DHMH Daily News Clips

The state Department of Agriculture is caught between two demanding groups on the West Nile virus issue: the worried public and protective environmentalists.

With the first two human cases of the virus in Maryland announced last week, the public demand for mosquito spraying is high. At the same time, the chemical used on West Nile carrier mosquitoes can threaten wildlife in the Chesapeake Bay, environmentalists say.

The state says it's struck a balance between the two groups that is working to protect the public health and coastal wildlife.

Department of Agriculture officials will increase mosquito spraying in the coming weeks to try to prevent the spread of West Nile to another human victim.

A 63-year-old Eastpoint woman died Saturday at Johns Hopkins Bayview Medical Center and a 72-year-old Baltimore man is in serious but stable condition at Sinai Hospital.

Until this week, the agriculture department did not often spray specifically to eliminate mosquitoes carrying the virus, said Don Vandrey, department spokesman. The state frequently does spray at the request of communities to kill large mosquito populations.

What concerns scientists and citizens is the government is not assessing the risk of spraying the pesticide compared to the risk of people contracting the virus.

There's a strong risk of doing more harm than good by spraying more than is necessary for a virus that affects so few in the population, said Kim Coble, a Chesapeake Bay Foundation scientist.

"The potential risks from pesticides is just too great," she said.

Reading the label alone of the pesticide permethrin, the chemical of choice to eradicate mosquitoes, is enough to cause concern about the methods used to spray it.

"This product is extremely toxic to fish and other aquatic organisms," the label says. "Do not apply directly to water or to areas where surface water is present or to intertidal areas below the mean high water mark."

While the department says it avoids spraying near water, Ms. Coble said no one is really monitoring applications. Plus, she said, the effects of the spraying are unknown.

"The impact of that kind of thing is really not tracked," she said.

But the bottom line, said Ms. Coble, is whether the spraying is effective. She said it's not because mosquitoes literally have to fly right into the spray to be killed.

However, Mr. Vandrey said spraying has proven effective.

"We know we are getting much lower mosquito counts," he said.

Effective or not, the reason the department sprays for West Nile virus is that the public demands it. Next year, however, Mr. Vandrey said there likely will be less spraying for mosquitoes.

"Each year, the level of anxiety and interest drops dramatically. The public concern for West Nile Virus is actually greater than the threat," he said.

The most effective way to control mosquito populations is to get rid of standing water said Lynn Goldman, professor at Johns Hopkins University, who added that the public needs to be more aware of such control measures.

In addition, there are safer pesticides that can be used, she said, but they are more expensive.

Published September 10, 2001, The Capital, Annapolis, Md.

Sinai throws doors open on $15 million, patient-friendly orthopedics center

By Rachel Mansour

Daily Record Business Writer

Tuesday, September 11, 2001

A patient awaiting limb-lengthening or joint reconstruction surgery at Sinai Hospital of Baltimore’s new Rubin Institute for Advanced Orthopedics will not see the typical institutional décor — bare walls, bland floors and nondescript furniture. Instead, the patient’s nerves could be calmed by natural colors of red, green, yellow and blue, bright floors peppered with sun, tree, fish and plant designs, doorways with geometric patterns and modern wall sconces lining the hallways.

“We always tried to create that feeling of a natural environment at the center because it evokes the healing process,” said Neil M. Meltzer, Sinai’s president and chief operating officer.

The hospital yesterday celebrated the grand opening of the $15 million, 48,000-square-foot expansion that will bring renowned physicians and international recognition as well as 146 new employees to the hospital.

The foundation of the Rubin Institute for Advanced Orthopedics (RIAO) was laid last year after Drs. Dror Paley and John Herzenberg, directors of the Maryland Center for Limb Lengthening and Reconstruction, agreed to move their practice to Sinai from Kernan Hospital, part of the University of Maryland Medical System.

Dr. Michael Mont, a joint replacement and preservation specialist from Good Samaritan Hospital, joined Sinai last year to lead the new institute with Paley and Herzenberg.

Patients from 42 countries and 50 states are expected to visit RIAO to receive orthopedic services offered at only a couple institutions across the nation, said Meltzer, also a senior vice president of LifeBridge Health, Sinai’s parent company.

“It really helps position us nationally, if not internationally, in the orthopedics department,” he said. “This rounds out the kind of services we already have.”

With the addition, Sinai officials wanted to make sure its facility conveyed “a sense of caring” as well as grandness — something missing at the campus, Meltzer said. The front entrances of the original hospital buildings, which face Northern Parkway and date back to the 1950s, were actually designed to be the back entrances.

The result: “It looked like a very typical, 1950s utilitarian structure,” he said.

Baltimore architecture firm Hord Coplan Macht and general contractor The Whiting-Turner Contracting Co. were hired late last year to get the job done before July — a particularly tight timeline for the construction business.

A four-story addition to the 36-year-old Ansel and Ellen Schoeneman Rehabilitation Building contains five operating rooms, 18 private inpatient rooms, including two VIP suites, an outpatient clinic, a 10-bed post-anesthesia recovery area, a gait lab and a therapy pool.

Plenty of large windows were included to ensure patient rooms, hallways and waiting rooms are full of natural light. The existing two-story base building was renovated with new carpeting, paint and furniture.

“We wanted to create as light a facility as possible,” said Scott Robison, project manager and vice president of Hord Coplan Macht, during a tour of the facility with The Daily Record.

Several patient rooms contain pullout couches and lounge chairs for family members that stay overnight with patients. Each patient room is private and features hardwood floors. The VIP suites contain a room for overnight guests.

Visitors of patients undergoing surgery have a separate, larger waiting room, which contains faux leather furniture, bright artwork and a picture window that overlooks the tree-filled area below.

The interior design is intended to use natural images to foster the healing process, said Judith James, an associate with Griswold, Heckel & Kelly Associates Inc., a Chicago-based design consulting firm. “The color scheme uses the sun and earth as symbols of regeneration.”

The graphic elements, such as diamonds and checkers on doorways and walls, diminish the visibility of machinery on the hospital walls. “Graphic elements relate to boutique hotels in an attempt to provide something that was clean and classic but also a little fun,” she said, adding that many children undergo surgery at RIAO.

Sinai Hospital is in for other changes, Meltzer says. Eventually the entire campus will have a new look. The hospital has been growing steadily the past decade and outgrowing its facilities, which are not designed to handle modern technology.

Scientists Urge Bigger Supply of Stem Cells

By Sheryl Gay Stolberg

New York Times

Tuesday, September 11, 2001

WASHINGTON, Sept. 10 — A panel of scientific experts has concluded that new colonies, or

lines, of human embryonic stem cells will be necessary if the science is to fulfill its potential, a

finding that is likely to inflame the political debate over President Bush's decision to restrict federally financed research to the 64 stem cell lines that are already known to exist.

In a 59-page report that examines the state of human stem cell science, the panel also endorsed

cloning technology to create new stem cells that could be used to treat patients. Mr. Bush strongly opposes human cloning for any reason, and the House of Representatives voted in July to outlaw any type of cloning, whether for reproduction or research.

The report by the National Academy of Sciences, perhaps the nation's most eminent organization of scientists, is scheduled to be made public on Tuesday morning at a news conference in Washington. It does not address Mr. Bush's policy directly, though it strongly supports federal financing for stem cell research.

"High quality, publicly funded research is the wellspring of medical breakthroughs," said the report, a copy of which was provided to The New York Times by Congressional supporters of stem cell research. It added that federal financing, and the government oversight that comes with it, "offers the most efficient and responsible means of fulfilling the promise of stem cells to meet the need for regenerative medical therapies."

Though the academy often issues its reports in response to requests from the government, it embarked on this study on its own earlier this year. The study was not an exhaustive review of the scientific literature in stem cells, but was rather intended to examine the prospects for the research and to make policy recommendations. The report was written and reviewed before Mr. Bush announced his decision on Aug. 9, and was not revised in response to the president's decision.

Stem cells, the human body's master cells, have the ability to grow into any one of the body's more than 200 cell types. Scientists hope to use them to create replacement tissues or organs — for instance, new insulin-producing cells that could treat diabetes, or new brain cells to treat Parkinson's disease.

But Mr. Bush and many others have moral qualms about the research, because the cells are extracted from human embryos that are destroyed in the process. Mr. Bush limited public financing to work on existing cell lines where the embryos had already been destroyed.

"While there is much that can be learned by using existing stem cell lines if they are made available for research," the report said, those cell lines might change over time. It also noted that the lines had been grown in the presence of animal cells, which could pose risks to human health if those stem cells were transplanted into people.

So the report called for new stem cell lines, which it said would be "important to replace those that become inviable." But the panel did not address whether the government, or the private sector, should pay for the creation of those new lines.

The report is being issued as Congress conducts a series of hearings intended to explore whether Mr. Bush's plan for stem cell research is sufficient to support the science. On Wednesday, the chairman of the academy's panel, Dr. Bert Vogelstein, is to testify in the Senate. This afternoon, Dr. Vogelstein, a professor of oncology and pathology at Johns Hopkins University, was on Capitol Hill briefing Democratic and Republican aides.

"The report clearly endorses strong federal support for stem cell research," Senator Edward M.

Kennedy, Democrat of Massachusetts, said. "The administration's proposal may well be inadequate to develop the treatments and cures urgently needed by millions of patients suffering from serious illnesses."

But "that concern is hypothetical," countered Jay Lefkowitz, who as the general counsel of the Office of Management and Budget helped Mr. Bush devise his policy. "The president's policy permits a tremendous amount of basic research, which is absolutely necessary before we will even know if stem cell research can live up to its potential."

Mr. Bush, who had spent months considering whether taxpayer dollars could be used to pay for

research on human embryonic stem cells, struck a compromise. In the weeks since Mr. Bush's

decision, scientists and patients' groups have raised questions about the quality of the 64 stem cell lines. Last week, Tommy G. Thompson, the secretary of health and human services, said only about two dozen of the 64 lines had been fully developed and ready for research.

While enough to get basic research started, scientists and patients' groups said the lines would not be enough to turn stem cells into therapies. They said that the lines were not genetically diverse enough, and might be unsuitable for use in therapies because in growing the stem cells, scientists had nourished them with cells from mice. This is a standard laboratory technique, but experts fear mouse cells could transmit viruses when the stem cells are transplanted into people. Most experts say it would be best to grow new stem cells that are not mixed with animal cells.

The academy's panel agreed. In addressing how stem cells might be used as therapies, the

seven-member panel, which included a neuroscientist, an immunologist and an ethicist, said the

problem of tissue rejection would be a significant hurdle in the years to come. The panel called cloning an "attractive option" for overcoming this hurdle.

In this method, known as therapeutic cloning, scientists would take cells, typically skin cells, from a patient and insert them into a fertilized egg whose nucleus had been removed. The result would be an embryo that could, if implanted into a woman's womb, grow into a baby that would be an exact genetic replica, or clone, of the patient. But instead of implanting the embryo, scientists would extract stem cells from it, and use those cells to grow tissue that would be a perfect genetic match for the patient.

Cloning, of course, is hugely controversial. Mr. Lefkowitz said Mr. Bush opposed "any research that requires the creation of human embryos for the express purpose of destroying them," which, he said, "raises serious ethical and moral concerns."

The panel's report said well over 100 million Americans, with conditions as varied as cardiovascular disease, burns, spinal cord injuries and cancer, could potentially be helped by research on human embryonic stem cells.

Headed by Dr. Vogelstein, the panel also included Barry Bloom, a immunologist and infectious disease specialist at the Harvard School of Public Health; Corey Goodman, a neuroscientist at the University of California at Berkeley; Patricia King, a medical ethicist at the Georgetown University Law Center; Guy McKhann, a neurologist at Johns Hopkins University; and Myron Weisfeldt, a cardiologist who is chairman of the department of medicine at the Columbia University College of Physicians and Surgeons.

The academy is a federally chartered but independent group that studies technical issues for the

government. It established the panel, which began its work in March, to assess what is known about stem cells, including how they become different types of tissues, as well as the differences in potential uses of cells obtained from embryos, fetal tissues or adult tissues.

The panel convened an all-day workshop in Washington on June 22, and heard from both proponents and opponents of the research.

At that workshop, opponents, including some scientists, argued that studying embryonic stem cells was not necessary because an alternative existed: so-called adult stem cells, which are derived from blood, bone marrow, fat and other tissues.

But the academy report concluded — as did a recent report by the National Institutes of Health — that research on both embryonic and adult stem cells should be pursued.

The panel also called for the creation of a national advisory committee of researchers, ethicists and others to "evaluate the technical merit" of any proposed human embryonic stem cell studies, and then approve or reject the work. Mr. Bush has said he will create a committee to advise him, but that committee would not have such oversight authority.

Noting that the government created a similar oversight committee to review gene therapy experiments, the panel said, "The use of embryonic stem cells is not the first scientific advance to raise public concerns about ethical and social issues in medical research."

Scientists have studied embryonic stem cells in mice for 20 years, and the report said that those studies have been important in demonstrating the potential of human embryonic stem cells. But while research in mice is necessary, the report said, it is not sufficient to make advances in treating human diseases. "Studies with human stem cells are essential," it stated, "to make progress in the development of treatments for human disease."

The Panel's Recommendations

New York Times

Tuesday, September 11, 2001

Following are the seven recommendations of the expert panel established by the National

Academy of Sciences to review stem cell research. The recommendations are in the executive

summary of the panel's report, and the italics are in the original.

1. Studies with human stem cells are essential to make progress in the development of treatments for human disease, and this research should continue.

2. Although stem cell research is on the cutting edge of biological science today, it is still in its infancy. Studies of both embryonic and adult human stem cells will be required to most efficiently advance the scientific and therapeutic potential of regenerative medicine. Research on both adult and embryonic human stem cells should be pursued.

3. While there is much that can be learned using existing stem cell lines if they are made widely

available for research, concerns about changing genetic and biological properties of these stem cell lines necessitate continued monitoring as well as the development of new stem cell lines in the future.

4. Human stem cell research that is publicly funded and conducted under established standards of

open scientific exchange, peer- review, and public oversight offers the most efficient and responsible means to fulfill the promise of stem cells to meet the need for regenerative medical therapies.

5. If the federal government chooses to fund human stem cell research, proposals to work on human embryonic stem cells should be required to justify the decision on scientific grounds and should be strictly scrutinized for compliance with existing and future federally mandated ethical guidelines.

6. A national advisory group composed of exceptional researchers, ethicists, and other stakeholders should be established at N.I.H. [the National Institutes of Health] to oversee research on human embryonic stem cells. The group should include leading experts in the most current scientific knowledge relevant to stem cell research who can evaluate the technical merit of any proposed research on human embryonic stem cells. Other roles for the group could include evaluation of potential risks to research subjects and ensuring compliance with all legal requirements and ethical standards.

7. In conjunction with research on stem cell biology and the development of potential stem cell

therapies, research on approaches that prevent immune rejection of stem cells and stem cell-derived tissues should be actively pursued. These scientific efforts include the use of a number of techniques to manipulate the genetic makeup of stem cells, including somatic cell nuclear transfer [cloning].

E.P.A. Finds Some Soot Is Bad, Other Soot Is Worse

By Andrew C. Revkin

New York Times

Tuesday, September 11, 2001

As the Environmental Protection Agency moves to tighten restrictions on tiny particles of air

pollution, new research shows that it may need to put even more stringent limits on soot from

some industrial sources.

For a decade, the agency has become steadily more concerned about risks posed by the smallest

particles, which can infiltrate deep into the lungs. Agency scientists have now found that size is not the only problem; the ingredients in some particles are worse than the ingredients in others.

In an unusual test of the toxicity of particles filtered from the same spots at different times, agency scientists found that substances collected near a Utah steel mill when it was running were more harmful to the lungs of volunteers than material captured when the plant was dormant.

To some, that result may seem self-evident, but many industry groups had long questioned the health threat from soot.

The issue has provoked one of the most intense battles over pollution regulations in recent decades.

The agency is already moving in the next year to apply tighter standards, including the first rules limiting the emission of soot motes less than 2.5 microns across. (A human hair is about 70 microns wide.) The new study could help justify a crackdown on the most hazardous types of emissions, agency scientists said.

"In the auto industry, they're saying, `Why me? Why not power plants?' " said Dr. Robert B. Devlin, an author of the study and the director of research on soot at the agency's National Health and Environmental Effects Research Laboratory in Research Triangle Park, N.C.

By examining the health effects of particles from different sources, Dr. Devlin said, the agency is

starting to answer that question. "We don't want to regulate everything inappropriately, things that may not be responsible for producing pollution that causes the adverse health effects," he said.

The experiment bolsters earlier statistical studies of patterns of illness and pollution in the late 1980's near the mill, 40 miles south of Salt Lake City, agency officials said. Industry groups had long challenged the statistical analyses, which helped persuade the Environmental Protection Agency to tighten soot restrictions in the 1990's.

But, agency officials said, the experiment also points to the need for a closer look at particles from other sources, like truck exhaust, to ensure that rules are tightened only where the threat is clearest. "These are the first baby steps toward recognizing there are potential differences in effects and source management," a senior agency scientist said.

The research looked at the health effects of extracts of the particles, not the particles themselves, so it confirmed in humans what laboratory tests had long implied: the health threat posed by tiny particles was not just in their size but also in their chemical composition. The study was published in a recent issue of The American Journal of Respiratory and Critical Care Medicine.

In a separate editorial in the journal, which is published by the American Thoracic Society, the

experiment was described as "strikingly innovative" by Dr. William S. Beckett, a professor of

environmental medicine at the University of Rochester medical school.

Other studies by the same research team on particles from the air near the mill point to certain metals as the source of harm. The metals, including zinc, iron and copper, appear to form highly reactive molecules, called free radicals, that can damage lung tissue, Dr. Devlin said. These studies have been described at medical meetings but have not yet been published.

The agency first published tighter standards for soot in 1997, but the states do not have to begin

meeting them until next year, and it will take more than a decade to put them all into effect. A final draft of the agency's recent review of the science pointing to soot's danger to health is scheduled to be published before the rules are put into effect.

The Bush administration has not indicated whether it will alter the standards from those set under

President Bill Clinton, although this year Christie Whitman, the E.P.A. administrator, strongly endorsed a related rule requiring sharp cuts in soot from diesel engines.

At every step, the tighter soot rules have been challenged by industry groups, which have criticized the underlying science. The critics contend that the high costs of capturing fine soot will outweigh any benefit.

One persistent skeptic, Dr. Robert F. Phalen, the director of the Air Pollution Health Effects

Laboratory at the University of California at Irvine, said of the new work, "This particular finding is exciting and represents a step forward in the way to do studies."

But Dr. Phalen went on to say that there was no way to know whether the inflammation seen in the volunteers' lungs was related to the illnesses around the mill.

"I could take laundry detergent, put it on wrists, rinse it off, and you'd have inflammation," Dr. Phalen said. "But if epidemiologists found deaths indoors on days that were hot, where people closed their windows and doors, does that mean the detergent is killing them?"

But agency officials and many environmental toxicologists said the evidence of risk, including the results of the new study, was clearer than ever. The agency has found dozens of studies generally concluding that more than 50,000 people die prematurely each year because of illnesses caused by exposure to soot.

The area around the Utah steel mill was the site of an influential study in the late 1980's. The mill was then the major source of pollution in the valley, but its current owner, the Geneva Steel Corporation, says it has cut emissions of fine particles 55 percent below 1989 levels.

In that earlier study, researchers from Brigham Young University looked at air quality and health in the hazy, mountain-rimmed valley and found that hospital admissions and the rates for asthma and other respiratory troubles dropped substantially in 1987, when the mill shut down because of a labor dispute. Illness rates rose again after the mill reopened the next year.

Industry groups contended that the pattern could have been caused by coincidental dips and peaks of viral illness. But several environmental health experts not connected to the research said the new study bolstered the original findings.

"The answer is really very, very clear — that the epidemiology was right all along, as most people have been saying," said Dr. Jane Q. Koenig, a professor of environmental health at the University of Washington.

The study, conducted at the E.P.A. research center in North Carolina, essentially "turned back the

hands of the clock," in the words of Dr. Beckett, by exposing volunteers to watery extracts of

substances captured with air filters by Utah state scientists through the same period studied by the epidemiologists.

In the experiment, two dozen volunteers' lungs were infused with material filtered either before, during or after the steel mill had its temporary shutdown. The study found much more inflammation and signs of tissue damage in those exposed to the industrial pollution collected when the mill was running.

Only one-thirtieth of one lung in each person was exposed to the material, and there were no lingering effects, the researchers said.

The experiment was somewhat akin to taking the volunteers back in time and across the continent and having them breathe Utah air for four or five days, Dr. Devlin said.

In many toxicology studies, he said, "Someone might say, `Where is the connection between what you're doing in the lab and the real world?'

"Here we've taken great pains to get coherence. This helps us believe both the epidemiology and the toxicology because both support each other."

Dr. Koenig emphasized that the study, despite its merits, still looked at only one kind of particle from one industrial operation.

She said that in other places, where trucks or power plants were the main sources of soot, it still might be that the small size of a particle was the most important threat. She added that much recent research pointed to the tiniest specks — those measured in tenths of a micron — as possibly posing the biggest hazard.

More work must be done, she said. "From the regulatory point of view, we are still left with the

problem of what do we need to stop doing?" she said. "What do we need to control to make the air less toxic to people?"

Group proposes step toward universal health care coverage

By Nora Achrati, Capital News Service

Prince George’s Journal

Tuesday, September 11, 2001

ANNAPOLIS - It's up to the state to create competitive and affordable insurance programs if all Maryland residents - especially the working poor - are to have adequate health care coverage, says a prominent health care reform advocacy group.

That's why a state-run insurance program is the keystone of the Maryland Citizens' Health Initiative plan to establish universal health care coverage in Maryland. The coalition of health care advocates unveiled its plan Friday at the Bloomberg School for Public Health at Johns Hopkins University.

The proposal is the result of several years of preparation and consultation coordinated by the initiative. The group has been meeting with academic and professional advisers from Johns Hopkins University, the University of Maryland and Georgetown University, among others.

Alfred Sommer, Bloomberg School dean, calls the initiative's plan ``the most comprehensive and complete proposal for universal health reform ever developed in Maryland history.''

Parts of the proposal are designed to mirror health care reforms advocated by the Bush administration. These include the proposed expansion of the Maryland Children's Health Insurance Program and the creation of a pool of funds to help seniors defray prescription drug costs.

But the centerpiece of the proposal is the ``Maryland Healthcare Trust,'' a state-run insurance program that initiative officials say would establish public accountability for plans statewide and dramatically rework the way insurance claims are handled.

For example, the proposal calls for a Web-based claims processing system that would allow the trust to make immediate payments to doctors and other health care providers. Commercial plans now take days or even months to make payments.

The trust also would cover mental health care, drug-addiction treatment, preventative dental care and prescription drug costs.

The group proposes increasing the tobacco tax as part of the plan to finance these changes.

Initiative spokesman Vincent DeMarco says the plan has been criticized as ``a stalking-horse for a single-payer approach'' to providing health care coverage for all Marylanders. In a single-payer system, all residents would be members of a state-run insurance program without being able to choose another health plan.

``Many people don't want to be forced into one insurance entity, and we need to build the strongest coalition possible,'' DeMarco said.

Instead, the initiative proposal would give employers the ability to select their own employee coverage program as long as the benefits were comparable to those offered by the proposed trust.

The employee coverage, said Pat Schoeni, National Coalition on Health Care spokeswoman, is already in jeopardy.

Part-time and temporary employees could still be left uncovered, she said, under the portion of the plan dealing with self-insured employers.

In addition, Schoeni says the group probably greatly underestimates the cost of coverage for each person.

``What's going to happen to that trust is, the people who'll end up being in that trust are all the people who can't get insurance anywhere else, so they're probably sicker [than most people],'' Schoeni says. ``Even if they've estimated the cost at around $3,000, it's probably going to be more than that.''

Other states successfully expanded Medicaid and CHIP coverage, Schoeni said. But states have fallen short in mandating coverage, running up against federal laws exempting certain employers from state universal insurance laws.

The proposal released Friday does not include a recommendation to require health care coverage for all residents. Such a mandate will be included in the second phase, initiative President Peter Beilenson said.

The Maryland General Assembly would likely see the plan in 2003. Officials see next year's election as an opportunity to attract public attention and make universal health coverage a major campaign issue.

The inititative is one of the largest independent health care reform organizations in state history, with more than 2,100 grass-roots member organizations statewide.

The governor's office did not return calls requesting comment.

Whooping cough vaccine may wear off

Scientists study booster for older children, adults

Associated Press

Baltimore Sun

Tuesday, September 11, 2001

WASHINGTON - Whooping cough is one of those diseases most people think is history - but the dangerous germ that can leave sufferers gasping for air is making a comeback.

The cough so strong it can break a rib once hit mostly babies and toddlers, but now it's striking more and more teen-agers and young adults. Apparently the whooping cough vaccinations Americans get as babies eventually can wear off.

Here's the real risk: While older people usually recover, they can easily spread the illness to infants too young for vaccinations. Whooping cough can kill babies.

So experts warn new parents to keep infants from anyone who's coughing, even as scientists study whether millions of Americans should start getting booster doses of whooping cough vaccine just as many get regular tetanus shots.

The goal is to develop boosters for older children and adults so there's "a wall of protection around the newborn baby," explains Dr. Michael Decker, a Vanderbilt University professor who has studied whooping cough, also called pertussis, for 20 years.

He just joined vaccine manufacturer Aventis Pasteur, which is working to bring a booster shot sold in Canada to this country.

Pertussis is a bacterial infection that at first seems like a cold: a runny nose and hacking cough, first at night and then during the day. Coughing fits begin a week or two later, up to 15 coughs in a row followed by a high-pitched "whoop" as patients gasp for air.

Infants are more likely to turn bluish than whoop as they run out of air. They can get pneumonia and become dehydrated and malnourished.

The Centers for Disease Control and Prevention counted 56,775 cases in the 1990s, a 51 percent increase from the 1980s - and a rise that's continuing.

Last year, the CDC had reports of more than 7,000 cases, and "we suspect there may be 10 times that amount" because of underdiagnosis of the disease in teens and young adults, said Dr. Kris Bisgard, a CDC epidemiologist.

That's still a far cry from the 250,000 Americans who once got pertussis annually before vaccinations began in the 1940s. But it's far worse than 1980, when there were only about 1,000 cases a year.

Today, Americans get their final dose of pertussis vaccine by age 6.

Americans can get booster doses of tetanus and diphtheria vaccine combined every 10 years. The idea is to add a pertussis booster to that shot.

First case of mad cow disease in Japan is suspected

Milk from cow was sold, but risk said to be low

Associated Press

Baltimore Sun

Tuesday, September 11, 2001

TOKYO - Japan's government announced yesterday that it has found the country's - and Asia's - first case of suspected mad cow disease and said imported feed was the likely cause.

Japanese health experts had asserted that the high standards of cleanliness on Japanese cattle ranches would keep the country free of the brain-wasting disease, which has ravaged herds in Britain and elsewhere in Europe and is believed linked to a fatal human disease.

But officials were alarmed last month when a cow in Shiroi in Chiba prefecture lost its ability to stand. The animal was slaughtered, and tests of its brain indicated signs of the illness, according to a statement issued yesterday by the Ministry of Agriculture.

"We must now ask ourselves if our previous way of thinking was wrong, if there were factors we hadn't foreseen," said Kiyoshi Onodera, deputy division chief of the Ministry of Agriculture's animal health division.

The government said more tests were necessary to determine conclusively whether the cow was infected with the disease. Testing last month had come up negative.

Milk produced by the 5-year-old Holstein had been sold before the slaughter, but scientists believe milk is unlikely to spread the disease. Norio Tsuruoka, an official at the Chiba prefectural office's stockbreeding sanitation section, said about 4,160 gallons of milk from the suspect cow were sold.

He said it was not immediately clear where the milk had been marketed. However, Chiba is a main supplier of agricultural products to Tokyo, in the prefecture that borders Chiba to the west. The cow was destroyed, and its meat was not sold.

About 30 other cows were being bred at the same farm as the suspect cow, and there are about 100 cattle in Shiroi - but the other animals are not thought to carry the disease, Tsuruoka said. Many have been quarantined, but officials have not decided whether to slaughter them.

Mad cow disease, or bovine spongiform encephalopathy, is believed spread by recycling meat and bones of infected animals into cattle feed. Mad cow disease is thought to cause a fatal brain-wasting disease in humans, variant Creutzfeldt-Jakob disease.

The suspect Holstein is believed to have been infected by feed that contained contaminated animal parts, said Katsuaki Sugiura of the Ministry of Agriculture's animal health division.

If confirmed, the case would be the first in Asia. World Health Organization officials said in December that they were concerned that infected animal feed might have been sold around the world.

Although most imported feed used in Japan comes from the United States, Canada and Australia - all believed to be free of mad cow disease - some shipments were imported from European countries, including Denmark and Italy, before a ban on European feed took effect this year, Sugiura said.

Japan has also restricted blood donations from people who lived in Britain - where more than 100 cases of variant CJD have been discovered - since 1980. Mad cow disease was diagnosed in 1986 there and has resulted in wholesale slaughter of herds, mandatory testing and a European Union ban on British beef exports that has since been lifted. Thousands of cattle in Europe have been infected with mad cow disease, most in Britain, and hundreds of thousands of cattle have been destroyed.

Madden to leave Senate at year's end

Minority leader notes business opportunity

By Michael Dresser and Larry Carson

Baltimore Sun Staff

Tuesday, September 11, 2001

State Senate Minority Leader Martin G. Madden, a moderate Howard County Republican who helped craft Maryland's welfare reform program, said yesterday that he will end his 11-year career in elected office for personal and business reasons.

Madden, 52, who has led the Senate's Republicans for three years, said he plans to leave his General Assembly seat at the end of the year. His district covers most of eastern Howard County and the Laurel area of Prince George's County.

Madden is a self-employed insurance agent. He said his decision to leave the Senate was prompted in part by "an exciting and unique opportunity to substantially grow my business." That opportunity, he said, would take too much of his time for him to stay in his leadership role.

"Once the decision was made not to run for re-election" next fall, the decision to step down at the end of this year "fell into place," he said. "The Republican caucus needs a fully energized minority leader over the next 14 months."

Madden's decision avoids what had been shaping up as a possible primary contest with fellow Howard County Republican Sen. Christopher J. McCabe. Republicans had expected Democrats who control the redistricting process to throw the two men into the same senatorial district.

But Madden said redistricting had "absolutely zero effect" on his decision to retire.

His departure comes as one more blow to the moderate wing of the state Republican Party, which has lost almost all of its Senate members to defeat, defection or death in the last five years.

The two-term senator, elected in 1994 after a term in the House of Delegates, expressed confidence that his successor in the Senate would be "a person out of my mold."

His replacement will be chosen by the Republican state central committees for Howard and Prince George's counties -- assuming that the two panels can agree on a candidate. If they can't, Democratic Gov. Parris N. Glendening would choose between the two nominees, a result Madden said he would prefer not to see.

The retirement deprives Howard County's GOP of one of its strongest vote-getters -- a candidate who won re-election in his heavily Democratic district in 1998 when other Republicans were being swamped. He said he had been sounded out by fellow Republicans about a possible candidacy for governor but decided he had no interest in such a race.

The next Senate Republican leader will almost certainly be more conservative than Madden, who often voted with the Democratic majority on such issues as gay rights, gun laws and a tobacco tax increase. While he fit in comfortably with his fellow Republicans in his opposition to abortion and support for business, he also compiled a strongly pro-environment voting record.

Madden said he assumes his successor as minority leader will be Sen. J. Lowell Stoltzfus, an Eastern Shore conservative who now serves as minority whip. He said the Republican caucus would make its choice in November or December.

Senate President Thomas V. Mike Miller, a Prince George's Democrat, said Madden will be missed by senators of both parties,

"Democrats particularly are going to miss him because he was part of the glue that held the Senate together," Miller said.

Drug maker predicts 3Q loss

MedImmune to take charge for regaining rights to drug Ethyol

By Julie Bell

Baltimore Sun Staff

Tuesday, September 11, 2001

MedImmune Inc. said yesterday that it will reacquire U.S. rights to its drug Ethyol next month, six months earlier than planned, resulting in $20 million in expenses and worse-than-expected results in the third quarter.

But analysts and the Gaithersburg pharmaceutical company said the move should benefit MedImmune in the long run, allowing it to more quickly book U.S. sales of the drug, which is designed to reduce certain toxic effects of chemotherapy and radiation cancer treatments.

Until Oct. 1, MedImmune will continue booking only a percentage of the sales of Ethyol, under its co-promotion agreement with Alza Corp. of Mountain View, Calif. Under the reworked agreement, the company will pay Alza a gradually diminishing royalty on sales of the drug.

MedImmune also said it now expects Canadian government approval of its top-selling drug Synagis in the fourth quarter, rather than in the third quarter.

That and the reacquisition of Ethyol rights from Alza caused the company to lower its estimate of third-quarter results by 11 cents a share.

MedImmune projects its third-quarter loss at 8 cents to 10 cents a share on revenue of $44 million to $48 million. The company said its projections for the fourth quarter remain the same, with earnings of 44 cents to 46 cents per share. For the year, the company projects earnings at 69 cents to 71 cents per share.

The company's revenue and earnings are heavily weighted to the fourth and first quarters, thanks to the seasonal nature of Synagis sales. The drug is for an infant respiratory virus that strikes in the winter months.

Synagis contributed $427 million of MedImmune's $495.8 million in product sales last year. By comparison, Ethyol booked $21.4 million in revenue last year.

Annual worldwide sales of Ethyol now run about $65 million, including about $45 million in the United States, the company said. But MedImmune believes it quickly can increase those numbers and is adding 50 people to its 30-person staff devoted to promoting cancer drugs.

"Ethyol is sensitive to sales promotion and we are looking forward to putting our own expanded oncology commercial team behind Ethyol in the fourth quarter," said Armando Anido, MedImmune's senior vice president of sales and marketing.

"Our objective is to achieve in excess of 20 percent growth in Ethyol sales in each of the next three to five years, enabling us to more than double Ethyol's worldwide sales by 2005."

Dennis R. Harp, an analyst for Deutsche Banc Alex. Brown, said moving up the date on which U.S. Ethyol rights return to MedImmune allows the company "to control the destiny for Ethyol."

Alza Corp., he noted, has been acquired by Johnson & Johnson, an even larger company for which a $65 million product like Ethyol would not get that much attention. MedImmune currently gets about 35 percent of Alza's U.S. sales of the drug, Chief Financial Officer Gregory S. Patrick said.

Ethyol's foreign sales are primarily marketed by affiliates of Schering-Plough Corp. Last year, those sales meant $6.5 million for MedImmune.

The $20 million in third-quarter costs associated with the reacquisition include payments to Alza for the projected profit it would have made from Oct. 1 through March 31, the repurchase of Ethyol inventory previously sold to Alza, and financing for expanded marketing.

Allowing lawsuits may limit access to health care

Baltimore Sun Letter to the Editor

Tuesday, September 11, 2001

I take strong exception to the claim that allowing lawsuits under a patient's bill of rights is the best way to ensure patients get the health care coverage they need. Such lawsuits will dramatically increase health care costs and force more people to lose their health care coverage.

Rather than giving a political payoff to trial lawyers, Congress should give patients access to an independent medical review by physicians - which would be similar to the law we have in Maryland.

This review ensures patients get the care they need quickly, not at the conclusion of a trial months or years later, when the only ones who will benefit will be the lawyers.

As a health insurance agent in Baltimore, I will soon deliver bad news to my clients: Most premiums in this area will go up 15 percent to 20 percent next year. The 4 percent or 5 percent that "patients' rights" proposals could add on top of that may force my clients to decide it's not worth it to offer health benefits to their employees.

A patients' bill of rights should focus on health care, not lawsuits.

Stephen J. Salamon

Timonium

Without Help, Frail Infants Died

Newborns Released to Troubled Mothers With Little D.C. Supervision

By Sari Horwitz and Scott Higham

Washington Post Staff Writers

Tuesday, September 11, 2001; Page A01

Third of four articles

The pattern was painstakingly documented. Fragile, sick babies were born to mothers in the District who had been abusing drugs or mistreating their children. Doctors and nurses noted their fears for the newborns' safety.

Still, the babies left the hospital with their mothers. And little was done to protect the infants -- even though a government panel repeatedly warned that they could die unless the city took action.

Eleven drug-exposed or medically frail newborns died from 1993 through 2000 after they were released to parents whose troubles were well documented by hospitals and social workers, according to previously confidential records obtained by The Washington Post.

The babies got lost in a system where no one assumes direct responsibility for them. Vague legal definitions and poor communication among caregivers hamstring those who would like to help, according to a review of case files and dozens of interviews conducted by The Post.

In the District's neonatal wards, few rules govern whether and when hospitals should release fragile, drug-exposed babies to troubled mothers. Hospital workers can call the D.C. Child and Family Services Agency when they are worried about sending an infant home, but each hospital makes those decisions differently.

In some instances when a sickly baby died, the hospitals did not notify the agency about the birth. In most cases, though, the agency failed to respond to the hospitals' calls, leaving babies in the hands of parents who were ill-equipped to care for them, according to government records.

"We do not have time to take care of everyone," agency social workers sometimes told hospital employees, according to a confidential survey of hospital staff members obtained by The Post.

"Child and Family Services says, 'We just can't handle all these cases,' " said Elizabeth Siegel, a lawyer who is a member of the D.C. Child Fatality Review Committee, a panel that examines the deaths of District children. "I say, 'We can't handle all these deaths.' "

Saying a Prayer

In her four years at the George Washington University Hospital's neonatal unit, hospital social worker Mary Kardauskas had seen her share of premature, drug-exposed babies. In October 1998, a baby girl named Tyrika Michelle Perry caught her eye.

Tyrika, a twin, was born six weeks early and weighed 4 pounds, 3 ounces. Her twin had serious respiratory and intestinal problems and was sent to another hospital.

Tyrika also had respiratory problems, though not as serious as her sister's. But Tyrika cried inconsolably as she suffered withdrawal from the cocaine her mother had used. Kardauskas was concerned.

She called Child and Family Services, the District's child protection agency. Kardauskas worried that the mother's drug use would affect her ability to care for the drug-exposed baby. The agency, which at the time was entering its third year of operation under a federal court order, is supposed to assess such calls and decide whether to monitor the family.

But a city worker told Kardauskas that the agency's "quota" of children was full and that it was unable to accept any new cases, fatality committee records show.

Agency officials now say that should never have happened. "Our quota is never full," said Karen Morgan Fletcher, an agency supervisor.

Hospital workers across the city have long expressed frustration that there is no law in the District that required the city to take further action. "Hospitals are told that the agency cannot act on simply drug-exposed babies without any other concerns," a report from a fatality committee file said.

On Oct. 8, 1998, hospital workers sent 6-day-old Tyrika home to her mother, providing her with an apnea monitor that would sound an alarm if the baby stopped breathing. They told the mother when and how to place the device on Tyrika.

After Tyrika left the hospital, Kardauskas said a prayer. It was a ritual she repeated every time a frail baby went to a home that Kardauskas knew would not be monitored by city social workers.

"These babies can't call 911 if they get into trouble," Kardauskas said.

'It's Crazy'

Drug-exposed babies are often born to mothers already known to District social workers because they neglected or abused their other children. The babies frequently are premature, with drugs in their blood, low birth weight, respiratory distress or deformities.

Social workers, doctors and city lawyers disagree about how deeply the government should intervene in these cases. The debate pits those who believe that mothers and children should be separated only as a last resort against others who argue that the government needs to do more to protect children from unsafe homes.

At the core of the debate is the question of whether drug use by pregnant women should be considered neglect or abuse under District law. Right now, it isn't.

"You have to make the connection between drug abuse and neglect to take away a mother's baby," Morgan Fletcher said. "You have to prove that substance abuse precludes a mother from being a good parent. There are functioning drug-addicted parents. You can't take their babies."

Others say that puts babies at risk.

"It's crazy," said Anne Schneiders, an attorney for neglected and abused D.C. children. "You have to wait until the newborn is neglected or hurt."

For years, some District child welfare advocates have been trying to change the law to classify drug use by pregnant women as neglect or abuse, following the lead of several states. If the law were changed, social workers would be required to monitor the babies or prevent them from going home with their parents.

At least 18 states have passed laws requiring some degree of government intervention -- ranging from investigations to removal of the child -- when a mother gives birth to a drug-exposed infant.

Last year, the Ohio Supreme Court ruled that a baby born addicted to cocaine is an abused child. In May, a South Carolina woman became the first mother in the nation to be convicted of homicide by child abuse for giving birth to a stillborn, crack-exposed baby.

Although the debate in the District remains unresolved, the fatality committee's files illustrate how babies have continued to die for the same reasons. The fatality committee began to examine the deaths of D.C. children in 1993 -- five years before Tyrika Perry was born. Committee members noted that medically fragile babies were going to unsafe homes and dying shortly afterward.

In 1994, the committee published its first report.

Its first goal: "Institute a city-wide policy that would require follow-up services to be provided to families of premature infants once released from the hospital."

Over seven years, the committee would recommend 46 more times that hospitals and social workers take steps to protect frail infants. But the warnings, many of which were confidential at the time, largely were not followed.

The year the committee issued its first report, a baby named Iesha Ferrell was born prematurely and weighed 2 pounds. Iesha and her twin sister were sent home to their mother with apnea monitors.

Child and Family Services had opened a case on Iesha's siblings the year before because of allegations that their mother was using drugs and alcohol and neglecting her children. But the agency failed to track the family, a fatality committee report states.

Records show that an agency social worker assigned to the case provided some services but "didn't address the mother's substance abuse problem." The worker then did not visit the family for more than a year "due to her heavy caseload," according to a fatality committee report.

The social worker didn't know that the premature twins had been born -- or were sent to a crowded two-bedroom home where nine children were living with four adults. A police officer would call the living conditions "deplorable."

Two months later, Iesha died. The D.C. medical examiner classified the death as sudden infant death syndrome, or SIDS, which is usually the cause given in the unexplained death of an infant. When her body was found, Iesha was not attached to the apnea monitor. In an interview with The Post, Iesha's mother denied using drugs. She also said that a nurse told her she could stop using the monitor after it set off several false alarms. But she told the police that she did not know the purpose of the monitor and hadn't used it for several weeks, according to a police report.

In its 1994 report, the committee noted Iesha's case and urged city officials to consider changing the law: "Explore legal barriers to removing newborns at birth from mothers who are addicted to drugs during pregnancy or mothers who have children currently in the child welfare system."

One After Another

In December 1995, Keyona Debrew was born prematurely at D.C. General Hospital, weighing 4 pounds. Child and Family Services had previously removed several children from the mother after receiving neglect complaints.

Keyona's grandmother, Lucy Brown, told The Post that her daughter had a history of mental and behavioral problems. The daughter, herself a foster child, started having children at 15, Brown said. Keyona was her ninth. "She was living wildly because she was on drugs," Brown said.

On Feb. 11, 1996, about a month after D.C. General sent Keyona home, the infant was found dead in a roach-infested apartment. Keyona's mother told police she awoke to find Keyona sleeping on her chest, her male companion's leg draped over Keyona's head. The fatality committee said the police report did not indicate whether the man was interviewed. Keyona's cause of death was listed as undetermined at first, but it was later reclassified as a homicide.

When it reviewed the case later that year, the fatality committee noted the substance abuse and mental health problems of Keyona's mother and criticized the hospital and the agency. "No follow-up services were provided by the hospital or [Child and Family Services] after child's discharge," the committee wrote in a confidential report.

The panel also found that the social worker, Michael Wright, did not visit Keyona after she was born, even though he knew that the baby and her mother needed help. The committee concluded that social worker caseloads were too high and that the workers were not trained to help substance-abusing parents.

Wright said in a recent interview that he did all he could for the mother. He said she had denied being pregnant. He also said he could not visit the house after the baby's birth because of a blizzard early in 1996.

He said he was frustrated that the law did not allow him to do more.

"You cannot take the child just because the child is born addicted," Wright said. "You have to try and monitor the situation the best you can."

Lucy Brown blames her daughter. "It's not just Child and Family Services. Has anybody thought about these mothers who don't care a damn about themselves? I know what went on with my daughter, and I'm not proud of it."

Brown and her son said they did not know how to locate Keyona's mother, and The Post was unable to find her.

In 1997, Dennis Campbell was born prematurely at D.C. General. The baby suffered from respiratory problems and tested positive for cocaine and heroin, which his mother had used during the pregnancy, fatality committee documents show.

D.C. General staffers were worried that the mother couldn't care for Dennis, but no one called Child and Family Services, the records show. If the staffers had checked, they might have learned that Dennis's mother appeared in agency files because one of her other children had been born exposed to drugs.

About a week after Dennis went home, he died. The medical examiner ruled the cause as SIDS.

"The hospital should not have released [the] child without at least contacting Child and Family Services first," the fatality committee wrote in a confidential 1998 report. "Hospitals should always contact [the agency] when a mother delivers a substance exposed infant to determine whether the family was known to the child welfare system."

In 1998, the year after Dennis died, Thornell Price was born at D.C. General. He, too, had been exposed to cocaine. Hospital staff members were concerned about sending Thornell home because of how his mother acted at the hospital. "Her behavior was erratic, and she was stealing from the gift shop," an internal agency report says.

The hospital asked Child and Family Services to remove Thornell from his mother's care. But a social worker said there was not enough evidence to support a neglect complaint, and D.C. General sent Thornell home. At 6 weeks old, the baby died, showing signs of malnourishment, fatality committee records state. The apartment also lacked food and electricity. "The baby should not have been discharged to the mother," fatality committee members said. They termed the agency's investigation "inadequate."

Thornell's mother, who had three other children, had been reported several times to Child and Family Services on allegations of neglect. One time, a U.S. Marshals Service employee notified the agency that she had appeared intoxicated in the courthouse cafeteria and dropped an infant on the floor several times. But a social worker said she was not able to find enough evidence to support a finding of child neglect.

"My daughter was taking drugs," said her father, Willie Price. "That was a known fact. The hospital shouldn't have released the baby into her hands. It was like suicide. It was just a matter of time."

Thornell's cause of death was listed as "undetermined" by the medical examiner.

"There are no standards, policies, procedures or consistent practice for dealing with substance abusing mothers, especially of newborns addicted to drugs," the committee wrote.

Thornell's mother is now in a drug rehabilitation program and said recently she is trying to put her life back together.

"They could have stepped in and said, 'You should get yourself together and then you can have the baby,' " said her father, Willie Price. "But they should not have put that baby in her hands. If they had given my daughter a blood test, they would have found nothing but drugs in her blood. A common person on the street could have looked at her and that baby and not released him to her."

Case Closed

By the time Tyrika Perry was born in 1998 at George Washington University Hospital, the fatality committee had made 32 recommendations to city officials to protect high-risk, medically fragile newborns after the deaths of Iesha Ferrell, Keyona Debrew, Dennis Campbell and several other babies. None of the recommendations was followed.

After Tyrika's drug-exposed birth, hospital worker Mary Kardauskas alerted Child and Family Services, where an unnamed worker declined to take the case, saying the agency had reached its "quota," according to fatality committee records.

Another agency worker called Kardauskas back three days later, after Tyrika had been sent home. Kardauskas said she told the worker that the medical staff at George Washington was "very concerned" about Tyrika going home. This time, Child and Family Services opened a formal case to monitor Tyrika and sent social worker Nadesia Henry to check on her.

Henry wrote in a report that the apartment was tidy, organized and well-stocked with food. Although the baby's mother said she had used cocaine and marijuana while she was pregnant with Tyrika, she told the social worker she didn't need drug treatment because she wasn't addicted.

"She considers herself a social drug user," Henry wrote in the report.

On Oct. 27, 1998, Henry filed her report to agency supervisor Rula Swann, recommending that the case be closed "because there were no other issues of child neglect."

Five months later, on March 22, 1999, Tyrika's mother awoke to find the baby dead inside her blue playpen. A jacket covered her body.

"I started hollering," she recalled in a recent interview.

Tyrika's apnea monitor was not attached. Her mother said a doctor told her she didn't need to use the monitor if the baby was improving.

An internal Child and Family Services Agency review faulted the handling of the case: "The CFSA worker was not adequately prepared to provide services on this case and needed more guidance in understanding and assessing risk with substance abusing parents and the medically fragile child."

Henry, the social worker, declined requests for comment.

"I have decided that it is in my best interest that I do not attempt to communicate with you, as I have no new information to contribute," Henry wrote to The Post.

Swann declined to comment through an agency spokeswoman.

The fatality committee criticized the death scene investigation as "inadequate." This past spring, two years after the event, Medical Examiner Jonathan L. Arden classified the baby's cause of death as SIDS.

Today, Tyrika's mother, who says she no longer uses drugs, works as a medical clerk. Tyrika's twin survived, but her mother still grieves for the baby she lost. The walls of her home are covered with photos of Tyrika. She keeps the playpen under a bed and one of Tyrika's pacifiers on her key chain.

"It was rough for a long time," she said.

Kardauskas, who now works at another hospital, said she has always dreaded the day she would receive a call or read about the death of a newborn who she knew needed help. When she first heard about Tyrika, she couldn't initially recall details of the case. There had been so many Tyrikas over the years, and so many warnings she had called in to Child and Family Services.

"I always heard from the agency, 'Give the mother a chance,' " Kardauskas said. "Indeed, people do deserve a chance. But who was advocating for this child? What about her chance?"

Database editor Sarah Cohen and Metro researcher Bobbye Pratt contributed to this report.

Group's special-master bid denied for Angelos' fee case

Washington Times

Tuesday, September 11, 2001

BALTIMORE (AP) -- The state has rejected a request by a taxpayers' group for an independent attorney to fight Peter Angelos' $1.1 billion fee for representing Maryland against the tobacco industry, the group announced yesterday.

The group, Project $1.1 Billion Recovery, had requested Aug. 16 that a special master be named to take on Mr. Angelos. They contended that the attorney general's office had a conflict of interest because it originally contracted with Mr. Angelos to represent the state.

In a letter dated Aug. 21, Randolph B. Rosencrantz, chairman of the Maryland Board of Contract Appeals, said the board did not have the authority to grant the request.

Project members said they are disappointed.

"Without the participation of an independent voice, how are taxpayers supposed to know if this is a fair proceeding or just an elaborate Kabuki dance designed to justify a huge award for Mr. Angelos?" said Jeff Hooke, co-founder of Project $1.1 Billion Recovery.

Last month, a spokesman for state Attorney General J. Joseph Curran Jr. said the office opposed the request.

According to the original contract, Mr. Angelos was supposed to get 25 percent of the state's portion of the settlement, expected to be about $4.4 billion over 20 years.

When the amount of work on the case turned out to be less than anticipated, state officials asked the firm to go to an arbitration panel set up by the tobacco industry to pay attorneys involved in the case.

Mr. Angelos, who has made millions representing plaintiffs in asbestos cases, refused, citing the original contract.

In 1999, Maryland sued Mr. Angelos after attempts to negotiate a lower fee failed. Lawmakers later voted to cut the fee to 121/2 percent.

Maryland has received about $280 million so far from the tobacco industry and has placed 25 percent of that amount in escrow.

Mr. Hooke said the group now plans a series of advertisements to raise public awareness about ways the state could use the money if less of it went to Mr. Angelos' firm.

The total fee in Mr. Angelos' original contract, $1.1 billion, "could provide 20,000 four-year scholarships for poor kids," Mr. Hooke said.