A delicate new balancing act in senior healthcare

When Claire Gordon arrived at Cedars-Sinai Medical Center, nurses knew she needed extra attention.

She was 96, had heart disease and a history of falls. Now she had pneumonia and the flu. A team of Cedars specialists converged on her case to ensure that a bad situation did not turn worse and that she didn't end up with a lengthy, costly hospital stay.

Frail seniors like Gordon account for a disproportionate share of healthcare expenditures because they are frequently hospitalized and often land in intensive care units or are readmitted soon after being released. Now the federal health reform law is driving sweeping changes in how hospitals treat a rapidly growing number of elderly patients.

The U.S. population is aging quickly: People older than 65 are expected to make up nearly 20% of it by 2030. Linda P. Fried, dean of the Columbia University Mailman School of Public Health, said now is the time to train professionals and test efforts to improve care and lower healthcare costs for elderly patients.

"It's incredibly important that we prepare for being in a society where there are a lot of older people," she said. "We have to do this type of experiment right now."

At Cedars-Sinai, where more than half the patients in the medical and surgical wards are 65 or older, one such effort is dubbed the "frailty project." Within 24 hours, nurses assess elderly patients for their risk of complications such as falls, bed sores and delirium. Then a nurse, social worker, pharmacist and physician assess the most vulnerable patients and make an action plan to help them.

The Cedars project stands out nationally because medical professionals are working together to identify high-risk patients at the front end of their hospitalizations to prevent problems at the back end, said Herb Schultz, regional director of the U.S. Department of Health and Human Services.

"For seniors, it is better care, it is high-quality care and it is peace of mind," he said.

The effort and others like it also have the potential to reduce healthcare costs by cutting preventable medical errors and readmissions, Schultz said. The federal law penalizes hospitals for both.

Gordon, an articulate woman with brightly painted fingernails and a sense of humor, arrived at Cedars-Sinai by ambulance on a Monday.

Soon, nurse Jacquelyn Maxton was at her bedside asking a series of questions to check for problems with sleep, diet and confusion. The answers led to Gordon's designation as a frail patient. The next day, the project team huddled down the hall and addressed her risks one by one. Medical staff would treat the flu and pneumonia while at the same time addressing underlying health issues that could extend Gordon's stay and slow her recovery, both in the hospital and after going home.

To reduce the chance of falls, nurses placed a yellow band on her wrist that read "fall risk" and ensured that she didn't get up on her own. To prevent bed sores, they got her up and moving as often as possible. To cut down on confusion, they reminded Gordon frequently where she was and made sure she got uninterrupted sleep. Medical staff also stopped a few unnecessary medications that Gordon had been prescribed before her admission, including a heavy narcotic and a sleeping pill.

"It is really a holistic approach to the patient, not just to the disease that they are in here for," said Glenn D. Braunstein, the hospital's vice president for clinical innovation.

Previously, nurse Ivy Dimalanta said, she and her colleagues provided similar care but on a much more random basis. Under the project, the care has become standardized.

The healthcare system has not been well designed to address the needs of seniors who may have had a lifetime of health problems, said Mary Naylor, gerontology professor at the University of Pennsylvania School of Nursing. As a result, patients sometimes fall through the cracks and return to hospitals again and again.

"That is not good for them and that is not good for society to be using resources in that way," Naylor said.

Using data from related projects, Cedars began a pilot program in 2011 and expanded it last summer. The research is continuing but early results suggest that the interventions are leading to fewer seniors being admitted to the intensive care unit and to shorter hospital stays, said Jeff Borenstein, researcher and lead clinician on the frailty project. "It definitely seems to be going in the right direction," he said.

The hospital is now working with Naylor and the University of Pennsylvania to design a program to help the patients once they go home.

"People who are frail are very vulnerable when they leave the hospital," said Harriet Udin Aronow, a researcher at Cedars. "We want to promote them being safe at home and continuing to recover."

In Gordon's case, she lives alone with the help of her children and a caregiver. The hospital didn't want her experiencing complications that would lengthen the stay, but they also didn't want to discharge her before she was ready. Under the health reform law, hospitals face penalties if patients come back too soon after being released.

Patients and their families often are unaware of the additional attention. Sitting in a chair in front of a vase of pink flowers, Gordon said she knew she would have to do her part to get out of the hospital quickly. "You have to move," she said. "I know you get bed sores if you stay in bed."

Gordon said she was comfortable at the hospital but she wanted to go back to her house as quickly as she could. "There's no place like home," she said.

Two days later, that's where she was.

anna.gorman@latimes.com

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For Families Struggling with Mental Illness, Carolyn Wolf Is a Guide in the Darkness

When a life starts to unravel, where do you turn for help?

Melissa Klump began to slip in the eighth grade. She couldn’t focus in class, and in a moment of despair she swallowed 60 ibuprofen tablets. She was smart, pretty and ill: depression, attention deficit disorder, obsessive-compulsive disorder, either bipolar disorder or borderline personality disorder.

In her 20s, after a more serious suicide attempt, her parents sent her to a residential psychiatric treatment center, and from there to another. It was the treatment of last resort. When she was discharged from the second center last August after slapping another resident, her mother, Elisa Klump, was beside herself.

“I was banging my head against the wall,” the mother said. “What do I do next?” She frantically called support groups, therapy programs, suicide prevention lines, anybody, running down a list of names in a directory of mental health resources. “Finally,” she said, “somebody told me, ‘The person you need to talk to is Carolyn Wolf.’ ”

That call, she said, changed her life and her daughter’s. “Carolyn has given me hope,” she said. “I didn’t know there were people like her out there.”

Carolyn Reinach Wolf is not a psychiatrist or a mental health professional, but a lawyer who has carved out what she says is a unique niche, working with families like the Klumps.

One in 17 American adults suffers from a severe mental illness, and the systems into which they are plunged — hospitals, insurance companies, courts, social services — can be fragmented and overwhelming for families to manage. The recent shootings in Newtown, Conn., and Aurora, Colo., have brought attention to the need for intervention to prevent such extreme acts of violence, which are rare. But for the great majority of families watching their loved ones suffer, and often suffering themselves, the struggle can be boundless, with little guidance along the way.

“If you Google ‘mental health lawyer,’ ” said Ms. Wolf, a partner with Abrams & Fensterman, “I’m kinda the only game in town.”

On a recent afternoon, she described in her Midtown office the range of her practice.

“We have been known to pull people out of crack dens,” she said. “I have chased people around hotels all over the city with the N.Y.P.D. and my team to get them to a hospital. I had a case years ago where the person was on his way back from Europe, and the family was very concerned that he was symptomatic. I had security people meet him at J.F.K.”

Many lawyers work with mentally ill people or their families, but Ron Honberg, the national director of policy and legal affairs for the National Alliance on Mental Illness, said he did not know of another lawyer who did what Ms. Wolf does: providing families with a team of psychiatrists, social workers, case managers, life coaches, security guards and others, and then coordinating their services. It can be a lifeline — for people who can afford it, Mr. Honberg said. “Otherwise, families have to do this on their own,” he said. “It’s a 24-hour, 7-day-a-week job, and for some families it never ends.”

Many of Ms. Wolf’s clients declined to be interviewed for this article, but the few who spoke offered an unusual window on the arcane twists and turns of the mental health care system, even for families with money. Their stories illustrate how fraught and sometimes blind such a journey can be.

One rainy morning last month, Lance Sheena, 29, sat with his mother in the spacious family room of her Long Island home. Mr. Sheena was puffy-eyed and sporadically inattentive; the previous night, at the group home where he has been living since late last summer, another resident had been screaming incoherently and was taken away by the police. His mother, Susan Sheena, eased delicately into the family story.

“I don’t talk to a lot of people because they don’t get it,” Ms. Sheena said. “They mean well, but they don’t get it unless they’ve been through a similar experience. And anytime something comes up, like the shooting in Newtown, right away it goes to the mentally ill. And you think, maybe we shouldn’t be so public about this, because people are going to be afraid of us and Lance. It’s a big concern.”

Her son cut her off. “Are you comparing me to the guy that shot those people?”

“No, I’m saying that anytime there’s a shooting, like in Aurora, that’s when these things come out in the news.”

“Did you really just compare me to that guy?”

“No, I didn’t compare you.”

“Then what did you say?”

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Boeing 787 Completes Test Flight

A Boeing 787 test plane flew for more than two hours on Saturday to gather information about the problems with the batteries that led to a worldwide grounding of the new jets more than three weeks ago.

The flight was the first since the Federal Aviation Administration gave Boeing permission on Thursday to conduct in-flight tests. Federal investigators and the company are trying to determine what caused one of the new lithium-ion batteries to catch fire and how to fix the problems.

The plane took off from Boeing Field in Seattle heading mostly east and then looped around to the south before flying back past the airport to the west. It covered about 900 miles and landed at 2:51 p.m. Pacific time.

Marc R. Birtel, a Boeing spokesman, said the flight was conducted to monitor the performance of the plane’s batteries. He said the crew, which included 13 pilots and test personnel, said the flight was uneventful.

He said special equipment let the crew check status messages involving the batteries and their chargers, as well as data about battery temperature and voltage.

FlightAware, an aviation data provider, said the jet reached 36,000 feet. Its speed ranged from 435 to 626 miles per hour.

All 50 of the 787s delivered so far were grounded after a battery on one of the jets caught fire at a Boston airport on Jan. 7 and another made an emergency landing in Japan with smoke coming from the battery.

The new 787s are the most technically advanced commercial airplanes, and Boeing has a lot riding on their success. Half of the planes’ structural parts are made of lightweight carbon composites to save fuel.

Boeing also decided to switch from conventional nickel cadmium batteries to the lighter lithium-ion ones. But they are more volatile, and federal investigators said Thursday that Boeing had underestimated the risks.

The F.A.A. has set strict operating conditions on the test flights. The flights are expected to resume early this week, Mr. Birtel said.

Battery experts have said it could take weeks for Boeing to fix the problems.

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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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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.”

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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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Venezuela Devalues Currency Amid Shortages and Inflation

CARACAS, Venezuela — Venezuela announced Friday that it was devaluing its currency, a step that had long been deemed necessary but could push the spiking inflation even higher.

The devaluation, which lowered the currency’s value against the dollar by nearly a third, was aimed at solidifying government finances and easing a tight market for dollars that has choked back imports and led to shortages of basic goods.

The move had been widely anticipated, but it had been unclear whether officials would make what could be a politically risky decision with President Hugo Chávez still out of the country after undergoing cancer surgery in Cuba on Dec. 11.

If Mr. Chávez were to die or were too ill to continue as president, a special election would have to be called, and many analysts thought that the government might try to postpone a devaluation until after that occurred.

“It is a sign of pragmatism that they carry out a devaluation even though we’re all aware there is some likelihood of a presidential election being held soon,” said Francisco Rodríguez, an economist with Bank of America Merrill Lynch. “This shows that they’re willing to correct basic economic distortions.”

The currency, the bolívar, will be set at 6.3 to the dollar. It had been set at 4.3.

Venezuela’s finance minister, Jorge Giordani, said that Mr. Chávez, who has not been seen or heard in public for more than eight weeks, had approved the measures.

“Here is the president’s signature if you want to recognize it or if you still have doubts,” Mr. Giordani said, holding up a document during a televised news conference.

The devaluation will help the government balance its books by giving it more bolívars for the dollars it earns selling oil on the world market. Venezuela’s economy is highly dependent on oil, with petroleum sales making up about 95 percent of total exports. The country is the fourth-largest foreign oil supplier to the United States.

Government spending soared last year during the campaign to re-elect Mr. Chávez, leading to a large deficit, even though, at more than $100 a barrel, the price of oil is very high.

Pressure to devalue had been building for months, as the black market exchange rate rose to more than four times the official rate. The imbalance was evident in the prices of many goods. A Big Mac at McDonald’s costs 70 bolívars, or $16.27, at the official pre-devaluation rate.

But the devaluation will also make imported goods more expensive, which will probably make inflation worse. Inflation for the 12 months ended on Jan. 31 was 22.2 percent, one of the highest rates in Latin America.

Surging inflation could cause political problems for the government. But the exchange rate had reduced the dollars available to importers, leading to shortages of goods like sugar, chicken and toilet paper. Many analysts believe that voters blame the government more for shortages than for inflation.

This article has been revised to reflect the following correction:

Correction: February 8, 2013

An earlier version of this article reported that Venezuela had devalued its currency by nearly one-half.

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FBI searches Las Vegas home of fugitive

Federal and local authorities served a search warrant at the Las Vegas home of an ex-police officer sought in connection with a series of shootings in Southern California, but said the suspect was not located.

FBI spokeswoman Laura Eimiller confirmed agents and Las Vegas police searched the home Thursday as part of the ongoing investigation into Christopher Jordan Dorner, 33, but did not elaborate as to what was recovered. The surrounding neighborhood was cleared as a precaution, she said.

No one was home at the time, Eimiller said.

PHOTOS: Manhunt for ex-LAPD officer

Several law enforcement agencies are involved in the ongoing manhunt for Dorner and alerts have been issued all across California and in Nevada, warning Dorner was considered "armed and extremely dangerous." Dorner was believed to be carrying multiple weapons, including an assault rifle.

In California, a SWAT team clad in military fatigues spent Thursday afternoon combing the mountain community of Big Bear after Dorner's burned-out truck was found on a forest road. Authorities were going door-to-door and checking all vehicles coming and going from the mountain.

Dorner, who was fired from the LAPD in 2009, is suspected of shooting three police officers, one of whom died, in Riverside County early Thursday.

PHOTOS: Manhunt for ex-LAPD officer

He also is suspected of killing a couple who were found shot in a car in Orange County earlier this week. One of the victims was the daughter of a former LAPD captain named in a lengthy online manifesto that law enforcement officials attributed to Dorner.

The Los Angeles Police Department had dispatched units across the region to protect at least 40 officers and others named in the document, which threatened "unconventional and asymmetrial warfare" against police.

Dorner received awards for his expertise with a rifle and pistol, according to military records obtained by The Times. He received an Iraq Campaign Medal and was a member of a mobile inshore undersea warfare unit.

Riverside Police Chief Sergio Diaz, calling the attack on his officers a "cowardly ambush," said Dorner is suspected of opening fire with a rifle about 1:30 a.m. Thursday as he pulled up to two police officers waiting at a traffic light.

The attack was carried out about 20 minutes after Dorner wounded an LAPD officer in a shooting in nearby Corona, police said.

Early Thursday, two women delivering the Los Angeles Times in Torrance were shot by Los Angeles police who were headed to the home of a police captain named in the manifesto.

The women, shot in the 19500 block of Redbeam Avenue, were taken to area hospitals, Torrance Police Lt. Devin Chase said. One suffered a minor wound, and the other was struck twice and listed in stable condition, LAPD Chief Charlie Beck told reporters.

"Tragically," Beck said, "we believe this is a case of mistaken identity."

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California boy to be arraigned in “swatting” prank on actor Kutcher

LOS ANGELES (Reuters) – Prosecutors charged a 12-year-old boy on Thursday with making a false emergency call that sent police swarming to the home of actor Ashton Kutcher in a “swatting” prank.

The name of the boy, who was arrested by Los Angeles police in December, was withheld due to his age. He was scheduled to be arraigned in a juvenile court in Los Angeles on Friday.

The trend toward placing false emergency calls is known as “swatting” because SWAT (Special Weapons and Tactics) officers often are sent to the purported crime scenes. Authorities say such situations can be dangerous due to the risk of a misunderstanding between police and occupants of a building.

The boy has been charged with two felony counts each of making false bomb threats and computer intrusion in connection with the October 3 emergency call that drew police to the Hollywood Hills home of Kutcher, star of the sitcom “Two and a Half Men,” and a similar call on October 10 that sent police to a Wells Fargo Bank.

Authorities have accused the boy of having reported men armed with guns and explosives in Kutcher’s home and that several people had been shot. Dozens of emergency personnel were sent to the house. Kutcher was not home at the time.

Swatting calls in recent months have also sent police to the homes of singers Justin Bieber and Miley Cyrus.

(Reporting by Alex Dobuzinskis; Editing by Bill Trott)

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Bucks Blog: Avoiding Valentine’s Day Flower Woes

It’s that time of year again, when people rush to send bouquets of roses to that special someone. Last February, I wrote about the post-holiday howling and hand-wringing over flowers that were ordered online but went undelivered — or were delivered late — for Valentine’s Day.

With all that in mind, the Web site Cheapism.com, devoted to recommendations that can save you money, has this suggestion: You may pay less, and get better results, by avoiding big name Web sites and calling a local florist directly to have it handle the delivery.

Using a local florist for delivery of a dozen red roses runs about $50 or less, depending on the location, and you’ll generally get more thoughtful service than with a big name online floral site, said Cheapism’s founder, Max Levitte. His staff contacted about 10 local florists in several states, including New York, California, Illinois and Nebraska, as well as the Society of American Florists, for pricing information. (Some shops tack on delivery charges of as much as $15, however, so it’s best to ask about such details up front.) They also scanned hundreds of online user reviews, on sites including Yahoo Shopping, Viewpoints, Epinions, ResellerRatings and TrustPilot.

Using a major online flower service will run from $59 to $86 with standard delivery, Cheapism found. And over all, Mr. Levitte said, the major floral services received poor marks for customer satisfaction on online review sites.

Unhappy customers are more likely to write about their experience than happy ones, he said, but his researchers took that into account: “We read online reviews for a living,” he said, adding in a follow-up email, “We try and focus on reviews that aren’t just scathing, but offer valuable information.” Still, the volume of negative online reviews about the major floral Web sites was hard to ignore, he said, making the direct call option worth a try.

If you contact a shop, Mr. Levitte said, you may be able to negotiate a lower price, since you are eliminating the transaction fees the shop would usually have to pay if filling an order for a national Web site. “You may be able to get a better deal if you go directly to the florist,” he said.

In addition, by contacting the florist yourself, you can ask exactly what blooms it has available, which can help reduce the risk of disappointment that can occur when ordering online, and the arrangement delivered bears no resemblance to the one pictured when you ordered it.

(Consumer Reports did a small test in 2011 and found that 1-800-Flowers scored the best at delivering arrangements that actually resembled the photos. The report also advised buyers to avoid mixed bouquets, which allow more potential for substitution.)

To find a florist near where you want the flowers delivered, you can try the Society of American Florists’ directory. Or, you can enter the recipient’s address into Google maps and search for nearby florists. Some have ratings on Yelp.com.

But beware of search-engine shenanigans, according to the Consumerist’s “Garden of Discontent,” which features outraged consumers’ tales of flower deliveries gone awry. When I typed in a search request for florists near my home address, the top item, above the list of local florists, was ProFlowers, a national retailer.

Still prefer the ease of online flower shopping? I have successfully ordered from the big services, but I always try to schedule delivery the day before a major holiday, to minimize the chance of a missed delivery. Most people are delighted to get flowers early, but they are quite unhappy when they arrive late. Some sites even offer a discount or waive service charges if you choose early delivery.

Do you send flowers for Valentine’s Day, and, if so, where do you buy them?

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L.A. County Sheriff's Department intends to fire seven deputies

Seven Los Angeles County sheriff's deputies have been notified that the department intends to fire them for belonging to a secret law enforcement clique that allegedly celebrated shootings and branded its members with matching tattoos, officials said.

The Times reported last year about the existence of the clique, dubbed the Jump Out Boys, and the discovery of a pamphlet that described the group's creed, which required aggressive policing and awarded tattoo modifications for police shootings.

The seven worked on an elite gang-enforcement team that patrols neighborhoods where violence is high. The team makes a priority of taking guns off the street, officials said.

The Sheriff's Department has a long history of secret cliques with members of the groups having reached high-ranking positions within the agency. Sheriff officials have sought to crack down on the groups, fearing that they tarnished the department's reputation and encouraged unethical conduct.

In the case of the Jump Out Boys, sheriff's investigators did not uncover any criminal behavior. But, sources said, the group clashed with department policies and image.

Their tattoos, for instance, depicted an oversize skull with a wide, toothy grimace and glowing red eyes. A bandanna with the unit's acronym is wrapped around the skull. A bony hand clasps a revolver. Smoke would be tattooed over the gun's barrel for members who were involved in at least one shooting, officials said.

One member, who spoke to The Times and requested anonymity, said the group promoted only hard work and bravery. He dismissed concerns about the group's tattoo, noting that deputies throughout the department get matching tattoos. He said there was nothing sinister about their creed or conduct. The deputy, who was notified of the department's intent to terminate him, read The Times several passages from the pamphlet, which he said supported proactive policing.

"We are alpha dogs who think and act like the wolf, but never become the wolf," one passage stated, comparing criminals to wolves. Another passage stated, "We are not afraid to get our hands dirty without any disgrace, dishonor or hesitation... sometimes (members) need to do the things they don't want to in order to get where they want to be."

Department spokesman Steve Whitmore said starting the termination process shows that Sheriff Lee Baca "does not take any of this lightly and will move forward with the appropriate action."

Investigators were less concerned about the tattoos, and more focused on the suspected admiration they showed for officer-involved shootings, which are expected to be events of last resort. The deputy told The Times, however, that investigators reviewed their shootings and arrests and found nothing unlawful.

"We get called a gang within the badge? It's unfair," he said. "People want to say you have a tattoo. So do fraternities. Go to Yale. Are they a gang?.... Boy Scouts have patches and they have mission statements, and so do we."

"We do not glorify shootings," he continued. "What we do is commend and honor the shootings. I have to remember them because it can happen any time, any day. I don't want to forget them because I'm glad I'm alive."

If the firings are upheld, it would be one of the largest terminations over one incident in the department's history. In 2011, the department fired about half a dozen deputies who were also said to have formed a clique. Those deputies worked on the third floor of Men's Central Jail and allegedly threw gang-like three-finger hand signs. They were fired after they fought two fellow deputies at an employee Christmas party and allegedly punched a female deputy in the face.

As part of the widening federal investigation of the Sheriff's Department, a criminal grand jury recently subpoenaed the agency for materials relating to deputy cliques, specifically citing several of the groups including the "3000 boys" and the Jump Out Boys.

When the pamphlet revealing the existence of the Jump Out Boys was initially found, officials didn't know if the group was real. But eventually, one member came forward and named the others, according to an official who asked for anonymity because he was not authorized to speak to the media.

The seven deputies can fight the department's decision to fire them.

robert.faturechi@latimes.com

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Psychiatric Hospitals Alter Rules on Patient Smoking

MANDEVILLE, La. — Annelle S., 64, who has paranoid schizophrenia, took an urgent drag on a cigarette at a supervised outdoor smoke break at Southeast Louisiana Hospital.

“It’s mandatory to smoke,” she explained. “It’s a mental institution, and we have to smoke by law.”

That was 18 months ago, and Annelle’s confusion was understandable. Until recently, Louisiana law required psychiatric hospitals to accommodate smokers — unlike rules banning smoking at most other health facilities. The law was changed last year, and by March 30, smoking is supposed to end at Louisiana’s two remaining state psychiatric hospitals.

After decades in which smoking by people with mental illness was supported and even encouraged — a legacy that experts say is causing patients to die prematurely from smoking-related illnesses — Louisiana’s move reflects a growing effort by federal, state and other health officials to reverse course.

But these efforts are hardly simple given the longstanding obstacles.

Hospitals often used cigarettes as incentives or rewards for taking medicine, following rules or attending therapy. Some programs still do. And smoking was endorsed by advocates for people with mental illness and family members, who sometimes sued to preserve smoking rights, considering cigarettes one of the few pleasures patients were allowed.

New data from the Centers for Disease Control and Prevention shows that the nearly 46 million adults with mental illness have a smoking rate 70 percent higher than those without mental illness, and consume about a third of the cigarettes in the country, though they make up one-fifth of the adult population.

People with psychiatric disorders are often “smoking heavier, their puffs are longer and they’re smoking it down to the end of the cigarette,” said William Riley, chief of the Science of Research and Technology Branch at the National Cancer Institute. With some diagnoses, like schizophrenia, rates are especially high.

A report by the National Association of State Mental Health Program Directors said data suggested that people with the most serious mental illnesses die on average 25 years earlier than the general population, with many from smoking-exacerbated conditions like heart or lung disease.

Now more treatment facilities are banning smoking, with some finding it easier than expected. Others still allow it, usually outside on their grounds during scheduled times. About a fifth of state hospitals are not smoke-free, a survey issued in 2012 by the State Mental Health Program Directors association found. Occasionally, hospitals that banned smoking have reinstated it to avoid losing patients.

Moreover, smoking is so deeply ingrained that smoke-free hospitals can only dent the problem; many patients are now hospitalized only for short stints and resume smoking later.

New research suggests scientific underpinnings for some of the affinity, said Dr. Nora D. Volkow, director of the National Institute on Drug Abuse. Nicotine has antidepressant effects and, for people with schizophrenia, helps dampen extraneous thoughts and voices, she and other experts said.

Other chemicals in cigarette smoke set off a perilous cycle, causing some medications to be metabolized faster, making them less effective and allowing symptoms to return. Because patients feel sicker, they may seek even more comfort from nicotine. “You may think, ‘Well, I need to smoke more,’ ” said Dr. Steven Schroeder, a professor of health and health care at the University of California, San Francisco.

Then, as smoking increases, “blood levels of their medication go down, and they end up back in the hospital,” said Judith Prochaska, an associate professor of medicine at Stanford University’s Prevention Research Center.

Socially, smoking provides “cover rituals for patients having psychiatric symptoms,” said Dr. Rona Hu, medical director of the acute psychiatric inpatient unit at Stanford Hospital in Palo Alto, Calif. “You tamp the box, you kind of play with the lighter, you can exhale and look into the middle distance and not look like you’re hallucinating.”

Dr. Thomas R. Frieden, director of the C.D.C., said hospitals had historically resisted going smoke-free, fearing it would interfere with treatment. “In my very first job as an aide in a psychiatric hospital,” he said, “if patients behaved better they got additional cigarettes.”

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DealBook: R.B.S. to Pay $612 Million Over Rate Rigging

A campaign to root out financial fraud secured a victory on Wednesday, as authorities took aim at the Royal Bank of Scotland for its role in an interest rate manipulation scheme that has emboldened prosecutors and consumed the banking industry.

American and British authorities struck a combined $612 million settlement with the bank, the latest case to emerge from the global investigation into rate-rigging. The Justice Department dealt another blow to the bank, forcing its Japanese unit to plead guilty to criminal wrongdoing.

The penalty for the subsidiary, a hub of rate manipulation, underscores a recent shift in the way federal authorities punish financial wrongdoing. The R.B.S. case echoed an earlier action taken against a UBS subsidiary, which similarly pleaded guilty to felony wire fraud as part of a larger settlement. These cases represent the first units of a big bank to agree to criminal charges in more than a decade.

“I want financial institutions to know that this department will absolutely hold them to account,” Lanny Breuer, head of the Justice Department’s criminal division, said in an interview Wednesday.

Some of the world’s largest financial institutions remain caught in the cross hairs of the rate manipulation case, an investigation that could drag on for years. Authorities suspect that more than a dozen banks falsified reports to influence benchmarks like the London Interbank Offered Rate, or Libor, which underpins the costs for trillions of dollars in financial products like mortgages and credit cards.

A person involved in the investigation indicated that the first banks to settle were among the worst actors in the rate case. But they also received a “discount” for their eager cooperation, according to people with knowledge of the matter.

That approach raises the prospect that remaining banks could face high-priced settlements.

Deutsche Bank, which set aside an undisclosed amount to cover potential penalties and suspended five employees tied to the case, is expected to settle with authorities in late 2013, several people briefed on the matter said. But the timetable could shift. The bank is not in formal settlement talks and is not prepared to resolve the case, the people said.

While foreign banks have borne the brunt of the scrutiny, an American institution could be among the next to settle. Citigroup and JPMorgan Chase are under investigation by the Commodity Futures Trading Commission, the American regulator leading the case, though actions are not imminent.

The R.B.S. action concluded a first phase of rate-rigging investigations for authorities, who are now planning to take a brief hiatus from filing cases. The next case is not expected until spring at the earliest, two of the people briefed on the matter said.

Some bank executives, fearful that fallout from the case will stain their firms, are pushing for a broad deal encompassing multiple institutions. But authorities are balking at a “global settlement,” people involved in the case say, arguing that investigations are proceeding at different stages and involve widely varying fact patterns.

As regulators continue to pursue actions, prosecutors are planning charges against traders involved in the scheme. The first charges came last year when the Justice Department filed actions against two former UBS traders.

“Our investigation is far from finished,” Mr. Breuer said.

The rate-rigging case has centered on how much banks charge each other for loans. Such figures form the basis of Libor and other rates. But banks corrupted the process. Government complaints filed over the last year outlined a scheme in which banks reported false rates to lift trading profits.

Authorities announced the first Libor case in June, extracting a $450 million settlement with the British bank Barclays. In December, UBS agreed to a record $1.5 billion settlement with authorities. The Justice Department also secured the guilty plea from one of the bank’s subsidiaries.

Royal Bank of Scotland, based in Edinburgh, had aimed to avert the guilty plea for its Japanese subsidiary, people involved in the case said. But the Justice Department’s criminal division declined to back down, and the bank had little leverage to push back. It decided not to formally appeal its case to Attorney General Eric H. Holder Jr., another person said.

With fines coming from multiple authorities, the $612 million case amounted to the second-largest penalty levied in the multiyear investigation into rate manipulation. “The settlement with R.B.S. is much more than a slap on the wrist,” argued Bart Chilton, a member of the trading commission who is critical of soft fines on big banks.

The settlement represents the latest setback for Royal Bank of Scotland, which has struggled to shake the legacy of the 2008 financial crisis. The British firm, which is majority-owned by the government after a bailout, already has put aside $2.7 billion to compensate customers who were inappropriately sold loan insurance in recent years.

Since the financial crisis, the bank has shaken up its management team and refocused its operations, as part of an effort to repair its bruised image. On Wednesday, it announced plans to claw back bonuses to help pay for the latest settlement.

At a news conference in London on Wednesday, Stephen Hester, the bank’s chief executive, admitted that the rate-rigging episode significantly strained the bank. “It is one of the most difficult moments over the entire period,” he said.

As authorities stitched together the R.B.S. case, they seized on a series of colorful e-mails that highlighted an effort to influence the rate-setting process, a plot that spanned multiple currencies and countries from 2006 to 2010. One Royal Bank of Scotland trader mused in a 2007 message how the process was becoming a “cartel,” adding “its just amazing how libor fixing can make you that much money.”

The wrongdoing spread broadly, authorities say, noting that Royal Bank of Scotland “aided and abetted” UBS and other firms. A senior official at the Justice Department’s antitrust unit, Scott D. Hammond, contends that the bank “secretly rigged” interest rates.

A UBS trader, the department said, once asked a co-worker to “have a word with” another bank about Libor submissions. The UBS trader, Thomas Hayes, who was recently charged by the Justice Department with fraud, indicated that he had already approached R.B.S. for help.

The government complaints also portray a permissive culture that allowed rate-rigging to persist for four years. David Meister, the enforcement director of the trading commission, declared that “the environment was ripe for manipulation at R.B.S.”

The bank’s own records captured the scheme in striking detail, revealing how traders pressured other employees to submit certain rates. Submitters and traders sat in earshot of each other in London, forming what authorities termed a “cozy ring.” The bank eventually separated the employees, who then moved to make additional requests via instant messages.

To persuade employees who submitted Libor rates, some traders promised affection. Others offered steak and sushi. One trader resorted to begging, invoking a plea of “pretty please.” Another trader, after pressuring a colleague to submit a certain rate, offered a reward of sorts: “I would come over there and make love to you.”

When authorities began scrutinizing the bank, the traders adopted a more covert approach. In 2010, a Libor submitter rebuffed an instant message request to influence rates. But then the submitter called the trader to explain “we’re not allowed to have those conversations” over instant message.

The employees laughed, according to a transcript of the call, and the submitter reassured the trader that he would fulfill the request: “Leave it with me, and uh, it won’t be a problem.”

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Child porn suspect indicted by federal grand jury

A North Hills woman whom authorities allege plied a young girl with crack cocaine and photographed her having sex with an older man was indicted Tuesday on federal charges of producing child pornography and sex trafficking.

Letha Montemayor Tucker was named Tuesday in a four-count indictment returned by a federal grand jury. If convicted of all the charges, Tucker would face a mandatory minimum federal sentence of 10 years and could get up to life in prison, authorities said.

The charges come a month after authorities sought the public's help in the investigation by releasing photographs of a man and woman depicted in a set of widely circulated child pornography photos.

Tips started pouring in immediately after the photos were released, investigators said.

Tucker, who goes by the name Butterfly, was located about 10 hours after the release of the photos and taken into custody, said Claude Arnold, special agent in charge for Homeland Security Investigations in Los Angeles, a division of U.S. Immigration and Customs Enforcement.

The alleged victim, who was about 12 when the photos were taken, was found within a week of the case going public, Arnold said. She is an adult now and is cooperating with authorities, he said.

In addition to photographing the girl having sex with the man, authorities said, Tucker also committed sex acts with the alleged victim.

The photos were part of a child pornography collection known as the "Jen Series."

The 40-plus photos were first discovered by investigators in the Chicago area in 2007. Investigators said images in the series have been reported about 300 times and have been found on computers across the country.

The victim "didn't even know these images were out there," Arnold said.

"The horror of child pornography is it's for life, the victimization," Arnold said. "Once the photos are there in cyberspace, they're there forever."

The girl, identified in court records only by the initials J.M.M., lived in the same Los Angeles County residential hotel as Tucker, who worked as a prostitute, authorities said.

Around 2000 or 2001, the girl stopped attending school regularly and spent more and more time in Tucker's room, smoking crack cocaine Tucker provided, according to the indictment.

The girl was present when Tucker engaged in prostitution with clients and was usually high when this happened, authorities allege. Tucker instructed the child to take off her clothes in front of the clients, prosecutors alleged in court papers.

The faces of Tucker and the girl are "clearly visible" in the photos, according to the indictment. Tucker had an eyebrow piercing and a tattoo of a sleeping cat behind her shoulder, which made her easier to identify, authorities said.

The face of the man, however, is blacked out in the photographs. Authorities are still trying to identify the man, Arnold said.

"Obviously, we want him also to answer for his crimes," Arnold said.

Arnold said the alleged victim is "going to be dealing with this for a long time."

Now that she has been identified, she will receive a victim notification every time one of the images turns up in an investigation, he said.

Tucker is being held without bond and is scheduled to be arraigned in federal court on Feb. 13. Her attorney could not be reached for comment.

hailey.branson@latimes.com

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Meryl Streep, Jean Dujardin returning to the Oscars

LOS ANGELES (TheWrap.com) – Three-time Oscar winner Meryl Streep will likely get to induct Daniel Day-Lewis into that triple-Oscar club on February 24 at the Dolby Theatre, while “The Sound of Music” star Christopher Plummer will probably hand the Best Supporting Actress award to a new screen-musical star, Anne Hathaway.

Those are two conclusions to be drawn from the Academy’s Tuesday announcement that last year’s acting winners, Streep, Plummer, Jean Dujardin and Octavia Spencer, will return to serve as presenters on this year’s Oscar telecast.

Streep won her third Oscar for “The Iron Lady,” while Dujardin, Spencer and Plummer won their first for “The Artist,” “The Help” and “Beginners,” respectively.

The previous year’s Best Actor and Best Supporting Actor winners typically present the Best Actress and Best Supporting Actress awards, and vice versa. And the immediate past winners are traditionally the first Oscar presenters to be announced.

So far, Oscar show producers Craig Zadan and Neil Meron have announced a number of musical participants, including Barbra Streisand, Norah Jones and a tribute to musicals of the past 10 years.

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Question Mark: Women’s Eggs Diminish With Age

Baby girls enter the world with enough of them to populate perhaps 40 small cities. A dozen or so years later, the first will make a debut of its own. And in the months and years to come, others will appear regularly, sometimes greeted with relief, other times with disappointment, perhaps most often with a touch of annoyance.

Abdullah Pope/Agence France-Presse — Getty Images

Not women's eggs, obviously.

Now, for women in the baby boom generation, they may be coming more sporadically, or not at all, signaling unmistakably that one time of life is over, and another begun. But what happened to all those eggs?

When girls are born, they have about two million eggs in their ovaries, nestled in fluid-filled cavities called follicles. That may sound like a lot, but consider that months earlier, when they were still in utero, they may have had as many as six or seven million eggs. Those eggs are still immature, and the proper name for them, by the way, is oocytes (rhymes with: nothing).

The first eggs to bite the dust were those in the fetus, which waste away. And by the time a girl reaches puberty, most of her remaining eggs have also deteriorated and been reabsorbed. If that sounds ominously like something from a “Star Trek” episode about the Borg, imagine if all those eggs had to take the customary path out of the body.

Even with the Great Egg Disappearance, girls enter puberty with many more than they will use, 300,000 or more. Each month, the body produces a hormone, FSH, which stimulates the follicles to prepare an egg for maturation and release.

With eggs backed up like bowling balls on a busy Saturday night at the lanes, the ovaries can afford to be a little wasteful, and as many as several dozen follicles are called into action. Then a single mature egg — usually, anyway — gets the tap on the shoulder and begins its travels to the uterus.

As for the maturing eggs that didn’t make the grade, there is no second chance. But they do not go out on their own. “Each month you probably lose a thousand or so,” said Dr. James T. Breeden, president of the American Congress of Obstetrics and Gynecology. “There’s just a natural death of them.”

For all the eggs a woman begins with, in the end only about 400 will go through ovulation. While men produce sperm throughout their lives, over time the number of eggs declines, and they disappear with increasing frequency the decade or so before menopause. Those that remain may decline in quality. “When you have a thousand or less within the ovaries, you’re thought to have undergone menopause,” said Dr. Mitchell Rosen, the director of the Fertility Preservation Center at the University of California, San Francisco.

It’s true that women make far more eggs than they end up using, but men should not pass judgment. “They produce millions of sperm, millions,” Dr. Rosen said. “The whole process is not the most efficient in the world.”

Questions about aging? E-mail boomerwhy@nytimes.com

Booming: Living Through the Middle Ages offers news and commentary about baby boomers, anchored by Michael Winerip. You can follow Booming via RSS here or visit nytimes.com/booming. You can reach us by e-mail at booming@nytimes.com.

This article has been revised to reflect the following correction:

Correction: February 5, 2013

An earlier version of this article incorrectly described estrogen levels at the time of ovulation. They rise, rather than fall.

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DealBook: E-Mails Show Alarm at S.&P. as Mortgage Crisis Exploded

10:17 p.m. | Updated

The executive at Standard & Poor’s was clear: “This market is a wildly spinning top which is going to end badly.”

That sober assessment of certain mortgage-related investments, delivered to colleagues in a confidential memo in December 2006, is now part of a trove of internal e-mails and documents that have come to light in a federal suit against S.& P., the nation’s largest credit ratings agency.

The correspondence, made public in court documents late Monday, provide a glimpse at the inner workings of an institution that the Justice Department says fraudulently inflated credit ratings, with dire consequences for the entire economy. In a series of e-mails, tensions appeared to be escalating inside the firm’s headquarters in Lower Manhattan as it publicly professed that its ratings were valid, even as the home loans bundled into mortgage-backed securities, or M.B.S., were failing at accelerating rates.

One comes from an S.& P. analyst in March 2007 borrowing from the Talking Heads song “Burning Down the House,” creating new lyrics: “Subprime is boi-ling o-ver. Bringing down the house.” S.& P. said prosecutors cherry-picked e-mails and that it would vigorously defend itself from “these unwarranted claims.”

In another 2007 e-mail, an analyst responds to a question about his new job: “Job’s going great. Aside from the fact that the M.B.S. world is crashing, investors and the media hate us and we’re all running around to save face … no complaints.”

Together, the documents show a portrait of some executives pushing to water down the firm’s rating models in the hope of preserving market share and profits, while others expressed deep concerns about the poor performance of the securities and what they saw as a lowering of standards.

The United States attorney general, Eric H. Holder Jr., joined by attorneys general from 16 states, unveiled the case on Tuesday in Washington, accusing S.& P. and its parent, the McGraw-Hill Companies, of intentionally propping up ratings of shaky mortgage investments and setting them up for a crash when the financial crisis struck.

The government is seeking $5 billion in penalties to cover losses to investors like state pension funds and federally insured banks and credit unions. The amount would be more than five times what S.& P. made in 2011.

“The action we announce today marks an important step forward in the administration’s ongoing effort to investigate — and punish — the conduct that is believed to have continued to the worst economic crisis in recent history,” Mr. Holder said.

The government, by bringing the civil fraud charges under a 1989 law created after the savings and loan crisis, faces a lower burden of proof when the victims are federally insured banks. But prosecutors could still face a high bar in convincing a jury by a preponderance of evidence that S.& P. knew that its ratings were faulty and that it intended to deceive investors.

“If the facts prove out, it certainly seems like Standard & Poor’s intentionally cooked its models in order to make the ratings higher than they otherwise thought they should be, in violation of the firm’s own policies and standards,” said Neil Barofsky, a former federal prosecutor who served as the special inspector general for the United States Treasury’s Troubled Asset Relief Program from 2008 to 2011.

“What we don’t know yet is, what’s the other stuff that could be out there?” he added, noting that the vast body of internal documents might also contain exculpatory material for S.& P.

The ratings agency said in a statement: “Claims that we deliberately kept ratings high when we knew they should be lower are simply not true.”

The company said that it had always been committed to “providing independent opinions on creditworthiness based on available information,” and that its actions reflected its best judgments about the investments at the heart of the suit — about 40 collateralized debt obligations, or C.D.O.’s, an exotic type of security made up of bundles of residential mortgage-backed securities, which in turn were composed of individual home loans. Those securities were packaged by banks, rated by S.& P. and sold to investors in 2007.

“Unfortunately,” the company’s statement said, “S.& P., like everyone else, did not predict the speed and severity of the coming crisis and how credit quality would ultimately be affected.”

Remarks that S.& P. employees made in internal memos and electronic communications show that as early as spring 2004, certain executives wanted to change the firm’s rating methodology, but only after polling “an appropriate number of issuers and investment bankers” as to the “rating implications.”

The idea of asking bankers what they thought about a change in the firm’s methods shocked some S.& P. analysts and executives, including one who fired back, “What does ‘rating implication’ have to do with the search for truth? Are you implying that we might actually reject or stifle ‘superior analytics’ for market considerations?”

In May 2004, an analyst warned that S.&. P. had just lost to its competitor Moody’s Investors Service the chance to rate a very large deal by being too hard-nosed about the amount of collateral that would be required to get a good rating. More collateral would mean less profit for Mizuho, the bank putting that deal together.

“We must address this now,” she said — otherwise the firm would lose more deals.

The complaint describes a debate in 2004 and 2005 about whether S.& P. should change its model for rating C.D.O.’s and what effect the proposed changes might have on its business. The change was scheduled for July 2005, but before it could happen, an analyst sent an e-mail saying that according to the investment bank Bear Stearns, the older model “had been the ‘best’ ” at rating weaker pools of mortgages, compared with Moody’s and Fitch.

As the housing market deteriorated in early 2007, the gallows humor in the e-mails intensified. Banks that had created mortgage-backed securities were unloading them quickly, to avoid being stuck with any duds.

“That means the market will crash,” one analyst told another in an instant message. “Deals will rush in before they take further loss.”

“Yes,” said the analyst’s colleague. “We should not push criteria,” continued the first, “but we give in anyway. Ahahhahaha.”

About a month later, another S.& P. employee wrote in another instant message, reproduced in the complaint: “We rate every deal. It could be structured by cows and we would rate it.”

In its statement Tuesday, S.& P. said that the cow e-mail “had nothing to do with R.M.B.S. or C.D.O. ratings or any S.& P. model, and the analyst had her concerns addressed with the issuer before S.& P. issued any rating.”

S.& P. said that there was a robust internal debate about how a rapidly deteriorating housing market might affect the C.D.O.’s, “and we applied the collective judgment of our committee-based system in good faith,” adding, “The e-mail excerpts cherry-picked by D.O.J. have been taken out of context, are contradicted by other evidence, and do not reflect our culture, integrity or how we do business.”

It was unclear whether the Justice Department was looking at the other two major ratings agencies, Moody’s and Fitch. Tony West, the acting associate attorney general, said he would not discuss actions against other ratings agencies.

Settlement talks between S.& P. and the Justice Department broke down in the last two weeks after prosecutors sought a penalty in excess of $1 billion and insisted that the company admit wrongdoing, several people with knowledge of the talks said. S.& P. had proposed a settlement of about $100 million, while the government pressed for an admission of guilt to at least one count of fraud, said the people.

McGraw-Hill shares fell nearly 11 percent on Tuesday. Moody’s shares fell about 9 percent, to $45.09.

Andrew Ross Sorkin, Michael J. de la Merced and Floyd Norris contributed reporting.

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Scientists identify remains as those of King Richard III

LONDON -- More than 500 years after his death in battle, scientists announced Monday that they had definitively identified a skeleton unearthed in central England last summer as that of Richard III, the medieval king portrayed by William Shakespeare as a homicidal tyrant who killed his two young nephews in order to ascend the throne.

DNA from the bones, found beneath the ruins of an old church, matches that of a living descendant of the monarch's sister, researchers said.

"Rarely have the conclusions of academic research been so eagerly awaited," Richard Buckley, the lead archaeologist on the excavation, told a phalanx of reporters Monday morning. "Beyond reasonable doubt, the individual exhumed ... is indeed Richard III, the last Plantagenet king of England."

PHOTOS: Remains of King Richard III

The dramatic announcement capped a brief hunt for Richard's remains, the progress of which has been closely charted by international media and whose success has been barely short of miraculous.

Working from old maps of Leicester, about 100 miles northwest of London, archaeologists from the local university had less than a month to dig in a small municipal parking lot -- one of the few spaces not built over in the crowded city center. The team stumbled on the ruins of the medieval priory where records say Richard was buried, then found the bones a few days later last September.

"It was an extraordinary discovery that stunned all of us," Buckley said.

The nearly intact skeleton bore obvious traces of trauma to the skull and of scoliosis, a curvature of the spine that matched contemporary descriptions of Richard's appearance. The feet were missing, almost certainly the result of later disturbance, and the hands were crossed at the wrist, which suggests that they may have been tied.

Scientists at the University of Leicester, which pioneered the practice of DNA fingerprinting, were able to extract samples from the bones and compare them to a man descended from Richard III's sister Anne. The match through the maternal line was virtually perfect.

"The DNA evidence points to these being the remains of Richard III," said Turi King, the project’s geneticist.

Richard reigned from 1483 to 1485, and occupies a unique place in England's long line of colorful rulers. He was the last English king to be killed in combat, at the Battle of Bosworth Field, by his successor, Henry VII. His death ended the Plantagenet dynasty and ushered in the long era of the Tudors, including Henry VIII and Elizabeth I.

Jo Appleby, an osteologist at the university, said the skeleton belonged to an adult male in his late 20s to late 30s; Richard III was 32 when he died. The man would have stood 5-foot-8 at full height, but the curved spine would have made him appear shorter.

The skull was riddled with wounds strongly indicative of death in battle, including two blows from bladed weapons, either of which would have been fatal, Appleby said.

Richard III is one of England's most controversial monarchs, reviled by some as a bloodthirsty despot who stopped at nothing to gain power, but revered by others who insist that he has been unfairly maligned. His supporters note that the repugnant portrait of Richard in today's popular imagination is based almost entirely on accounts from the time of the usurping Tudors, especially Shakespeare's indelible characterization of him as a "deform'd, unfinish'd" man without scruples.

Fans say Richard III was an enlightened, capable ruler whose important social reforms included the presumption of innocence for defendants and the granting of bail, which remain pillars of the legal system in Britain and the U.S.

However, what happened to Richard's two nephews, who were his rivals for the throne and who were locked up in the Tower of London as young boys, never to be seen again, remains a mystery.

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Robert De Niro cements place in Hollywood movies

LOS ANGELES (Reuters) – Double Oscar winner Robert De Niro cemented his place in acting history on Monday by placing his hands and feet in concrete in front of Hollywood‘s historic Chinese Theatre.

De Niro, 69, gave a short thank you speech with a few punchlines of his own.

“(Actor) Joe Pesci always said I’d end up with my feet in cement. I don’t think this is what he had in mind,” said De Niro, referring to the many gangster movies he has filmed over his 40-year career.

“They say everyone in the film industry has three homes – the home where they live, the home where their first wife lives, and Hollywood. I love New York, and I’m proud to be a citizen of Hollywood. Thank you for this honor and thank you for making me feel at home here,” he said.

De Niro, who founded the Tribeca Film Festival in 2002 in a bid to revive lower Manhattan after the September 11, 2001, attacks, is in the running for a third Oscar this month for his supporting role in comedy “Silver Linings Playbook.”

Billy Crystal, who played therapist to De Niro‘s insecure mob boss in the 1999 film “Analyze This,” praised the New York actor for his ability to bridge comedies like “Meet the Parents” and dramas such as “GoodFellas” and “Taxi Driver.”

“Even in his darkest performances, even in ‘Raging Bull‘ … he could make you laugh, and that he did in spades in ‘Analyze This.’ … I’m not used to playing straight for anybody, but it was a thrill of a lifetime to be on the opposite side of that genius,” Crystal said.

“Silver Linings Playbook” director David O. Russell praised De Niro‘s sensitivity in taking on the role of the father of a bipolar son in the movie.

“When we first read the script together he cried because he has known people who struggled with PTSD or bipolar disorder. … Many families are no stranger to these challenges and they have to find the magic and the love that Bob brought in his soul, and he did bring his soul to this movie,” Russell said.

De Niro won Oscars for his lead role in “Raging Bull” and his supporting turn in “The Godfather: Part II.”

His handprints and footprints in the courtyard of the Chinese Theatre are near those of Marilyn Monroe, Elizabeth Taylor, Brad Pitt and George Clooney.

(Reporting by Jill Serjeant; Editing by Xavier Briand)

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Well: Expressing the Inexpressible

When Kyle Potvin learned she had breast cancer at the age of 41, she tracked the details of her illness and treatment in a journal. But when it came to grappling with issues of mortality, fear and hope, she found that her best outlet was poetry.

How I feared chemo, afraid
It would change me.
It did.
Something dissolved inside me.
Tears began a slow drip;
I cried at the news story
Of a lost boy found in the woods …
At the surprising beauty
Of a bright leaf falling
Like the last strand of hair from my head

Ms. Potvin, now 47 and living in Derry, N.H., recently published “Sound Travels on Water” (Finishing Line Press), a collection of poems about her experience with cancer. And she has organized the Prickly Pear Poetry Project, a series of workshops for cancer patients.

“The creative process can be really healing,” Ms. Potvin said in an interview. “Loss, mortality and even hopefulness were on my mind, and I found that through writing poetry I was able to express some of those concepts in a way that helped me process what I was thinking.”

In April, the National Association for Poetry Therapy, whose members include both medical doctors and therapists, is to hold a conference in Chicago with sessions on using poetry to manage pain and to help adolescents cope with bullying. And this spring, Tasora Books will publish “The Cancer Poetry Project 2,” an anthology of poems written by patients and their loved ones.

Dr. Rafael Campo, an associate professor of medicine at Harvard, says he uses poetry in his practice, offering therapy groups and including poems with the medical forms and educational materials he gives his patients.

“It’s always striking to me how they want to talk about the poems the next time we meet and not the other stuff I give them,” he said. “It’s such a visceral mode of expression. When our bodies betray us in such a profound way, it can be all the more powerful for patients to really use the rhythms of poetry to make sense of what is happening in their bodies.”

On return visits, Dr. Campo’s patients often begin by discussing a poem he gave them — for example, “At the Cancer Clinic,” by Ted Kooser, from his collection “Delights & Shadows” (Copper Canyon Press, 2004), about a nurse holding the door for a slow-moving patient.

How patient she is in the crisp white sails
of her clothes. The sick woman
peers from under her funny knit cap
to watch each foot swing scuffing forward
and take its turn under her weight.
There is no restlessness or impatience
or anger anywhere in sight. Grace
fills the clean mold of this moment
and all the shuffling magazines grow still.

In Ms. Potvin’s case, poems related to her illness were often spurred by mundane moments, like seeing a neighbor out for a nightly walk. Here is “Tumor”:

My neighbor walks
For miles each night.
A mantra drives her, I imagine
As my boys’ chant did
The summer of my own illness:
“Push, Mommy, push.”
Urging me to wind my sore feet
Winch-like on a rented bike
To inch us home.
I couldn’t stop;
Couldn’t leave us
Miles from the end.

Karin Miller, 48, of Minneapolis, turned to poetry 15 years ago when her husband developed testicular cancer at the same time she was pregnant with their first child.

Her husband has since recovered, and Ms. Miller has reviewed thousands of poems by cancer patients and their loved ones to create the “Cancer Poetry Project” anthologies. One poem is “Hymn to a Lost Breast,” by Bonnie Maurer.

Oh let it fly
let it fling
let it flip like a pancake in the air
let it sing: what is the song
of one breast flapping?

Another is “Barn Wish” by Kim Knedler Hewett.

I sit where you can’t see me
Listening to the rustle of papers and pills in the other room,
Wondering if you can hear them.
Let’s go back to the barn, I whisper.
Let’s turn on the TV and watch the Bengals lose.
Let’s eat Bill’s Doughnuts and drink Pepsi.
Anything but this.

Ms. Miller has asked many of her poets to explain why they find poetry healing. “They say it’s the thing that lets them get to the core of how they are feeling,” she said. “It’s the simplicity of poetry, the bare bones of it, that helps them deal with their fears.”

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Have you written a poem about cancer? Please share them with us in the comments section below.

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Frequent Flier: An Unhappy Meal and an Aborted Business Trip - Frequent Flier

I WAS going to go into academics, but then decided to serve the marketing machine by going into public relations. A lot of my travel involves conferences, speaking engagements and, of course, pitching new business and meeting with existing clients.

Jason Schlossberg, a partner in the public relations agency Kwittken & Company, in Kyoto, Japan, last year. He still looks forward to flying.

Q. How often do you fly for business?

A. Three to four times a month, a mix of domestic and international.

Q. What’s your least favorite airport?

A. Charles de Gaulle in Paris. It’s just a big monstrosity and very confusing.

Q. Of all the places you’ve been, what’s the best?

A. Everywhere I go is usually my favorite. But if I have to choose, I’d say Tokyo. It’s like being on another planet. The food, culture and people are amazing. Plus, I speak Japanese, but only as well as a smart third grader.

Q. What’s your secret airport vice?

A. I fly in and out of Logan Airport in Boston a lot and will push my flight back just so I can stop at Legal Sea Foods and have a lobster roll and a Sam Adams.

Even though the airlines are doing everything in their power to make me hate flying, I still get excited about getting on a plane.

I used to be a D.J., and still do it on occasion. A few years ago, I would leverage my business trips to Chicago, Tokyo and Miami, all places where we had clients, into D.J. gigs by checking out the D.J. message boards for open slots in these cities. It was a great way to break the ice with clients.

Sometimes I travel with colleagues, but there’s always this unspoken agreement that plane time is alone time. My business partner took that to a new level.

For several years, we had a client in the Napa Valley. We always held our meetings on a Monday. It was a great place to go, and when I traveled alone, I would leave New York early on a Sunday, land in San Francisco, and drive up to Napa. I’d have a great dinner, and some wine. That’s the way to start a business trip.

But my business partner looks at travel as more of a chore. He’s a workaholic, but hates sacrificing family time because of business travel. So when we traveled together to Napa, he always insisted on taking the last flight out of New York on Sunday night. That left no time to enjoy Napa.

At the start of one Napa trip, we got to Kennedy Airport a little late, and neither of us had eaten. So I grabbed a quick meal at a deli before it was time to board, and my partner went to a fast-food place.

After finishing my meal, such as it was, I got on the plane and looked for my partner. We were supposed to be seated a few rows apart. I didn’t see him. I got myself settled, and then my phone went off.

It was my partner telling me he had been kicked off the flight. I asked him how that was possible since we weren’t boarding for that long. I thought he was kidding. I thought he just wanted out of traveling. I mean, this guy is not the type of guy to get kicked off a plane.

But apparently, his fast-food meal quickly disagreed with him, and he had some stomach difficulties. To make matters worse, he appears to have a little quirk that happens any time he gets nauseous. Basically, he kind of whimpers, or screams, depending on how you define the loud noise that he was emitting, in between his bouts of nausea. I couldn’t believe it. It was the strangest thing I ever heard. It’s not like he has a disease. He’s a healthy guy.

The flight attendants and fellow passengers weren’t happy with him. Not only did they have to deal with a guy who was getting sick in his seat, but also one who was loud. Very loud. They probably thought there wasn’t enough Pepto-Bismol on the plane, let alone the planet, to help him. He was escorted off.

I told him I knew he didn’t like traveling, but this was ridiculous. And then, I couldn’t stop laughing. He and I are still business partners, and friends.

We still travel together quite often and every time I get on a plane with him now, I just look at him and smirk. And hope that he hasn’t had any fast food.

By Jason Schlossberg, as told to Joan Raymond. E-mail: joan.raymond@nytimes.com.

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