Insurance Industry Report Faults High Fees for Out-of-Network Care

Michael Nagle for The New York Times

Angel Gonzalez, 36, faced huge bills after emergency gallbladder surgery, despite having good insurance coverage. “I was on the hook for more than I made in a year.”

Just over a year ago, Angel Gonzalez, 36, awoke with searing chest pain at 2 a.m. A friend drove him to the closest emergency room.

Though he was living on $18,000 a year as a graduate student, Mr. Gonzalez had good insurance and the hospital, St. Charles in Port Jefferson, N.Y., was in his network. But the surgeon who came in to remove Mr. Gonzalez’s gallbladder that Sunday night was not.

He billed Mr. Gonzalez $30,000, and an assistant billed an additional $30,000. Mr. Gonzalez’s policy covered out-of-network providers, but at a rate it considered appropriate: $2,000. “I was on the hook for more than I made in a year,” Mr. Gonzalez said.

A health insurance industry report to be released on Friday highlights the exorbitant fees charged by some doctors to out-of-network patients like Mr. Gonzalez. The report, by America’s Health Insurance Plans, or AHIP, contrasts some of the highest bills charged by non-network providers in 30 states with Medicare rates for the same services. Some of the charges, the insurers assert, are 30, 40 or nearly 100 times greater than Medicare rates.

Insurers hope to spotlight a vexing problem that they say the Affordable Care Act does little to address. “When you’re out of network, it’s a blank check,” said Karen Ignagni, president and chief executive of AHIP. “The consumer is vulnerable to ‘anything goes.’ ”

“Unless we deal with cost, we won’t have affordability,” she added. “And unless we have affordability, we won’t have people participating” under the Affordable Care Act.

Among the fees on the report’s list are a $6,205 outpatient office visit to a doctor in Massachusetts for which Medicare would have paid $152; a $12,000 bill for examining a tissue specimen in New York for which Medicare would have paid $128; and a $48,983 surgeon’s fee for a total hip replacement in New Jersey that Medicare would have reimbursed at $1,543. Many of the highest billers were in New York, Texas, Florida and New Jersey.

Elisabeth R. Benjamin, co-founder of the Health Care for All New York coalition, who is often at odds with the insurance industry, said that “is one area we totally agree on.” She continued, “Out-of-network billing is just out of control.”

Even when out-of-network fees are compared with average commercial insurance reimbursements, which are usually greater than Medicare, she said, “It’s pretty outrageous.”

Doctors say the report is skewed because it focuses on a few dozen cases of overcharging that are not representative of their billing. In response to the insurers’ report, the American Medical Association noted on Thursday that a recent analysis found that doctors’ services account for just 16 percent of health care costs.

“There are outliers in every profession, in every business,” said Dr. Andrew Y. Kleinman, a plastic surgeon who is vice president of the Medical Society of the State of New York.

Dr. Kleinman also noted that insurers had effectively shifted the costs of out-of-network care onto patients by changing reimbursement formulas. Instead of the rates commercial insurers usually pay doctors, insurers increasingly are basing their out-of-network payments on Medicare rates, usually far lower.

A growing number of high-end, flexible health plans offer policies that cover outside providers at, for example, 140 percent of Medicare. “They’re selling you an insurance product you can’t use,” Dr. Kleinman said. “You’re buying an insurance policy where the out-of-network benefit is worthless.”

The industry’s own report suggests that using Medicare rates as a benchmark will lead to patients’ picking up much more of the cost for out-of-network care, whether they carefully select a specialist or, as in the case of Mr. Gonzalez and many others, have no choice in the matter.

Had Mr. Gonzalez been 65 or older, Medicare would have paid only $958 for the surgery. The average commercial price is $12,292, according to FAIR Health, an independent nonprofit group that tracks information on health care costs.

But Mr. Gonzalez’s health plan, United Healthcare, determined the fee should be $1,273, of which the company paid $838. Mr. Gonzalez filed appeals, which were rejected. He then contacted Community Health Advocates at the Community Service Society of New York for help, and the group’s caseworkers negotiated with the surgeon on his behalf.

After months of wrangling, the surgeon agreed to accept a significantly reduced payment: $340.

Consumer advocates and health insurance executives are calling for greater transparency in health care pricing, including upfront disclosure of prices of medical procedures and services.

“The health care industry can give you an estimate, just like any other industry,” said Carrie H. Colla, an assistant professor at the Dartmouth Institute for Health Policy and Clinical Practice, noting that the Dartmouth-Hitchcock Medical Center has a patient price estimator online.  

“It’s just not current practice right now,” Dr. Colla said. “Sometimes a doctor won’t even know. The patient really has to push for it.”

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DealBook: Doubt Is Cast on Firms Hired to Help Banks

Federal authorities are scrutinizing private consultants hired to clean up financial misdeeds like money laundering and foreclosure abuses, taking aim at an industry that is paid billions of dollars by the same banks it is expected to police.

The consultants operate with scant supervision and produce mixed results, according to government documents and interviews with prosecutors and regulators. In one case, the consulting firms enabled the wrongdoing. The deficiencies, officials say, can leave consumers vulnerable and allow tainted money to flow through the financial system.

“How can you be independent if you’re hired by the entity you’re reviewing?” Senator Jack Reed, Democrat of Rhode Island, who sits on the Senate Banking Committee, said.

The pitfalls were exposed last month when federal regulators halted a broad effort to help millions of homeowners in foreclosure. The regulators reached an $8.5 billion settlement with banks, scuttling a flawed foreclosure review run by eight consulting firms. In the end, borrowers hurt by shoddy practices are likely to receive less money than they deserve, regulators said.

On Thursday, Senator Elizabeth Warren, Democrat of Massachusetts, and Representative Elijah Cummings, Democrat of Maryland, announced that they would open an investigation into the foreclosure review, seeking “additional information about the scope of the harms found.”

Critics concede that regulators have little choice but to hire outsiders for certain responsibilities. after they find problems at the banks. The government does not have the resources to ensure that banks follow the rules. Still, consultants like Deloitte & Touche and the Promontory Financial Group can add to regulators’ headaches, the government documents and interviews indicate. Some banks that work with consultants continue to run afoul of the law. At other times, consultants underestimate the extent of the misdeeds or facilitate them, preventing regulators from holding institutions accountable.

Now, regulators and lawmakers are rethinking their relationship with the consultants. Officials at the Federal Reserve, which oversees many large banks, are questioning the prudence of relying on consultants so heavily, said two people with direct knowledge of the matter.

When the Office of the Comptroller of the Currency penalized JPMorgan Chase last month for breakdowns in money-laundering controls, it imposed stricter requirements, ordering the bank to hire a consultant with “specialized experience” in money laundering and to ensure that the firm “not be subject to any conflict of interest.” In a separate action against the bank related to a $6 billion trading loss last year, the agency opted not to mandate an outside consultant at all.

While the comptroller’s office will continue requiring consultants in certain cases, some agency officials are worried about the quality of the work, as well as the consultants’ independence, according to three government officials briefed on the matter.

Since the financial crisis, regulators have increasingly relied on consultants. The comptroller’s office ordered banks to hire consultants in more than 130 enforcement actions since 2008, or nearly 15 percent of the cases.

It can be a lucrative business. In 2011, regulators mandated that 14 banks employ consultants to determine whether homeowners were wrongfully evicted. Over 14 months, the consultants collected about $2 billion in fees, according to regulators and bank officials.

Those fees amounted to more than half of what homeowners will receive under the $8.5 billion settlement that ended the review. As part of the deal, officials will disburse $3.3 billion to 3.8 million borrowers in foreclosure.

According to consultants and regulators, the broad review was plagued with inefficiencies. For example, Promontory initially instructed employees to calculate lawyers’ fees for each loan, to assess if borrowers were overcharged. Later, it scrapped the original procedure, only to reverse the policy again two weeks later, according to two reviewers who worked for Promontory.

“From Day 1, Promontory strove to conduct its review work as thoroughly and independently as possible,” a spokesman for the firm, Christopher Winans, said in a statement. “Our overarching concern at all times was to serve the best interests of borrowers.”

Some lawmakers question whether a consultant’s regulatory connections helped it secure contracts. PricewaterhouseCoopers, which has a stable of former Securities and Exchange Commission officials, won much of the foreclosure review work, signing deals with four banks, including Citigroup. Promontory, the firm examining loans for Wells Fargo, Bank of America and PNC, was founded in 2000 by the former head of the comptroller’s office, Eugene A. Ludwig.

When the contracts were initially awarded, some housing advocates complained that consulting firms could not objectively evaluate banks with which they had pre-existing business relationships. The comptroller’s office said it vetted the firms to spot such potential conflicts, and argued that the process provided swifter relief for homeowners than if the government had hired the companies directly through a lengthy contracting process.

But concerns persisted. Deloitte, which won the contract to review JPMorgan’s loans, had previously audited Washington Mutual and Bear Stearns, two firms JPMorgan acquired during the financial crisis. In May, the comptroller’s office replaced Allonhill, the consultant for Aurora Bank, after the firm disclosed that it had already reviewed some “of the same pool of loans” as part of an earlier contract.

“It’s clear from the foreclosure settlement that oversight over consultants was inadequate and the review process was deeply flawed,” said Representative Carolyn B. Maloney, Democrat of New York, who recently pressed regulators to detail how consultants were paid. People close to the review say consultants relied on a process that the comptroller’s office designed in 2011, under previous leadership.

“This was a very complex process,” a spokesman for the comptroller said. “Throughout the process, regulators provided continuous oversight, guidance and were available to discuss issues.” The agency also performs spot checks on the consultants.

Still, the foreclosure review highlighted broader concerns about the role consultants play.

Since the financial crisis, the comptroller’s office has issued nearly 20 enforcement actions against banks that had already hired consultants to help iron out problems, according to government documents. While consultants cannot be expected to remedy every last issue at the banks, the actions raise questions about the effectiveness of their work.

When HSBC, the British bank, was sanctioned in 2003 over porous money-laundering controls, the bank turned to Deloitte to review its compliance, an official briefed on the matter said. Deloitte also worked for HSBC from 2006 to 2008, the person said, building a system to monitor money flows more effectively. But the bank ran into trouble in 2010 over similar issues, as highlighted in a recent scathing report by the Senate’s Permanent Subcommittee on Investigations.

As part of a regulatory order, HSBC again hired Deloitte, this time to assess the number of times the bank failed to report suspicious transactions. Deloitte, three officials said, generously bundled hundreds of missed transfers into a single report. That helped save the bank from some government fines.

Despite the undercounting, HSBC still paid a record $1.9 billion last year to settle accusations that it enabled drug cartels to move money through its American subsidiaries.

In a statement, a spokesman for the firm said, “Deloitte fully stands behind the quality and integrity of its work on behalf of regulatory authorities.”

Deloitte has also been suspected of helping institutions cloak illicit transfers of money to rogue nations around the globe. In August, New York’s top banking regulator, Benjamin M. Lawsky, accused Deloitte of helping the British bank Standard Chartered flout American sanctions.

The consulting firm was hired to flag suspicious transfers routed through Standard Chartered’s New York branches. Instead, it instructed bankers on how to escape regulatory scrutiny, according to state court documents.

Deloitte turned over “highly confidential information” from which the bank gleaned insight into “regulators’ concerns and strategies,” the court documents said. The firm later doctored its report to regulators, Mr. Lawsky said, deliberately removing some illegal transfers on behalf of Iranian clients. In an e-mail, a Deloitte partner admitted that a report on the transactions was a “watered-down version.”

The authorities never took legal action against Deloitte, and federal officials noted in a separate settlement agreement that Standard Chartered employees withheld critical information from the consulting firm.

Despite these concerns, regulators are turning to a familiar source to help Standard Chartered. As part of a $327 million settlement last year, the bank is required to hire “an independent consultant.”

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Bell city clerk testifies signatures on documents were forged

A key prosecution witness in the Bell corruption case testified Wednesday that signatures on city contracts, minutes for council meetings, agendas and even resolutions were forged.

Bell City Clerk Rebecca Valdez's testimony could bolster the defense's argument that record-keeping in Bell was so sloppy that it would be difficult to prove that six former council members inflated their annual salaries to nearly $100,000 by serving on boards and commissions that met for a few minutes, if ever.

On her third day on the witness stand, Valdez said she noticed the forgeries in 2010 when pulling together records requested by investigators looking into possible wrongdoing. She said she never looked into the forgeries, and didn't make a list of the questionable documents.

Los Angeles County Superior Court Judge Kathleen Kennedy ordered Valdez to look through the paperwork being used as exhibits for the trial.

After thumbing through binders filled with documents from 2005 to 2010, the city clerk said she detected about eight agendas from 2005 to 2006 that had forged signatures.

"It looks like R Valdez, but that's not the way I sign," Valdez said of the name written in cursive. She said the forgery appeared to be the work of her predecessor, Theresa Diaz.

"That appears to be her handwriting?" defense attorney Alex Kessel asked Valdez.

"Yes."

"So from your knowledge of her penmanship you believe she signed your name?"

"Yes."

As the city clerk, Valdez was responsible for keeping accurate records of public meetings but her testimony has revealed that she signed minutes for meetings she didn't attend, sometimes made mistakes in her records and for three years was the clerk in name only, performing almost none of the required duties.

"Forgery is another area that questions the legitimacy and accuracy of the minutes and agenda which is the cornerstone of the district attorney's argument that no work was being done," Kessel told The Times.

The prosecution has used many documents signed by Valdez to illustrate that Luis Artiga, Victor Bello, George Cole, Oscar Hernandez, Teresa Jacobo and George Mirabal did little work when it came to the authorities that beefed up their paychecks.

Among those is the Solid Waste and Recycling Authority, which Deputy Dist. Atty Edward Miller has labeled a "sham."

On Wednesday Miller read the ordinance for that authority, which said it could be created "for the purpose of acquiring, constructing, maintaining or operating an enterprise for the collection, treatment or disposal of waste."

Miller then asked Valdez: "Have you seen an enterprise for the collection, treatment or disposal of waste in the city of Bell?"

"No," she replied.

Defense attorneys have attempted to pin much of the city's alleged corruption on former City Administrator Robert Rizzo. Valdez said Rizzo expected people to do what he said and was a chronic micromanager.

"It was pretty well-known to the employees that important events that happened in your life, like going to school, having a baby or buying a house — he had to be the first one to find out," Valdez said. "If he found out through a second person or third person, the employee would kind of be in the doghouse.

"When I got married," she said, "he was the first one to know before any of my peers knew."

Valdez said Rizzo questioned her about a house she was thinking of buying and urged her to make a 20% down payment. When she told him she didn't have the money, Rizzo offered her a $48,000 loan, she said.

Prosecutors say her loan, along with dozens of others provided to city employees, was given without proper authorization.

Valdez, who was granted immunity for her testimony, said she processed the repayment of such loans. She also prepared salary contracts for the council members, as well as Rizzo. She said she was aware of Rizzo's salary before the news became public.

Valdez testified that during a July 2010 meeting requested by Times reporters, Artiga and Hernandez appeared shocked when they heard that Rizzo was making nearly $800,000.

She also recalled that Hernandez, "said something to the effect of 'To have a good city manager you have to pay him well.' "

corina.knoll@latimes.com

ruben.vives@latimes.com

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<em>New York Times</em> Hacked Again, This Time Allegedly by Chinese

In a dramatic announcement late Wednesday, the New York Times reported that hackers from China had been routing through the paper’s network for at least four months, stealing the passwords of reporters in an apparent attempt to identify sources and gather other intelligence about stories related to the family of China’s prime minister.

The hackers breached the network sometime around Sept. 13 and stole the corporate passwords for every Times employee, using them to gain access to the personal computers of 53 employees, according to the report.

The hacking coincided with an investigation the Times published last October that looked into a fortune that the family of China’s Prime Minister Wen Jiabao had amassed. The hackers breached the network while the paper was in the process of concluding its reporting for the investigation.

The hackers broke into the email account of the newspaper’s Shanghai bureau chief, David Barboza, who conducted the investigation, as well as the email account of Jim Yardley, the paper’s South Asia bureau chief in India, who had previously worked out of Beijing.

Executive Editor Jill Abramson said, however, that forensic experts with Mandiant, the computer security firm hired to investigate the breach, found “no evidence that sensitive e-mails or files from the reporting of our articles about the Wen family were accessed, downloaded or copied.”

It’s not the first time that the paper has been hacked. In 1998, a group known as HFG — or H4acking for Girl13z — hacked the paper’s web site to protest the arrest of hacker Kevin Mitnick and accuse Times reporter John Markoff of helping to catch him.

In 2002, former hacker Adrian Lamo, famously hacked the paper’s network after discovering multiple vulnerabilities and accessed a database containing the details of 3,000 contributors to the paper’s op-ed page, among other things.

In 2011, former executive editor of the Times, Bill Keller, hinted that WikiLeaks or someone associated with the group had hacked into the accounts of some of the paper’s staff. During a period of heightened tension between WikiLeaks founder Julian Assange and the paper, which was then a publishing partner of WikiLeaks, the e-mail accounts of at least three people associated with the project were apparently hacked. Keller suggested that Assange and WikiLeaks was behind the intrusions but never offered evidence to support this.

In the latest hack, the attackers, in an attempt to hide their tracks, routed their attacks through computers that they hacked at universities in North Carolina, Arizona, Wisconsin and New Mexico, as well as at small companies and internet service providers. They apparently used the same university computers that hackers working for the Chinese military used previously to attack Defense Department contractors.

During the three months they were in the paper’s network, the attackers installed 45 pieces of custom malware, though nearly all of it went detected. Although the newspaper uses antivirus products made by Symantec, the monitoring software identified and quarantined only one of the attacker’s tools during that time, according to the report.

The attackers increased their activity in late October after the paper published its investigation of the prime minister’s relatives, and were also particularly active the night of the Nov. 6 presidential election.

The paper noted that there were concerns the hackers would try to shut down its publishing system that night, but they turned out to be unwarranted since the attackers apparently showed interest only in the paper’s reporting about the prime minister’s family.

“They could have wreaked havoc on our systems,” said Marc Frons, the Times’s chief information officer said in the report. “But that was not what they were after.”

The Times had been on alert for suspicious activity after learning that Chinese officials had warned that the paper’s reporting would have consequences. The paper asked AT&T, which monitors its network, to be on the lookout for suspicious activity.

After AT&T reported finding such activity, the FBI was notified, and the Times called in Mandiant to investigate.

Evidence showed that the hackers installed three backdoors and routed their way through the network for two weeks before uncovering a system containing the computer usernames and hashed passwords for all of the paper’s employees. The hackers apparently cracked a number of passwords to gain entry to employee computers.

“They created custom software that allowed them to search for and grab Mr. Barboza’s and Mr. Yardley’s e-mails and documents from a Times e-mail server,” the paper revealed.

The intrusion is apparently part of a wider campaign directed by Chinese hackers against western media outlets since 2008. Hackers from China also attempted to hack into the network of Bloomberg News last year after publishing stories about the relatives of China’s vice president.

Mandiant has investigated many of the breaches and found evidence that Chinese hackers had stolen e-mails, contact lists and files from more than 30 journalists and executives working for western media outlets.

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Patty Andrews of Andrews Sisters dead at 94

LOS ANGELES (AP) — Patty Andrews, the last surviving member of the singing Andrews Sisters trio whose hits such as the rollicking “Boogie Woogie Bugle Boy of Company B” and the poignant “I Can Dream, Can’t I?” captured the home-front spirit of World War II, died Wednesday. She was 94.

Andrews died of natural causes at her home in the Los Angeles suburb of Northridge, said family spokesman Alan Eichler in a statement.

Patty was the Andrews in the middle, the lead singer and chief clown, whose raucous jitterbugging delighted American servicemen abroad and audiences at home.

She could also deliver sentimental ballads like “I’ll Be with You in Apple Blossom Time” with a sincerity that caused hardened GIs far from home to weep.

“When I was a kid, I only had two records and one of them was the Andrews Sisters. They were remarkable. Their sound, so pure,” said Bette Midler, who had a hit cover of “Bugle Boy” in 1973. “Everything they did for our nation was more than we could have asked for. This is the last of the trio, and I hope the trumpets ushering (Patty) into heaven with her sisters are playing “Boogie Woogie Bugle Boy.”

From the late 1930s through the 1940s, the Andrews Sisters produced one hit record after another, beginning with “Bei Mir Bist Du Schoen” in 1937 and continuing with “Beat Me Daddy, Eight to the Bar,” ”Rum and Coca-Cola” and more. They recorded more than 400 songs and sold over 80 million records, several of them going gold.

Other sisters, notably the Boswells, had become famous as singing acts, but mostly they huddled before a microphone in close harmony. The Andrews Sisters — LaVerne, Maxene and Patty — added a new dimension. During breaks in their singing, they cavorted about the stage in rhythm to the music.

Their voices combined with perfect synergy. As Patty remarked in 1971: “There were just three girls in the family. LaVerne had a very low voice. Maxene’s was kind of high, and I was between. It was like God had given us voices to fit our parts.”

Kathy Daris of the singing Lennon Sisters recalled on Facebook late Wednesday that the Andrews Sisters “were the first singing sister act that we tried to copy. We loved their rendition of songs, their high spirit, their fabulous harmony.”

The Andrews Sisters‘ rise coincided with the advent of swing music, and their style fit perfectly into the new craze. They aimed at reproducing the sound of three harmonizing trumpets.

“I was listening to Benny Goodman and to all the bands,” Patty once remarked. “I was into the feel, so that would go into my own musical ability. I was into swing. I loved the brass section.”

Unlike other singing acts, the sisters recorded with popular bands of the ’40s, fitting neatly into the styles of Benny Goodman, Glenn Miller, Jimmy Dorsey, Bob Crosby, Woody Herman, Guy Lombardo, Desi Arnaz and Russ Morgan. They sang dozens of songs on records with Bing Crosby, including the million-seller “Don’t Fence Me In.” They also recorded with Dick Haymes, Carmen Miranda, Danny Kaye, Al Jolson, Jimmy Durante and Red Foley.

The Andrews’ popularity led to a contract with Universal Pictures, where they made a dozen low-budget musical comedies between 1940 and 1944. In 1947, they appeared in “The Road to Rio” with Bing Crosby, Bob Hope and Dorothy Lamour.

The trio continued until LaVerne’s death in 1967. By that time the close harmony had turned to discord, and the sisters had been openly feuding.

Midler’s cover of “Bugle Boy” revived interest in the trio. The two survivors joined in 1974 for a Broadway show, “Over Here!” It ran for more than a year, but disputes with the producers led to the cancellation of the national tour of the show, and the sisters did not perform together again.

Patty continued on her own, finding success in Las Vegas and on TV variety shows. Her sister also toured solo until her death in 1995.

Her father, Peter Andrews, was a Greek immigrant who anglicized his name of Andreus when he arrived in America; his wife, Olga, was a Norwegian with a love of music. LaVerne was born in 1911, Maxine (later Maxene) in 1916, Patricia (later Patty, sometimes Patti) in 1918.

All three sisters were born and raised in the Minneapolis area, spending summers in Mound, Minn., on the western shores of Lake Minnetonka, about 20 miles west of Minneapolis.

Listening to the Boswell Sisters on radio, LaVerne played the piano and taught her sisters to sing in harmony; neither Maxene nor Patty ever learned to read music. All three studied singers at the vaudeville house near their father’s restaurant. As their skills developed, they moved from amateur shows to vaudeville and singing with bands.

After Peter Andrews moved the family to New York in 1937, his wife, Olga, sought singing dates for the girls. They were often turned down with comments such as: “They sing too loud and they move too much.” Olga persisted, and the sisters sang on radio with a hotel band at $ 15 a week. The broadcasts landed them a contract with Decca Records.

They recorded a few songs, and then came “Bei Mir Bist Du Schoen,” an old Yiddish song for which Sammy Cahn and Saul Kaplan wrote English lyrics. (The title means, “To Me You Are Beautiful.”) It was a smash hit, and the Andrews Sisters were launched into the bigtime.

Their only disappointment was the movies. Universal was a penny-pinching studio that ground out product to fit the lower half of a double bill. The sisters were seldom involved in the plots, being used for musical interludes in film with titles such as “Private Buckaroo,” ”Swingtime Johnny” and “Moonlight and Cactus.”

Their only hit was “Buck Privates,” which made stars of Abbott and Costello and included the trio’s blockbuster “Boogie Woogie Bugle Boy from Company B.”

In 1947, Patty married Martin Melcher, an agent who represented the sisters as well as Doris Day, then at the beginning of her film career. Patty divorced Melcher in 1949 and soon he became Day’s husband, manager and producer.

Patty married Walter Weschler, pianist for the sisters, in 1952. He became their manager and demanded more pay for himself and for Patty. The two other sisters rebelled, and their differences with Patty became public. Lawsuits were filed between the two camps.

“We had been together nearly all our lives,” Patty explained in 1971. “Then in one year our dream world ended. Our mother died and then our father. All three of us were upset, and we were at each other’s throats all the time.”

Patty Andrews is survived by her foster daughter, Pam DuBois, a niece and several cousins. Weschler died in 2010.

A memorial service is planned in Los Angeles, with the date to be determined.

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Well: Waiting for Alzheimer's to Begin

My gray matter might be waning. Then again, it might not be. But I swear that I can feel memories — as I’m making them — slide off a neuron and into a tangle of plaque. I steel myself for those moments to come when I won’t remember what just went into my head.

I’m not losing track of my car keys, which is pretty standard in aging minds. Nor have I ever forgotten to turn off the oven after use, common in menopausal women. I can always find my car in the parking lot, although lots of “normal” folk can’t.

Rather, I suddenly can’t remember the name of someone with whom I’ve worked for years. I cover by saying “sir” or “madam” like the Southerner I am, even though I live in Vermont and grown people here don’t use such terms. Better to think I’m quirky than losing my faculties. Sometimes I’ll send myself an e-mail to-do reminder and then, seconds later, find myself thrilled to see a new entry pop into my inbox. Oops, it’s from me. Worse yet, a massage therapist kicked me out of her practice for missing three appointments. I didn’t recall making any of them. There must another Nancy.

Am I losing track of me?

Equally worrisome are the memories increasingly coming to the fore. Magically, these random recollections manage to circumnavigate my imagined build-up of beta-amyloid en route to delivering vivid images of my father’s first steps down his path of forgetting. He was the same age I am now, which is 46.

“How old are you?” I recall him asking me back then. Some years later, he began calling me every Dec. 28 to say, “Happy birthday,” instead of on the correct date, Dec. 27. The 28th had been his grandmother’s birthday.

The chasms were small at first. Explainable. Dismissible. When he crossed the street without looking both ways, we chalked it up to his well-cultivated, absent-minded professor persona. But the chasms grew into sinkholes, and eventually quicksand. When we took him to get new pants one day, he kept trying on the same ones he wore to the store.

“I like these slacks,” he’d say, over and over again, as he repeatedly pulled his pair up and down.

My dad died of Alzheimer’s last April at age 73 — the same age at which his father succumbed to the same disease. My dad ended up choosing neurology as his profession after witnessing the very beginning of his own dad’s forgetting.

Decades later, grandfather’s atrophied brain found its way into a jar on my father’s office desk. Was it meant to be an ever-present reminder of Alzheimer’s effect? Or was it a crystal ball sent to warn of genetic fate? My father the doctor never said, nor did he ever mention, that it was his father’s gray matter floating in that pool of formaldehyde.

Using the jarred brain as a teaching tool, my dad showed my 8-year-old self the difference between frontal and temporal lobes. He also pointed out how brains with Alzheimer’s disease become smaller, and how wide grooves develop in the cerebral cortex. But only after his death — and my mother’s confession about whose brain occupied that jar — did I figure out that my father was quite literally demonstrating how this disease runs through our heads.

Has my forgetting begun?

I called my dad’s neurologist. To find out if I was in the earliest stages of Alzheimer’s, he would have to look for proteins in my blood or spinal fluid and employ expensive neuroimaging tests. If he found any indication of onset, the only option would be experimental trials.

But documented confirmation of a diseased brain would break my still hopeful heart. I’d walk around with the scarlet letter “A” etched on the inside of my forehead — obstructing how I view every situation instead of the intermittent clouding I currently experience.

“You’re still grieving your father,” the doctor said at the end of our call. “Sadness and depression affect the memory, too. Let’s wait and see.”

It certainly didn’t help matters that two people at my father’s funeral made some insensitive remarks.

“Nancy, you must be scared to death.”

“Is it hard knowing the same thing probably will happen to you?”

Maybe the real question is what to do when the forgetting begins. My dad started taking 70 supplements a day in hopes of saving his mind. He begged me to kill him if he wound up like his father. He retired from his practice and spent all day in a chair doing puzzles. He stopped making new memories in an all-out effort to preserve the ones he already had.

Maybe his approach wasn’t the answer.

Just before his death — his brain a fraction of its former self — my father managed to offer up a final lesson. I was visiting him in the memory-care center when he got a strange look on his face. I figured it was gas. But then his eyes lit up and a big grin overtook him, and he looked right at me and said, “Funny how things turn out.”

An unforgettable moment?

I can only hope.

---

Nancy Stearns Bercaw is a writer in Vermont. Her book, “Brain in a Jar: A Daughter’s Journey Through Her Father’s Memory,” will be published in April 2013 by Broadstone.

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L.A. city workers' union doesn't endorse Garcetti or Greuel

An influential union representing City Hall workers failed to reach a consensus Tuesday evening on whether and whom to endorse in Los Angeles' mayoral campaign, labor officials said.

Members of six locals of the Service Employees International Union questioned City Controller Wendy Greuel and City Councilman Eric Garcetti, two top contenders in the race, for at least half an hour. Neither was recommended for an endorsement, even though Greuel was ranked higher on a scoring sheet prepared by union officials.

The rating was prepared in December and ranked Greuel 4.3 out of 5 on issues important to the union. Garcetti was rated a 3.5, and consistently was graded lower on issues such as furloughs — the unpaid days imposed on civilian city workers — and on retirement benefits, according to the document, a copy of which was obtained by The Times.

Favel Jens, political coordinator for SEIU Local 721, which represents 10,000 city workers, said the scoring sheet was prepared by the political directors of six SEIU locals in December, after the candidates responded to written questionnaires.

Lowell Goodman, communications director for SEIU Local 721, said the heads of the union locals still could decide in the next few weeks to issue separate endorsements. "Or they could decide to go together and endorse the same candidate," Goodman said.

The union locals held a town hall-style gathering Tuesday evening so they could, for a second time, consider making an endorsement in the March 5 election to replace Mayor Antonio Villaraigosa.

Filing out of the meeting at union headquarters, attendees who described themselves as members of SEIU Local 99 — which represents school district employees — said their local decided not to pick either candidate. Employees with SEIU's United Service Workers West, which represents security guards, airport workers and others, said they too had decided not to endorse. But Myran Cotton, a city employee represented by SEIU Local 721, said her local recommended Greuel.

SEIU's backing is considered important because Los Angeles is a heavily Democratic, generally labor-friendly city. Also, SEIU has shown its support can mean a significant number of get-out-the-vote campaign volunteers and financial donations to pay for mailers and advertising.

But some of Greuel's and Garcetti's opponents are suggesting the next mayor needs to be more independent of public employee unions.

Greuel and Garcetti, the only two invited back for additional interviews Tuesday, were on the council when it voted for a package of raises for civilian city workers that totaled roughly 25%. Greuel moved on to citywide office by 2010, and did not have to vote when the council ordered unpopular layoffs, furloughs, employee transfers and reductions in an array of services.

In the competition for union support, those decisions have put Garcetti, who was then City Council president, at a disadvantage this election year. Greuel sought to sow doubt about Garcetti during the initial interview sessions with SEIU members last month. She cited his involvement in employee layoffs, telling workers they needed someone who would be with them "every step of the way."

City officials are grappling with a $220-million budget shortfall and trying to persuade the public to hike taxes.

Greuel already has the backing of the Department of Water and Power employees' union, which has given $250,000 to a committee supporting her candidacy and is expected to spend hundreds of thousands of dollars more. She has also picked up the support of the rank-and-file police officers' union, which spent nearly $750,000 to elect City Atty. Carmen Trutanich in 2009.

The SEIU did not invite three other leading candidates — Councilwoman Jan Perry, former radio host Kevin James and tech executive Emanuel Pleitez — to Tuesday's event. All three have been more critical than Greuel and Garcetti of the city's handling of its budget crisis.

The union employees "clearly don't want someone independent making decisions at City Hall," said James, shortly before Tuesday's SEIU session began.

Perry said earlier this week that she lost out on the endorsement because she said she had no plans to remove City Administrative Officer Miguel Santana, the budget official who recommended layoffs and reductions in pension benefits for new hires. Union officials asked the candidates last month to say whether they would keep Santana.

SEIU Local 721 has been at odds with Santana and Villaraigosa over their successful push to raise the retirement age and to roll back pensions for new hires. That pension measure was approved by the council last fall, but does not apply to DWP hires, or any current city employees.

The union also has been fighting efforts to turn the zoo and city Convention Center over to private management entities.

david.zahniser@latimes.com

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Charlize Theron’s ‘Hatfields & McCoys’ Update Gets NBC Pickup

NEW YORK (TheWrap.com) – NBC has ordered the drama pilot “Hatfields & McCoys,” a modern-day tale of the famously warring families from a team that includes executive producer Charlize Theron.

The series bears no relation to History’s hit miniseries of the same name, which aired last year. But it does trade on the same legend of feuding West Virginia families.

In the new version, the families have moved to nearby Pittsburgh, where a startling death rekindles the feud. The blue-collar McCoys battle the wealthy Hatfields for control of the city.

And no, they aren’t fighting over which family gets to not be in charge of Pittsburgh, which is a lovely place, if you’ve ever been.

The series is written and executive produced by John Glenn, with Theron, A.J. Dix, Dawn Olmstead, and Beau Flynn also executive producing. It comes from ABCS, Denver & Delilah,Tower Hill, Beau Flynn Productions and Grady Girl.

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Well: Helmets for Ski and Snowboard Safety

Recently, researchers from the department of sport science at the University of Innsbruck in Austria stood on the slopes at a local ski resort and trained a radar gun on a group of about 500 skiers and snowboarders, each of whom had completed a lengthy personality questionnaire about whether he or she tended to be cautious or a risk taker.

The researchers had asked their volunteers to wear their normal ski gear and schuss or ride down the slopes at their preferred speed. Although they hadn’t informed the volunteers, their primary aim was to determine whether wearing a helmet increased people’s willingness to take risks, in which case helmets could actually decrease safety on the slopes.

What they found was reassuring.

To many of us who hit the slopes with, in my case, literal regularity — I’m an ungainly novice snowboarder — the value of wearing a helmet can seem self-evident. They protect your head from severe injury. During the Big Air finals at the Winter X Games in Aspen, Colo., this past weekend, for instance, 23-year-old Icelandic snowboarder Halldor Helgason over-rotated on a triple back flip, landed head-first on the snow, and was briefly knocked unconscious. But like the other competitors he was wearing a helmet, and didn’t fracture his skull.

Indeed, studies have concluded that helmets reduce the risk of a serious head injury by as much as 60 percent. But a surprising number of safety experts and snowsport enthusiasts remain unconvinced that helmets reduce overall injury risk.

Why? A telling 2009 survey of ski patrollers from across the country found that 77 percent did not wear helmets because they worried that the headgear could reduce their peripheral vision, hearing and response times, making them slower and clumsier. In addition, many worried that if they wore helmets, less-adept skiers and snowboarders might do likewise, feel invulnerable and engage in riskier behavior on the slopes.

In the past several years, a number of researchers have attempted to resolve these concerns, for or against helmets. And in almost all instances, helmets have proved their value.

In the Innsbruck speed experiment, the researchers found that people whom the questionnaires showed to be risk takers skied and rode faster than those who were by nature cautious. No surprise.

But wearing a helmet did not increase people’s speed, as would be expected if the headgear encouraged risk taking. Cautious people were slower than risk-takers, whether they wore helmets or not; and risk-takers were fast, whether their heads were helmeted or bare.

Interestingly, the skiers and riders who were the most likely, in general, to don a helmet were the most expert, the men and women with the most talent and hours on the slopes. Experience seemed to have taught them the value of a helmet.

Off of the slopes, other new studies have brought skiers and snowboarders into the lab to test their reaction times and vision with and without helmets. Peripheral vision and response times are a serious safety concern in a sport where skiers and riders rapidly converge from multiple directions.

But when researchers asked snowboarders and skiers to wear caps, helmets, goggles or various combinations of each for a 2011 study and then had them sit before a computer screen and press a button when certain images popped up, they found that volunteers’ peripheral vision and reaction times were virtually unchanged when they wore a helmet, compared with wearing a hat. Goggles slightly reduced peripheral vision and increased response times. But helmets had no significant effect.

Even when researchers added music, testing snowboarders and skiers wearing Bluetooth-audio equipped helmets, response times did not increase significantly from when they wore wool caps.

So why do up to 40 percent of skiers and snowboarders still avoid helmets?

“The biggest reason, I think, is that many people never expect to fall,” says Dr. Adil H. Haider, a trauma surgeon and associate professor of surgery at Johns Hopkins University in Baltimore and co-author of a major new review of studies related to winter helmet use. “That attitude is especially common in people, like me, who are comfortable on blue runs but maybe not on blacks, and even more so in beginners.”

But a study published last spring detailing snowboarding injuries over the course of 18 seasons at a Vermont ski resort found that the riders at greatest risk of hurting themselves were female beginners. I sympathize.

The takeaway from the growing body of science about ski helmets is in fact unequivocal, Dr. Haider said. “Helmets are safe. They don’t seem to increase risk taking. And they protect against serious, even fatal head injuries.”

The Eastern Association for the Surgery of Trauma, of which Dr. Haider is a member, has issued a recommendation that “all recreational skiers and snowboarders should wear safety helmets,” making them the first medical group to go on record advocating universal helmet use.

Perhaps even more persuasive, Dr. Haider has given helmets to all of his family members and colleagues who ski or ride. “As a trauma surgeon, I know how difficult it is to fix a brain,” he said. “So everyone I care about wears a helmet.”

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