Choreographer, actor with CP use dance to transform his body

From The New York Times:

Gregg Mozgala (pictured), a 31-year-old actor with cerebral palsy, had 12 years of physical therapy while he was growing up. But in the last eight months, a determined choreographer with an unconventional résumé has done what all those therapists could not: She has dramatically changed the way Mr. Mozgala walks.

In the process, she has changed his view of himself and of his possibilities.

Mr. Mozgala and the choreographer, Tamar Rogoff, have been working since last winter on a dance piece called “Diagnosis of a Faun.” It is to have its premiere on Dec. 3 at La MaMa Annex in the East Village, but the more important work of art may be what Ms. Rogoff has done to transform Mr. Mozgala’s body.

“I have felt things that I felt were completely closed off to me for the last 30 years,” he said. “The amount of sensation that comes through the work has been totally unexpected and is really quite wonderful.”

Cerebral palsy, a neurological disorder in which the brain does not send the proper signals to the muscles, affects gait and other movements. Those with severe cases use wheelchairs.

Mr. Mozgala’s condition is less severe but disruptive enough to have caused him to walk for most of his life like “a human velociraptor,” as he put it: up on his toes, lower extremities turned in, seesawing from side to side to maintain balance.

“My knees were going in, my hips were totally rotated inward,” Mr. Mozgala said. “Gravity was just taking me down. So my upper body — arms and chest — overcompensated, curling back and up.”

That is how he looked when Ms. Rogoff saw him in March 2008 playing the male lead in a production of “Romeo and Juliet” by Theater Breaking Through Barriers, a group whose shows mix actors with disabilities and those without. Ms. Rogoff has often worked outside normal dance parameters — with prison inmates, for instance — and knew immediately that she wanted to try to create a piece for Mr. Mozgala.

“I didn’t know what I was going to do for him,” she said, “but I just knew he was inspiring to me.”

Originally, she envisioned a simple study, maybe 10 minutes long. Mr. Mozgala’s expectations when he agreed to the project were equally narrow: he said that he thought that she would either merely create a dance that made use of the physical abilities he already had or, after seeing his limitations, tell him, “Thanks but no thanks.”

Once they began working together, though, Ms. Rogoff realized that a broader approach was needed.

“Every time he tried to move in a way that wasn’t specific to his habitual pattern, he would fall down or just not know how to address it,” she said, “because he had a certain amount of patterning linked to his C.P., and I was asking him to step out of these patterns. I realized I couldn’t ask him to do that unless I supported it with a lot of body knowledge.”

She introduced Mr. Mozgala to a tension-releasing shaking technique, and it was immediately revelatory.

“My body just really took to it,” Mr. Mozgala said. “I did that for about 20 or 30 minutes, and when I stood up, I was walking completely differently. My feet were flat on the ground.”

They knew they were onto something. They began doing intensive one-on-one sessions they call body work, Ms. Rogoff using her knowledge of the body and dance-training techniques to help Mr. Mozgala “find” individual bones, muscles and tendons that he had had no command of before.

They started at the top and worked down — sternum, sacrum, knees — with Mr. Mozgala’s body and brain opening paths of communication that had not existed.

“There’s a lot of howling, screaming, crying, sweating,” Ms. Rogoff said. But “we often have these huge eureka moments.”

The other day, for instance, it was brain, meet lower-leg tendon.

“I said today, ‘I can feel my Achilles,’ ” Mr. Mozgala said. “You have to realize, I have never felt my Achilles before.”

Dr. Stephen A. Paget, chief of rheumatology at the Hospital for Special Surgery in Manhattan, who has been acting as a sort of sounding board for Ms. Rogoff during the project, said the changes being wrought in Mr. Mozgala support a relatively new way of thinking about neurological impairments.

“In the past, people thought that a neurological deficit was fixed and immutable,” Dr. Paget said. “Now there’s this whole concept of neuroplasticity: the neurological system has this ability to change itself and constantly grow.”

Apparently Mr. Mozgala’s has done just that. Before, his gait was extreme enough that it would draw stares on the street. (“The lurch,” he and Ms. Rogoff have come to call it.) Now, when he is fully concentrating, a passer-by might have to look twice to realize he has a disability at all.

Unlike his earlier physical therapists, he said, Ms. Rogoff has given him knowledge of his body and specific instructions that he can employ while going about his everyday life: “Sternum down, tailbone up,” and so on.

“I have the key now,” he said. “Before, I was always being manipulated by someone else.”

Ms. Rogoff, whose father was a doctor, said that she knew little about cerebral palsy when she and Mr. Mozgala began, and that she had made a point of not learning too much. “That way I didn’t have any ideas about what he could and couldn’t do,” she said.

The physical changes Mr. Mozgala has experienced have had ramifications beyond the gym and the studio. Since high school, he has had a comical routine he would employ when he fell (“falling with style,” he called it) as a defense mechanism, to get people on his side; that is now gone.

So are the swings of self-image in which he would go from not caring if people were staring at him to feeling like “John Merrick on Fleet Street,” as he put it.

As Mr. Mozgala changed, so did Ms. Rogoff’s concept for the dance. The 10-minute study she had envisioned is now a work of more than an hour, with a cast of four. The piece has antecedents in “Afternoon of a Faun,” the Nijinsky ballet. Mr. Mozgala plays a 5,000-year-old Faun who turns up in a modern-day hospital as the work explores the intersection of science and art.

Emily Pope-Blackman, an experienced dancer who has a very physical, sensuous duet with Mr. Mozgala in the piece, had the task of helping him translate the progress he was making in the body-work sessions onto the dance floor. It was, she said, a slow process of “finding out between the two of us how much force, as he got stronger, we could risk: how hard could I pull him toward me; how much could he push me over without falling over himself.”

The piece, which also features Lucie Baker and Dr. Don Kollisch (a real-life family physician), is financed with a grant from VSA Arts, a nonprofit group that supports arts by people with disabilities. After its New York run, it will be seen at the VSA International Arts Festival in June at the Kennedy Center in Washington.

Ms. Rogoff calls Mr. Mozgala “the best student I’ve ever had.” Yet both of them are emphatic about what they have not achieved.

“This isn’t a cure,” Mr. Mozgala said. “I’m always going to have cerebral palsy.”

But now he doesn’t feel so enslaved by it.

“Everybody told me there was nothing I could do,” he said. “That’s just what you hear, from the time you’re 5 to adulthood. Tamar gave me an option.”

Whether the methods they have used can translate to others remains to be seen. But Dr. Paget said their progress held a message for anyone with a neurological impairment.

“It’s not over,” he said. “There’s always a chance to change. You should not — you dare not — give up.”

NFL teams required to hear from independent neurologists in brain injury cases

From The New York Times:

In a shift in the National Football League’s approach to handling concussions, the league will soon require teams to receive advice from independent neurologists while treating players with brain injuries, several people with knowledge of the plan confirmed Sunday.

For generations, decisions on when players who sustain concussions should return to play have been made by doctors and trainers employed by the team, raising questions of possible conflicts of interest when coaches and owners want players to return more quickly than proper care would suggest.

As scientific studies and anecdotal evidence have found a heightened risk for brain damage, dementia and cognitive decline in retired players, the league has faced barbed criticism from outside experts and, more recently, from Congress over its policies on handling players with concussions.

The league and Commissioner Roger Goodell have insisted that the N.F.L.’s policies are safe and that no third-party involvement is necessary, pointing to research by its committee on concussions as proof. But after an embarrassing hearing on the issue before the House Judiciary Committee last month in which the league was compared to the tobacco industry, the N.F.L. seems to have begun to embrace the value of outside opinion.

“I don’t want to call it forced, but it’s been strongly urged because of the awareness of the issue these days,” Chester Pitts, a lineman and union representative for the Houston Texans, said in a telephone interview. “When you have Congress talking about the antitrust exemption and them calling them the tobacco industry, that’s pretty big. But it’s a good thing it’s transpiring.”

The league spokesman Greg Aiello offered no details of the new guideline, first reported Sunday on Fox’s N.F.L. pregame broadcast, like when it will go into effect, how the independent doctors will be identified and compensated, or even whether their input must be followed.

But Mr. Goodell, interviewed Nov. 22 on the NBC program “Football Night in America,” referring to the use of independent doctors for concussion cases, said: “As we learn more and more, we want to give players the best medical advice. This is a chance for us to expand that and bring more people into the circle to make sure we’re making the best decisions for our players in the long term.”

George Atallah, the players union’s assistant executive director for external affairs, said in an e-mail message that his organization had been speaking with N.F.L. officials for two weeks about implementing some sort of independent scrutiny for players who receive concussions — perhaps including an outside doctor present at every game. He said that the union’s medical director, Dr. Thom Mayer, “has personally approved and reviewed doctors for roughly one-third of the teams,” suggesting that the union would cooperate on the program.

Mr. Atallah said he did not know when the policy might take effect.

Mr. Atallah added that the union had pushed for the program “with the hope that this example spreads to every level of football.” More than 1.2 million teenagers play high school football every fall, with many getting seriously injured by playing through concussions or not having proper medical care for them.

At the House Judiciary Committee hearing on football brain injuries last month, several members of Congress portrayed Mr. Goodell and the league as impeding proper player care and obfuscating the long-term effects of concussions. The league and a co-chairman of its committee on brain injuries, Dr. Ira Casson, have consistently played down studies and anecdotal evidence linking retired N.F.L. players to brain damage commonly associated with boxers and dementia rates several times that of the national population.

Regarding the care of current players who sustain concussions, in 2007, the league enacted measures that required all players to undergo baseline neuropsychological testing and then be retested before being cleared to play; forbade players who were knocked unconscious to return to play the same day; and set up a hot line through which players could report being pressured to play against a doctor’s advice.

The hot line was in response to the story of Ted Johnson, a former New England Patriots linebacker who said he was coerced by Patriots Coach Belichick into playing too soon after a concussion, and sustained a more serious injury that led to a debilitating case of postconcussion syndrome. (Belichick denied the accusation.) Requiring an independent doctor at games or for follow-up consultation would protect against similar incidents that players say are less overt but nonetheless prevalent in a league without guaranteed contracts.

An independent doctor cannot address what many experts consider the primary area needing reform: the tendency of players who sustain concussions to hide them from medical personnel and endanger themselves. Even Sean Morey, a special-teams player for the Arizona Cardinals who is a co-chairman of the union’s committee on brain injuries, admitted this season that he played a game despite a concussion.

Consulting doctors beyond the team does not necessarily solve all of the league’s conflict-of-interest issues. And it is unclear how guidelines would define who is an independent expert.

The most prominent current — and instructive — N.F.L. concussion is probably that of the Philadelphia Eagles running back Brian Westbrook (pictured). He sustained one major injury Oct. 26, was held out of the next two games by team doctors, and then sustained another concussion Nov. 15.

Given that repetitive concussions are known to cause far more damage than single injuries, the Eagles sent Westbrook to well-regarded concussion specialists at the University of Pittsburgh Medical Center last week for a third-party examination. Complicating matters could be that the Pittsburgh group includes the Steelers’ team neurosurgeon as well as the league’s director of neurological testing.

South Carolina center for people with intellectual disabilities held liable for sexual assaults of residents

From GoUpstate.com:

Officials at the Whitten Center didn't believe John Doe when he told them he was being sexually assaulted by Daniel Maxwell Bradley, a caregiver at the Clinton facility for the mentally handicapped. They said Doe had a history of making false claims against employees.

That all changed when the FBI came knocking at the door, and agents didn't come empty-handed. They had photographs, taken by Bradley and shared on the Internet, of the assaults.

Bradley eventually pleaded guilty to sexually assaulting three residents - including Doe, whose real name is being withheld because the Herald-Journal generally does not identify sexual assault victims.

Nov. 19, Circuit Judge Mark Hayes approved a settlement in which the Whitten Center agreed to pay Doe $300,000. The amount is the maximum allowed by law because the Whitten Center, a residential facility for the mentally handicapped that provides individualized training for its clients, is a state-run facility.

The money will be paid by the state Insurance Reserve Fund and will be placed in a trust fund for the 22-year-old victim.

Wes Kissinger, the attorney representing the victim, told Hayes the entire amount was to compensate the victim for his physical, mental and emotional pain. Kissinger said that although the Department of Disabilities and Special Needs denied any responsibility, it was negligent in its hiring and training of Bradley.

"Their attorney says they aren't liable," said the victim's mother, who was in court Thursday. "But this settlement says they are."

Bradley was 18 when he went to work at the Whitten Center in 2001. He said in a deposition that his mother filled out the application for him because his handwriting was illegible and that he never went to the center before being hired.

During his tenure, he was sent home at least twice because of a lack of personal hygiene.

Lois Park Mole, a spokeswoman for the Department of Disabilities and Special Needs, said Bradley went through a rigorous hiring process. She said that included an interview with human resources staff, a State Law Enforcement Division check and a drug screening.

"There was nothing that gave us any reason to suspect this type of behavior," Mole said. "As soon as there was a reason, we cooperated completely with law enforcement. The health and safety of these residents is our highest priority."

In March 2004, the victim began living in the unit where Bradley worked second shift. He had been there less than a month when he told other workers that Bradley had sexually assaulted him in the shower.

Kissinger said the center suspended Bradley while it investigated the victim's claim. Five days later, officials said the allegations were unsubstantiated and reinstated Bradley.

Before Bradley could return to work, however, the FBI intervened. Bradley was convicted of first-degree criminal sexual conduct in 2006 and sentenced to 12 years in prison. He is incarcerated at the Kershaw County Correctional Institution.

Mole said Bradley's suspension was not due to allegations of sexual assault, although she could not confirm the specific reason. She also said he was never "officially" reinstated.

The settlement is the third one involving the Whitten Center this year, Mole said, adding that the other two were not sexual assault cases. The payouts in the other cases were $25,000 and $130,000, respectively. Kissinger, an attorney with the Spartanburg firm of Harrison White Smith and Coggins, has another case pending against the facility. He would not comment on the specifics.

Doe was the only victim at the center who was able to communicate. His mother said "he spoke for so many others."

The victim is now at another facility in the state. His mother said the incident will "haunt" him and his family for the rest of their lives.

"You spend your whole life trying to protect your children and get them the care and support they need," she said. "Then you have a betrayal like this, and you never trust anyone again."

Prosecutors in Italy want prison time for Google executives, in case of offensive online video of teen with Down syndrome

From The New York Times:

Italian prosecutors on Nov. 25 asked a judge to issue prison sentences for three Google executives and one former executive accused of defamation and failure to comply with privacy laws in a case that could alter the way Google operates in Italy and the rest of Europe.

The prosecutors contend that Google was negligent because it allowed a video of high school kids bullying a disabled classmate to stay on its Italian-language video service for two months in 2006. The company, based in California, says it removed the video several hours after being alerted of its existence.

The prosecutors submitted a 119-page document with evidence they say shows Google must have known about the video long before it was taken down.

The prosecutors rested their case after asking for a one-year sentence for three executives — David Drummond, senior vice president and chief legal officer; Peter Fleischer, global privacy counsel; and George Reyes, a former chief financial officer. They are seeking a six-month sentence for Arvind Desikan, who is now head of consumer marketing in Britain.

If found guilty, the four defendants, none of whom were present in court, would not serve jail time because sentences of less than three years are commuted in Italy for those who do not have a criminal record.

If prosecutors can persuade the judge the company knew the video was online and chose to do nothing, Google might be forced to change its operating practices in Italy and the rest of Europe by creating filters to flag offensive videos.

Google and the prosecutors agree the video was uploaded Sept. 8 and removed Nov. 7, 2006. The prosecutors presented evidence showing that in early October, a month before the video’s removal, there were comments posted saying that it should be taken down. One of those messages read, “This is shameful! This should be taken down immediately.”

“It is reasonable to imagine that comments like this were followed by requests by these same people that the video be removed,” the prosecutors wrote in the document they presented to the judge.

Prosecutors say the video was removed only after Vivi Down, an Italian association that defends the rights of people with Down Syndrome mentioned in the video, contacted authorities who then contacted Google.

Google, which will present its defense next month, said in a statement Wednesday that it “did exactly what is required under European and Italian law.”

“We took the video down when notified by the authorities and, thanks to our cooperation, the bullies who recorded and uploaded it have been identified and punished,” the statement said.

Google is apologizing for a racially offensive image of Michelle Obama that appeared near or at the top of the list when users searched for pictures of her on its site, The Associated Press reported from San Francisco.

Google placed a text ad above the image titled “Offensive Search Results” that states: “Sometimes our search results can be offensive. We agree.”

Users who clicked on the ad were directed to a letter from Google that explained that its results “can include disturbing content,” but noted that Google did not endorse content on those Web sites. “We apologize if you’ve had an upsetting experience using Google,” the company wrote.

The White House declined to comment.

Some California doctors recommending medical marijuana for teens with ADHD

From The New York Times:

At the Peace in Medicine Healing Center in Sebastopol, the wares on display include dried marijuana — featuring brands like Kryptonite, Voodoo Daddy and Train Wreck — and medicinal cookies arrayed below a sign saying, “Keep Out of Reach of Your Mother.”

The warning tells a story of its own: some of the center’s clients are too young to buy themselves a beer.

Several Bay Area doctors who recommend medical marijuana for their patients said in recent interviews that their client base had expanded to include teenagers with psychiatric conditions including attention-deficit hyperactivity disorder.

“It’s not everybody’s medicine, but for some, it can make a profound difference,” said Valerie Corral, a founder of the Wo/Men’s Alliance for Medical Marijuana, a patients’ collective in Santa Cruz that has two dozen minors as registered clients.

Because California does not require doctors to report cases involving medical marijuana, no reliable data exist for how many minors have been authorized to receive it. But Dr. Jean Talleyrand, who founded MediCann, a network in Oakland of 20 clinics who authorize patients to use the drug, said his staff members had treated as many as 50 patients ages 14 to 18 who had A.D.H.D. Bay Area doctors have been at the forefront of the fierce debate about medical marijuana, winning tolerance for people with grave illnesses like terminal cancer and AIDS. Yet as these doctors use their discretion more liberally, such support — even here — may be harder to muster, especially when it comes to using marijuana to treat adolescents with A.D.H.D.

“How many ways can one say ‘one of the worst ideas of all time?’ ” asked Stephen Hinshaw, the chairman of the psychology department at the University of California, Berkeley. He cited studies showing that tetrahydrocannabinol, or THC, the active ingredient in cannabis, disrupts attention, memory and concentration — functions already compromised in people with the attention-deficit disorder.

Advocates are just as adamant, though they are in a distinct minority. “It’s safer than aspirin,” Dr. Talleyrand said. He and other marijuana advocates maintain that it is also safer than methylphenidate (Ritalin), the stimulant prescription drug most often used to treat A.D.H.D. That drug has documented potential side effects including insomnia, depression, facial tics and stunted growth.

In 1996, voters approved a ballot proposition making California the first state to legalize medical marijuana. Twelve other states have followed suit — allowing cannabis for several specified, serious conditions including cancer and AIDS — but only California adds the grab-bag phrase “for any other illness for which marijuana provides relief.”

This has left those doctors willing to “recommend” cannabis — in the Alice-in-Wonderland world of medical marijuana, they cannot legally prescribe it — with leeway that some use to a daring degree. “You can get it for a backache,” said Keith Stroup, the founder of the National Organization for the Reform of Marijuana Laws.

Nonetheless, expanding its use among young people is controversial even among doctors who authorize medical marijuana.

Gene Schoenfeld, a doctor in Sausalito, said, “I wouldn’t do it for anyone under 21, unless they have a life-threatening problem such as cancer or AIDS.”

Dr. Schoenfeld added, “It’s detrimental to adolescents who chronically use it, and if it’s being used medically, that implies chronic use.”

Dr. Nora D. Volkow, director of the National Institute on Drug Abuse, said she was particularly worried about the risk of dependency — a risk she said was already high among adolescents and people with attention-deficit disorder.

Counterintuitive as it may seem, however, patients and doctors have been reporting that marijuana helps alleviate some of the symptoms, particularly the anxiety and anger that so often accompany A.D.H.D. The disorder has been diagnosed in more than 4.5 million children in the United States, according to the Centers for Disease Control and Prevention.

Researchers have linked the use of marijuana by adolescents to increased risk of psychosis and schizophrenia for people genetically predisposed to those illnesses. However, one 2008 report in the journal Schizophrenia Research suggested that the incidence of mental health problems among adolescents with the disorder who used marijuana was lower than that of nonusers.

Marijuana is “a godsend” for some people with A.D.H.D., said Dr. Edward M. Hallowell, a psychiatrist who has written several books on the disorder. However, Dr. Hallowell said he discourages his patients from using it, both because it is — mostly — illegal, and because his observations show that “it can lead to a syndrome in which all the person wants to do all day is get stoned, and they do nothing else.”

Until the age of 18, patients requesting medical marijuana must be accompanied to the doctor’s appointment and to the dispensaries by a parent or authorized caregiver. Some doctors interviewed said they suspected that in at least some cases, parents were accompanying their children primarily with the hope that medical authorization would allow the adolescents to avoid buying drugs on the street.

A recent University of Michigan study found that more than 40 percent of high school students had tried marijuana.

“I don’t have a problem with that, as long as we can have our medical conversation,” Dr. Talleyrand said, adding that patients must have medical records to be seen by his doctors.

The Medical Board of California began investigating Dr. Talleyrand in the spring, said a board spokeswoman, Candis Cohen, after a KGO-TV report detailed questionable practices at MediCann clinics, which, the report said, had grossed at least $10 million in five years.

Dr. Talleyrand and his staff members are not alone in being willing to recommend marijuana for minors. In Berkeley, Dr. Frank Lucido said he was questioned by the medical board but ultimately not disciplined after he authorized marijuana for a 16-year-old boy with A.D.H.D. who had tried Ritalin unsuccessfully and was racking up a record of minor arrests.

Within a year of the new treatment, he said, the boy was getting better grades and was even elected president of his special-education class. “He was telling his mother: ‘My brain works. I can think,’ ” Dr. Lucido said.

“With any medication, you weigh the benefits against the risks,” he added.

Even so, MediCann patients who receive the authorization must sign a form listing possible downsides of marijuana use, including “mental slowness,” memory problems, nervousness, confusion, “increased talkativeness,” rapid heartbeat, difficulty in completing complex tasks and hunger. “Some patients can become dependent on marijuana,” the form also warns.

The White House’s recent signals of more federal tolerance for state medical marijuana laws — which pointedly excluded sales to minors — reignited the debate over medical marijuana.

Some advocates, like Dr. Lester Grinspoon, an associate professor emeritus of psychiatry at Harvard University, suggest that medical marijuana’s stigma has less to do with questions of clinical efficacy and more to do with its association, in popular culture, with illicit pleasure and addiction.

Others, like Alberto Torrico of Fremont, the majority leader of the California Assembly, argue for more oversight in general. “The marijuana is a lot more powerful these days than when we were growing up, and too much is being dispensed for nonmedical reasons,” he said in an interview last week, bluntly adding, “Any children being given medical marijuana is unacceptable.”

As advocates of increased acceptance try to win support, they may find their serious arguments compromised by the dispensaries’ playful atmosphere.

OrganiCann, a dispensary in Santa Rosa, has a Web site advertisement listing the “medible of the week” — butterscotch rock candy — invitingly photographed in a gift box with a ribbon. OrganiCann also offers a 10 percent discount, every Friday, for customers with a valid student ID.

Teen runaway with Asperger's spent 11 days living on NY subway

From The New York Times:

Day after day, night after night, Francisco Hernandez Jr. (pictured) rode the subway. He had a MetroCard, $10 in his pocket and a book bag on his lap. As the human tide flowed and ebbed around him, he sat impassively, a gangly 13-year-old boy in glasses and a red hoodie, speaking to no one.

After getting in trouble in class in Bensonhurst, Brooklyn, and fearing another scolding at home, he had sought refuge in the subway system. He removed the battery from his cellphone. “I didn’t want anyone to scream at me,” he said.

All told, Francisco disappeared for 11 days last month — a stretch he spent entirely in subway stations and on trains, he says, hurtling through four boroughs. And somehow he went undetected, despite a round-the-clock search by his panicked parents, relatives and family friends, the police and the Mexican Consulate.

Since Oct. 26, when a transit police officer found him in a Coney Island subway station, no one has been able to fully explain how a boy could vanish for so long in a busy train system dotted with surveillance cameras and fliers bearing his photograph.

But this was not a typical missing-person search. Francisco has Asperger’s syndrome, a form of autism that often causes difficulty with social interaction, and can lead to seemingly eccentric behavior and isolation. His parents are Mexican immigrants, who say they felt the police were slow to make the case a priority.

“Maybe because you might not understand how to manage the situation, because you don’t speak English very well, because of your legal status, they don’t pay you a lot of attention,” said Francisco’s mother, Marisela García, 38, a housecleaner who immigrated in 1994 and has struggled to find ways to help her son.

The police, however, say they took the case seriously from the start, interviewing school officials and classmates, canvassing neighborhoods and leafleting all over the city.

Francisco says his odyssey wound through three subway lines: the D, F and No. 1. He would ride a train until its last stop, then wait for the next one, wherever it was headed. He says he subsisted on the little he could afford at subway newsstands: potato chips, croissants, jelly rolls, neatly folding the wrappers and saving them in the backpack. He drank bottled water. He used the bathroom in the Stillwell Avenue station in Coney Island.

Otherwise, he says, he slipped into a kind of stupor, sleeping much of the time, his head on his book bag. “At some point I just stopped feeling anything,” he recalled.

Though the boy’s recollections are incomplete, and neither the police nor his family can retrace his movements in detail, the authorities say that he was clearly missing for 11 days and that they have no evidence he was anywhere but the subway.

For his parents, the memories of those 11 frantic days — the dubious sightings, the dashed hopes and no sleep — remain vivid. “It’s the most terrible thing,” his mother said in Spanish.

Just what propelled Francisco to take flight on Oct. 15 is unclear. Administrators at his school, Intermediate School 281, would not comment. But Francisco said he had failed to complete an assignment for an eighth-grade class, and was scolded for not concentrating.

After school, he phoned his mother to say he was heading home. She told him the school had called and she wanted a serious talk with him.

His first impulse was to flee. He walked eight blocks to the Bay Parkway station and boarded a D train. It seemed a safe place to hide, he said.

When he did not arrive home, his mother started to panic. In January, after another problem at school, Francisco had left home and ridden the subway, but returned after five hours. “We thought this time it would be the same,” Ms. García said. “But unfortunately it wasn’t.”

Her husband, also named Francisco Hernandez, went to the nearest subway station and waited for several hours while she stayed at home on Bay 25th Street with their 9-year-old daughter, Jessica. After midnight, the couple called the police, and two officers from the 62nd Precinct visited their apartment.

The next morning, Mr. Hernandez, 32, a construction laborer, borrowed a bicycle and scoured Bensonhurst. He and his wife separately explored the subway from Coney Island to Midtown Manhattan.

They had been trying to help their son for years. Born in Brooklyn, Francisco grew up a normal child in many ways, his mother said, earning mostly passing grades and enjoying drawing and video games. But he had no friends outside school, and found it difficult to express emotions. A gentle, polite boy, he spoke — when he did speak — in a soft monotone.

In 2006, his parents had him evaluated at a developmental disabilities research clinic on Staten Island, where his Asperger’s was diagnosed. The clinic’s chief neuropsychologist concluded that Francisco struggled in situations that demanded a “verbal or social response.”

“His anxiety level can elevate, and he freezes in confusion because he does not know what to do or say,” the doctor wrote.

After he disappeared, his parents printed more than 2,000 color leaflets with a photo of Francisco wearing the same red hoodie; friends and relatives helped post them in shops, on the street and throughout the subway in Brooklyn. The family hand-lettered fluorescent-colored signs.

“Franky come home,” one pleaded in Spanish. “I’m your mother I beg you I love you my little boy.”

Francisco said he never saw the signs. He lost sense of time. He was prepared, he said, to remain in the subway system forever.

No one spoke to him. Asked if he saw any larger meaning in that, he said, “Nobody really cares about the world and about people.”

Sightings were reported. An image of a boy resembling Francisco had been captured by a video game store’s security camera, but he turned out to be someone else, the police said. A stranger called Mr. Hernandez to say he had spotted Francisco with some boys at a movie theater in Sheepshead Bay, Brooklyn. A search turned up nothing.

Ms. García said one detective told her the boy was probably hiding out with a friend. She replied that her son had no friends to hide out with. Frustrated, the parents sought help from the Mexican Consulate. Officials there contacted the Spanish-language news media, which ran brief newspaper and television reports about Francisco, and called the police — “to use the weight that we have to encourage them, to tell them that we have an emergency,” a consular spokesman said.

Six days after Francisco’s disappearance, on Oct. 21, the case shifted from the police precinct to the Missing Persons Squad, and the search intensified. A police spokeswoman explained that a precinct must complete its preliminary investigation before the squad takes over.

The squad’s lead investigator on the case, Detective Michael Bonanno, said he turned the focus to the subway. He and his colleagues blanketed the system with their own signs, rode trains and briefed station attendants.

About 6 a.m. on Oct. 26, the police said, a transit officer stood on the D train platform at the Stillwell Avenue station studying a sign with Francisco’s photo. He turned and spotted a dirty, emaciated boy sitting in a stopped train. “He asked me if I was Francisco,” the boy recalled. “I said yes.”

Asked later how it felt to hear about the work that had gone into finding him, Francisco said he was not sure. “Sometimes I don’t know how I feel,” he said. “I don’t know how I express myself sometimes.”

Apart from leg cramps, he was all right physically, and returned to school a week later. But Ms. García said she was still trying to learn how to manage her son’s condition. Though doctors had recommended that Francisco be placed in a small school for children with learning disorders, she said, officials at his school told her he was testing fine and did not need to be transferred.

“I tell him: ‘Talk to me. Tell me what you need. If I ever make a mistake, tell me,’ ” she said. “I don’t know, as a mother, how to get to his heart, to find out what hurts.”

One of the fluorescent signs hangs on the living room wall. The others are stacked discreetly in a corner, and Ms. García said she was not ready to discard them.

“It’s not easy to say it’s over and it won’t happen again,” she said.

Paralympian protests by dragging himself through the airport, after Australian airline requires him to check his wheelchair

From AFP:

MELBOURNE — Australian budget airline Jetstar apologised on Nov. 24 after making a Paralympic champion check in his wheelchair before catching a flight, prompting him to drag himself through the airport.

Kurt Fearnley (pictured), who had just completed a gruelling 96 kilometre (60 mile) crawl using his hands along a Papua New Guinea jungle track, had complained bitterly about the weekend incident.

The equivalent for an able-bodied person "would be having your legs tied together, your pants pulled down and be carried or pushed through an airport", he said.

Fearnley, 28, hauled himself around Brisbane airport using his hands, including through a bathroom, and on to his flight in protest when Jetstar asked him to check in his personal wheelchair.

He spurned the airline's offer of its own wheelchair specially designed for planes, complaining that he would lose his mobility and have to be pushed around by airport staff.

Jetstar, the budget offshoot of national carrier Qantas, issued a statement apologising to the two-time Paralympic champion, saying any embarrassment and hurt was not intentional.

It said its policy was for passengers in wheelchairs to be transferred to the airline wheelchair, which is easier to manoeuvre inside the plane, at the boarding gate.

Fearnley, who won the marathon gold in the Beijing and Athens Paralympics, said the airline had told him it was working on an alternative boarding procedure for disabled passengers.

"As long as that's going ahead, I'm more than happy," he told Australian Associated Press.

Documentary about disability and religious communities to begin airing on ABC stations in December

From Diva Communications, producer of the documentary:

Diva Communications, Inc., a three-time Emmy award-winning programming and production company, has completed "A Place for All: Faith and Community for Persons with Disabilities," a unique interfaith documentary due to begin airing on ABC stations in December.

The documentary, produced in conjunction with the New York Board of Rabbis, had the support of an extraordinary lineup of faith groups including the National Council of Churches, the Evangelical Lutheran Church in America (ELCA), the Islamic Society of North America (ISNA), the United Methodist Church, the United Church of Christ and the U.S. Council of Catholic Bishops.

The faiths' relationship with persons with persons with disabilities is a critical issue since it is estimated that 1 out of 5 Americans has a disability.

'A Place for All' explores the courageous stories of persons with disabilities as the succeed in making their faith communities truly inclusive.

It features people such as Rabbi Darby Jared Leigh, a spiritual leader at Congregation Bnai Keshet in New Jersey and one of the handful of deaf rabbis in the world; members of ELCA's DAYLE program where Definitely Abled Youth unite at the 40,00 strong triennial Evangelical Lutheran youth gathering; Rev. Beth Lockard, the pastor of Christ the King Deaf Church; and Brandon Kaplan (pictured), a severely disabled boy with limited sigh and speech who recently had the privilege of becoming a Bar Mitzvah.

ABC stations nationwide will begin airing the program December 6, 2009 as a part of ABC's Vision and Values series, a presentation of the Interfaith Broadcasting Commission.

Canadian hunters with disabilities win right to bring hunting companions in their vehicles

From The Vancouver Sun in Canada:

The BC Human Rights Tribunal has ruled the environment ministry discriminates against handicapped hunters by not allowing them to have a designated “hunting companion” with them in their vehicles while out hunting.

The ruling followed a complaint by Larry Hall, a hunter of 55 years experience who suffers from Guillian-Barre Syndrome, a disease that causes nerve damage, leaving him able to walk only short distances.

The Kootenay hunter filed his first complaint in November 2004, and another in 2007 on behalf of the Canadian Outdoor Disabled Alliance.

Hall — one of the 100 or so hunters who is eligible for the disabled hunter special access permit — said the regulation discriminated against disabled hunters because it does not allow them to bring hunting companions along in their vehicles to track and kill wounded animals.

Disabled hunters were only allowed to carry “non-hunting” companions in their vehicles and these people were not permitted to dispatch wounded animals. A non-hunting companion could only be used to retrieve killed game.

Hall said the regulation put him in a “Catch 22” in that if he shoots an animal, but due to his disability he’s unable to dispatch it, he contravenes section 35 of the Wildlife Act.

Hunting companions were only allowed to be present if they walked, or biked or came in on horseback carrying their own firearms and equipment.

The hunting companion also had to leave the same way as he or she came in without any of their equipment being transported in the disabled person’s vehicle.

The ministry said this was to prevent a hunting companion benefiting from access to areas set aside for disabled hunters, and to prevent undue hardship to the environment, the roads, wildlife habitat and exerting unnecessary pressure on hunting in the designated areas.

But tribunal member Judy Parrack disagreed.

In a complex 75-page decision, she found the ministry had contravened the Human Rights Code by failing to consider fully “the impact that the absence of a hunting companion would have on Mr. Hall and when it failed to take reasonable steps to accommodate Mr. Hall and other disabled hunters in the Kootenay Region.”

However, neither side had provided submissions on what should be done in the event Hall’s complaint was upheld.

Given this, Parrack said it would be inappropriate for her to “craft a remedy” without submissions, as the issue is a complicated one that “may have implications beyond Mr. Hall and the disabled hunters in the Kootenay Region.”

She gave both parties 60 days to submit recommendations.

Poverty report: Ghana's toilets are not disability accessible

From AllAfrica.com:

ACCRA, Ghana — It is estimated that 10% of Ghana's population suffer from some form of disability with the blind, deaf and physically disabled people being the most visible. According to the Ghana Poverty Reduction Strategy (GPRS) papers, the 10% of the population living with disabilities are indeed amongst the poorest of the poor.

In a 2007 publication, SEND-Ghana noted that poverty of persons with disability (PWDs) is characterized by landlessness, unemployment, illiteracy, homelessness and political powerlessness.

It is reasonable to suggest that the disabled, being poor, would find it most difficult to put up their own homes with toilets. They may rent rooms, live with relatives or even friends. In worst case scenarios, some PWDs are forced to become squatters or slum dwellers.

The big question is whether they will have access to decent toilets to exercise a very important human right - to empty their bowels. The 2000 Population and Housing Census estimated that more than 20% of Ghanaians do not have any form of latrines and therefore resort to open defaecation. The Census established that 31.45% of households in Ghana use public latrines as compared to 8.5% using Water Closet. 22% use pit latrines while 6.9% utilize KVIP. Bucket or pan latrine serves 4% while 6.9% of the population attends nature's call in other people's houses.

The figures from the Census show that Ghana is far from achieving targets set in the MLGRD's Environmental Sanitation Policy of 1999. the policy is unequivocal on households and public toilets; the policy states that at least 90% of the population should have access to acceptable domestic toilet while the remaining 10% should have access to hygienic public toilets.

While the world observed 'Toilet Day' on November 19, Ghana marked the day under the theme "Stop Open defaecation, use Toilets." Two deputy ministers - Hon Elvis Afriyie Ankrah of the Ministry of Local Government and Rural Development (MLGRD) and Dr Hanna Bissiw of the Ministry of Water Resources, Works and Housing - symbolically used the East Ayawaso Sub Metro (AMA) Toilet No 12B.

After them, Mr Alexander Tetteh, Executive Director, Centre for Employment of Persons With Disabilities and a physically disabled person, also tried to use the facility which has an entrance measuring a yard-and-a-quarter. Alas! He was not able to use it. It was simply inaccessible. There was no ramp for his wheelchair to go over.

And even if he was able to entre the facility, he could not have squatted to "poopoo." So for many people like Mr Tetteh, there are obvious questions about the existence of an all-encompassing sanitation policy. The current design of the majority of public toilets ensures that PWDs who have no access to toilets are denied their right to empty their bowels.

Mr Tetteh expressed his frustration to media personnel. He said it was worrying that the facility was not a water closet. He noted that similar facilities like "this are all over." He called on authorities to make public toilets disability-friendly.

His call resonates with the provisions of the Persons With Disability Act, 2006 (Act 715). Section 60 of the Act stipulates, "The owner or occupier of an existing building to which the public has access shall within ten years of the commencement of this Act make the building accessible to and available for use by a person with disability."

The Act is more than three years old; only seven years remain for meeting the moratorium. It is unclear when this particular toilet facility was provided but three years is certainly enough time to have noticed the defect in the facility.

In 2007, SEND-Ghana noted that safety measures and interventions were included in the GPRS II but many new public physical infrastructures were not disability friendly. "For example they do not have facilities for persons utilizing wheel chairs to enter unassisted."

SEND-Ghana points out that the need for government to enforce policies on disabled access to physical infrastructure to public facilities cannot be overemphasized. "We demand that government put in place an appropriate monitoring system to ensure that...all public buildings have disability friendly toilets, entrance and exit facilities."

India focuses on eliminating polio in Uttar Pradesh

From Press TV in India:

India has launched a campaign to eradicate polio from its northern state of Uttar Pradesh, thought to have the world's highest concentration of the infection.

Some 2,700 booths have been situated in and around the state capital of Uttar Pradesh, Lucknow, to give out vaccine drops, the BBC reported.

There are also plans to immunize two million children in the Indian capital, New Delhi.

Bihar and Uttar Pradesh are the only two states left in India where polio infection is still endemic.

Uttar Pradesh has a population of over 190 million and the world's highest concentration of the crippling disease.

The infection is now endemic in just four countries - Afghanistan, India, Pakistan, and Nigeria.

The World Health Organization (WHO) is currently making efforts to totally eradicate polio.

Disabled vet finds sports passion in sitting volleyball

From Jenni Carlson's sports column in The Daily Oklahoman:

EDMOND, Okla. — Ed O’Neil (pictured) went to war for his country, battled for it, even sacrificed for it.

The master sergeant was commanding an Army Special Forces team a year and a half ago in Iraq when an armor-piercing explosive ripped through his Humvee. It also ripped through the lower part of his right leg.

That leg was amputated just below the knee.

Now, O’Neil has a new mission — being part of the U.S. Paralympic sitting volleyball team.

He is one of eight wounded warriors taking part in a developmental camp this weekend at Central Oklahoma. All of them are new to the sport, which is played just like the standing game except for the lowered net, smaller court and sitting players. But all of them are eager to learn and driven to succeed.

At a time when injured soldiers are coming home in droves, this is a chance like no other.

"It’s just a gift from God for me,” O’Neil said, sweat from a morning practice session beading just below his graying hairline. "If we were ever to win a gold medal, it’s really not about that.

"It’s about the journey.”

Still, O’Neil never imagined his path would lead back to a volleyball court. Even though he played volleyball in high school, it became a thing of the past when he joined the Army. He rose through the ranks and became part of Special Forces, and over the next decade, he was sent around the world.

In the spring of 2008, he was on his third deployment to Iraq.

"I’d seen a lot of people injured or killed,” he said.

O’Neil, however, had come away unscathed.

In the days after his unit arrived in Iraq, his team set about delivering supplies to other special forces units around the country. One day, their convoy was traveling through Najaf, a holy but dangerous city south of Baghdad, with O’Neil in the lead vehicle. He’d put his best soldier in the driver’s seat and his best gunner on the vehicle’s machine gun.

As they traveled through town, the lead vehicle was hit by an improvised explosive device made to pierce armor.

"It goes in one side,” O’Neil said, "and it’ll just keep on going and go on out the other side.”

All of the men in the Humvee were knocked out.

When O’Neil came to, the vehicle had stopped moving after hitting a median. The driver was slumped over, dead. The gunner had been ejected from the vehicle and onto the sidewalk.

Everything was on fire.

"I was freaking out,” O’Neil said. "It was just a nightmare.”

His life changed in a moment. Much of his lower left leg had been blown off. There would be dozens of surgeries to try to repair the damage, but in the end, his leg would be amputated just below his knee.

O’Neil praises the military’s medical system. It did right by him. The same goes for his family.

Despite that top-notch care, O’Neil realized he needed to do more than get well. He needed to get back. He’s a husband, a father, a go-getter, a leader, and that didn’t change that horrible day in Iraq.

"I was really unsure what I was going to do with my life,” O’Neil said.

He isn’t alone.

While wars in Iraq and Afghanistan have killed many American soldiers, many more have been injured. They want the highest quality of life possible, and that includes being physically fit.

That’s why the military started doing sports camps for injured soldiers about five years ago. The soldiers are exposed to everything from wheelchair basketball to sitting volleyball to adaptive weight lifting.

The benefits have been numerous. Physical rehabilitation is enhanced. Mental well-being is improved.

"I think it really goes back to finding ability again,” said Kallie Quinn, who works with the U.S. Paralympics Military Program. "So many of them have been so active. Then when they’ve been injured, they lose a piece of that ability side of them.”

They also lose the camaraderie and the teamwork that is such a part of the military.

That’s one of the reasons Daniel Jacobs soaked up every moment of this weekend. Like O’Neil, he lost the lower part of his right leg to a roadside bomb. While he works in the Wounded Warrior Battalion helping others like him adapt, there was something different about being part of the sitting volleyball camp.

"You can get together, relate, joke around,” Jacobs said. "You open up more to these people than you do for anybody else.”

The above-knee amputees give the below-knee amputees a hard time.

"Oh,” they’ll chide, "you still have your knee.”

Jacobs knows some people might think them sick or twisted for saying such things, but he swears that’s not the case.

"We just have fun with it,” he said. "This is what we have.”

And they intend to make the most of it.

O’Neil has already agreed to move to Edmond and be a resident athlete in training. His wife and three kids even came to town this weekend so they could look at houses and plan their move.

"I’d be a fool not to stick with this program,” he said. "I’m going to ride this as long as possible.”

Blind woman in California sues National Conference of Bar Examiners over accommodations

From the San Jose Mercury-News:

Being blind didn't keep Stephanie Enyart (pictured) from graduating from Stanford University. It didn't keep her from earning a law degree at UCLA. And she's determined not to let it keep her from practicing law.

Enyart, 32, is suing the National Conference of Bar Examiners, which repeatedly has denied her request to take the bar exam using adaptive technology.

She was a 15-year-old high school sophomore growing up in Nipomo, south of San Luis Obispo, when she learned she suffered from a rare form of macular degeneration called Stargardt's disease. Her central vision was deteriorating rapidly, and there was no way to stop it. At first, she refused to believe it.

"I was a kid; I didn't accept that I was going to be disabled," she told me.

She aced high school by using big-print textbooks, but by the time she got to Stanford, she needed a computer with adaptive software. Today, with no central vision but some peripheral vision, she lives by herself, gets around without a white cane and reads using ZoomText, a screen magnifier, and JAWS, a text reader that converts computer type to audio. That's how she got through law school, and that's how she reads e-mail and legal documents in her job at Disability Rights Advocates in Berkeley.

Enyart graduated from UCLA last year. When she applied to take the bar exam, the California Bar Association told her she could use both JAWS and ZoomText for the test. But the NCBE, which controls the multistate standardized portions of the exam, turned her down — three times. She was told she could use JAWS, the audio text reader, but not ZoomText.

She was baffled. The Americans with Disabilities Act grants disabled people the right to reasonable accommodations when taking professional certification tests. Having only an audio reader might work for some blind people, but Enyart is accustomed to reading as well as listening.

"It's like if a person is running a marathon who wears size 8 shoes, and they say they'll give you shoes, but they're size 5," she said. "It just doesn't work for me."

When I called Erika Moser at the NCBE, she declined to comment. So I don't know what the conference's rationale was. Enyart says the NCBE cited cost and security concerns in denying her request.

"That's bizarre," said Anna Levine, one of the staff attorneys at Disability Rights Advocates who filed the lawsuit earlier this month. Yes, there would be a security issue if Enyart brought her own laptop into the exam room. But the NCBE already provides laptops with audio reader software for blind applicants, she said.

"We would be happy to provide the other software," she said. "We are talking about a piece of software that costs $400. That's the cost standing between Stephanie and her career."

There are fewer than 500 blind lawyers in the country, according to one of them, Scott Labarre, president of the National Association of Blind Lawyers. He has a theory about why the NCBE won't grant Enyart's request.

"I think they're just being stubborn," he said. "In my view, it's a very reasonable accommodation. Today most blind students go through law school using a variety of technology."

If the NCBE thinks Enyart will give up without a fight, they've got the wrong woman. She's not just fighting for herself; she's fighting for all disabled students. While in law school she founded the National Association of Law Students with Disabilities and served as the first president. In her lawsuit, she isn't asking the NCBE for damages, just an assurance that other blind people will receive the accommodations to which they are entitled.

"If she wins this case, it would be a huge victory for blind lawyers in this country," said Labarre. "I just want her to have the same chance as other law students to practice law."

After all, it's not as if technology will give Enyart an advantage over test-takers who can see. She still has to move her eyes around the enlarged page to see with her limited peripheral vision and listen to the questions with headphones. As exhausting as the three-day test is for any bar applicant, it's even more physically demanding for her.

But Enyart is accustomed to doing things the hard way, if that's the only way to get what she wants. And this young woman really wants to pass the bar so she can help other disabled people fight for their rights.

Death penalty won't be sought in Illinois murder trial of man with Asperger's

From the News-Courier:

CENTRALIA, Ill. — The trial of an autistic Southern Illinois man in the rape and stabbing death of a Centralia first-grade teacher can go forward now that the prosecution has agreed state law does not allow the death penalty.

Neil Barrall, 29, of Centralia, faces two counts of first-degree murder for the October 2007 slaying of Rita Michelle Caveletto.

Prosecutors in Marion County allege Barrall ran over Caveletto with his vehicle while she was jogging along Schwartz Road in rural Walnut Hill, then sexually assaulted her, repeatedly kicked her in the head and stabbed her multiple times with a knife in the chest and neck.

Barrall suffers from Asperger's syndrome, a form of autism. The case had been on hold awaiting a decision by the Appellate Court on the judge's decision that found Barrall is fit to stand trial with special assistance.

Barrall's attorney has argued that he is unfit to stand trial because of mental disease. Prosecutors now say that state law prohibits the imposition of the death penalty with a finding that Barrall has Asperger's syndrome and must be provided special assistance at trial.

On April 27, the judge ruled Barrall "is fit to stand trial with special provisions and assistance provided him" by statute. The order stated, "That special assistance should include appointment of a qualified person trained in dealing with persons diagnosed with Asperger's (syndrome) to assist the defendant as needed at trial."

Earlier this week, Barrall's attorney, Matt Vaughn of Fairfield, dropped his appeal of the judge's original ruling. He then filed a motion in Circuit Court asking the judge to bar the death penalty, citing U.S. Supreme Court rulings that prohibit the death penalty for mentally retarded individuals.

Marion County State's Attorney Matt Wilzbach says that with the appeal off the table, state law will require the possibility of the death penalty to be removed. It is expected the decision to bar the death penalty will be issued during a conference call on Dec. 3.

Crisis Intervention Teams can assist police when on calls involving someone with a mental illness

From the San Jose Mercury-News:

One out of every four San Jose police officers is specially trained to respond to emergency calls that involve a mentally ill or suicidal person.

But none of them were sent to Daniel Pham's home the day the 27-year-old mentally ill man had his deadly encounter with police.

There's no guarantee that calling for such expert backup would have changed the outcome May 10, when two officers shot Pham with 12 bullets in his backyard after he threatened them with a knife. San Jose police insist it would not have.

However, new details in the Pham case released this month underscore how San Jose police's strategy differs from other police departments in dealing with the mentally ill.

In New York City or Memphis, Tenn., an officer with special mental health training would have been automatically dispatched to Pham's house the moment a 911 dispatcher learned police were likely dealing with a mentally disturbed person.

Not so in San Jose, which leaves the decision to call for help to the dispatcher or the responding officer — a strategy that many experts say isn't ideal. It's unfair, they say, to expect patrol officers to make such calls while weighing split-second judgments in highly volatile situations.

"It would have been better, in retrospect, in having a CIT officer there'' at the Pham house, said John Mitchem, president of the Santa Clara County chapter of the National Alliance on Mental Illness. The nonprofit helped craft a nationwide police training program called the Crisis Intervention Team.

"That training makes a difference,'' said Mitchem, who praised San Jose police for successfully managing many psychotic episodes peacefully in the past.

CIT officers undergo 40 hours of training to recognize mental illness and how to defuse confrontations. While experts refuse to judge whether San Jose police could have done anything differently in the Pham case, there are certain strategies that CIT officers learn: avoid shouting at schizophrenics who are hearing voices; don't try to argue with paranoid people about their fears; turn off sirens; move slowly; show empathy.

"Sometimes these techniques work, and sometimes they don't. We're not teaching them to be psychologists,'' said Dr. Agi Schenley, who trains San Jose police and other departments.

Police also learn that manic people might exhibit the same behavior as those high on drugs.

When San Jose police arrived at the Pham home that day, records show that Brian Pham told police his younger brother was high on drugs and had sliced him in the neck for no reason. In an interview with the Mercury News, Brian Pham insisted he told police when they arrived that Daniel was mentally ill.

That information is crucial for police dispatchers. Mitchem said his group coaches mentally ill clients and their families to specifically request a CIT officer when they call 911.

Brian's now ex-girlfriend had called 911 from a locked bedroom but wasn't sure Daniel was mentally ill. She used his Vietnamese name, Son Pham, to describe the attacker. The police dispatcher quickly learned that police had been to the same address months before to take Daniel Pham to a psychiatric ward but wasn't sure if Daniel and Son were the same person.

Some experts say that an automatic trigger to send out a CIT officer simply takes out the guesswork.

In Memphis, when 911 calls aren't clear about mental illness, retired police Maj. Sam Cochran said dispatchers are trained to "err on the side of caution'' and send the CIT units anyway. New York uses a similar strategy.

Ten years ago, Cochran trained San Jose police — the first in California — under the model he helped create in Tennessee in 1988 after police there killed a mentally ill, knife-wielding man.

San Jose police say they "don't have the staffing for an automatic trigger,'' said San Jose police Sgt. Teresa Jeglum, who heads up the CIT unit.

The Memphis Police Department has about 230 CIT-trained officers out of a force of about 1,200 — less than 20 percent. That's compared with 349 CIT-trained officers in San Jose for a force of nearly 1,380 — or 25 percent of its force. This year, San Jose trained 90 new officers.

San Jose isn't alone in not sending special crisis intervention officers automatically to mental disturbance calls. Santa Clara police leave it up to patrol officers to call for CIT help. And in Chicago, where only 8 percent of the force is CIT-trained, dispatchers "do their best" to send out a CIT officer "if one is available,'' said Dr. Bruce Handler, a CIT trainer.

Cochran said while many people assume that an overwhelming number of police calls involve mentally ill people, his meticulous record-keeping proved to his own once-skeptical community that the number was less than 2 percent of the 800,000 annual calls to Memphis police. In San Jose, mental disturbance calls represent on average 0.5 percent of the 430,000 calls police receive each year.

"Our numbers gave the community an awareness about mental illness and proved influential when we needed to make a point,'' Cochran said.

San Jose police stopped tracking how often CIT officers are sent on calls, said Sgt. Ronnie Lopez, because of a clerical shortage.

San Jose police have defended their response in the Pham shooting. Officers Brian Jeffrey and Matthew Blackerby were cleared by a grand jury in October. Their reports indicate that the officers hopped over a backyard fence and ordered Pham to drop his knife. He refused, even after being shocked with a Taser, and, police say, lunged at one of the officers before they opened fire. He was dead at 11:51 a.m., 18 minutes after the dispatcher answered the 911 call.

The 911 transcripts released last week after a months-long public records battle show that an officer trained in using a bean bag gun was on the way to Pham's house. But they did not call a CIT unit. Since the Columbine shootings in 1999, many police agencies are now trained not to hesitate and rush right in to subdue an aggressor — even if that person has a mental illness.

"You're asking police to do an impossible task,'' said Ron Honberg, the National Alliance on Mental Illness' legal director. "In 99 percent of the cases, police do an excellent job. It's just the 1 percent that make the news.''

Eugene O'Donnell, a former New York City cop who now teaches law and police studies at New York's John Jay College of Criminal Justice, agrees that police officers become a scapegoat for society's lack of attention to mental illness.

"It's hard to think of anyone worse to send in to a situation like that than a police officer,'' O'Donnell said. "But we wait until the eleventh hour to call cops, who have, at best, minimal skills to deal with this, no matter how good their tactics. It's just terrible public policy to make cops be mental health providers.''