The Texas Tribune: Advocates Seek Mental Health Changes, Including Power to Detain

Matt Rainwaters for Texas Monthly

The Sherman grave of Andre Thomas’s victims.

SHERMAN — A worried call from his daughter’s boyfriend sent Paul Boren rushing to her apartment on the morning of March 27, 2004. He drove the eight blocks to her apartment, peering into his neighbors’ yards, searching for Andre Thomas, Laura Boren’s estranged husband.

Expanded coverage of Texas is produced by The Texas Tribune, a nonprofit news organization. To join the conversation about this article, go to texastribune.org.

For more articles on mental health and criminal justice in Texas, as well as a timeline of the Andre Thomas case: texastribune.org

Matt Rainwaters for Texas Monthly

Laura Boren

He drove past the brightly colored slides, swings and bouncy plastic animals in Fairview Park across the street from the apartment where Ms. Boren, 20, and her two children lived. He pulled into a parking spot below and immediately saw that her door was broken. As his heart raced, Mr. Boren, a white-haired giant of a man, bounded up the stairwell, calling out for his daughter.

He found her on the white carpet, smeared with blood, a gaping hole in her chest. Beside her left leg, a one-dollar bill was folded lengthwise, the radiating eye of the pyramid facing up. Mr. Boren knew she was gone.

In a panic, he rushed past the stuffed animals, dolls and plastic toys strewn along the hallway to the bedroom shared by his two grandchildren. The body of 13-month-old Leyha Hughes lay on the floor next to a blood-spattered doll nearly as big as she was.

Andre Boren, 4, lay on his back in his white children’s bed just above Leyha. He looked as if he could have been sleeping — a moment away from revealing the toothy grin that typically spread from one of his round cheeks to the other — except for the massive chest wound that matched the ones his father, Andre Thomas (the boy was also known as Andre Jr.), had inflicted on his mother and his half-sister as he tried to remove their hearts.

“You just can’t believe that it’s real,” said Sherry Boren, Laura Boren’s mother. “You’re hoping that it’s not, that it’s a dream or something, that you’re going to wake up at any minute.”

Mr. Thomas, who confessed to the murders of his wife, their son and her daughter by another man, was convicted in 2005 and sentenced to death at age 21. While awaiting trial in 2004, he gouged out one of his eyes, and in 2008 on death row, he removed the other and ate it.

At least twice in the three weeks before the crime, Mr. Thomas had sought mental health treatment, babbling illogically and threatening to commit suicide. On two occasions, staff members at the medical facilities were so worried that his psychosis made him a threat to himself or others that they sought emergency detention warrants for him.

Despite talk of suicide and bizarre biblical delusions, he was not detained for treatment. Mr. Thomas later told the police that he was convinced that Ms. Boren was the wicked Jezebel from the Bible, that his own son was the Antichrist and that Leyha was involved in an evil conspiracy with them.

He was on a mission from God, he said, to free their hearts of demons.

Hospitals do not have legal authority to detain people who voluntarily enter their facilities in search of mental health care but then decide to leave. It is one of many holes in the state’s nearly 30-year-old mental health code that advocates, police officers and judges say lawmakers need to fix. In a report last year, Texas Appleseed, a nonprofit advocacy organization, called on lawmakers to replace the existing code with one that reflects contemporary mental health needs.

“It was last fully revised in 1985, and clearly the mental health system has changed drastically since then,” said Susan Stone, a lawyer and psychiatrist who led the two-year Texas Appleseed project to study and recommend reforms to the code. Lawmakers have said that although the code may need to be revamped, it will not happen in this year’s legislative session. Such an undertaking requires legislative studies that have not been conducted. But advocates are urging legislators to make a few critical changes that they say could prevent tragedies, including giving hospitals the right to detain someone who is having a mental health crisis.

From the time Mr. Thomas was 10, he had told friends he heard demons in his head instructing him to do bad things. The cacophony drove him to attempt suicide repeatedly as an adolescent, according to court records. He drank and abused drugs to try to quiet the noise.

bgrissom@texastribune.org

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Promise, peril seen for crowd-funding investors

Crowd funding is widely seen as a revolutionary idea.

A 2012 federal law known as the JOBS Act opens the door to allowing small, privately owned businesses to market ownership stakes in their ventures to people over the Internet.

Companies will be able to sell up to $1 million in equity a year to ordinary investors without having to register the offering with the Securities and Exchange Commission or state regulators.

Before the average person can use crowd funding to stake a claim in a startup, the SEC still must draft rules that the Obama administration hopes will result in U.S. businesses growing and adding jobs. At the same time, the securities cop needs to include safeguards that protect less sophisticated individual investors drawn to inherently risky startups.

That's why equity crowd funding under JOBS, or Jumpstart our Business Startups, has some longtime regulators and securities lawyers squirming.

"It can be an invitation for fraudsters to steal money," Matthew Brown, a Katten Muchin Rosenman lawyer, said last month at a CFA Society of Chicago event at 1871, a center for digital startups in Chicago.

But Brown also noted that equity crowd funding also democratizes small-business financing, a process that historically has given access mostly to wealthier — or, as they're known in high-finance circles, "accredited" — investors.

"The world has changed dramatically, and who's to say who is smarter than anyone else?" Brown added.

Many existing crowd-funding platforms such as Kickstarter don't sell equity stakes in businesses to average investors. Rather, they give consumers the chance to donate money to an enterprise or to get an early or discounted crack at a new product. Since Kickstarter's launch in April 2009, more than $450 million has been pledged by more than 3 million people funding more than 35,000 projects, the New York-based company's website says.

Their acceptance suggests that consumers are willing to engage with companies on a deeper level. As such, enabling unaccredited consumers to invest in companies in small increments online has promise and could become part of the fundraising "ecosystem," says one Chicago entrepreneur.

Abe's Market, a Chicago-based e-commerce site selling natural and organic products from more than 1,000 suppliers, said it would consider crowd funding under the JOBS Act, saying it and its vendors have "die-hard fans" and "a core group of customers" who might like to invest in their vision.

Last month, Abe's raised $5 million from Carmel Ventures, Index Ventures, Beringea and Accel Partners, a Groupon backer. New backers include OurCrowd, a crowd-funding site for accredited investors.

"If you can get passionate people to invest in your business, you're not just gaining investors, you're gaining evangelists," Abe's Chief Executive Richard Demb said. "The challenge for any consumer brand is: How do you find not just customers, but the right customers who are going to tell their friends?"

But there would also be potential headaches for companies raising equity financing through crowd funding, he said.

"You have to make sure that expectations would be set fairly, that no one is putting their life savings into the investment, and that they don't also come back and become a challenge to manage as the business grows," Demb said. "You don't want someone who invested $250 to come back and say, 'I don't think we should expand to the West Coast.'"

Safeguards for average investors exist in the JOBS Act. They include capping nonaccredited individuals' crowd-funding investments at $2,000, or 5 percent of annual income or net worth of less than $100,000, whichever is greater.

Snapclass, launched a few weeks ago at 1871, provides software enabling businesses to provide training online. Co-founder Scott Mandel, who has financed the company himself, doesn't expect to take advantage of equity crowd funding in the future and instead would seek, say, venture capital funding.

"Not all checks are the same," said Mandel, previously a trader and professional poker player. "I'd want someone who could add more than just the cash, such as connections and experience and help with things that I'm not an expert in."

One of 1871's fastest-growing startups is MarkITx. It recently raised $1.2 million from wealthy individuals in its first fundraising round, has seven employees and is looking to add sales jobs. It's an online exchange for businesses wanting to buy and sell used information technology equipment, from iPads to Oracle servers.

"For us, it wouldn't be the sole way to raise money, but it definitely is a viable vehicle to look at raising money," MarkITx partner Marc Brooks said of equity crowd funding under the JOBS Act.

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Charges filed in slaying of Clemente High School student

Authorities filed charges against a 34-year-old man in connection with the shooting death of an 18-year-old Clemente High School student killed on the West Side last week.

Larry Luellen Jr., 34, was charged with first degree murder in the death of Frances Colon. Luellen is due in court today.

Luellen lives in the 3900 block of West Division Street in West Humboldt Park, around the corner from where Colon was shot. Police don't believe she was the target.

Colon is the third student at Roberto Clemente to be killed this school year, according to the school's principal Marcey Sorensen.

Rey Dorantes, 14, of the 2400 block of West Augusta Boulevard, was shot and killed on Jan. 11. His death came about a month after another Clemente student, 16-year-old Jeffrey Stewart, of the 5200 block of West Race Avenue, was shot and killed on Dec. 9.

Colon was a senior who was preparing to attend college. Hours before the shooting, she had watched President Barack Obama speak at Hyde Park Academy on the South Side about gun violence, according to her father.

Check back for more information.

pnickeas@tribune.com
Twitter: @peternickeas

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Drone Pilots Found to Get Stress Disorders Much as Those in Combat Do

U.S. Air Force/Master Sgt. Steve Horton

Capt. Richard Koll, left, and Airman First Class Mike Eulo monitored a drone aircraft after launching it in Iraq.

The study affirms a growing body of research finding health hazards even for those piloting machines from bases far from actual combat zones.

“Though it might be thousands of miles from the battlefield, this work still involves tough stressors and has tough consequences for those crews,” said Peter W. Singer, a scholar at the Brookings Institution who has written extensively about drones. He was not involved in the new research.

That study, by the Armed Forces Health Surveillance Center, which analyzes health trends among military personnel, did not try to explain the sources of mental health problems among drone pilots.

But Air Force officials and independent experts have suggested several potential causes, among them witnessing combat violence on live video feeds, working in isolation or under inflexible shift hours, juggling the simultaneous demands of home life with combat operations and dealing with intense stress because of crew shortages.

“Remotely piloted aircraft pilots may stare at the same piece of ground for days,” said Jean Lin Otto, an epidemiologist who was a co-author of the study. “They witness the carnage. Manned aircraft pilots don’t do that. They get out of there as soon as possible.”

Dr. Otto said she had begun the study expecting that drone pilots would actually have a higher rate of mental health problems because of the unique pressures of their job.

Since 2008, the number of pilots of remotely piloted aircraft — the Air Force’s preferred term for drones — has grown fourfold, to nearly 1,300. The Air Force is now training more pilots for its drones than for its fighter jets and bombers combined. And by 2015, it expects to have more drone pilots than bomber pilots, although fighter pilots will remain a larger group.

Those figures do not include drones operated by the C.I.A. in counterterrorism operations over Pakistan, Yemen and other countries.

The Pentagon has begun taking steps to keep pace with the rapid expansion of drone operations. It recently created a new medal to honor troops involved in both drone warfare and cyberwarfare. And the Air Force has expanded access to chaplains and therapists for drone operators, said Col. William M. Tart, who commanded remotely piloted aircraft crews at Creech Air Force Base in Nevada.

The Air Force has also conducted research into the health issues of drone crew members. In a 2011 survey of nearly 840 drone operators, it found that 46 percent of Reaper and Predator pilots, and 48 percent of Global Hawk sensor operators, reported “high operational stress.” Those crews cited long hours and frequent shift changes as major causes.

That study found the stress among drone operators to be much higher than that reported by Air Force members in logistics or support jobs. But it did not compare the stress levels of the drone operators with those of traditional pilots.

The new study looked at the electronic health records of 709 drone pilots and 5,256 manned aircraft pilots between October 2003 and December 2011. Those records included information about clinical diagnoses by medical professionals and not just self-reported symptoms.

After analyzing diagnosis and treatment records, the researchers initially found that the drone pilots had higher incidence rates for 12 conditions, including anxiety disorder, depressive disorder, post-traumatic stress disorder, substance abuse and suicidal ideation.

But after the data were adjusted for age, number of deployments, time in service and history of previous mental health problems, the rates were similar, said Dr. Otto, who was scheduled to present her findings in Arizona on Saturday at a conference of the American College of Preventive Medicine.

The study also found that the incidence rates of mental heath problems among drone pilots spiked in 2009. Dr. Otto speculated that the increase might have been the result of intense pressure on pilots during the Iraq surge in the preceding years.

The study found that pilots of both manned and unmanned aircraft had lower rates of mental health problems than other Air Force personnel. But Dr. Otto conceded that her study might underestimate problems among both manned and unmanned aircraft pilots, who may feel pressure not to report mental health symptoms to doctors out of fears that they will be grounded.

She said she planned to conduct two follow-up studies: one that tries to compensate for possible underreporting of mental health problems by pilots and another that analyzes mental health issues among sensor operators, who control drone cameras while sitting next to the pilots.

“The increasing use of remotely piloted aircraft for war fighting as well as humanitarian relief should prompt increased surveillance,” she said.

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16 airport investors show interest in Midway

An international array of airport investors and operators have shown interest in developing bids to privatize Midway Airport, the city announced Friday evening.

Sixteen parties responded to the city's "request for qualifications" by a 4 p.m. deadline, indicating they had interest in leasing, operating and improving the Southwest Side airport, the nation's 26th busiest, with about 9 million passengers passing through annually.

"The response generated from the  ... process is encouraging and provides the city with a sense of the strong level of interest in a potential lease," said Lois Scott, the city's chief financial officer. "We must evaluate fully if this could be a win for Chicagoans."

The city and its advisers will review the responses to identify qualified potential bidders.

Of the 16, seven had both the operational and financial capabilities sought in the RFQ. The city identified them as:

-- ACO Investment Group, an investor and operator with global airport experience.

-- AMP Capital Investors Limited, a manager and investor in airports, including Melbourne Airport in Australia and Newcastle Airport, in Britain.

--  Corporacion America Group, an Argentina-based airport operator with 49 airports in seven countries.

-- Global Infrastructure Partners (GIP), which is the controlling investor and active manager of London City Airport, London Gatwick Airport and Edinburgh Airport.

--Great Lakes Airport Alliance, which is a partnership of Macquarie Infrastructure and Real Assets and Ferrovial. Its airport operations include London's Heathrow, Brussels Airport and Copenhagen Airport.

-- Incheon International Airport and Hastings Funds Management, which is the sole owner and operator of Incheon International Airport in South Korea and an investor with 16 airport-related investments.

--  Industry Funds Management and Manchester Airport Group, an investor with interests in 13 airports, including Melbourne Airport and Brisbane Airport, both in Australia, and operator of Manchester Airport and East Midlands Airport, in Britain.

If the city moves forward and seeks proposals, a privatization plan could be submitted to the City Council this summer.

This is the second time Chicago has looked at privatizing Midway. A 99-year lease that would have brought in $2.5 billion died in 2009 when the financial markets froze. That deal had drawn six serious bidders.

Mayor Rahm Emanuel has said any second attempt would have to provide city taxpayers with a better deal than the widely criticized 75-year agreement to privatize parking meter operations, carried out during former Mayor Richard Daley's administration. Proceeds from the earlier deal were used to plug operating deficits, and meter rates rose sharply.

This time, proposed leases must be less than 40 years, which locks in the city for a shorter period.

Rather than making only an upfront payment, the private operator also must share revenue with the city on an ongoing basis. Initial proceeds would be used to pay down debt issued since 1996 to rebuild the airport, the mayor's office said. There is about $1.4 billion in outstanding debt.

Longer term, cash flow would be directed to city infrastructure needs. The mayor has pledged proceeds would not be used to pay for city operations.

kbergen@tribune.com

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Court to Madigan: No rehearing on concealed-carry guns ruling

SPRINGFIELD — A divided federal appeals court today rejected Illinois Attorney General Lisa Madigan’s request for a rehearing on the case where the state has been ordered to allow citizens to carry guns in public.

Madigan made the request following the U.S. Seventh Circuit Court of Appeals decision in December that gave Illinois 180 days to put together a law that would allow concealed weapons in Illinois.

There has been no word yet from Madigan’s office on her next move. She could choose to appeal to the U.S. Supreme Court or decide to let the ruling stand.

The appeals court action officially rejected Madigan’s request for a rehearing by the full court, but the denial came with a stinging dissent from four of the nine members of the appeals court who reviewed the matter. The original order came down from a three-member panel that also had a split vote.

The arguments made in the dissent, written by Judge David Hamilton, could bolster Madigan’s cause if she appeals to the nation’s high court.

“The Supreme Court has not yet decided whether .. the individual right to keep and bear arms at home under the Second Amendment extends beyond the home,” Hamilton wrote.

Illinois is the only state in the nation that does not allow citizens to carry weapons in public in some form.

Hamilton’s dissent also noted the ruling that called for Illinois to allow concealed carry is the “first decision by a federal court of appeals striking down legislation restricting the carrying of arms in public.”

He wrote that three major points are worthy of consideration by the full appellate court rather than simply the three-member panel:

*Whether to extend the right to bear arms outside the home and into the public sphere, a matter that “presents issues very different from those involved in the home itself, which is all the Supreme Court decided” in a case currently viewed as the law of the land.

*How to handle what the panel did not decide. The three-member panel left Illinois a “good deal of constitutional room for reasonable public safety measures concerning public carrying of firearms.”

*How to proceed in future decisions about laws that are more narrowly tailored and any state interests that justify some restrictions on rights.

“Where the law is genuinely in doubt, as it is likely to remain for some time under the Second Amendment, a trial court can do a great service by ensuring the development of a thorough and complete record that provides a reliable, accurate factual foundation for constitutional adjudication,” Hamilton wrote. “The federal courts are likely to do a better job of constitutional adjudication if our considerations are based on reliable facts rather than hypothesized and assumed facts.”

You can read the opinion HERE.

rlong@tribune.com

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United not planning on Dreamliner until June

The All Nippon Airways Dreamliner 787 arrives at Mineta San Jose International Airport. (Gary Reyes/San Jose Mercury News/MCT / January 22, 2013)

Staff and wire report

1:35 p.m. CST, February 21, 2013

The parent company of United Airlines says it is taking the Boeing 787 off its schedule through June 5 for all but one of its routes.

United Continental Holdings Inc. said it still plans to use the 787 on its flights between Denver and Tokyo's Narita airport starting May 12. It had aimed to start that route on March 31.

United, currently world's largest airline and the only U.S. customer for the 787, said the timing of that reinstatement will depend on resolution of the Dreamliner's current issues.

The 50 Dreamliners in commercial service were grounded worldwide last month after a series of battery-related incidents including a fire on board a parked plane in the United States and an in-flight problem on another jet in Japan. United had only been flying the plance since November.

Sources told Reuters earlier this week that Boeing Co. has found a way to fix the battery problems that involves increasing the space between the lithium ion battery cells.

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Major snowstorm bearing down on Chicago region

A winter storm that is walloping the Great Plains will hit the Chicago area tonight and linger through the morning commute on Friday, possibly dumping up to half a foot of snow here.

A winter weather advisory has been issued for the Chicago area from 9 p.m. Thursday until 6 p.m. Friday,  with snow falling at a rate of an inch per hour overnight in some places and winds blowing at 25 to 30 miles per hour, according to the National Weather Service.

The snow will change over to freezing drizzle Friday morning, the weather service said.

Anywhere from 3 to 7 inches could fall here, but up to 16 inches are expected in Kansas and Nebraska, states expected to bear the brunt of the storm that has already closed schools, scuttled air travel and cut off power to some communities.

The storm could be the worst to hit the Midwest since a storm dumped 1 to 2 feet of snow from central Oklahoma to the lower Great Lakes and central New England between Jan. 31 to Feb. 2, 2011. The storm spawned the infamous Groundhog Day Blizzard that buried Chicago in 20.2 inches of snow.

Winter storm warnings and advisories are in place for much of the central and southern Plains and into the upper Midwest and Mississippi River Valley as the storm moves east, packing snow, sleet and freezing rain, the National Weather Service said.

Ice storm warnings were in effect for parts of northern Arkansas. The massive storm was expected to unleash thunderstorms and rain on its southern edge from eastern Texas to Georgia, the forecaster said.

Missouri Gov. Jay Nixon declared a state of emergency because of hazardous travel and possible power outages. Kansas Gov. Sam Brownback ordered state offices closed because of the storm.

Kansas City encountered an unusual mixture of snow, thunder and lightning, with 2 to 3 inches of snow falling per hour.

"When there is thunder and lightning, it's a pretty screaming clue that you are going to have massive snowfall," said Andy Bailey, a meteorologist with the National Weather Service in Pleasant Hill, Mo. A foot of snow is likely there by Thursday afternoon, he said.

In Nebraska, a woman was killed in a two-car Interstate 80 accident Wednesday afternoon near Giltner. The victim was identified as Kristina Leigh Allen, 19, of Calloway, Neb. The Nebraska State Patrol said weather was a factor.

More than 90 percent of flights out of Kansas City International Airport were canceled Thursday morning, according the airport website.

Some 55 commuter flights were canceled out of Denver International Airport overnight, mostly due to adverse conditions in Midwestern destinations in Kansas and Nebraska, said spokeswoman Laura Coale.

About 30 flights in and out of Omaha's Eppley Airfield were canceled by mid-morning Thursday.

The brunt of the snowstorm churned through Kansas, causing scores of accidents and vehicles sliding off roads, but no fatalities, according to the state highway patrol. Two semi-trucks got stuck on Interstate 35 near Emporia, Kansas, closing the southbound lane Thursday morning, according to transportation officials.

"Most of the issues we are dealing with are people getting stuck in the snow on ramps when they go to exit," said Gary Warner of the Kansas Highway Patrol office in Wichita. Snow on Wednesday resulted in about 50 crashes with no injuries and 11 with injuries on Wichita area highways, he said.

Some parts of southeast Kansas reported power outages because warmer temperatures created sleet and ice on power lines, said Sharon Watson, spokesperson for Kansas emergency management services.

The snowstorm had been predicted well in advance, prompting schools and offices to close and keeping a lot of people off the roads, said Watson.

In Oklahoma, up to 12.5 inches of snow fell in northern parts of the state while schools were closed throughout the Oklahoma City area because of treacherous driving conditions.

Areas of southwest and central Nebraska received 8 inches of snow overnight, according to the National Weather Service. Snowfall of 3 to 4 inches was widespread in central Nebraska.

Omaha and Lincoln in eastern Nebraska were bracing for about 8 or more inches of snow.

Even as students were making their way to school this morning in Iowa, administrators in dozens of districts announced early dismissals.

Few of the 150 members of the Iowa General Assembly were in the state capitol in Des Moines this morning, deciding not to brave the weather.

Snow from the powerful storm fell as far south as Tucson, Ariz. on Wednesday. The rare snowfall halted play at the World Golf Championships-Accenture Match Play tournament near Tucson.

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Well: Getting Patients to Think About Costs

A colleague and I recently got into a heated discussion over health care spending. It wasn’t that he disagreed with me about the need to rein in costs; but he said he was frustrated every time he tried to do so.

Earlier that week, for example, he had tried to avoid ordering a costly M.R.I. scan for a patient who had been suffering from headaches. After a thorough examination, my colleague was convinced the headaches were the result of stress.

But the patient was not.

“She wouldn’t leave until she got that M.R.I.,” my colleague said. Even after he had explained his conclusions several times, proposed a return visit in a month to reassess the situation and ran so far overtime that his office nurse knocked on the door to make sure nothing had gone awry, the patient continued to insist on getting the expensive study.

When my colleague finally evoked cost – telling the woman that while an M.R.I. might ferret out rare causes, it didn’t make sense to spend the enormous fee on something of such marginal benefit – the woman became belligerent. “She yelled that this was her head we were talking about,” he recalled. “And expensive tests like this were the reason she had health insurance.”

Face flushed, he paused to take a deep breath. “Yeah, I may be all for controlling costs,” he finally said. “But are our patients?”

According to a new study in the journal Health Affairs, his concern about patients may not be far off the mark.

A growing number of initiatives aimed at controlling spiraling health care costs have been championed in recent years, aiming to replace the current model in which doctors are reimbursed for every office visit, test or procedure performed. These programs range from pay-for-performance, where doctors can earn more money by meeting predetermined quality “goals” like controlling patients’ blood sugar or high blood pressure, to accountable care organizations, where clinicians and hospitals in partnership are paid a lump sum to cover all care.

Their uninspired monikers aside, all of these plans share one defining feature: doctors are to be the key agents of change. Whether linked with quality measures, bundled payments or satisfaction scores, it is the doctors’ behavior and choice of treatments that result in savings, goes the thinking.

But as the new study reveals, doctors need to take into account more than just symptoms and diseases when deciding what to prescribe and offer. They must also consider their patients’ opinions and willingness to be cost conscious when it comes to their own care.

The researchers conducted more than 20 patient focus groups and asked the participants to imagine themselves with various symptoms and a choice of diagnostic and treatment options that varied only slightly in effectiveness but significantly in cost. They were asked, for example, to choose between an M.R.I. or a CT scan for a severe long-standing headache, with the M.R.I. being much more expensive but also more likely to catch some extremely rare problems.

When it came to their own treatment, “patients for the most part did not want cost to play any role in decision-making,” said Dr. Susan Dorr Goold, one of the study authors and a professor of internal medicine and health management and policy at the University of Michigan in Ann Arbor. Most did not want their doctors to take expenditures into account, and many made it clear that they would ask for the significantly more expensive medications, procedures or diagnostic studies, even if those options were only slightly better than the cheaper alternatives. “That puts doctors, whose primary responsibility is to their individual patients, in a very difficult position.”

A majority of the participants refused to consider the expenses borne by insurers or by society as a whole when making their choices. Some doubted that one individual’s efforts would have any real overall impact and so gave up considering cost-savings altogether. Others said they would go out of their way to choose the more expensive options, viewing such decisions as acts of defiance and a kind of well-deserved “payback” after years of paying insurance premiums.

Underlying all of these comments was the belief that cost was synonymous with quality. Even when the focus group leaders reminded participants that the differences between proposed options were nearly negligible, participants continued to choose the more expensive options as if it were beyond question that they must be more efficacious or foolproof.

The study’s findings are disheartening. But Dr. Goold and her co-investigators believe that public beliefs and attitudes about cost and quality can be changed. They cite the dramatic transformation in attitudes about end-of-life care as an example of how initiatives to improve understanding can lead people to make higher quality and more cost-effective decisions, like choosing hospices over hospitals.

“We need to begin to talk about these issues in a way that doesn’t turn it into a discussion pitting money against life, and we need to find ways of getting people to think about not spending money on things that offer marginal benefit” Dr. Goold said. “Because it’s going to be tough otherwise trying to implement any cost-saving measures, if patients don’t accept them.”

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Chicago home sales up 32% from last year

The inventory of homes available for sale in the Chicago area continued to be whittled down in January but prices were relatively flat from a year ago.

The Illinois Association of Realtors said Thursday that 6,244 existing single-family homes and condos were sold in the nine-county Chicago area last month, a 36.8 percent year-over-year gain. The median price of a home sold last month was $141,000, up 0.7 percent from $140,000 in January 2012.

Pricing gains were more impressive within the city of Chicago, where the median price of a home sold last month was $159,000, up 7.4 percent from a year ago. Condos fared even better, as the median price rose 8.7 percent from last year, to $202,500 in January.

The number of homes sold in Chicago last month rose 32.2 percent from its year-ago pace, to 1,485 properties sold.

Lack of inventory remains an issue and is leading to quicker sales. Within the city, for example, the number of properties listed for sale last month was down 41.6 percent from a year ago. As a result, it took an average of 78 days to sell a Chicago home last month. A year ago in January, it took an average of 89 days.

For the entire Chicago area, inventory was down almost 37 percent and market time decreased 16 percent from a year ago.

"Foreclosures continue to dampen price gains and reduce inventory levels as prospective sellers are wary of the effect these properties have on their own prospects," said Geoffrey J.D. Hewings, a University of Illinois economist, in a statement.

mepodmolik@tribune.com | Twitter @mepodmolik

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