Big Bear locked down amid manhunt









The bustling winter resort of Big Bear took on the appearance of a ghost town Thursday as surveillance aircraft buzzed overhead and police in tactical gear and carrying rifles patrolled mountain roads in convoys of SUVs, while others stood guard along major intersections.


Even before authorities had confirmed that the torched pickup truck discovered on a quiet forest road belonged to suspected gunman Christopher Dorner, 33, officials had ordered an emergency lockdown of local businesses, homes and the town's popular ski resorts. Parents were told to pick up their children from school, as rolling yellow buses might pose a target to an unpredictable fugitive on the run.


By nightfall, many residents had barricaded their doors as they prepared for a long, anxious evening.





PHOTOS: A tense manhunt amid tragic deaths


"We're all just stressed," said Andrea Burtons as she stocked up on provisions at a convenience store. "I have to go pick up my brother and get him home where we're safe."


Police ordered the lockdown about 9:30 a.m. as authorities throughout Southern California launched an immense manhunt for the former lawman, who is accused of killing three people as part of a long-standing grudge against the LAPD. Dorner is believed to have penned a long, angry manifesto on Facebook saying that he was unfairly fired from the force and was now seeking vengeance.


Forest lands surrounding Big Bear Lake are cross-hatched with fire roads and trails leading in all directions, and the snow-capped mountains can provide both cover and extreme challenges to a fugitive on foot. It was unclear whether Dorner was prepared for such rugged terrain.


Footprints were found leading from Dorner's burned pickup truck into the snow off Forest Road 2N10 and Club View Drive in Big Bear Lake.


San Bernardino County Sheriff John McMahon said that although authorities had deployed 125 officers for tracking and door-to-door searches, officers had to be mindful that the suspect may have set a trap.


"Certainly. There's always that concern and we're extremely careful and we're worried about this individual," McMahon said. "We're taking every precaution we can."


PHOTOS: A fugitive's life on Facebook


Big Bear has roughly 400 homes, but authorities guessed that only 40% are occupied year-round.


The search will probably play out with the backdrop of a winter storm that is expected to hit the area after midnight.


Up to 6 inches of snow could blanket local mountains, the National Weather Service said.


FULL COVERAGE: Sweeping manhunt for rampaging ex-cop


Gusts up to 50 mph could hit the region, said National Weather Service meteorologist Mark Moede, creating a wind-chill factor of 15 to 20 degrees.


Extra patrols were brought in to check vehicles coming and going from Big Bear, McMahon said, but no vehicles had been reported stolen.


"He could be anywhere at this point," McMahon said. When asked if the burned truck was a possible diversion, McMahon replied: "Anything's possible."


Dorner had no known connection to the area, authorities said.


Craig and Christine Winnegar, of Murrieta, found themselves caught up in the lockdown by accident. Craig brought his wife to Big Bear as a surprise to celebrate their 28th wedding anniversary. Their prearranged dinner was canceled when restaurant owners closed their doors out of fear.





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Tyler, Fleetwood push Hawaii celeb privacy bill


HONOLULU (AP) — Rock legends Steven Tyler and Mick Fleetwood have convinced a Hawaii Senate committee to approve a bill to protect celebrities or anyone else from intrusive paparazzi.


The state Senate Judiciary Committee approved the so-called Steven Tyler Act Friday after the stars testified at a hearing.


The bill would give people power to sue others who take photos or video of their private lives in an offensive way.


Tyler says he asked state Sen. Kalani English to introduce the measure after paparazzi took a photo of the Aerosmith frontman and his girlfriend in his home, causing a ripple in his family.


The former "American Idol" judge says his kids don't want to go out with him in Hawaii because of the threat of paparazzi.


Opponents say the bill limits constitutional rights.


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Well: Think Like a Doctor: A Confused and Terrified Patient

The Challenge: Can you solve the mystery of a middle-aged man recovering from a serious illness who suddenly becomes frightened and confused?

Every month the Diagnosis column of The New York Times Magazine asks Well readers to sift through a difficult case and solve a diagnostic riddle. Below you will find a summary of a case involving a 55-year-old man well on his way to recovering from a series of illnesses when he suddenly becomes confused and paranoid. I will provide you with the main medical notes, labs and imaging results available to the doctor who made the diagnosis.

The first reader to figure out this case will get a signed copy of my book, “Every Patient Tells a Story,” along with the satisfaction of knowing you solved a case of Sherlockian complexity. Good luck.

The Presenting Problem:

A 55-year-old man who is recovering from a devastating injury in a rehabilitation facility suddenly becomes confused, frightened and paranoid.

The Patient’s Story:

The patient, who was recovering from a terrible injury and was too weak to walk, had been found on the floor of his room at the extended care facility, raving that there were people out to get him. He was taken to the emergency room at the Waterbury Hospital in Connecticut, where he was diagnosed with a urinary tract infection and admitted to the hospital for treatment. Doctors thought his delirium was caused by the infection, but after 24 hours, despite receiving the appropriate antibiotics, the patient remained disoriented and frightened.

A Sister’s Visit:

The man’s sister came to visit him on his second day in the hospital. As she walked into the room she was immediately struck by her brother’s distress.

“Get me out of here!” the man shouted from his hospital bed. “They are coming to get me. I gotta get out of here!”

His brown eyes darted from side to side as if searching for his would-be attackers. His arms and legs shook with fear. He looked terrified.

For the past few months, the man had been in and out of the hospital, but he had been getting better — at least he had been improving the last time his sister saw him, the week before. She hurried into the bustling hallway and found a nurse. “What the hell is going on with my brother?” she demanded.

A Long Series of Illnesses:

Three months earlier, the patient had been admitted to that same hospital with delirium tremens. After years of alcohol abuse, he had suddenly stopped drinking a couple of days before, and his body was wracked by the sudden loss of the chemical he had become addicted to. He’d spent an entire week in the hospital but finally recovered. He was sent home, but he didn’t stay there for long.

The following week, when his sister hadn’t heard from him for a couple of days, she forced her way into his home. There she found him, unconscious, in the basement, at the bottom of his staircase. He had fallen, and it looked as if he may have been there for two, possibly three, days. He was close to death. Indeed, in the ambulance on the way to the hospital, his heart had stopped. Rapid action by the E.M.T.’s brought his heart back to life, and he made it to the hospital.

There the extent of the damage became clear. The man’s kidneys had stopped working, and his body chemistry was completely out of whack. He had a severe concussion. And he’d had a heart attack.

He remained in the intensive care unit for nearly three weeks, and in the hospital another two weeks. Even after these weeks of care and recovery, the toll of his injury was terrible. His kidneys were not working, so he required dialysis three times a week. He had needed a machine to help him breathe for so long that he now had to get oxygen through a hole that had been cut into his throat. His arms and legs were so weak that he could not even lift them, and because he was unable even to swallow, he had to be fed through a tube that went directly into his stomach.

Finally, after five weeks in the hospital, he was well enough to be moved to a short-term rehabilitation hospital to complete the long road to recovery. But he was still far from healthy. The laughing, swaggering, Harley-riding man his sister had known until that terrible fall seemed a distant memory, though she saw that he was slowly getting better. He had even started to smile and make jokes. He was confident, he had told her, that with a lot of hard work he could get back to normal. So was she; she knew he was tough.

Back to the Hospital:

The patient had been at the rehab facility for just over two weeks when the staff noticed a sudden change in him. He had stopped smiling and was no longer making jokes. Instead, he talked about people that no one else could see. And he was worried that they wanted to harm him. When he remained confused for a second day, they sent him to the emergency room.

You can see the records from that E.R. visit here.

The man told the E.R. doctor that he knew he was having hallucinations. He thought they had started when he had begun taking a pill to help him sleep a couple of days earlier. It seemed a reasonable explanation, since the medication was known to cause delirium in some people. The hospital psychiatrist took him off that medication and sent him back to rehab that evening with a different sleeping pill.

Back to the Hospital, Again:

Two days later, the patient was back in the emergency room. He was still seeing things that weren’t there, but now he was quite confused as well. He knew his name but couldn’t remember what day or month it was, or even what year. And he had no idea where he was, or where he had just come from.

When the medical team saw the patient after he had been admitted, he was unable to provide any useful medical history. His medical records outlined his earlier hospitalizations, and records from the nursing home filled in additional details. The patient had a history of high blood pressure, depression and alcoholism. He was on a long list of medications. And he had been confused for the past several days.

On examination, he had no fever, although a couple of hours earlier his temperature had been 100.0 degrees. His heart was racing, and his blood pressure was sky high. His arms and legs were weak and swollen. His legs were shaking, and his reflexes were very brisk. Indeed, when his ankle was flexed suddenly, it continued to jerk back and forth on its own three or four times before stopping, a phenomenon known as clonus.

His labs were unchanged from the previous visit except for his urine, which showed signs of a serious infection. A CT scan of the brain was unremarkable, as was a chest X-ray. He was started on an intravenous antibiotic to treat the infection. The thinking was that perhaps the infection was causing the patient’s confusion.

You can see the notes from that second hospital visit here.

His sister had come to visit him the next day, when he was as confused as he had ever been. He was now trembling all over and looked scared to death, terrified. He was certain he was being pursued.

That is when she confronted the nurse, demanding to know what was going on with her brother. The nurse didn’t know. No one did. His urinary tract infection was being treated with antibiotics, but he continued to have a rapid heart rate and elevated blood pressure, along with terrifying hallucinations.

Solving the Mystery:

Can you figure out why this man was so confused and tremulous? I have provided you with all the data available to the doctor who made the diagnosis. The case is not easy — that is why it is here. I’ll post the answer on Friday.

Friday Feb. 8 4:13 p.m. | Updated Thanks for all your responses. You can read about the winner at “Think Like a Doctor: A Confused and Terrified Patient Solved.”


Rules and Regulations: Post your questions and diagnosis in the comments section below.. The correct answer will appear Friday on Well. The winner will be contacted. Reader comments may also appear in a coming issue of The New York Times Magazine.

Correction: The patient’s eyes were brown, not blue.

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Stocks close higher; S&P 500 highest since Nov. `07












The Standard and Poor's 500 edged up to a five-year high Friday, extending a rally that started in January.

The S&P 500 rose 8.54 points to 1,517.93, closing 0.3 percent up for the week. The index is at its highest since November 2007 and has advanced for six weeks, the longest streak of gains since August.

The Dow Jones industrial average rose 48.92 points, or 0.4 percent, to 13,992.97. The Nasdaq composite climbed 28.74 points, or 0.9 percent, to finish the week at 3,193.87.

The Dow had its best January in almost two decades, and closed above 14,000 on Feb. 1 for the first time since 2007. The index is up 6.8 percent so far this year; the S&P 500 is up 6.4 percent.

A last-minute budget deal in Washington to avoid the “fiscal cliff” of tax hikes and spending cuts helped powered the rally, as did as optimism about the housing sector and gradual improvements in the jobs market.

The S&P 500 finished the week higher despite logging its biggest daily decline in almost three months Monday following worrying news from Europe.

The index fell 1.2 percent that day as bond yields in Spain and Italy rose on concern that the region's politicians will drag Europe back into crisis. European Central Bank President Mario Draghi's cautious comments about the region's economy also weighed on markets Thursday.

“Everybody seems to be saying this market needs to correct,” said Robert Pavlik, chief market strategist at Banyan Partners. “Nobody wants to be in it, but nobody wants to be out of it.”

Largely positive corporate earnings reports and a report that showed that the U.S. trade deficit narrowed sharply in December provided more fuel for the market's advance Friday.

The trade deficit fell nearly 21 percent in December from November to $38.6 billion, the smallest in nearly three years, as exports rose while oil imports plummeted. The smaller trade gap means the economy likely performed better in the final three months of last year than first reported last week.

“The trade balance was surprisingly very good,” said Phil Orlando, chief market strategist at Federated Investors.

The government estimated that the U.S. economy contracted at an annual rate of 0.1 percent in the last three months of 2012. Orlando estimates that may now be revised to growth of 0.5 percent.

Shares of LinkedIn, the online professional networking service, jumped $26.39, or 21.3 percent, to $150.40 after the company reported fourth-quarter results late Thursday that beat analysts' forecasts. AOL soared $2.31 to $33.72 after the Internet company said its quarterly revenue grew for the first time in eight years, helped by strength in worldwide advertising.

Currently, analysts are expecting earnings for the fourth quarter of 2012 to rise 6.5 percent for S&P 500 companies, according to data from S&P Capital I&Q. That's an increase from the 2.4 percent growth rate recorded for the preceding quarter.

Stocks have benefited as investors poured a net $4.1 billion into stock mutual funds since the start of the year, according to data provided by Lipper.

“I'm very encouraged by the fact, that finally, for the first time in many years, individual investors seem to be participating in this,” said David Kelly, chief global strategist at J.P. Morgan Funds.

The yield on the 10-year note, which moves inversely to its price, fell one basis point to 1.95 percent.

Trading volume was light as Wall Street braced for what is forecast to be the largest winter storm in more than a year. Up to 2 feet of snow forecast along the densely populated Interstate 95 corridor from the New York City area to Boston and beyond.

Among other stocks making big moves;

— Microchip Technology, a semiconductor maker, jumped $2.45, or 7.2 percent, to $36.39 after its earnings beat estimates. The company said it was seeing “exceptionally strong” bookings.

— Moody's slumped $3.62, or 7.7 percent, to $43.37 even after reporting that fourth-quarter net income jumped 66 percent and revenue blew away expectations. Many are expecting the ratings agency will be the next target of the Justice Department, which filed a suit against rival Standard & Poor's for its actions before the housing market collapse.

— Activision Blizzard, which makes “Call of Duty” and other video games, rose $1.35, or 11.2 percent, to $13.41. The company posted sharply higher earnings and revenue in the fourth quarter, surpassing Wall Street's expectations.

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Ex-cop at center of manhunt called 'depraved,' 'cowardly'









The fired LAPD officer suspected of terrorizing Southern California in a bloody rampage opened fire on two Riverside police officers with a rifle in a "cowardly ambush" early Thursday morning, Riverside police Chief Sergio Diaz told reporters at a morning news conference.


A 34-year-old officer who was an 11-year veteran of the department was killed in the attack. He was training a 27-year-old officer, who was shot in the upper body but survived, Diaz said. Their names were not released.


Diaz, a former Los Angeles Police Department deputy chief, said he believed the attack was random, coming less than 20 minutes after the suspect -- identified as Christopher Jordan Dorner -- had opened fire on two LAPD officers in Corona near the Magnolia Street exit ramp on Interstate 15.





PHOTOS: The Manhunt


Those officers were among 41 special details dispatched to protect LAPD officers whom Dorner, in an online manifesto, allegedly threatened to hunt down in revenge for being dismissed from the force.


"My opinion of the suspect is unprintable,'' Diaz said. "The manifesto I think speaks for itself as evidence enough of a depraved and abandoned mind and heart.''


The suspect allegedly opened fire as the Riverside officers were stopped at red light at the intersection of Magnolia Avenue and Arlington Boulevard around 1:35 p.m. Bullets pierced the patrol car's windshield, hitting both officers in the chest, Diaz said.


Law enforcement officers from agencies around the Inland Empire descended on Riverside after the shooting to assist with the manhunt. Officers tooting rifles and shotguns stood vigil outside the Riverside police station, which has been placed on "high alert.''


Diaz described the situation as surreal.


"We're hoping to wake up and find this is a bad dream,'' he said


Corona police Chief Michael Abel said the suspect opened fire on two LAPD officers after they were flagged down by a resident who recognized Dorner's Nissan Titan pickup truck. After a short pursuit, Dorner shot at the officers with a rifle, grazing one on the head. The LAPD officers returned fire but their patrol car was disabled and they could not continue the pursuit.


The LAPD officer who was shot was hospitalized and a full recovery is expected, said LAPD Dep. Chief Jose Perez. He was not identified.


Diaz's news conference, held in a Riverside police station near the Tyler Mall, was flooded with television news crews and other media.


Diaz said the department decided to delay releasing the names of the slain and wounded officers because of fears that Dorner, in his quest to hunt down police officers and their relatives, may target their families.


With the city on edge, Diaz urged parents to continue sending their children to school -- which he said was the safest place for them -- and for local businesses to stay open. There's no evidence that Dorner remained in Riverside, or that that he was targeting anyone in the city, Diaz said.


Diaz said he did not know the suspect while he was with the LAPD, and did not have any role in the grievance proceeding that led to Dorner's dismissal in 2009.


"We're going to find him. You can't have this many people looking for you and not be found,'' Diaz said.


Some schools in the area were closed.


A note posted on the Notre Dame Catholic High School website said the school was closed because of the shooting. The school is not far from the scene of the attack.


Meanwhile, a spokeswoman with the Riverside Unified School District said officials were trying to reassure parents that the district's campuses were safe and that they were working closely with authorities.

"Of course, we are being vigilant, even more extra than we normally do," said district spokeswoman Jacquie Paul.


Despite the outreach some parents have chosen to keep their children at home, she said.


PHOTOS: The Manhunt


The district oversees about 42,000 students from kindergarten through high school. She said students would be excused if their parents decided to keep them home. 


"We're very understanding of parents who are nervous, because we understand where they are coming from."


Assistant Supt. David Hansen of the Corona Norco Unified School District said some parents in his district had also kept their students home.


Hansen said all schools were operating normally. He said a automatic phone message was sent to parents telling them that officials were aware if the shootings, and to ensure them they were working closely with police.


"There's anxiety all around because this has been on the news," Hansen said.





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Afghan boys from nominated film to walk red carpet


KABUL, Afghanistan (AP) — Fawad Mohammadi has spent half his life peddling maps and dictionaries to foreigners on a street of trinket shops in Kabul. Now the 14-year-old Afghan boy with bright green eyes is getting ready for a trip down the red carpet at the Oscars.


It will also be his first time out of the country and his first time on a plane.


Mohammadi was plucked from the dingy streets of the Afghan capital to be one of the main stars of "Buzkashi Boys," a coming-of-age movie filmed entirely in a war zone and nominated in the Best Live Action Short Film category.


The movie is about two penniless young boys — a street urchin and a blacksmith's son — who are best friends and dream of becoming professional players of buzkashi, a particularly rough and dangerous game that somewhat resembles polo: Horseback riders wrangle to get a headless goat carcass into a circular goal at one end of the field.


It's also part of an American director's effort to help revive a film industry devastated by decades of civil war and by the Taliban, an Islamic fundamentalist movement that banned entertainment and burned films and theaters during its five years in power.


Sam French, a Philadelphia native who has lived in Afghanistan for about five years, said his 28-minute movie was initially conceived as a way of training local film industry workers — the first installment in his nonprofit Afghan Film Project.


"We never dreamed of having the film come this far and get an Oscar nomination," French, 36, said in a telephone interview from Los Angeles, where he is preparing for the Feb. 24 Academy Awards and raising money to fly the two young co-stars in for the ceremony.


The two boys playing the main characters — Mohammadi and Jawanmard Paiz — can barely contain their excitement about going to the Oscars.


"It will be a great honor for me and for Afghanistan to meet the world's most famous actors," said Mohammadi, whose real-life dream is to become a pilot. He's also hoping to go see the cockpit during the flight.


The farthest Mohammadi has ever traveled was to the northern Afghan city of Mazar-i-Sharif when he was younger.


Mohammadi's father died a few years ago, leaving him with his mother, five brothers and a sister. He started selling chewing gum when he was about 7 years old and soon expanded his trade to maps and dictionaries.


He learned to speak English hustling foreigners on Chicken Street, the main tourist area in Kabul with shops selling multicolor rugs, lapis bowls and other crafts and souvenirs, and gained a reputation for being polite, helpful and trustworthy. He was even able to enroll in a private school, thanks to the generosity of some other foreigners unrelated to the film project.


In the movie Mohammadi plays the blacksmith's son, Rafi, whose father wants him to follow in his footsteps.


"His life was so much harder than mine," Mohammadi said. "The blacksmith made him go out on the streets. I came myself here (to Chicken Street). My family didn't make me come. I wanted to make money to feed myself and to feed my family. He didn't have a home. They lived in the blacksmith shop."


Ironically it's not Mohammadi but Paiz, the youngest son of a well-known Afghan actor, who plays the homeless boy Ahmad.


Paiz, also 14, already was an experienced actor: He's appeared in films since the age of 5 and has gone to the Cannes Film Festival.


Paiz and Mohammadi had a lot to learn from each other and became friends. He gave Mohammadi tips for acting and handling himself in live interviews, while Fawad taught him about life outside his sheltered surroundings.


"When I saw Fawad was such a good actor even though he was a street boy and he was so brave in acting, I was very surprised and I said to myself, 'Everybody can achieve what they desire to do,'" Paiz said during an interview this week, shivering in the snow-covered courtyard of the Afghan Film Institute while a local TV series was being filmed nearby.


French, who co-wrote the script and produced "Buzkashi Boys" with Martin Roe of the Los Angeles-based production company Dirty Robber, launched a fundraising drive that's raised almost $10,000 so far to help bring the boys to Los Angeles for the ceremony. Any extra money will be placed in a fund to provide for Mohammadi's education and help his family. The boys will travel with an escort and will stay with the extended Afghan family of one of the film's producers, French said.


French said he's aware of the pitfalls in working with child actors from developing countries.


The makers of "Slumdog Millionaire," the rags-to-riches blockbuster about three poor Indian children, have struggled to make a better life for the young stars, and four boys who acted in "The Kite Runner" had to leave Afghanistan out of concern they could be ostracized or subject to violence because of a rape scene in the movie.


French said he and others involved in the "Buzkashi Boys" took pains to involve the community and made sure to avoid any scenes that could be offensive.


"We're not filmmakers who just do a film and leave. We remain there and present," he said. "We had lots and lots of tea with lots and lots of people."


The Academy of Motion Picture Arts and Sciences says there have been three documentary features nominees filmed at least in part in Afghanistan since 2007 — all about the U.S. military. The Kite Runner, which was nominated for original score in 2007, was set in Afghanistan but not filmed there.


Afghanistan had a burgeoning film industry starting in the early 20th century, but it suffered from fighting during the civil war and the Taliban campaign to stamp out entertainment. Actors and film industry workers like Paiz's father and the actor who plays the blacksmith, Wali Talash, fled the country. They returned only after the 2001 U.S.-led assault that ousted the Islamic movement and its al-Qaida allies.


Talash, 56, said he hopes the "Buzkashi Boys" will show the world the rich culture of Afghanistan, which too few in the world know beyond reports of roadside bombs and suicide attacks.


"I hope if this movie wins that it will be an earthquake that will shake the industry and help Afghan filmmakers get back on their feet," he said.


Mohammadi, meanwhile, says he knows the money and fame he earned from the movie can carry him only so far. He still sells maps, though not so often as before, because he has school.


"For my work I used to know a lot of foreigners and I still do, but before they used to know me as a map seller. Now they know me as an actor," he said, waving a plastic-covered map as weary Afghans walked by on the muddy street. "Most of them take pictures with me and sometimes they buy maps from me even if they don't need any just because they spotted me in the movie."


___


Associated Press writer Steve Loeper in Los Angeles contributed to this report.


___


Online:


Fundraising site — https://rally.org/buzkashiboys


Film website — http://www.buzkashiboys.com/


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Well: The 'Monday Morning' Medical Screaming Match

I did not think I would ever see another “morbidity and mortality” conference in which senior doctors publicly attacked their younger colleagues for making medical errors. These types of heated meetings were commonplace when I was a medical student but have largely been abandoned.

Yet here they were again on “Monday Mornings,” a new medical drama on the TNT network, based on a novel by Dr. Sanjay Gupta, CNN’s chief medical correspondent and one of the executive producers of the show. Such screaming matches may make for good television, but it is useful to review why new strategies have emerged for dealing with medical mistakes.

So-called M&M conferences emerged in the early 20th century as a way for physicians to review cases that had either surprising outcomes or had somehow gone wrong. Although the format varied among institutions and departments, surgery M&Ms were especially known for their confrontations, as more experienced surgeons often browbeat younger doctors into admitting their errors and promising to never make them again.

Such conferences were generally closed door — that is, attended only by physicians. Errors were a private matter not to be shared with other hospital staff, let alone patients and families.

But in the late 1970s, a sociology graduate student named Charles L. Bosk gained access to the surgery department at the University of Chicago. His resultant 1979 book, “Forgive and Remember,” was one of the earliest public discussions of how the medical profession addressed its mistakes.

Dr. Bosk developed a helpful terminology. Technical and judgment errors by surgeons could be forgiven, but only if they were remembered and subsequently prevented by those who committed them. Normative errors, which called into question the moral character of the culprit, were unacceptable and potentially jeopardized careers.

Although Dr. Bosk’s book was more observational than proscriptive, his depiction of M&M conferences was disturbing. I remember attending a urology M&M as a medical student in which several senior physicians berated a very well-meaning and competent intern for a perceived mistake. The intern seemed to take it very well, but my fellow students and I were shaken by the event, asking how such hostility could be conducive to learning.

There were lots of angry accusations in the surgical M&Ms in the pilot episode of “Monday Mornings.” In one case, a senior doctor excoriated a colleague who had given Tylenol to a woman with hip pain who turned out to have cancer. “You allowed metastatic cancer to run amok for four months!” he screamed.

If this was what Dr. Bosk would have called a judgment error, the next case raised moral issues. A neurosurgeon had operated on a boy’s brain tumor without doing a complete family history, which would have revealed a disorder of blood clotting. The boy bled to death on the operating table. “The boy died,” announced the head surgeon, “because of a doctor’s arrogance.”

In one respect, it is good to see that the doctors in charge were so concerned. But as the study of medical errors expanded in the 1990s, researchers found that the likelihood of being blamed led physicians to conceal their errors. Meanwhile, although doctors who attended such conferences might indeed not make the exact same mistakes that had been discussed, it was far from clear that M&Ms were the best way to address the larger problem of medical errors, which, according to a 1999 study, killed close to 100,000 Americans annually.

Eventually, experts recommended a “systems approach” to medical errors, similar to what had been developed by the airline industry. The idea was to look at the root causes of errors and to devise systems to prevent them. Was there a way, for example, to ensure that the woman with the hip problem would return to medical care when the Tylenol did not help? Or could operations not be allowed to occur until a complete family history was in the chart? Increasingly, hospitals have put in systems, such as preoperative checklists and computer warnings, that successfully prevent medical errors.

Another key component of the systems approach is to reduce the emphasis on blame. Even the best doctors make mistakes. Impugning them publicly — or even privately — can make them clam up. But if errors are seen as resulting from inadequate systems, physicians and other health professionals should be more willing to speak up.

Of course, the systems approach is not perfect. Studies continue to show that physicians conceal their mistakes. And elaborate systems for preventing errors can at times interfere with getting things done in the hospital.

Finally, it is important not to entirely remove the issue of responsibility. Sad to say, there still are physicians who are careless and others who are arrogant. Even if today’s M&M conferences rarely involve screaming, supervising physicians need to let such colleagues know that these types of behaviors are unacceptable.


Barron H. Lerner, M.D., professor of medicine at New York University Langone Medical Center, is the author, most recently, of “One for the Road: Drunk Driving Since 1900.”
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BlackBerry's new phone is off to a good start in Britain and Canada

























































































BlackBerry Z10


The BlackBerry Z10 went on sale in Canada on Tuesday and sales are up more than 50% from previous BlackBerry phone launches.


(Frank Gunn, Associated Press / February 5, 2013)





































































The long-awaited BlackBerry Z10 won't be available in the U.S. until March, but it's already out in other countries and sales are hot, according to the maker.


BlackBerry's Z10 touch-screen smartphone has gotten off to a better start in Britain than any of its previous models, the company said.


To be precise, the Z10 is "selling almost three times better" than previous BlackBerry models have in their first week, according to a Bloomberg report that cites BlackBerry Chief Executive Thorsten Heins as the source.





The Z10 is also doing well in BlackBerry's homeland of Canada, with sales up more than 50% from previous BlackBerry phone launches, Heins said.


That's great news for BlackBerry, which is relying on the Z10 and its new Blackberry 10 operating system to remain relevant in the smartphone market.


But the Z10's big test will come next month when the Z10 makes its debut in the U.S. It will be carried by AT&T, Verizon Wireless and T-Mobile.


None of the companies have given release dates for the phone, but Verizon has said the phone will be available for $200 with a new contract.


salvador.rodriguez@latimes.com






















































































































































































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Boy Scouts postpone decision on admitting gays




























































































A decision on whether the Boy Scouts of America will keep its policy that excludes gay members and leaders will not be voted on until the organization's annual meeting in May.
































































IRVING, Texas -- The Boy Scouts of America decided Wednesday to put off a decision on whether to lift a national ban of gay members and leaders, saying the issue of sexual orientation was too complex and needed more time for study.


The decision to wait came after the organization recently announced that it would consider changing its policies and might allow local chapters to decide whether to admit gays as Scouts and leaders.


“After careful consideration and extensive dialog within the Scouting family, along with comments from those outside the organization, the volunteer officers of the Boy Scouts of America's National Executive Board concluded that due to the complexity of this issue, the organization needs time for a more deliberate review of its membership policy,” Deron Smith, the BSA director of public relations, said in a statement.



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jQuery(document).ready(function(){
jQuery('#story-body-text').append(muskalsig);
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  • Boy Scouts are expected to address gay ban




    Boy Scouts are expected to address gay ban







































  • Boy Scouts' opposition to background checks let pedophiles in




    Boy Scouts' opposition to background checks let pedophiles in







































  • Groups fight over Scouts' ban on gays with a petition and prayer




    Groups fight over Scouts' ban on gays with a petition and prayer



















  • “To that end, the executive board directed its committees to further engage representatives of Scouting’s membership and listen to their perspectives and concerns. This will assist the officers’ work on a resolution on membership standards,” he stated.


    The approximately 1,400 voting members of the national council will take action on the resolution at the national meeting in May in Grapevine, Texas, he said.


    It was the Scouts that put the issue back on the agenda for the current executive board meeting, held in its headquarters in Irving. But the move also came amid declining membership, questions by corporate sponsors and public pressure from activists who oppose the current national ban.


    “Today the Boy Scouts of America have chosen to remain irrelevant by delaying the vote,” said James Dale, who was expelled from the Scouts in 1990 for being openly gay. “For over 23 years, since I was expelled from the Scouts, I have held out hope that the Boy Scouts would end their discriminatory policy. With each passing day the Scouts will continue to lose members, sponsors and funding. No parent or child should associate with an organization that sends a toxic message telling children they are immoral if they are gay.”


    GLAAD, the nation's lesbian, gay, bisexual and transgender advocacy group, condemned the decision to wait.


    “An organization that serves youth and chooses to intentionally hurt dedicated young people and hard-working parents not only flies in the face of American principles, but the principles of being a Boy Scout,” GLAAD President Herndon Graddick stated.


    “The Boy Scouts of America is choosing to ignore the cries of millions, including religious institutions, current Scouting families, and corporate sponsors, but these cries will not be silenced. We're living in a culture where hurting young gay people because of who they are is unpopular and discriminatory. They had the chance to end the pain this ban has caused to young people and parents; they chose to extend the pain.”


    Those seeking to keep the ban were also vocal. A majority of the Boy Scout organizations are sponsored by local churches, many of which have religious objections to homosexuals.


    About 100 people gathered outside Boy Scouts headquarters in suburban Dallas carrying signs that said “Save our boys from homosexual acts;” “God votes no gays” and “Don't invite sin into the camp.”


    Texas Values, a conservative group that organized a prayer vigil this week in support of keeping gays out of the Scouts, said the Scouts organization was right to delay a decision.


    “It's a temporary victory,” Jonathan Saenz said of Wednesday's vote. “Good for them -- they're obviously listening. We are encouraged and we're glad they're going to delay the decision. When you deal with such fundamental principles, it's not something you want to tinker with overnight.”


    Robert Davis, 48, of Benbrook, Texas, wore his Longhorn Council Scouting uniform and brought his two sons to the protest Wednesday.


    “I think it's a good sign,” he said of the organization’s vote. “The Boy Scouts of America is one of the last moral high grounds in this country. I hate to see it die.”


    Among politicians, both President Obama and Texas Gov. Rick Perry have been part of the debate.


    “My attitude is that gays and lesbians should have access and opportunity the same way everybody else does in every institution and walk of life,” said Obama, who as U.S. president is the honorary president of BSA, in a Sunday interview with CBS.


    Perry, the author of the book “On My Honor: Why the American Values of the Boy Scouts Are Worth Fighting For,” said in a speech Saturday that “to have popular culture impact 100 years of their standards is inappropriate.”


    ALSO:


    Gov. Christie eats a doughnut with Letterman


    Police: Concealed-carry coach who killed student is a 'victim'


    Florida judge denies request to postpone George Zimmerman trial





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    Chris Brown returns to court for probation issues


    LOS ANGELES (AP) — Chris Brown, accompanied by Rihanna, briefly returned to court Wednesday to face allegations he failed to complete his community labor sentence for Rihanna's 2009 beating, but the judge asked for more information and scheduled another hearing in two months.


    Rihanna blew Brown a kiss as he entered the courtroom, and they left together after the short proceeding in which Superior Court Judge James Brandlin set the next hearing for April 5.


    Prosecutors alleged this week that investigators could not find credible evidence he completed his community labor.


    A motion filed Tuesday also raised for the first time in Brown's felony assault case several incidents that prosecutors said demonstrate Brown has ongoing anger management issues.


    Brandlin noted during the brief session that a prosecution filing did not request revocation of Brown's probation and he, therefore, would not revoke it.


    They cited a Jan. 27 fight between Brown and fellow R&B star Frank Ocean, and a 2011 outburst in which Brown threw a chair through a window after he was asked about the Rihanna attack on "Good Morning America."


    The filing represents a dramatic shift in the case against Brown, who was repeatedly praised by the judge overseeing his case for his completion of domestic violence courses and his community service work in his home state of Virginia. That changed in September, when prosecutors raised concerns about Brown's community service after he logged 701 hours in seven months — an amount that had previously taken him more than two years to achieve.


    Los Angeles investigators traveled to Richmond, Va., to investigate Brown's service, which was only described in broad strokes by Richmond Police Chief Bryan Norwood, who was overseeing the singer's community labor.


    "This inquiry provided no credible, competent or verifiable evidence that defendant Brown performed his community labor as presented to this court," Deputy District Attorney Mary Murray wrote.


    Brown's attorney Mark Geragos blasted the court filing, saying the prosecutor ignored interviews "where sworn peace officers stated unequivocally that Mr. Brown was supervised and did all of the community service."


    "I plan on asking for sanctions from the DA's office for filing in frivolous, scurrilous and frankly defamatory motion," he said Tuesday.


    It will be up to a new judge to evaluate the prosecutor's allegations; Brown's case was transferred to Brandlin after a recent shuffling of judicial assignments.


    After pleading guilty to the Rihanna attack, Brown was given permission to serve 180 days of community labor in his home state of Virginia, but only as long as he performed manual labor such as graffiti removal and roadside cleanup.


    Given problems with documentation and statements from some witnesses who contradict Brown's claims of work, prosecutors asked Brandlin to order Brown to repeat his service in Los Angeles.


    Brown spent one-third of the hours he logged in Virginia working night shifts at a day care center in rural Virginia where his mother once served as director and where the singer spent time as a child.


    A detective who checked on Brown's work nine times at the Tappahannock Children's Center found the singer, his mother and a bodyguard at the center on each visit.


    The records said Brown waxed floors or performed "general cleaning" at the center.


    A professional floor cleaner contracted to work at the daycare center told investigators he had been cleaning the floors during the months Brown reported working at the facility.


    "Claims that the defendant cleaned, stripped and waxed floors at that location have been credibly contradicted," prosecutors said in the filing.


    Brown's mother, Joyce Hawkins, no longer had a formal role at day care center but had her own set of keys and coordinated her son's work at the facility, prosecutors said.


    Murray stated in her filing that Norwood's report on Brown's service was "at best sloppy documentation and at worst fraudulent reporting."


    Richmond police spokesman Gene Lepley declined to discuss the allegations.


    "We believe it would inappropriate to comment on a matter that's before the court," Lepley said.


    According to the motion, officials with Virginia's probation office told investigators that Brown's arrangement to be supervised by Norwood was "extremely unusual" and had not been approved by the agency. No one from Virginia's probation department oversaw Brown's hours, prosecutors said.


    The motion noted that the only records the department has to indicate Brown was supervised were officers' overtime sheets. Five of 21 days that officers logged overtime for Brown were spent providing security for the singer's concerts.


    The allegations are the latest pre-Grammy controversy for Brown, who was arrested shortly after the 2009 ceremony for his attack on Rihanna. He has since returned to the awards show by performing and winning an award in 2011 for his album "F.A.M.E."


    Brown and Ocean are competing against one other for the Best Urban Contemporary Album category at Sunday's Grammys.


    ___


    AP writers Anthony McCartney and Ryan Pearson contributed to this report.


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