago," it said.


On Tuesday morning, two maids entered a cabin in the 1200 block of Club View Drive and ran into a man who they said resembled the fugitive, a law enforcement official said. The cabin was not far from where Dorner's singed truck had been found and where police had been holding news conferences about the manhunt.


The man tied up the maids, and he took off in a purple Nissan parked near the cabin, the official said. About 12:20 p.m., one of the maids broke free and called police.


FULL COVERAGE: Sweeping manhunt for ex-cop


Nearly half an hour later, officers with the California Department of Fish and Wildlife spotted the stolen vehicle and called for backup, authorities said. The suspect turned down a side road in an attempt to elude the officers but crashed the vehicle, police said.


A short time later, authorities said, the suspect carjacked a light-colored pickup truck. Allan Laframboise said the truck belonged to his friend Rick Heltebrake, who works at a nearby Boy Scout camp.


Heltebrake was driving on Glass Road with his Dalmatian, Suni, when a hulking African American man stepped into the road, Laframboise said. Heltebrake stopped. The man told him to get out of the truck.


INTERACTIVE MAP: Searching for suspected shooter


"Can I take my dog?" Heltebrake asked, according to his friend.





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