The ConsUmer: Questions About a Robotic Surgery

Ever since it was approved by the Food and Drug Administration in 2005, robotic surgery for hysterectomy has been heavily advertised. Surgeons promise that using the da Vinci robotic device will bring better results and an easier recovery, and many hospitals claim that patients will experience less pain and fewer complications, getting back on their feet faster.

The company that makes da Vinci robotic surgery equipment promoted it last May at free health workshops organized by the federal Office on Womens’ Health. On Sunday, the Liberty Science Museum in Jersey City will host its first “Let’s Operate Day,” offering guests “hands-on” practice peering into video monitors and using da Vinci’s robot arms to pick up and manipulate small objects.

The cost of the new technology is rarely mentioned. But last week, a new study that evaluated outcomes in more than a quarter of a million American women raised questions about the manufacturer’s claims. The paper, published in The Journal of the American Medical Association, compared outcomes in 264,758 women who had either laparoscopic or robotically assisted hysterectomy at 441 hospitals between 2007 and 2010. Both methods are minimally invasive and involve smaller incisions than open abdominal surgery.

The researchers found no overall difference in complication rates between the two groups, and no difference in the rates of blood transfusion, even though one of the claims regarding robotic surgery is that it causes less blood loss.

But the researchers did find a big difference in cost. Robotically assisted surgery for hysterectomy costs on average about one-third more than laparoscopic surgery.

“It’s important to separate the marketing from the data,” said Dr. Jason D. Wright, the study’s lead author, an assistant professor of obstetrics and gynecology at Columbia University Medical Center. “For the surgeon, there is a greater degree of movement and control of the instruments and the visualization is better.

“But the ultimate question is, does this change outcomes for patients? This study suggests that there really is not a lot of difference as far as quantifiable outcomes.”

The majority of patients in both groups left the hospital in less than two days, though patients who had robotic surgery were slightly more likely to go home that early: 80 percent went home in less than two days, compared with 75 percent of those who had laparoscopic surgery.

But the cost of robotic surgeries was significantly higher, with a median cost to the hospital of $8,868, compared with $6,679 for laparoscopic hysterectomy. The study did not look at the difference in patients’ bills, but according to Newchoicehealth.com, the average patient price for a laparoscopic hysterectomy ranges from $7,700 in Dallas to $11,600 in Los Angeles.

With laparoscopic surgery — sometimes called keyhole surgery — narrow instruments and a small video camera are inserted through tiny incisions; the surgeon sees the image on a monitor and can cut and sew tissue with the instruments. With robotically assisted surgery, the surgeon sits at a console with a 3-dimensional view of the surgical site, and computer technology translates his or her hand movements into precise, scaled movements of the instruments.

Even without offering clear advantages the proportion of hysterectomies performed robotically has increased rapidly, up to nearly 10 percent of hysterectomies in 2010 from less than 1 percent in 2007, Dr. Wright said. Minimally invasive surgeries for hysterectomies are increasing across the board, he found, even at hospitals not performing robotic surgery.

Dr. Myriam J. Curet, chief medical adviser to Intuitive Surgical, which makes the da Vinci systems, did not dispute the study’s findings, but said the important message was that more women were able to receive minimally invasive surgeries because more options were available.

“That’s good for patients and for the health care system,” Dr. Curet said. Women who are not candidates for laparoscopic surgery might still be candidates for robotically-assisted surgery, she added.

Right now, however, it is not clear how to identify which women would benefit from robotic surgery and which would do well with a less expensive method.

The growing use of robotic surgery in hospitals will continue to drive up health costs, said Joel S. Weissman, of Brigham and Women’s Hospital and a co-author of an editorial published with the study.

“Once you have that robot, the tendency is to use it for all kinds of things, for which it may or may not have great value,” Dr. Weissman said. Studies like this one, he said, demonstrate the waste of health care dollars on “something that costs a lot more and doesn’t offer any added benefit over current treatment options.”

Each year approximately 600,000 American women have hysterectomies, according to the Centers for Disease Control and Prevention. By age 60, one in three American women has had her uterus removed, often along with her ovaries and cervix.

Critics who say far too many hysterectomies are done in the United States worry that all the attention to surgical method distracts from the question of whether patients should be having the surgery at all.

Most hysterectomies are prescribed for conditions that are not life-threatening, and advocates worry that women are not fully informed of the long-term harms, which may include a loss of sexual responsiveness, depression and chronic constipation, and higher risk for osteoporosis and heart disease, said Nora W. Coffey, the founder of the nonprofit Hysterectomy Educational Resources and Services Foundation.

“That’s the conversation we should be having,” Ms. Coffey said.

---

Nora W. Coffey and other experts emphasize that women considering a hysterectomy should discuss all options with their doctors.

¶Ask what the alternatives are and whether watchful waiting is an option. Remember that it is irreversible, regardless of how the surgery is done.

¶Learn about the nonreproductive functions of the uterus, ovaries and cervix, and the potential long-term consequences associated with their removal, as well as the function of the ovaries and cervix.

¶If you proceed, discuss the advantages and disadvantages of different surgical methods with your doctor. Interview several surgeons and inquire about the cost and how much insurance will cover. Your co-pay may vary depending on the surgical method.

¶Tell your surgeon if you do not want your ovaries and cervix removed.

Read More..

Bernanke warns Congress that budget cuts pose danger to economy

WASHINGTON -- Federal Reserve Chairman Ben S. Bernanke warned Tuesday that the upcoming budget cuts under the so-called sequestration would create a "significant" burden on an economy that is growing only moderately.

In his semi-annual economic report to Congress, the Fed chief urged lawmakers and the Obama administration to "consider replacing the sharp, front-loaded spending cuts required by the sequestration with policies that reduce the federal deficit more gradually in the near term but more substantially in the longer run."

He told the Senate Banking Committee that the sequestration set to take effect March 1, which would cut federal spending by $85 billion this year, and other recent near-term budget changes could create a "significant headwind for the economic recovery."

"Besides having adverse effects on jobs and incomes, a slower recovery would lead to less actual deficit reduction in the short run for any given set of fiscal actions," he said in prepared remarks.

Bernanke said that the economy was continuing to grow at a moderate pace and that the flattening of growth late last year did not indicate a "stalling-out" of the recovery, but instead reflected weather-related disruptions and other transitory factors.

Still, Bernanke again highlighted the weakness and hardships in the labor market, noting the high unemployment rate and the millions of people struggling with long-term joblessness and the inability to obtain full-time work.

In addition to the slow recovery and the risks of sequestration, Bernanke's remarks came as the U.S. and the world faced renewed threats from the Eurozone debt crisis, which had quieted since late last year but reawakened this week in the wake of an impasse in Italian elections.   

Bernanke, in a question-and-answer session after his testimony, was expected to address those economic conditions as well as increased concerns about the effectiveness of the central bank's aggressive monetary stimulus to support the weak economy.

Inside and outside the Fed, experts and policymakers are concerned that the Fed's easy-money policies could be sowing the seeds of runaway inflation, asset bubbles and unstable financial markets down the road.

ALSO: 

U.S. debt woes are not so dire, experts say

Average Americans are feeling pain of U.S. debt

Fed policymakers increasingly divided over monetary stimulus

Read More..

Oscars 2013: An 'Argo' night at Academy Awards

For the second straight year, the movie business fell for itself.

"Argo" — in which a Hollywood producer and makeup artist help engineer the rescue of six Americans from Iran — won the top prize at the 85th Academy Awards, one year after the silent film story "The Artist" took the best picture Oscar.

"I never thought I'd be back here. And I am," producer-director Ben Affleck said in accepting the best picture trophy Sunday night, 15 years after he won an original screenplay Oscar for "Good Will Hunting" and then saw his career fall into a tailspin that included "Gigli" and "Daredevil."

FULL COVERAGE: Oscars 2013 | Winners

"It doesn't matter how you get knocked down in life. That's going to happen," said Affleck, who wasn't nominated for directing "Argo," one of nine films in the best picture race. "All that matters is that you've got to get up."

"Argo," which became the first movie to win best picture without its director being nominated since 1989's "Driving Miss Daisy," collected two other Academy Awards, for editing and adapted screenplay. But it was not the evening's most recognized film: That honor went to Ang Lee's "Life of Pi," which won four Oscars — for directing, visual effects, cinematography and score.

"Thank you, movie god," said Lee, whose movie came into the evening with 11 nominations, one behind Steven Spielberg's "Lincoln." The film about the 16th president helped Daniel Day-Lewis make movie history, as he became the only man to ever win three lead actor statuettes. "Lincoln" won one other prize, for production design.

The song-and-dance heavy ceremony, hosted by Seth MacFarlane, hewed closely to a traditional awards show script, but there were several surprises. First Lady Michelle Obama, who joined the ABC telecast from the White House, announced "Argo" as the best picture. And the ceremony featured only the sixth tie in Oscar history and the first since 1994, with the sound editing award split between "Zero Dark Thirty" and "Skyfall." For the first time in Oscar history, six best picture nominees were $100-million blockbusters.

The ceremony was billed as a tribute to music in film, and boasted a number of extravagant musical numbers — including a medley of songs from movie musicals and an appearance by Barbra Streisand, who sang "The Way We Were." The telecast also paid homage to the long running James Bond series, with Adele singing the theme from "Skyfall" and Dame Shirley Bassey performing the theme from 1964's "Goldfinger."

Oscars 2013: Nominee list | Red carpet | Highlights

Jennifer Lawrence, 22, nabbed the lead actress prize for her role as an emotionally unstable widow in "Silver Linings Playbook" — and promptly tripped over her long dress walking up the stairs to accept her statuette. The crowd quickly gave her a standing ovation. "You guys are just standing up because you feel bad that I fell and that's embarrassing," Lawrence said to the applauding crowd at the Dolby Theatre.

The evening's very first award — for supporting actor — was a shocker, with long shot Christoph Waltz winning for his role as bounty hunter Dr. King Schultz in Quentin Tarantino's "Django Unchained" over favored contenders Robert De Niro ("Silver Linings Playbook") and Tommy Lee Jones ("Lincoln"). Waltz, who won the same award three years ago for Tarantino's "Inglourious Basterds," dedicated his prize to his writer-director, who also won the Oscar for original screenplay. "We participated in a hero's journey — the hero being Quentin," Waltz said.

Tarantino pulled off a mild surprise with the screenplay triumph for his slave-revenge tale. He dedicated his award to his eclectic cast of actors. "I actually think if people know my movies 30-50 years from now it's because of the characters I create," Tarantino said.

Anne Hathaway's supporting actress win for her emotionally raw portrayal of a doomed seamstress in "Les Misérables" was hardly as startling. The 30-year-old had been the odds-on favorite to win since the film first screened for members of the Motion Picture Academy in late November. "It came true," she stage-whispered as she picked up her trophy for her performance, the centerpiece of which is the lament "I Dreamed a Dream."

Oscars 2013: Backstage | Quotes | Best & Worst moments

Some of the evening's wins were bittersweet.

The animated feature Oscar was shared by "Brave" directors Mark Andrews and Brenda Chapman, an unusual pairing given that Chapman was fired from the Pixar Animation Studios film and replaced by Andrews in the middle of production. "Making these are a struggle — it's a battle, it's a war," Andrews said backstage. "I was very happy it was him who took my place," Chapman said.

Rhythm & Hues Studios, the company behind "Life of Pi's" visual effects win, recently filed for bankruptcy and laid off hundreds of its employees. As Oscar winner Bill Westenhofer addressed the situation in his acceptance speech, he ran over time and the theme from "Jaws" began to play him off the stage. His microphone was cut off just as he said the words "I urge you all…"

William Goldenberg was a double nominee in the film editing category — he worked on both "Argo" and "Zero Dark Thirty" — and won the prize for Affleck's CIA drama.

"Working at my father's deli, I had to do a million things at one time," Goldenberg said backstage about the best training for his job. "It really does prepare you for the multitasking it takes to be in an editing room."

Read More..

'Argo' wins best picture on scattered Oscar night

LOS ANGELES (AP) — Just as Oscar host Seth MacFarlane set his sights on a variety of targets with a mixture of hits and misses, the motion picture academy spread the gold around to a varied slate of films. "Argo" won best picture as expected, along with two other prizes. But "Life of Pi" won the most awards with four, including a surprise win for director Ang Lee.

"Les Miserables" also won three Academy Awards, while "Django Unchained" and "Skyfall" each took two.

Among the winners were the front-runners throughout this lengthy awards season: best actor Daniel Day-Lewis for his deeply immersed portrayal of Abraham Lincoln in Steven Spielberg's epic "Lincoln," best actress Jennifer Lawrence as a troubled young widow in "Silver Linings Playbook" and supporting actress Anne Hathaway as the doomed prostitute Fantine in the musical "Les Miserables." Christoph Waltz was a bit of a surprise for supporting actor as a charismatic bounty hunter in Quentin Tarantino's "Django Unchained," an award he'd won just three years ago for Tarantino's "Inglorious Basterds."

The 22-year-old Lawrence, who got to show her lighter side in the oddball romance "Silver Linings Playbook" following serious roles in "Winter's Bone" and "The Hunger Games," gamely laughed at herself as she tripped on the stairs en route to the stage in her poufy, pale pink Dior Haute Couture gown. Backstage in the press room, when a reporter asked what she was thinking, she responded: "A bad word that I can't say that starts with 'F.'" Keeping journalists in hysterics, she explained, "I'm sorry. I did a shot before I ... sorry."

That's the kind of raunchiness MacFarlane himself seemed to be aiming for as host while also balancing the more traditional demands of the job. There was a ton of singing and dancing during the three-and-half-hour broadcast — no surprise from the musically minded creator of the animated series "Family Guy" — including a poignant performance from Barbra Streisand of "The Way We Were," written by the late Marvin Hamlisch, during the memorial montage. But MacFarlane also tried to keep the humor edgy with shots at Mel Gibson, George Clooney, Chris Brown and Rihanna.

An extended bit in which William Shatner came back from the future as his "Star Trek" character, Capt. James T. Kirk, had its moments while a joke about the drama "Flight" being restaged entirely with sock puppets was a scream. A John Wilkes Booth gag in reference to "Lincoln" was a bit of a groaner, perhaps intentionally, while MacFarlane relied on his alter ego, the cuddly teddy bear from his directorial debut "Ted," to make a crack about a post-Oscar orgy at Jack Nicholson's house. (MacFarlane already has indicated he's one-and-done with Academy Awards hosting.)

But it was Day-Lewis who came up with the kind of pop-culture riffing that's MacFarlane's specialty. In accepting his record third best-actor award from presenter Meryl Streep, he deadpanned that before they'd swapped roles, he originally was set to play Margaret Thatcher "and Meryl was Steven's first choice for 'Lincoln,' and I'd like to see that version."

Besides best picture, "Argo" won for Chris Terrio's adapted screenplay and for William Goldenberg's film editing. Affleck famously (and strangely) wasn't included in the best-director category for his thrilling and surprisingly funny depiction of a daring rescue during the 1979 Iranian hostage crisis. But as a producer on the film alongside George Clooney and Grant Heslov, he got to take home the top prize of the night.

"I never thought I'd be back here, and I am because of so many of you in this academy," said Affleck, who shared a screenplay Oscar with pal Matt Damon 15 years earlier for their breakout film "Good Will Hunting."

Among the wisdom he's acquired since then: "You can't hold grudges — it's hard but you can't hold grudges."

Lee, who previously won best director in 2006 for "Brokeback Mountain" (which also didn't win best picture), was typically low-key and self-deprecating in victory. His "Life of Pi" is a fable set in glorious 3-D, but Spielberg looked like the favorite for "Lincoln." The film also won for its cinematography, original score and visual effects.

"Thank you, movie god," the Taiwanese director said on stage. Later, he thanked his agents and said: "I have to do that," with a little shrug and a smile.

"Les Miserables" also won for sound mixing and makeup and hairstyling. The other Oscar for "Django Unchained" came for Tarantino's original screenplay. Asked about his international appeal backstage, Tarantino was enthusiastic as usual in saying: "I'm an American, and a filmmaker, but I make movies for the planet Earth."

Speaking of global hits, the James Bond action thriller "Skyfall" won for its original song by the unstoppable Adele (with Paul Epworth). It also tied for sound editing with "Zero Dark Thirty," the only win of the night for Kathryn Bigelow's detailed saga about the hunt for Osama bin Laden.

Among the other winners, "Searching for Sugar Man," about a forgotten musician's rediscovery, took the prize for best documentary feature. Pixar's fairy tale "Brave" won best animated feature.

One of the biggest moments of the night came at the end, as First Lady Michelle Obama announced the winner of the best picture prize. Backstage, Affleck described how surreal it was when he heard her say the word: "Argo."

"I was sort of hallucinating when that was happening," he explained. "In the course of a hallucination it doesn't seem that odd: 'Oh look, a purple elephant. Oh look, Michelle Obama.'"

___

Contact AP Movie Critic Christy Lemire through Twitter: http://twitter.com/christylemire

Read More..

Mediterranean Diet Can Cut Heart Disease, Study Finds

About 30 percent of heart attacks, strokes and deaths from heart disease can be prevented in people at high risk if they switch to a Mediterranean diet rich in olive oil, nuts, beans, fish, fruits and vegetables, and even drink wine with meals, a large and rigorous new study found.

The findings, published on the New England Journal of Medicine’s Web site on Monday, were based on the first major clinical trial to measure the diet’s effect on heart risks. The magnitude of the diet’s benefits startled experts. The study ended early, after almost five years, because the results were so clear it was considered unethical to continue.

The diet helped those following it even though they did not lose weight and most of them were already taking statins, or blood pressure or diabetes drugs to lower their heart disease risk.

“Really impressive,” said Rachel Johnson, a professor of nutrition at the University of Vermont and a spokeswoman for the American Heart Association. “And the really important thing — the coolest thing — is that they used very meaningful end points. They did not look at risk factors like cholesterol of hypertension or weight. They looked at heart attacks and strokes and death. At the end of the day, that is what really matters.”

Until now, evidence that the Mediterranean diet reduced the risk of heart disease was weak, based mostly on studies showing that people from Mediterranean countries seemed to have lower rates of heart disease — a pattern that could have been attributed to factors other than diet.

And some experts had been skeptical that the effect of diet could be detected, if it existed at all, because so many people are already taking powerful drugs to reduce heart disease risk, while other experts hesitated to recommend the diet to people who already had weight problems, since oils and nuts have a lot of calories.

Heart disease experts said the study was a triumph because it showed that a diet is powerful in reducing heart disease risk, and it did so using the most rigorous methods. Scientists randomly assigned 7,447 people in Spain who were overweight, were smokers, had diabetes or other risk factors for heart disease to follow the Mediterranean diet or a low-fat one.

Low-fat diets have not been shown in any rigorous way to be helpful, and they are also very hard for patients to maintain — a reality born out in the new study, said Dr. Steven E. Nissen, chairman of the department of cardiovascular medicine at the Cleveland Clinic Foundation.

“Now along comes this group and does a gigantic study in Spain that says you can eat a nicely balanced diet with fruits and vegetables and olive oil and lower heart disease by 30 percent,” he said. “And you can actually enjoy life.”

The study, by Dr. Ramon Estruch, a professor of medicine at the University of Barcelona, and his colleagues, was long in the planning. The investigators traveled the world, seeking advice on how best to answer the question of whether a diet alone could make a big difference in heart disease risk. They visited the Harvard School of Public Health several times to consult Dr. Frank M. Sacks, a professor of cardiovascular disease prevention there.

In the end, they decided to randomly assign subjects at high risk of heart disease to three groups. One would be given a low-fat diet and counseled on how to follow it. The other two groups would be counseled to follow a Mediterranean diet. At first the Mediterranean dieters got more intense support. They met regularly with dietitians while the low-fat group just got an initial visit to train them in how to adhere to the diet followed by a leaflet each year on the diet. Then the researchers decided to add more intensive counseling for them, too, but they still had difficulty staying with the diet.

One group assigned to a Mediterranean diet was given extra virgin olive oil each week and was instructed to use at least 4 tablespoons a day. The other group got a combination of walnuts, almonds and hazelnuts and was instructed to eat about an ounce of them each day. An ounce of walnuts, for example, is about a quarter cup — a generous handful. The mainstays of the diet consisted of at least 3 servings a day of fruits and at least two servings of vegetables. Participants were to eat fish at least three times a week and legumes, which include beans, peas and lentils, at least three times a week. They were to eat white meat instead of red, and, for those accustomed to drinking, to have at least 7 glasses of wine a week with meals.

They were encouraged to avoid commercially made cookies, cakes and pastries and to limit their consumption of dairy products and processed meats.

Read More..

Most economists see 'sequestration' budget cuts as unavoidable

WASHINGTON -- With just a few days to go before new government spending cuts are set to take effect, what are the chances that another eleventh-hour action will avert the latest impending hit to the economy?

Very little, according to a survey of economists released Monday by the National Assn. for Business Economics. The group said that nearly 60% of economists now expect the so-called sequestration, which will slice about $85 billion from the federal budget, to begin March 1 in full or partial form.

The survey of 49 professional economists, representing industry, government and universities, indicates that experts don't see a recession scenario as a result of the new spending cuts, as they did the "fiscal cliff" of tax increases and fiscal reductions, which were mostly avoided at the last minute at the start of this year.

More than half of these economists predicted that the effects of sequestration and other budget uncertainties would shave economic growth by less than half a percentage point this year. Another one-third said the pain would be greater, with real gross domestic product, or total economic output, sliced by up to a full percentage point.

Either way, that's no small number given the mediocre pace of GDP growth since the Great Recession of a little more than 2% on average. And many economists, policymakers and business people across the country have expressed fears that the indiscriminate nature of the cuts under sequestration will impose unnecessary hardships on certain programs such as Head Start for preschool children.

Total government spending and investments are now seen as falling by 1% this year from 2012, according to the median, or mid-point, of the responses from the economists surveyed. That is worse than the 0.6% drag forecast in the association's survey in December.
 
Real GDP is expected to expand by 2% this year, down a bit from the 2.2% GDP growth in 2012. The nation is projected to add 170,000 jobs a month on average, down from 181,000 last year, according to the median value of responses. That should bring down the unemployment rate gradually, to 7.5% in the fourth quarter of 2013 from 7.9% at the start of this year.

Economists, however, see economic growth accelerating next year as the nation absorbs the fiscal spending cuts and benefits from the housing market recovery and a pickup in business investments. Real GDP is seen as growing by almost 3% in 2014, the survey said, and the unemployment rate is forecast to fall to 7% by the end of next year.

ALSO:  

U.S. debt woes are not so dire, experts say

Average Americans are feeling pain of U.S. debt

54% of Americans want Congress to delay spending cuts, poll says

Read More..

Oscars stage manager braces for his final cues to the stars

He delivered a forgotten harmonica to Stevie Wonder onstage at the Grammy Awards, supplied a shoulder to lean on for a post-hip-surgery Gregory Peck at the Oscars and served as a human Xanax for hundreds of other stars in the most terrifying and exhilarating moments of their careers.

Stage manager Dency Nelson, 61, works behind the scenes at the Oscars, plus at times the Grammys, Screen Actors Guild Awards, Teen Choice Awards, MTV Movie Awards and other shows. This year will mark his 25th — and last, he said — Academy Awards, as he plans to retire from one of show business' least known but most stressful gigs.

An anonymous but critical piece of the Hollywood awards season machinery, stage managers like Nelson control the chaos of the live TV broadcast — they deliver the correct winning envelopes, ensure that the pop-up microphone actually pops up and, most delicately, orchestrate the flow of talent through the stage wings.

Oscars 2013: Nominee list | Ballot | Trivia | Timeline

An avuncular former hippie with twinkling green eyes, a silver earring and a scruffy, salt-and-pepper beard, Nelson is stationed in the stage-right wings, a hot spot where most of the Oscar telecast's jittery presenters enter and elated winners exit.

"It's like air traffic control," he said one recent afternoon at the Dolby Theatre at the Hollywood & Highland Center, where he was preparing for Sunday's show. "Ninety percent of the people in the room don't know my name, but when they round the corner and come into the wings there's a smile, 'Oh, that guy.'"

Even seasoned performers rely on stage managers for assurance in the unforgiving medium of live TV, and backstage figures like Nelson develop a rapport with stars they see at multiple shows.

Last year, before Meryl Streep stepped onto the Oscar stage to present an award, she reviewed her script, smoothed her gown and cast a tentative glance at Nelson. "You'll push me out when it's time?" she asked. He gently led the actress by the arm to the edge of the curtain, sending her off to face an audience of 40 million.

An hour later, after winning lead actress for "The Iron Lady," the first person an emotional Streep saw was Nelson, with a chair and a welcome water bottle.

"Dency's businesslike, but he makes people comfortable," said American Film Institute founder George Stevens Jr., who met him when the recent college grad was lugging heavy film reels for the L.A.-based nonprofit. Charmed by the young man's work ethic, nearly four decades later Stevens still hires him to stage-manage the "Kennedy Center Honors" and "Christmas in Washington" shows every year.

Many of the approximately 500-person backstage crew at the Oscars have been performers themselves, including head stage manager Gary Natoli (Nelson's boss) and a stage manager who specializes in talent, Valdez Flagg, both former actors and dancers.

TIMELINE: Academy Award winners

According to guild minimums, the stage managers must make at least $746 for a 12-hour day, and many work other steady jobs. Thanks to the proliferation of performance-based reality shows such as "American Idol" and "The Voice," there's a lot of work available for the specialized group who know how to do it.

Nelson has stage-managed the game show "Let's Make a Deal" and the syndicated variety program "The Wayne Brady Show."

"Anyone can do this job as long as nothing goes wrong," said Flagg. "If you can't go with the flow, you won't last. You'll freak out."

The year Wonder forgot his harmonica, for instance, the Grammys crew had to think quickly — how do you subtly signal a blind man? Ultimately, Nelson asked the director to frame a tight shot on the singer's face while he sneaked up from below and tugged on Wonder's pant-leg. At the Emmys, when an impostor tried to walk off with "Hill Street Blues" star Betty Thomas' trophy, Nelson skidded on stage with another.

And then there's that other occupational hazard: jerks. "People are just nervous in some cases and take it out on you," Nelson said with a shrug.

This year's Oscar telecast is a particularly taxing one for the stage crew, with many singing and dancing casts to maneuver. The consequences of a missed cue can be dire — at several points in the show, 34.5-foot lifts built into the stage floor will open to move scenery pieces.

Nelson, who grew up in Menlo Park the son of an Army auditor, originally wanted to be an actor. As a child he hosted the Andy Williams Christmas show by himself in front of the Christmas tree, with a toilet paper roll as a microphone.

After graduating from UC Santa Cruz with a degree in theater, he took a job as a driver and mail clerk for AFI and worked behind the scenes as "the guy who guarded the doughnuts" for the 1970s soap opera parody "Mary Hartman, Mary Hartman" and a cue card man for "Saturday Night Live" and David Letterman.

Play-at-home ballot: Have you made your picks yet?

Along the way he continued to act in commercials, basement theaters and tiny walk-on roles (in Woody Allen's "Manhattan," you can see Nelson stride across Park Avenue carrying an attaché case). "I wasn't really getting anywhere," he said. "I just saw my actor colleagues, their talent, and saw I'm not that."

The frustrated performance experience, however, gives Nelson a nuanced understanding of what the people he's pushing into the lights on Oscar night are feeling. "There have been plenty of times where I have held a trembling hand and smiled," he said. "I so admire anyone who can do that."

The stage crew prepares with the thoroughness of a military campaign. During rehearsals, Nelson marks his show rundown with different colors of highlighters and pens, noting when he'll send a performer upstage or where a piece of scenery will move. Unlike some younger stage managers, he still uses paper, not an electronic device, for storing his "road map."

In a change this year, six college film students will deliver the trophies onstage, instead of the usual cadre of models who float from show to show. On Wednesday, Nelson was coaching them on the subtle art of statuette distribution.

"Let the kiss and hug happen," he said, his hands stained with red ink from jotting notes on his script, six roles of tape swinging from his belt. "Just linger upstage, let that traffic happen."

At Nelson's first Oscars, before the students were born, Jack Lemmon was the host. Over the years, Nelson said he's noticed an evolution in the awards show scene, as older performers who approached show business with a certain gentility have given way to a more casual and sometimes cruder generation.

"I'm no prude, but there was a certain formality and respect to things," he said. "I'm sorry to see it go, although I understand the financial necessity 'cause it's about the ratings."

A married father of one grown daughter, Nelson lives in Hermosa Beach and is active in Democratic party politics and environmental causes; he helped found a nonprofit devoted to alternative vehicles called Plug in America (he owns two electric cars). Especially engaged in the union to which stage managers belong, the Directors Guild of America, this year he received the guild's Franklin J. Schaffner Award for service.

He said he's retiring to devote more time to his political passions, but he also appears ready to shed the pressures of awards season.

"I don't want to make any mistakes," Nelson said. "The worst is just before the show starts. That's awful. That last hour in the wings.... It's not calm inside. As I am nearing my retirement, I just keep thinking of Jack Nicholson's line in 'Terms of Endearment' ... 'Inches from a clean getaway.'"

Play-at-home ballot: Have you made your picks yet?

rebecca.keegan@latimes.com

Read More..

The Texas Tribune: Advocates Seek Mental Health Changes, Including Power to Detain

Matt Rainwaters for Texas Monthly

The Sherman grave of Andre Thomas’s victims.

SHERMAN — A worried call from his daughter’s boyfriend sent Paul Boren rushing to her apartment on the morning of March 27, 2004. He drove the eight blocks to her apartment, peering into his neighbors’ yards, searching for Andre Thomas, Laura Boren’s estranged husband.

Expanded coverage of Texas is produced by The Texas Tribune, a nonprofit news organization. To join the conversation about this article, go to texastribune.org.

For more articles on mental health and criminal justice in Texas, as well as a timeline of the Andre Thomas case: texastribune.org

Matt Rainwaters for Texas Monthly

Laura Boren

He drove past the brightly colored slides, swings and bouncy plastic animals in Fairview Park across the street from the apartment where Ms. Boren, 20, and her two children lived. He pulled into a parking spot below and immediately saw that her door was broken. As his heart raced, Mr. Boren, a white-haired giant of a man, bounded up the stairwell, calling out for his daughter.

He found her on the white carpet, smeared with blood, a gaping hole in her chest. Beside her left leg, a one-dollar bill was folded lengthwise, the radiating eye of the pyramid facing up. Mr. Boren knew she was gone.

In a panic, he rushed past the stuffed animals, dolls and plastic toys strewn along the hallway to the bedroom shared by his two grandchildren. The body of 13-month-old Leyha Hughes lay on the floor next to a blood-spattered doll nearly as big as she was.

Andre Boren, 4, lay on his back in his white children’s bed just above Leyha. He looked as if he could have been sleeping — a moment away from revealing the toothy grin that typically spread from one of his round cheeks to the other — except for the massive chest wound that matched the ones his father, Andre Thomas (the boy was also known as Andre Jr.), had inflicted on his mother and his half-sister as he tried to remove their hearts.

“You just can’t believe that it’s real,” said Sherry Boren, Laura Boren’s mother. “You’re hoping that it’s not, that it’s a dream or something, that you’re going to wake up at any minute.”

Mr. Thomas, who confessed to the murders of his wife, their son and her daughter by another man, was convicted in 2005 and sentenced to death at age 21. While awaiting trial in 2004, he gouged out one of his eyes, and in 2008 on death row, he removed the other and ate it.

At least twice in the three weeks before the crime, Mr. Thomas had sought mental health treatment, babbling illogically and threatening to commit suicide. On two occasions, staff members at the medical facilities were so worried that his psychosis made him a threat to himself or others that they sought emergency detention warrants for him.

Despite talk of suicide and bizarre biblical delusions, he was not detained for treatment. Mr. Thomas later told the police that he was convinced that Ms. Boren was the wicked Jezebel from the Bible, that his own son was the Antichrist and that Leyha was involved in an evil conspiracy with them.

He was on a mission from God, he said, to free their hearts of demons.

Hospitals do not have legal authority to detain people who voluntarily enter their facilities in search of mental health care but then decide to leave. It is one of many holes in the state’s nearly 30-year-old mental health code that advocates, police officers and judges say lawmakers need to fix. In a report last year, Texas Appleseed, a nonprofit advocacy organization, called on lawmakers to replace the existing code with one that reflects contemporary mental health needs.

“It was last fully revised in 1985, and clearly the mental health system has changed drastically since then,” said Susan Stone, a lawyer and psychiatrist who led the two-year Texas Appleseed project to study and recommend reforms to the code. Lawmakers have said that although the code may need to be revamped, it will not happen in this year’s legislative session. Such an undertaking requires legislative studies that have not been conducted. But advocates are urging legislators to make a few critical changes that they say could prevent tragedies, including giving hospitals the right to detain someone who is having a mental health crisis.

From the time Mr. Thomas was 10, he had told friends he heard demons in his head instructing him to do bad things. The cacophony drove him to attempt suicide repeatedly as an adolescent, according to court records. He drank and abused drugs to try to quiet the noise.

bgrissom@texastribune.org

Read More..

Jason Bateman gives Ernest Borgnine's estate a new identity

Markus Canter and Cristie St. James, who share the title luxury properties director at Prudential in Beverly Hills, like Jason Bateman's real estate sense. The actor got privacy, potential and a knoll location for $3 million.

Actor Jason Bateman and his wife, actress Amanda Anka, are dropping anchor in the Beverly Crest area with the purchase of the estate of Ernest Borgnine for $3 million.

The gated country English compound sits on a half-acre knoll. The 6,148-square-foot home features a formal entry hall, a grand staircase, a paneled library, an office, a den, six bedrooms and seven bathrooms. There is a guesthouse and a swimming pool.

Bateman, 44, stars in the comic film "Identity Thief," released this month. He is known to generations of TV viewers for his roles in "Arrested Development" (2003-present) and "Valerie," later retitled "The Hogan Family" (1986-91). Anka, 44, has appeared in "Bones" (2008), "Notes From the Underbelly" (2007) and "Beverly Hills, 90210" (1996).

Borgnine, who died last year at 95, is remembered for his Oscar-winning performance in "Marty" (1955) and his work in the title role as commander of a madcap crew in the sitcom "McHale's Navy" (1962-65). Until 2011 he was the voice of Mermaidman on "SpongeBob SquarePants."

The estate came on the market in October for the first time in 60 years priced at $3.395 million.

Billy Rose, Paul Lester and Aileen Comora of the Agency in Beverly Hills were the listing agents. Richard Ehrlich of Westside Estate Agency represented the buyers.

Where pair spent days of their lives

Soap star Peter Reckell and his wife, singer Kelly Moneymaker, have sold their custom-built, eco-friendly home in Brentwood for $3.35 million.

Before building the 3,345-square-foot house, the couple had the existing home on the site torn down, crated and shipped to Mexico for reuse by Habitat for Humanity. Then they designed and built a three-bedroom, four-bathroom contemporary that uses solar power.

Green elements include a photovoltaic system with battery backup, skylights, recycled glass terrazzo floors with radiant heating, recycled denim and organic cotton insulation, bamboo cabinets and doors, a roof garden and a water reclamation system.

A temperature-controlled wine cave and a recording studio are among other features.

Along with an indoor/outdoor koi pond, a meditation fountain and a solar infinity pool, outdoor amenities include a 16th century East Indian temple that was turned into a pavilion.

"This is my sanctuary," Reckell said. It frames views of the Santa Monica Mountains Conservancy.

Reckell, 57, played Bo Brady on "Days of Our Lives" from 1983 through last year. The show began in 1965. He also appeared in "Knots Landing" (1988-89). He is an avid environmentalist and bikes to work.

Moneymaker, 42, is a former member of the music group Exposé. She was inspired to build an environmentally friendly home because the carpet and other elements in the old house bothered her allergies and affected her voice.

Public records show they bought the property in 2003 for $1.14 million.

Daniel Banchik of Prudential's West Hollywood office was the listing agent. Scott Segall of John Aaroe Group represented the buyer.

Another rock owner for home

Hard Rock Cafe co-founder Peter Morton has made his mark on L.A.'s real estate scene of late, buying the old Elvis Presley estate in Beverly Hills at year-end for $9.8 million.

But flying under the radar was his bigger off-market purchase midyear for a property in Bel-Air at $25 million, public records show. Area real estate agents not involved in the transaction say Morton plans to take down the existing home and build another on the site. The estate had belonged to Joseph Farrell, who founded National Research Group Inc. in 1978 and brought market testing to Hollywood. Farrell died in December 2011.

Read More..

Athletes cash in on California's workers' comp

SACRAMENTO — In his seven-year career with the Denver Broncos, running back Terrell Davis, a former Super Bowl Most Valuable Player, dazzled fans with his speed and elusiveness.

At the end of his rookie year in 1995, he signed a $6.8-million, five-year contract. Off the field he endorsed Campbell's soup. And when he hung up his cleats, he reported for the National Football League Network and appeared in movies and TV shows.

So it may surprise Californians to find out that in 2011, Davis got a $199,000 injury settlement from a California workers' compensation court for injuries related to football. This came despite the fact Davis was employed by a Colorado team and played just nine times in California during an 88-game career, according to the NFL.

Davis was compensated for the lifelong effects of multiple injuries to the head, arms, trunk, legs and general body, according to California workers' compensation records.

He is not alone.

Over the last three decades, California's workers' compensation system has awarded millions of dollars in benefits for job-related injuries to thousands of professional athletes. The vast majority worked for out-of-state teams; some played as little as one game in the Golden State.

All states allow professional athletes to claim workers' compensation payments for specific job-related injuries — such as a busted knee, torn tendon or ruptured spinal disc — that happened within their borders. But California is one of the few that provides additional payments for the cumulative effect of injuries that occur over years of playing.

A growing roster of athletes are using this provision in California law to claim benefits. Since the early 1980s, an estimated $747 million has been paid out to about 4,500 players, according to an August study commissioned by major professional sports leagues. California taxpayers are not on the hook for these payments. Workers' compensation is an employer-funded program.

Now a major battle is brewing in Sacramento to make out-of-state players ineligible for these benefits, which are paid by the leagues and their insurers. They have hired consultants and lobbyists and expect to unveil legislation next week that would halt the practice.

"The system is completely out of whack right now," said Jeff Gewirtz, vice president of the Brooklyn Nets — formerly the New Jersey Nets — of the National Basketball Assn.

Major retired stars who scored six-figure California workers' compensation benefits include Moses Malone, a three-time NBA most valuable player with the Houston Rockets, Philadelphia 76ers and other teams. He was awarded $155,000. Pro Football Hall of Fame wide receiver Michael Irvin, formerly with the Dallas Cowboys, received $249,000. The benefits usually are calculated as lump-sum payments but sometimes are accompanied by open-ended agreements to provide lifetime medical services.

Players, their lawyers and their unions plan to mount a political offensive to protect these payouts.

Although the monster salaries of players such as Los Angeles Lakers guard Kobe Bryant and Denver Broncos quarterback Peyton Manning make headlines, few players bring in that kind of money. Most have very short careers. And some, particularly football players, end up with costly, debilitating injuries that haunt them for a lifetime but aren't sufficiently covered by league disability benefits.

Retired pros increasingly are turning to California, not only because of its cumulative benefits but also because there's a longer window to file a claim. The statute of limitations in some states expires in as little as a year or two.

"California is a last resort for a lot of these guys because they've already been cut off in the other states," said Mel Owens, a former Los Angeles Rams linebacker-turned-workers' compensation lawyer who has represented a number of ex-players.

To understand how it works, consider the career of Ernie Conwell. A former tight end for the St. Louis Rams and New Orleans Saints, he was paid $1.6 million for his last season in 2006.

Conwell said that during his 11-year career, he underwent about 18 surgeries, including 11 knee operations. Now 40, he works for the NFL players union and lives in Nashville.

Hobbled by injuries, he filed for workers' compensation in Louisiana and got $181,000 in benefits to cover his last, career-ending knee surgery in 2006, according to the Saints. The team said it also provided $195,000 in injury-related benefits as part of a collective-bargaining agreement with the players union.

But such workers' compensation benefits paid by Louisiana cover only specific injuries. So, to deal with what he expects to be the costs of ongoing health problems that he said affect his arms, legs, muscles, bones and head, Conwell filed for compensation in California and won.

Even though he played only about 20 times in the state over his professional career, he received a $160,000 award from a California workers' compensation judge plus future medical benefits, according to his lawyer. The Saints are appealing the judgment.

Read More..