The Boss: New Leaders Inc. C.E.O. on Giving Children a Chance





I AM the youngest of 10 children in my family, and the only one born in the United States. My father was a municipal judge who fled Haiti during the Duvalier regime. He and my mother settled in the Bedford-Stuyvesant area of Brooklyn, but could not initially afford to bring over my four brothers and five sisters, who stayed in Haiti with relatives.







Jean S. Desravines is the chief executive of New Leaders Inc. in New York.




AGE 41


FAVORITE PASTIMES Karate and taekwondo


MEMORABLE BOOK "How Children Succeed: Grit, Curiosity and the Hidden Power of Character," by Paul Tough






Since he did not speak English fluently, my father worked as a janitor and had a second job as a hospital security guard. He later took a third job driving a taxi at night to pay for my tuition at Nazareth Regional High School, a Roman Catholic school in Brooklyn. My parents were determined that I was going to get a good education, and wanted to keep me away from local troubles, which did claim two of my childhood friends.


Working so many jobs overwhelmed my father. He had a heart attack and died at age 59 behind the wheel of his taxi. My mother found it difficult to cope without my father and moved back to Haiti in 1989 with two of my siblings. I thought I would have to leave school because I had no money for tuition, but Nazareth agreed to pay my way.


I wound up sleeping in my car for almost three months, showering at school after my track team’s practice. I also held down two jobs, both in retailing, and one of my sisters and I rented a basement apartment in East Flatbush.


After graduating from high school in 1990, I attended St. Francis College in Brooklyn, on athletic and academic scholarships. I worked first at the New York City Board of Education, where H. Carl McCall was president, then in his office after he became New York State comptroller. I later worked in the office of Ruth Messinger, then the Manhattan borough president.


I broadened my nonprofit organization experience at the Faith Center for Community Development while earning my master’s of public administration at New York University. I married my high school sweetheart, Melissa, and we now have two children.


In 2001, I began to work toward my original goal — improving educational opportunities for children — and joined the city’s Department of Education. I was later recruited under the new administration of Mayor Michael R. Bloomberg to help start a program as part of his Children First reforms.


In 2003, I became the Department of Education’s executive director for parent and community engagement, and, two years later, senior counselor to Joel I. Klein, then the school chancellor. He taught me a great deal about leadership and how to change the education system. But I began to realize public education could not be transformed without great principals who function like C.E.O.’s of their schools.


So in 2006 I returned to the nonprofit world, to New Leaders, a national organization founded in 2000 to recruit and develop leaders to turn around low-performing public schools. Initially, I managed city partnerships and expanded our program in areas like New Orleans and Charlotte, N.C.


In 2011, I became C.E.O., and revamped our program to produce even stronger student achievement results, streamlined our costs, diversified funding sources and forged new partnerships. We have an annual budget of $31.5 million, which comes from foundations, businesses, individuals and government grants, and a staff of about 200 people at a dozen locations.


We have a new partnership with Pearson Education to provide greater learning opportunities to public school principals. The goal of these efforts is to have a great principal in each of our nation’s public schools — to make sure that, just as I did, all kids get a chance at success.


As told to Elizabeth Olson.



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A backyard nuclear shelter? Yes, paranoia does sell








One sterling quality of American businesses is that they'll try to make money from anything.


Paranoia, for instance. So say hello to Ron Hubbard, the owner of Montebello-based Atlas Survival Shelters, which converts huge corrugated metal tubes up to 50 feet long into fully equipped, all-the-comforts-of-home underground shelters at a price of up to about $78,000 each, not including shipping and interment.


You may have spotted the Atlas shop from the 5 Freeway as you're heading into downtown. There's a corrugated tube out front, painted bright yellow and looking like a tipped-over corn silo. High on the exterior wall facing the road is a banner declaring that the shelters offer protection from nuclear blasts, nuclear fallout, EMP (that's electromagnetic pulses, which can foul electrical systems), solar flares, mobs, looters, earthquakes and chemical warfare. If there's anything left off that list, it's probably not worth worrying about.






"People who buy my shelters are not radical crazy people," Hubbard told me recently as he guided me around the Montebello shop. "I get maybe three crazy calls a year. They're practical people."


Hubbard, 50, is a big Texan with a toothy grin and the friendly enthusiasm of someone trying to sell you something. He'll expound cheerily on the basic practicality, not to mention the sheer joy, of having a 40-foot corrugated steel drum buried 20 feet deep in your yard and tricking it out with a big-screen TV and Internet connection for those long days and nights hunkered down against nuclear blasts, the Chinese army or domestic looters. His shelters also offer such necessities as microwave ovens, space for a year's worth of provisions and high-grade air filtration.


"We don't know where our country will go," he said. "If we're going to be attacked, my shelters will protect you from Sarin gas or super flu. If we go bankrupt and we don't pay China, that could be the start of World War III. We could attack Iran or back Israel, and that could start a war. This is insurance. Why do we carry insurance on our homes? Just. In. Case."


Hubbard doesn't describe these dystopias as though he actually believes in them, but rather with the air of a salesman trying out any buzzword that might trigger a deal. During the couple of hours we were together, he described his products serially as underground condos, second homes, combination second homes and bomb shelters, man caves, man caves that happen to be bombproof, weekend cabins and hunting cabins.


Atlas Survival Shelters hasn't turned a significant profit yet. Hubbard said it made no money in the start-up year of 2011, was modestly in the black last year and may show a profit for 2013. But the business is unusual enough that it has won featured spots on several reality shows. An episode on A&E Network's "Shipping Wars" shows a team of moving experts trying to figure out how to transport a 32-foot shelter on their flatbed truck. During the episode Hubbard regales them with the virtues of the unit's escape-hatch feature, a second portal that opens only from the inside, in case of an attack.


"Somebody sees you going down; while they're trying to smoke you out, you're going to the back tunnel, you're gonna come up through an escape hatch that's hidden underground, you can shoot 'em in the back. Pretty cool, huh?" (Remarked one of the show's plainly creeped-out female cast members, "Remind me to never pay him a visit.")


More recently, Atlas was featured on an episode of the National Geographic Channel series "Doomsday Preppers," which chronicles the lifestyles of the scared and nervous. Hubbard's customer is described in network publicity as Brian Smith, a father of 12 "preparing for a total collapse of the U.S. monetary system."


Hubbard got into the underground shelter business a little more than a year ago after years of selling wrought-iron doors from the same location, operating as Hubbard Iron Doors. That business was brought low by the poor economy and cheap Chinese knockoffs, Hubbard says. It filed for bankruptcy in 2011; Hubbard says it's now owned and run by his brother, though the two companies share space with each other.


While he was casting about for a new business, Hubbard said, he happened across a brochure for Radius Engineering International, a Texas company that manufacturers fiberglass shelters mostly for business, government and military buyers. But the Radius products were expensive — they run from $150,000 up to millions, depending on the design and capacity. Hubbard thought he could do better on price while turning out a more appealing hideaway.


He's still trying to get a feel for the market, however. With his six or seven full-time workers, he can turn out one shelter a week. Orders, he said, come in at somewhere between one a month and one a week, more in periods of publicity-driven paranoia — during the run-up to the supposed Mayan apocalypse at the end of December, he said, calls jumped up to one a day.


The joke was on the callers, however, because Hubbard's six-week lead time meant that no one who called because they had just seen a Mayan feature on TV could get a shelter built, much less on site and in the ground, in time to beat the end of the world. Luckily, the apocalypse was a bust.


And for all that he plays up Armageddon in all its possible varieties in his sales pitch, doomsday may not be that great a marketing tool. "If I just sold bomb shelters, there would be about this big of a market." Hubbard holds his thumb and forefinger a half-inch apart. "But if I say, 'man cave,' 'wine cellar,' 'getaway,' then I get the recreational shelter owner too."


He says most of his calls come from retired military men, doctors, lawyers and business owners — possibly because the latter are among the few categories of buyers with the wherewithal to plunk down $60,000 or $70,000 for a man cave/bomb shelter, plus installation.


The size of the overall shelter market is unclear, in part because its promoters make a point of secrecy about whom they sell to and where. Privately held Radius has claimed to sell more than $30 million worth of shelters a year, but you have to take their word for it.


Then there are firms like Vivos Group, a Del Mar, Calif., company that claims to have started survivalist communities in three states — but they appear to be sort of co-op arrangements in which you have to apply to be considered for "co-ownership" of your refuge community. Once you're chosen, they'll let you know where to go when the end times come.


"This is just the threshold of something that's going to become common," Hubbard said, putting a hopeful spin on his words as though aware that paranoia may be peaking today, but gone tomorrow. "So I say, don't buy a bomb shelter. Buy an underground cabin, and enjoy it."


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






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A Google-a-Day Puzzle for Jan. 19











Our good friends at Google run a daily puzzle challenge and asked us to help get them out to the geeky masses. Each day’s puzzle will task your googling skills a little more, leading you to Google mastery. Each morning at 12:01 a.m. Eastern time you’ll see a new puzzle posted here.


SPOILER WARNING:
We leave the comments on so people can work together to find the answer. As such, if you want to figure it out all by yourself, DON’T READ THE COMMENTS!


Also, with the knowledge that because others may publish their answers before you do, if you want to be able to search for information without accidentally seeing the answer somewhere, you can use the Google-a-Day site’s search tool, which will automatically filter out published answers, to give you a spoiler-free experience.


And now, without further ado, we give you…


TODAY’S PUZZLE:



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Ken is a husband and father from the San Francisco Bay Area, where he works as a civil engineer. He also wrote the NYT bestselling book "Geek Dad: Awesomely Geeky Projects for Dads and Kids to Share."

Read more by Ken Denmead

Follow @fitzwillie and @geekdads on Twitter.



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J.J. Abrams to produce Lance Armstrong biopic






LOS ANGELES (AP) — He’s already gotten the Oprah treatment. Now Lance Armstrong is headed for the silver screen.


Paramount Pictures and J.J. Abramsproduction company, Bad Robot, are planning a biopic about the disgraced cyclist, a studio spokeswoman said Friday.






They’ve secured the rights to New York Times reporter Juliet Macur‘s upcoming book “Cycle of Lies: The Fall of Lance Armstrong,” due out in June. Macur covered the seven-time Tour de France winner for over a decade.


No director, writer, star or start date have been set.


Armstrong is in the midst of a two-part interview with Oprah Winfrey in which he admits to using performance-enhancing drugs to reach his historic victories, something he’d defiantly denied for years. The International Olympic Committee stripped him of his 2000 bronze medal this week.


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Business Briefing | Medicine: F.D.A. Clears Botox to Help Bladder Control



Botox, the wrinkle treatment made by Allergan, has been approved to treat adults with overactive bladders who cannot tolerate or were not helped by other drugs, the Food and Drug Administration said on Friday. Botox injected into the bladder muscle causes the bladder to relax, increasing its storage capacity. “Clinical studies have demonstrated Botox’s ability to significantly reduce the frequency of urinary incontinence,” Dr. Hylton V. Joffe, director of the F.D.A.’s reproductive and urologic products division, said in a statement. “Today’s approval provides an important additional treatment option for patients with overactive bladder, a condition that affects an estimated 33 million men and women in the United States.”


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Analysis: Amid Tears Lance Armstrong Leaves Unanswered Questions in Oprah Winfrey Interview





In an extensive interview with Oprah Winfrey that was shown over two nights, Lance Armstrong admitted publicly for the first time that he doped throughout his cycling career. He revealed that all seven of his Tour de France victories were fueled by doping, that he never felt bad about cheating, and that he had covered up a positive drug test at the 1999 Tour with a backdated doctor’s prescription for banned cortisone.




Armstrong, the once defiant cyclist, also became choked up when he discussed how he told his oldest child that the rumors about Armstrong’s doping were true.


Even with all that, the interview will most likely be remembered for what it was missing.


Armstrong had not subjected himself to questioning from anyone in the news media since United States antidoping officials laid out their case against him in October. He chose not to appeal their ruling, leaving him with a lifetime ban from Olympic sports.


He personally chose Winfrey for his big reveal, and it went predictably. Winfrey allowed him to share his thoughts and elicited emotions from him, but she consistently failed to ask critical follow-up questions that would have addressed the most vexing aspects of Armstrong’s deception.


She did not press him on who helped him dope or cover up his drug use for more than a decade. Nor did she ask him why he chose to take banned performance-enhancing substances even after cancer had threatened his life.


Winfrey also did not push him to answer whether he had admitted to doctors in an Indianapolis hospital in 1996 that he had used performance-enhancing drugs, a confession a former teammate and his wife claimed they overheard that day. To get to the bottom of his deceit, antidoping officials said, Armstrong has to be willing to provide more details.


“He spoke to a talk-show host,” David Howman, the director general of the World Anti-Doping Agency, said from Montreal on Friday. “I don’t think any of it amounted to assistance to the antidoping community, let alone substantial assistance. You bundle it all up and say, ‘So what?’


Jeffrey M. Tillotson, the lawyer for an insurance company that unsuccessfully withheld a $5 million bonus from Armstrong on the basis that he had cheated to win the Tour de France in 2004, said his client would make a decision over the weekend about whether to sue Armstrong. If it proceeds, the company, SCA Promotions, will seek $12 million, the total it paid Armstrong in bonuses and legal fees.


“It seemed to us that he was more sorry that he had been caught than for what he had done,” Tillotson said. “If he’s serious about rehabbing himself, he needs to start making amends to the people he bullied and vilified, and he needs to start paying money back.”


Armstrong, who said he once believed himself to be invincible, explained in the portion of the interview broadcast Friday night that he started to take steps toward redemption last month. Then, after dozens of questions had already been lobbed his way, he became emotional when he described how he told his 13-year-old son, Luke, that yes, his father had cheated by doping. That talk happened last month over the holidays, Armstrong said as he fought back tears.


“I said, listen, there’s been a lot of questions about your dad, my career, whether I doped or did not dope, and I’ve always denied, I’ve always been ruthless and defiant about that, which is probably why you trusted me, which makes it even sicker,” Armstrong said he told his son, the oldest of his five children. “I want you to know it’s true.”


At times, Winfrey’s interview seemed more like a therapy session than an inquisition, with Armstrong admitting that he was narcissistic and had been in therapy — and that he should be in therapy regularly because his life was so complicated.


In the end, the interview most likely accomplished what Armstrong had hoped: it was the vehicle through which he admitted to the public that he had cheated by doping, which he had lied about for more than a decade. But his answers were just the first step to clawing back his once stellar reputation.


On Friday, Armstrong appeared more contrite than he had during the part of the interview that was shown Thursday, yet he still insisted that he was clean when he made his comeback to cycling in 2009 after a brief retirement, an assertion the United States Anti-Doping Agency said was untrue. He also implied that his lifetime ban from all Olympic sports was unfair because some of his former teammates who testified about their doping and the doping on Armstrong’s teams received only six-month bans.


Richard Pound, the founding chairman of WADA and a member of the International Olympic Committee, said he was unmoved by Armstrong’s televised mea culpa.


“If what he’s looking for is some kind of reconstruction of his image, instead of providing entertainment with Oprah Winfrey, he’s got a long way to go,” Pound said Friday from his Montreal office.


Armstrong acknowledged to Winfrey during Friday’s broadcast that he has a long way to go before winning back the public’s trust. He said he understood why people recently turned on him because they felt angry and betrayed.


“I lied to you and I’m sorry,” he said before acknowledging that he might have lost many of his supporters for good. “I am committed to spending as long as I have to to make amends, knowing full well that I won’t get very many back.”


Armstrong also said that the scandal has cost him $75 million in lost sponsors, all of whom abandoned him last fall after Usada made public 1,000 pages of evidence that Armstrong had doped.


“In a way, I just assumed we would get to that point,” he said of his sponsors’ leaving. “The story was getting out of control.”


In closing her interview, Winfrey asked Armstrong a question that left him perplexed.


“Will you rise again?” she said.


Armstrong said: “I don’t know. I don’t know. I don’t know what’s out there.”


Then, as the interview drew to a close, Armstrong said: “The ultimate crime is the betrayal of these people that supported me and believed in me.”


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Home sweet home or merely a teardown?









The courtyard patio at the classic California Spanish house was ringed by camellia bushes. In the living room, the fireplace boasted genuine Malibu tile and in the dining room, the original thin-planked oak floors gleamed.


Listed for sale at $2.6 million, the immaculately maintained, three-bedroom home — a blend of traditional and modern stylings in one of Santa Monica's toniest neighborhoods — could go either way: to a family who falls in love with its character. Or to a builder, as a teardown.


"It's a tweener," real estate agent John Hathorn said Sunday. "We're seeing both buyers."





This celery-green Spanish with the barrel tile roof was among three properties with open houses Sunday on the Westside. Judging by the crowds, the real estate downturn on the Westside, if it ever existed, is over. Hordes showed up for each viewing, complaining that almost nothing was on the market.


Spaniard Mila Jimenez said she and her husband could get more for their money on the Westside than in Madrid or Amsterdam. An older couple from Mandeville Canyon wanted to relocate where they could buy a loaf of bread without mounting an overland expedition. Several viewers were eager to live near their workplaces to avoid the Westside's horrendous traffic.


Judging by the number of empty lots on the Westside with cranes idled over piles of dirt, the teardown phenomenon is also revving back up. This comes as no surprise. The reasons for teardowns are simple: Somebody thinks they can make more money or live better by knocking down a house and building a newer, bigger and shinier one. Way bigger: many of the new houses are gargantuan, built out as close as they can get to the lot lines to maximize resale value down the line.


What was eye-popping were the prices people will pay for the privilege of ripping down a home. One Brentwood fixer-upper featured misbegotten design choices such as square bathroom tile in a light mauve and a gaping Jacuzzi tub. The fireplaces in the living room and bedroom were hung with rusty chain curtains, and mold was growing on the garage ceiling. It was listed at $1.5 million.


"I hope that comes with a bulldozer," said one viewer.


A young man in commercial real estate named Farz said the house had "potential." Clutching his girlfriend Tina's hand, Farz said you could start by putting in a second floor, then "three or five years down the line, tear it down and built it up again." Tina, a physician, agreed, saying she's living with her family nearby and wants to remain in the area.


Up close, teardowns make economic sense. A two-physician couple pushing a bubbly 4-month-old in a stroller explained that with interest rates under 3%, mortgage payments on a million-dollar property would be roughly equivalent to rents in Brentwood and Santa Monica, $3,000 to $4,000 a month. Building a new home can be cheaper than renovating.


But stepping back, it's striking to realize that while tens of thousands of people who lost in the recession are still fighting to hang on to their homes, others are lining up to tear them down. L.A. real estate spans two worlds: one in which owning a house — any house — is the dream of a lifetime, and another in which a house is just a nuisance.


A few streets away from the fixer-upper, a charming Cape Cod-style house — white, with a picket fence and dormer windows — was also listed at $1.5 million.


A psychology professional and a physician had lived in the home. It was in impeccable repair and full of loving details. A framed copy of an ode a son had written to the couple's marriage hung on the wall. A Chinese elm shaded the brick patio, and a kelly green lawn sloped deep and wide back to a thicket of citrus and other trees.


But it, too, faced at least the possibility of being torn down, though the agent, Dolly Niemann, said its chances were probably better than many other homes of its vintage.


However, a potential bidder had already asked about removing the tree out back, suggesting demolition is on the table.


Back at the Santa Monica Spanish open house, an Anna-Wintouresque real estate woman in giant sunglasses dropped by and opined that the celery-colored house was doomed.


"It's under-built for the neighborhood," she said. "The kitchen is nothing."


"Two words, it's not functional, and it's not for modern living," her male business partner said (they declined to be identified, saying they're well-known in Westside real estate circles.)


Sure, if your routine includes yoga classes, boot camp, charity balls, cocktail parties, volunteer work, school drop-offs and pickups, your wardrobe is not going to fit in 1930s-scale closets. Not to mention the shoes.


The house next door to the Spanish already sold as a teardown. Its replacement, a humongous oblong building, looms over its neighbor, blocking out air and sun.


Granted in Santa Monica, replacement houses are often more artfully designed. Hathorn said the latest thing in teardown replacements are traditional features such as coffered ceilings and wainscoting.


But even the professionals sometimes feel a twinge: Saundra lives in Brentwood and works in real estate so she gets the teardown calculus. She showed up at the showing of the Cape Cod house, which she thinks is so cute she often drives past just to view it. But she was horrified it might go as a teardown.


"That would be so sad," she said.


gale.holland@latimes.com





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A Google-a-Day Puzzle for Jan. 18











Our good friends at Google run a daily puzzle challenge and asked us to help get them out to the geeky masses. Each day’s puzzle will task your googling skills a little more, leading you to Google mastery. Each morning at 12:01 a.m. Eastern time you’ll see a new puzzle posted here.


SPOILER WARNING:
We leave the comments on so people can work together to find the answer. As such, if you want to figure it out all by yourself, DON’T READ THE COMMENTS!


Also, with the knowledge that because others may publish their answers before you do, if you want to be able to search for information without accidentally seeing the answer somewhere, you can use the Google-a-Day site’s search tool, which will automatically filter out published answers, to give you a spoiler-free experience.


And now, without further ado, we give you…


TODAY’S PUZZLE:



Note: Ad-blocking software may prevent display of the puzzle widget.




Ken is a husband and father from the San Francisco Bay Area, where he works as a civil engineer. He also wrote the NYT bestselling book "Geek Dad: Awesomely Geeky Projects for Dads and Kids to Share."

Read more by Ken Denmead

Follow @fitzwillie and @wiredgeekdad on Twitter.



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Robert Wagner not interviewed in new Wood inquiry






LOS ANGELES (AP) — Robert Wagner has declined to be interviewed by detectives in a renewed inquiry into the drowning death of his wife Natalie Wood three decades ago, an investigator said Thursday.


Wagner was interviewed by authorities soon after Wood’s drowning in 1981, but the actor is the only person who was on the yacht the night Wood died who has not spoken to detectives as part of the latest inquiry, despite repeated requests and attempts, sheriff’s Lt. John Corina said.






Blair Berk, an attorney for Wagner and his family, said the actor had cooperated with authorities since his wife died.


Detectives began re-investigating the case in November 2011. Since then investigators have interviewed more than 100 people, but Wagner has refused and Corina said the actor’s representatives have not given any reason for his silence.


The detective’s remarks provided new insight into the case that has remained one of Hollywood’s enduring mysteries. Earlier this week, coroner’s officials released an updated autopsy report that had been under a security hold. It detailed why Wood’s death had been reclassified from an accidental drowning to a drowning caused by “undetermined factors.”


“Mr. Wagner has fully cooperated over the last 30 years in the investigation of the accidental drowning of his wife in 1981,” Berk said in a prepared statement. “Mr. Wagner has been interviewed on multiple occasions by the Los Angeles sheriff’s department and answered every single question asked of him by detectives during those interviews.”


After 30 years, Berk said, neither Wagner nor his daughters have any new information to add. She said the latest investigation was prompted by people seeking to exploit and sensationalize the 30th anniversary of the death.


The renewed inquiry came after the yacht‘s captain Dennis Davern told “48 Hours” and the “Today” show that he heard Wagner and Wood arguing the night of her disappearance and believed Wagner was to blame for her death.


Authorities have not identified any suspects in the case.


Wood, 43, was on a yacht with Wagner, Christopher Walken and the boat captain on Thanksgiving weekend of 1981 before she somehow ended up in the water.


Corina said Walken gave a prepared statement and spoke to detectives for an hour.


Detectives have also interviewed other actors who knew both Wagner and Wood to learn more about their relationship.


Corina said detectives have tried at least 10 times to interview Wagner but have been refused. He said some of the refusals have come from the actor’s attorney, and that detectives at one point traveled to Colorado to try to speak with Wagner but were unsuccessful.


Corina said the latest inquiry had turned up new evidence.


“Most of the people we’ve talked to were never talked to 30 years ago,” he said. “We’ve got a lot of new information.”


Asked if the information might lead to criminal charges, Corina said that would be up to prosecutors if they are presented a case.


“All we can do is collect the facts,” he said. “We’re still trying to collect all the facts.”


Corina said new people have emerged with information each time the case is in the news. Detectives would like to interview other people who haven’t agreed to talk, he said.


Coroner’s officials released an update autopsy report on Monday that detailed the reasons Wood’s death certificate was changed last year from a drowning death to “drowning and other undetermined factors.”


The updated report states the change was made in part because investigators couldn’t rule out that some of the bruises and marks on Wood’s body happened before she went into the water.


“Since there are unanswered questions and limited additional evidence available for evaluation, it is opined by this medical examiner that the manner of death should be left as undetermined,” Chief Medical Examiner Dr. Lakshmanan Sathyavagiswaran wrote in the report completed in June.


Officials also considered that Wood wasn’t wearing a life jacket, had no history of suicide attempts and didn’t leave a note as reasons to amend the death certificate.


Wood was famous for roles in films such as “West Side Story” and “Rebel Without a Cause” and was nominated for three Academy Awards.


Conflicting versions of what happened on the yacht have contributed to the mystery of her death. Wood, Wagner and Walken had all been drinking heavily in the hours before the actress disappeared.


Wagner wrote in a 2008 memoir that he and Walken argued that night. He wrote that Walken went to bed and he stayed up for a while, but when he went to bed, he noticed that his wife and a dinghy that had been attached to the yacht were missing.


“Nobody knows,” he wrote. “There are only two possibilities; either she was trying to get away from the argument, or she was trying to tie the dinghy. But the bottom line is that nobody knows exactly what happened.”


___


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


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Well: The Fallout of a Chance Medical Finding

An incidental finding — I was convinced of it. My patient had undergone a CT scan of the abdomen at another hospital because of stomach pains and “incidentally noted” was a 2-centimeter mass in her adrenal gland. She brought in the report for me to see, nervous that she might have cancer.

I reassured her that it was exceedingly unlikely that she had cancer. Benign masses in the adrenal gland are nearly as common as birthmarks. They almost never cause symptoms and we stumble across them only because we do so many scans for other reasons. They’ve even earned their own appellation: incidentalomas, and that’s what I was sure she had.

Of course a tiny fraction — 1 to 2 percent — of these adrenal masses can wreak havoc by churning out an excess of adrenal hormones or by being cancerous. Luckily, the mass on my patient’s scan possessed all the reassuring characteristics of benignity: it was small, low-attenuating, well circumscribed, with smooth borders. And she had no symptoms to suggest adrenal hyperactivity or cancer. It was most likely a benign adrenal adenoma that would never cause her harm.

Nevertheless, once the incidentaloma had been given life, so to speak, it was no longer incidental. We were now obliged to run some highly complicated — and expensive — lab tests. I winced as I ordered urinary metanephrines to test the adrenaline-producing capacity of the adrenal. The computer warned me with exclamation points and asterisks that this was a “greater-than-$100-send-out test.” Explaining how to correctly collect a 24-hour urine sample was its own involved discussion. Then I had to explain the even more complicated logistics of the overnight dexamethasone-suppression test to evaluate the cortisol-producing capacity of the adrenal.

After that, I considered the follow-up CT scans, recommended at six months, one year and two years, to ensure that the mass wasn’t growing. What about all that radiation? One group of endocrinologists estimated that the chance of uncovering a malignant cancer in patients like mine was roughly equal to the chance of causing a fatal cancer from the radiation of these follow-up CT scans. And might these CT scans pick up other incidental findings, opening yet more Pandora’s boxes of medical evaluation?

And what about the issue of skyrocketing medical costs? The evaluation of this incidentaloma was going to cost more than a thousand dollars. Tens of millions of CT scans are done every year in the United States. It doesn’t take many back-of-the-envelope calculations to see how quickly the costs of incidental findings, and their subsequent evaluations, add up. How much should the societal obligation weigh into the decisions for my patient?

My thoughts flitted back to the doctor who had ordered this CT in the first place. Perhaps if the doctor had had more time to spend on the history and physical, the CT would not have been necessary. From my 15 years with this patient, I knew that her symptoms could be voluminous in quantity and quality. This wasn’t to say that something serious couldn’t squeak in, but over the years I have learned that it takes immense perseverance and patience to tease out the significance of each symptom. Otherwise we’d be doing a CT every week for her.

But I could understand how a doctor in a busy ER on a weekend might have been overwhelmed by the plethora of symptoms and simply ordered a CT “to be on the safe side.” I wished that doctor had tried to call me before ordering the scan, but what’s done was done. The fallout of that decision was now in my lap.

By now we had run well over our allotted time and my patient was utterly overwhelmed by the complex testing procedures and schedules. The adrenal mass was an incidental finding, after all, but it had completely steamrolled our visit. My patient’s diabetes, obesity, depression, arthritis and elevated cholesterol all ended up with the short end of the clinical stick — an outcome that surely is not incidental to her health.


Danielle Ofri is an associate professor of medicine at New York University School of Medicine and editor in chief of the Bellevue Literary Review. Her most recent book is “Medicine in Translation: Journeys With My Patients.”

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