Feds OK insurance exchange partnership

Health and Human Services Secretary Kathleen Sebelius on Wednesday said her department conditionally approved Illinois’ plan to operate a health insurance exchange in a partnership with the federal government, a widely expected move that makes the state the third to receive the official go ahead. 

Sebelius plans to make the announcement Wednesday afternoon at a West Side clinic alongside Gov. Pat Quinn, Sebelius said the approval will allow the state and the federal government to continue work on readying the online marketplace for Oct. 1, when uninsured Illinoisans can begin signing up for health insurance offered under the 2010 health care overhaul law.

Under the partnership model, Illinois will maintain its responsibility for regulating the insurance market, a function that will allow the state to tailor the types of private health insurance plans offered through the exchange. Illinois also will be in charge of customer assistance, which will allow it to conduct outreach efforts and aid people in signing up.

The federal government is responsible for building and operating the exchange.

Illinois becomes the third state to have its partnership plan approved, following Delaware and Arkansas. A handful of other states, including Iowa, Michigan, West Virginia and New Hampshire, also are interested in the partnership model. Other states have opted to set up and run their own exchanges, while a majority refused to participate, relying on the federal government to do so.

Sebelius is in town through Thursday to meet with several large stakeholders, including union leaders, clergy and community groups, to raise awareness about the forthcoming exchanges, a spokesman said.

The exchanges are a crucial part of the government's plan to expand the number of Americans who have some form of health insurance.

Eventually, an estimated 20 million people will benefit from federal tax credits starting in 2014 that will help offset the cost of paying for insurance premiums. Even so, the government estimates that about 6 million Americans will not sign up and will start paying tax penalties in 2014.

In the first year, those penalties are relatively modest, starting at $95 for adults and $47.50 per child. But they’re expected to increase in future years, eventually totaling nearly $7 billion in 2016, an average fine of about $1,200 per person.

While states were given the option of setting up and running their own exchanges, only 18 chose to do so, with most of the rest opting to allow the federal government to operate them, at least in the beginning.

Julie Hamos, director of the state Department of Healthcare and Family Services, has said she hopes to get legislation passed this spring to authorize a purely state-run exchange that will be up and ready in time for open enrollment for 2015.

Meanwhile, consumers can expect a marketing blitz during the summer and into the fall touting the exchanges, which will serve individuals who are not eligible for Medicare or Medicaid and not offered health insurance through their employers.

pfrost@tribune.com | Twitter: @peterfrost

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Hadiya Pendleton shooting suspect: 'She was just there'

The gunman in the slaying of Hadiya Pendleton told police he was in the middle of a three-year battle with a rival gang when he opened fire at a South Side park and hit the 15-year-old who "had nothing to do" with the feud, according to prosecutors.

"She was just there," Michael Ward, 18, told police after he was arrested with Kenneth Williams, 20, prosecutors said during a hearing where both were denied bail.

Williams told witnesses he and Ward were driving around on Jan. 29, looking for members of a rival gang that had killed one of Ward's friends, according to prosecutors. Williams had also been wounded by a rival gang member last summer, police said.

"Ward stated that his gang and the rival gang had been shooting at one another since 2010. [Ward] stated that when the rival gang killed one of his friends, he thought, 'If we keep standing for this, we are going to be some straight bitches,' " prosecutors said.

"It hurt, it hurt," he told police, according to prosecutors. "It hurt to a point where everyone had to go."

Ward confessed to police that he and Williams mistook a Pendleton companion for a rival gang member as the girl was with friends at the park near King College Prep High School, about a mile away from President Barack Obama's home.

In court today, prosecutors disclosed that surveillance video captured the white Nissan the two used to flee after the shooting. Police had identified Williams and Ward as occupants of the car "within approximately 10 minutes of the shooting," prosecutors said.

The two were not arrested until this past weekend.

Williams said he and Ward pulled up to Harsh Park in the North Kenwood neighborhood, according to prosecutors. Ward got out and "snuck up on the group and they didn't see him coming," prosecutors quoted Ward as telling police. "Ward admitted he approached the fence and fired the gun six times. He ran back to the car and both defendants fled."

Williams appeared in court in a black-hooded sweatshirt and his hair in dreadlocks, while Ward was dressed in a dark gray vest and blue jeans. Both defendants kept their hands behind their backs and stood silently before the judge as Assistant State’s Attorney Jennifer Sexton detailed the charges before a packed courtroom.

Relatives and supporters showed up in court for both Ward and Williams, but no one spoke to reporters following the bond hearing.

Ward’s lawyer, Jeffrey Granich, contended that police refused his client’s repeated requests for a lawyer while he was being questioned by detectives. He also maintained that Ward was being “railroaded” because of the high-profile homicide.

“This is a serious case, not a political platform,” Granich told reporters in the lobby of the Leighton Criminal Court Building.

Granich said Ward was attending Malcolm X College to obtain a GED, a requirement of his probation sentence for a weapons conviction.

Williams’ attorney, Matthew McQuaid, said his client had graduated from the same high school as Hadiya – King College Prep – and was working for an air courier service at O’Hare International Airport. He has no criminal background.

McQuaid also denied that Williams belonged to a gang.

David Smith, a close friend of the Pendleton family, said after the court hearing that the family was keeping tabs on developments from Washington. Hadiya’s parents are guests of First Lady Michelle Obama at the president’s State of the Union address tonight.
“They need to be off the streets, absolutely,” Smith said in expressing satisfaction that the two suspects were ordered held without bond. But at the same time, he said the entire case saddens him.

“I feel sad for Haydia and seeing those guys (in court) they looked sad, too, like little kids themselves,” Smith said.

Another family friend, Ray Hill, said he hoped the shooting would galvanize residents against violence.
“Everybody needs to wake up because if it can happen to our family, it can happen to yours,” Hill said. “We need to get the city more involved with our children.”

Detectives arrested the two Saturday night as the suspects were on their way to a suburban strip club to celebrate a friend's birthday, police said. Pendleton had been buried only hours earlier in a funeral attended by first lady Michelle Obama.

Police Superintendent Garry McCarthy said that two days before the killing, police had stopped Ward in his Nissan Sentra as part of a routine gang investigation. That information wound up being the starting point for detectives when witnesses in the shooting described seeing a similar car driving away from the shooting scene, he said.

Through surveillance and interviews — including several fruitful interviews with parolees in the neighborhood — detectives were able to home in on Ward and Williams, police said. On Saturday night, the decision was made to stop the two if they were spotted. Police watched as they departed in a caravan of cars headed to the strip club in Harvey. They were stopped near 67th Street and South King Drive and taken in for questioning.

McCarthy said Williams was shot July 11 at 39th Street and South Lake Park Avenue and an arrest was made. But that gunman was let go after Williams refused to cooperate, McCarthy said.

McCarthy noted that at the time of Hadiya's slaying, Ward was on probation for a weapons conviction. McCarthy said weak Illinois gun laws allowed Ward to avoid jail time because of the absence of mandatory minimum sentences.

"This incident did not have to occur," McCarthy said. "And if mandatory minimums existed in the state of Illinois, Michael Ward would not have been on the street to commit this heinous act."

State's Attorney Anita Alvarez echoed McCarthy's call for stronger sentencing laws for gun offenses.

After the hearing, she said prosecutors had asked for prison time for Ward when he was convicted of a weapon charge in 2011, but he was instead given probation because he was only 17 at the time of the offense. A state law that went into effect that year requires a mandatory minimum sentence of 1 year in prison for unlawful use of a weapon but only for offenders 18 or older, she said.

“What we want to do with the new legislation is to fix that so that we are holding these people responsible…and that they receive an amount of jail time that is going to serve as a deterrent,” she said.

Responding to a Tribune report that Ward had been arrested three times while on probation for his gun conviction but still was on the street, Alvarez said the Cook County Adult Probation Department was responsible for notifying prosecutors of the new arrests and filing for a violation of probation. That can result in an arrestee being sent to prison.

“What I’ve been told (is) the probation department has admitted that they did not notify us, so obviously we didn’t proceed on that violation of probation,” Alvarez said.

jmeisner@tribune.com

jgorner@tribune.com

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Well: Straining to Hear and Fend Off Dementia

At a party the other night, a fund-raiser for a literary magazine, I found myself in conversation with a well-known author whose work I greatly admire. I use the term “conversation” loosely. I couldn’t hear a word he said. But worse, the effort I was making to hear was using up so much brain power that I completely forgot the titles of his books.

A senior moment? Maybe. (I’m 65.) But for me, it’s complicated by the fact that I have severe hearing loss, only somewhat eased by a hearing aid and cochlear implant.

Dr. Frank Lin, an otolaryngologist and epidemiologist at Johns Hopkins School of Medicine, describes this phenomenon as “cognitive load.” Cognitive overload is the way it feels. Essentially, the brain is so preoccupied with translating the sounds into words that it seems to have no processing power left to search through the storerooms of memory for a response.

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Katherine Bouton speaks about her own experience with hearing loss.

A transcript of this interview can be found here.

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Over the past few years, Dr. Lin has delivered unwelcome news to those of us with hearing loss. His work looks “at the interface of hearing loss, gerontology and public health,” as he writes on his Web site. The most significant issue is the relation between hearing loss and dementia.

In a 2011 paper in The Archives of Neurology, Dr. Lin and colleagues found a strong association between the two. The researchers looked at 639 subjects, ranging in age at the beginning of the study from 36 to 90 (with the majority between 60 and 80). The subjects were part of the Baltimore Longitudinal Study of Aging. None had cognitive impairment at the beginning of the study, which followed subjects for 18 years; some had hearing loss.

“Compared to individuals with normal hearing, those individuals with a mild, moderate, and severe hearing loss, respectively, had a 2-, 3- and 5-fold increased risk of developing dementia over the course of the study,” Dr. Lin wrote in an e-mail summarizing the results. The worse the hearing loss, the greater the risk of developing dementia. The correlation remained true even when age, diabetes and hypertension — other conditions associated with dementia — were ruled out.

In an interview, Dr. Lin discussed some possible explanations for the association. The first is social isolation, which may come with hearing loss, a known risk factor for dementia. Another possibility is cognitive load, and a third is some pathological process that causes both hearing loss and dementia.

In a study last month, Dr. Lin and colleagues looked at 1,984 older adults beginning in 1997-8, again using a well-established database. Their findings reinforced those of the 2011 study, but also found that those with hearing loss had a “30 to 40 percent faster rate of loss of thinking and memory abilities” over a six-year period compared with people with normal hearing. Again, the worse the hearing loss, the worse the rate of cognitive decline.

Both studies also found, somewhat surprisingly, that hearing aids were “not significantly associated with lower risk” for cognitive impairment. But self-reporting of hearing-aid use is unreliable, and Dr. Lin’s next study will focus specifically on the way hearing aids are used: for how long, how frequently, how well they have been fitted, what kind of counseling the user received, what other technologies they used to supplement hearing-aid use.

What about the notion of a common pathological process? In a recent paper in the journal Neurology, John Gallacher and colleagues at Cardiff University suggested the possibility of a genetic or environmental factor that could be causing both hearing loss and dementia — and perhaps not in that order. In a phenomenon called reverse causation, a degenerative pathology that leads to early dementia might prove to be a cause of hearing loss.

The work of John T. Cacioppo, director of the Social Neuroscience Laboratory at the University of Chicago, also offers a clue to a pathological link. His multidisciplinary studies on isolation have shown that perceived isolation, or loneliness, is “a more important predictor of a variety of adverse health outcomes than is objective social isolation.” Those with hearing loss, who may sit through a dinner party and not hear a word, frequently experience perceived isolation.

Other research, including the Framingham Heart Study, has found an association between hearing loss and another unexpected condition: cardiovascular disease. Again, the evidence suggests a common pathological cause. Dr. David R. Friedland, a professor of otolaryngology at the Medical College of Wisconsin in Milwaukee, hypothesized in a 2009 paper delivered at a conference that low-frequency loss could be an early indication that a patient has vascular problems: the inner ear is “so sensitive to blood flow” that any vascular abnormalities “could be noted earlier here than in other parts of the body.”

A common pathological cause might help explain why hearing aids do not seem to reduce the risk of dementia. But those of us with hearing loss hope that is not the case; common sense suggests that if you don’t have to work so hard to hear, you have greater cognitive power to listen and understand — and remember. And the sense of perceived isolation, another risk for dementia, is reduced.

A critical factor may be the way hearing aids are used. A user must practice to maximize their effectiveness and they may need reprogramming by an audiologist. Additional assistive technologies like looping and FM systems may also be required. And people with progressive hearing loss may need new aids every few years.

Increasingly, people buy hearing aids online or from big-box stores like Costco, making it hard for the user to follow up. In the first year I had hearing aids, I saw my audiologist initially every two weeks for reprocessing and then every three months.

In one study, Dr. Lin and his colleague Wade Chien found that only one in seven adults who could benefit from hearing aids used them. One deterrent is cost ($2,000 to $6,000 per ear), seldom covered by insurance. Another is the stigma of old age.

Hearing loss is a natural part of aging. But for most people with hearing loss, according to the National Institute on Deafness and Other Communication Disorders, the condition begins long before they get old. Almost two-thirds of men with hearing loss began to lose their hearing before age 44. My hearing loss began when I was 30.

Forty-eight million Americans suffer from some degree of hearing loss. If it can be proved in a clinical trial that hearing aids help delay or offset dementia, the benefits would be immeasurable.

“Could we do something to reduce cognitive decline and delay the onset of dementia?” he asked. “It’s hugely important, because by 2050, 1 in 30 Americans will have dementia.

“If we could delay the onset by even one year, the prevalence of dementia drops by 15 percent down the road. You’re talking about billions of dollars in health care savings.”

Should studies establish definitively that correcting hearing loss decreases the potential for early-onset dementia, we might finally overcome the stigma of hearing loss. Get your hearing tested, get it corrected, and enjoy a longer cognitively active life. Establishing the dangers of uncorrected hearing might even convince private insurers and Medicare that covering the cost of hearing aids is a small price to pay to offset the cost of dementia.

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Katherine Bouton is the author of the new book, “Shouting Won’t Help: Why I — and 50 Million Other Americans — Can’t Hear You,” from which this essay is adapted.

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This post has been revised to reflect the following correction:

Correction: February 12, 2013

An earlier version of this article misstated the location of the Medical College of Wisconsin. It is in Milwaukee, not Madison.

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Chicago leads nation in gas-price spikes

Drivers in Chicago are seeing a painful rise in gas prices get even worse this month.

The average price of regular unleaded in the Chicago metro area on Tuesday is $3.93, according to AAA. That's up 12 cents from a week ago. A month ago, the average was $3.42. Statewide, the average is about $3.79, up 8 cents from last week and 46 cents last month.

Prices are rising at pumps across the country, too, but not as dramatically. The national average is $3.60, up about 7 cents from a week ago and 30 cents higher than this time last month.

It's not typical to see gas price spikes at this time of year. Demand is typically low and picks up in the spring before driving season. And in general, gas is cheaper to produce in the winter because refineries can use less expensive blends.

The main reason for the spike is the higher price of crude oil. The price of oil has gone from around $85 a barrel in December to around $97 now because of improving economic certainty as the country moved past the election and the fiscal cliff deadline, according to energy analyst Phil Flynn. It's also being driven by better-than-expected growth in China, the world's second largest economy.

Prices in the Chicago area are typically some the highest in the nation, but the cost of a local fill-up is accelerating at almost double the national rate.

Flynn attributes this to a number of refinery issues in the region. Some scheduled maintenance at refineries -- where gasoline and other products are produced from oil -- occurred earlier than usual, which cut off some supply, affecting prices. Many close at this time of year to start the switchover to lower-emission summer blends of gasoline.

Besides a major overhaul of BP's Whiting refinery, the largest supplier of gasoline to Midwest markets, that's believed to be driving prices higher, a fire temporarily shut down a refinery in northwest Ohio.

AAA, which tracks daily gasoline prices around the country, predicts they will continue their rapid climb as local refinery issues continue into the beginning of peak driving season.

Flynn is more optimistic.

He believes that once the major Whiting refinery overhaul is complete later this year, gas prices will stabilize.

"I'm probably in the minority but I think we are starting to see some light at the end of the tunnel," he said.

sbomkamp@tribune.com | Twitter: @SamWillTravel

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Charges in Hadiya Pendleton slaying could come soon: McCarthy

Charges could come this evening against two people being questioned in the shooting death of 15-year-old Hadiya Pendleton, Police Superintendent Garry McCarthy said today.
"We will bring this all to closure, probably sometime this evening we're anticipating hopefully that we'll have charges," McCarthy said at a news conference with Mayor Rahm Emanuel and Cook County State's Attorney Anita Alvarez to announce a push for stiffer jail terms for people convicted of gun crimes.
McCarthy declined to provide more specifics, saying the investigation is ongoing.

"We're still doing lineups. We're still crossing some t's and dotting some i's that we need to do before we can get charges approved for these individuals," he said.

Chicago police picked up the two men, 18 and 20, were picked up over the weekend, hours after first lady Michelle Obama attended the funeral for the teenager whose death has become a symbol of escalating violence in Chicago.

The men were pulled over near East 67th Street and South Chicago Avenue late Saturday night or early Sunday morning after detectives canvassed the area of the park where she was shot and killed Jan. 29 and tracked down witnesses, the sources said.

Hadiya was fatally shot in Vivian Gordon Harsh Park, about a mile north of President Barack Obama's Kenwood neighborhood home on the South Side, a little more than a week after the honor student performed with the King College Prep band in Washington during inauguration festivities. Two other teens were wounded.

The shooting in the 4400 block of South Oakenwald Avenue happened after classes were dismissed for the day during finals week at King. Hadiya, a sophomore at King, was at the park with a group of teens, primarily other students from the school, when a male gunman climbed over a fence, ran to the group and started firing, police have said. The shooter escaped in what has been described as a white Nissan vehicle, possibly driven by a getaway driver.

One of the sources said at least one of the men brought into custody was riding in a Nissan Sentra, one of the two vehicles police pulled over when bringing the pair into custody. The source didn't know that Nissan's color.

Police have insisted the teens in Hadiya's group who had gathered in the park were not involved in gangs. But police have been looking into whether the gunman may have mistaken them for rival gang members.

While police and neighbors have generally described Harsh Park and its immediate surroundings as safe, there has been an internal gang conflict brewing in the area between factions of the Gangster Disciples, police said. The two men being questioned Sunday are alleged members of the Gangster Disciples, sources said.

One of the two men has a previous weapons conviction, according to court records.

In addition to Hadiya's homicide, there have been at least three other shootings within blocks of Harsh Park so far this year, according to police records.

No charges have been filed against the men, who are being held at Area Central police headquarters on the South Side.

Mayor Rahm Emanuel personally called Hadiya's parents, Cleopatra Cowley-Pendleton and Nathaniel Pendleton, to inform them of the development, according to a source. Nathaniel Pendleton told the Tribune on Sunday night that he didn't want to say too much about the men being questioned because charges have not been filed.
“Right now, we're just happy that Chicago police have some leads and things are moving,” he said.

Shatira Wilks, a cousin of Hadiya's and a family spokesperson, said the development is a “good response” and better news than the family had Saturday.

Arrests and charges “will bring a small level of closure to the family, although (the shooter) still will be allowed to eat, drink, mingle,” Wilks said. “The thing about that is, Hadiya is no longer (able) to do so.”

On how Hadiya's family is doing, Wilks said, “Everyone keeps asking that. I don't know if you'll ever get an answer that we're feeling good or we're feeling fine.”

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The New Old Age: The Executor's Assistant

I’m serving as executor for my father’s estate, a role few of us are prepared for until we’re playing it, so I was grateful when the mail brought “The American Bar Association Guide to Wills and Estates” — the fourth edition of a handbook the A.B.A. began publishing in 1995.

This is a legal universe, I’m learning, in which every step — even with a small, simple estate that owes no taxes and includes no real estate or trusts — turns out to be at least 30 percent more complicated than expected.

If my dad had been wealthy or owned a business, or if we faced a challenge to his will, I would have turned the whole matter over to an estate lawyer by now. But even then, it would be helpful to know what the lawyer was talking about. The A.B.A. guide would help.

Written with surprising clarity (hey, they’re lawyers), it maps out all kinds of questions and decisions to consider and explains the many ways to leave property to one’s heirs. Updated from the third edition in 2009, the guide not only talks taxes and trusts, but also offers counsel for same-sex couples and unconventional families.

If you want to permit your second husband to live in the family home until he dies, but then guarantee that the house reverts to the children of your first marriage, the guide tells you how a “life estate” works. It explains what is taxable and what isn’t, and discusses how to choose executors and trustees. It lists lots of resources and concludes with an estate-planning checklist.

In general, the A.B.A. intends its guide for the person trying to put his or her affairs in order, more than for family members trying to figure out how to proceed after someone has died. But many of us will play both these parts at some point (and if you are already an executor, or have been, please tell us how that has gone, and mention your state). We’ll need this information.

Editor’s Note: More information about “The American Bar Association Guide to Wills and Estates” can be found here.

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Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

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Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

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Maker's Mark lowering proof to meet demand

In response to rapidly increasing demand for bourbon, Maker's Mark announced it is reducing the amount of alcohol in the spirit to keep pace with consumer demand.

In an email to its best customers, representatives of the brand said the entire bourbon category is "exploding" and demand for Maker's Mark is growing even faster. Some customers have even reported empty shelves in their local stores, it said.

After looking at "all possible solutions," the total alcohol by volume of Maker's Mark is being reduced by 3 percent. Representatives said the change will allow it to maintain the same taste while making sure there's "enough Maker's Mark to go around." It's working to expand its distillery and production capacity, too.

Maker's Mark, made by Deerfield-based Beam Inc., said it's done extensive testing to ensure the same taste. It says bourbon drinkers couldn't tell the difference. It also underscored the fact that nothing else in the production process has changed.

"In other words, we've made sure we didn't screw up your whisky," the note said.

Rob Samuels, chief operating officer and grandson of Maker's Mark Founder Bill Samuels, Sr., said this is a permanent decision that won’t be reversed when demand for bourbon slows down. Samuels said that bourbon has gone from the slowest growing spirits category to the fastest over the last 18 months, driven by growth overseas and demand from younger drinkers. An average bottle of Maker’s Mark takes six and half years to produce from start to finish, and since the company doesn’t buy or trade whiskey, it’s been impossible to keep up. 

The first bottle of Maker's Mark, with its signature red wax closure, was produced in 1958.

Beam is the country's second-largest spirits company by volume. It also makes Jim Beam, Sauza tequila and Pinnacle vodka. It's still dwarfed by industry-leading Diageo, the London-based maker of Smirnoff, Tanqueray, Captain Morgan and Johnnie Walker.

It's a tough time to take a risk with one of its oldest and most popular brands. Beam has promised that 25 percent of sales will come from new products, a difficult goal to attain but a critical one for investor confidence.The move met some backlash on social media sites, where some said they would boycott the bourbon if the company went ahead with its plans.

Many also complained that they'd rather see an increase in its price than a decrease in the alcohol. But observers say that by raising the price, Beam would have hurt itself by positioning Maker's Mark to compete against its own higher end brands like Basil Hayden's.

sbomkamp@tribune.com | Twitter: @SamWillTravel

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Obama coming to Chicago to 'talk about the gun violence'

President Barack Obama speaks during the House Democratic Issues Conference in Lansdowne, Va., Feb. 7, 2013. (JONATHAN ERNST/Reuters / February 10, 2013)

By Christi Parsons




Tribune reporter

2:43 p.m. CST, February 10, 2013

President Barack Obama will visit Chicago this week, following his wife here as the city finds itself in the national spotlight after the slaying of 15-year-old Hadiya Pendleton.

The White House said the visit will be among three trips Obama will make to press issues raised in his State of the Union speech on Tuesday.

"The president will travel to Chicago for an event amplifying some of the policy proposals included in the State of the Union that focus on strengthening the economy for the middle class and the Americans striving to get there," a White House official said.

"He’ll of course also talk about the gun violence that has tragically affected too many families in communities across Chicago and across the country," the official added.

On Saturday, Michelle Obama joined Mayor Rahm Emanuel and Gov. Pat Quinn at the funeral of Hadiya, who was gunned down about a mile from Obama's Kenwood home about a week after performing with the King College Prep band in Washington during inauguration festivities. She made no public statements.

Community activists in Chicago have been urging President Obama to speak out on Chicago violence. A petition on the White House website had called on the Obamas to attend Hadiya's funeral.
 
Hadiya’s death occurred during the deadliest January for Chicago homicides in a decade, and came on the heels of a homicide total last year that was the highest since 2008.
 
Chicago’s homicides in recent years are far below their annual total of more than 900 in the early 1990s. But the recent surge has caused alarm and brought national attention to the city. While Chicago was moving back over 500 homicides last year, the total fell below 500 in New York City – with about triple the population of Chicago.
 
Local officials have stepped up efforts against gun violence.

In Chicago, Mayor Rahm Emanuel has moved to strengthen laws for purchasing guns in the city. Cook County Board President Toni Preckwinkle also has made an effort to tighten loopholes in the law.

During his annual State of the State address last week, Gov. Pat Quinn mentioned Hadiya as an example of why the state needs tougher gun laws.

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For Families Struggling with Mental Illness, Carolyn Wolf Is a Guide in the Darkness

When a life starts to unravel, where do you turn for help?

Melissa Klump began to slip in the eighth grade. She couldn’t focus in class, and in a moment of despair she swallowed 60 ibuprofen tablets. She was smart, pretty and ill: depression, attention deficit disorder, obsessive-compulsive disorder, either bipolar disorder or borderline personality disorder.

In her 20s, after a more serious suicide attempt, her parents sent her to a residential psychiatric treatment center, and from there to another. It was the treatment of last resort. When she was discharged from the second center last August after slapping another resident, her mother, Elisa Klump, was beside herself.

“I was banging my head against the wall,” the mother said. “What do I do next?” She frantically called support groups, therapy programs, suicide prevention lines, anybody, running down a list of names in a directory of mental health resources. “Finally,” she said, “somebody told me, ‘The person you need to talk to is Carolyn Wolf.’ ”

That call, she said, changed her life and her daughter’s. “Carolyn has given me hope,” she said. “I didn’t know there were people like her out there.”

Carolyn Reinach Wolf is not a psychiatrist or a mental health professional, but a lawyer who has carved out what she says is a unique niche, working with families like the Klumps.

One in 17 American adults suffers from a severe mental illness, and the systems into which they are plunged — hospitals, insurance companies, courts, social services — can be fragmented and overwhelming for families to manage. The recent shootings in Newtown, Conn., and Aurora, Colo., have brought attention to the need for intervention to prevent such extreme acts of violence, which are rare. But for the great majority of families watching their loved ones suffer, and often suffering themselves, the struggle can be boundless, with little guidance along the way.

“If you Google ‘mental health lawyer,’ ” said Ms. Wolf, a partner with Abrams & Fensterman, “I’m kinda the only game in town.”

On a recent afternoon, she described in her Midtown office the range of her practice.

“We have been known to pull people out of crack dens,” she said. “I have chased people around hotels all over the city with the N.Y.P.D. and my team to get them to a hospital. I had a case years ago where the person was on his way back from Europe, and the family was very concerned that he was symptomatic. I had security people meet him at J.F.K.”

Many lawyers work with mentally ill people or their families, but Ron Honberg, the national director of policy and legal affairs for the National Alliance on Mental Illness, said he did not know of another lawyer who did what Ms. Wolf does: providing families with a team of psychiatrists, social workers, case managers, life coaches, security guards and others, and then coordinating their services. It can be a lifeline — for people who can afford it, Mr. Honberg said. “Otherwise, families have to do this on their own,” he said. “It’s a 24-hour, 7-day-a-week job, and for some families it never ends.”

Many of Ms. Wolf’s clients declined to be interviewed for this article, but the few who spoke offered an unusual window on the arcane twists and turns of the mental health care system, even for families with money. Their stories illustrate how fraught and sometimes blind such a journey can be.

One rainy morning last month, Lance Sheena, 29, sat with his mother in the spacious family room of her Long Island home. Mr. Sheena was puffy-eyed and sporadically inattentive; the previous night, at the group home where he has been living since late last summer, another resident had been screaming incoherently and was taken away by the police. His mother, Susan Sheena, eased delicately into the family story.

“I don’t talk to a lot of people because they don’t get it,” Ms. Sheena said. “They mean well, but they don’t get it unless they’ve been through a similar experience. And anytime something comes up, like the shooting in Newtown, right away it goes to the mentally ill. And you think, maybe we shouldn’t be so public about this, because people are going to be afraid of us and Lance. It’s a big concern.”

Her son cut her off. “Are you comparing me to the guy that shot those people?”

“No, I’m saying that anytime there’s a shooting, like in Aurora, that’s when these things come out in the news.”

“Did you really just compare me to that guy?”

“No, I didn’t compare you.”

“Then what did you say?”

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The fine line between legitimate businesses and pyramid schemes

Controversy is again casting a shadow over the multilevel marketing industry, as nutritional supplement company Herbalife Inc., which has thousands of distributors in the Chicago region, has been publicly called a pyramid scheme by a prominent investor — an allegation the company vigorously denies.

Meanwhile, a different multilevel marketer, Fortune Hi-Tech Marketing, was shut down in recent weeks after a lawsuit was brought by regulators and several states, including Illinois, alleging the company scammed consumers out of $169 million. The scheme affected an estimated 100,000 Americans, including some in Chicago, where it targeted Spanish-speaking consumers, the Federal Trade Commission alleged.

Most people outside the industry might have only a vague notion about multilevel marketing, also called network marketing and direct selling. It often involves personal sales of cosmetics, wellness products or home decor items — or as critics flippantly call it, "pills, potions and lotions" — usually sold through product parties hosted by friends or relatives.

For sellers, the companies offer the appeal of starting a business on the cheap with little training, working from home and being their own boss, if only for part-time money. Some might recruit friends and family to become sellers, which augments their own commissions and gives them a shot at the six-figure compensation many such marketing companies tout but few distributors attain.

The largest multilevel marketing companies, often known as MLMs, are household names: Avon, Mary Kay, Pampered Chef and Amway. MLMs have annual sales of about $30 billion, with about 16 million people in the United States selling their products, according to the industry group Direct Selling Association, which represents these firms and others.

The recent controversies might raise the question: What's the difference between a legitimate multilevel marketing company and an illegal pyramid scheme, in which only people who get in first — at the top of the pyramid-like structure — make money and everyone else is a dupe?

The harshest critics maintain there is no difference, that there's no such thing as a legitimate MLM and that the industry's secrets stay safe because of a cultlike mentality and a blind eye of regulators.

Jon M. Taylor, who was once a seller for an MLM company, said he has studied the industry for 18 years and analyzed more than 500 MLM companies. He maintains the website MLM-thetruth.com and offers a free e-book there.

"I have not yet found a good MLM — a good MLM is an oxymoron," Taylor said.

He said all MLM companies have the same flaw: They depend on endless chains of recruiting new members.  "There is no more unfair and deceptive practice than multilevel marketing," Taylor said.

Tracy Coenen, a forensic accountant and fraud investigator with Sequence Inc. in Chicago and Milwaukee, is author of the Fraud Files Blog. She is also a critic.

"Multilevel marketing companies are pyramid schemes that the government allows to operate," said Coenen. "The only difference is that Herbalife, or any multilevel marketing company, has a tangible product that they use to make their pyramid appear legitimate."

The Direct Selling Association says MLMs are legitimate businesses, and that the group has about 200 members carefully screened by the organization to ensure they are not pyramid schemes and don't use deceptive practices.

The Federal Trade Commission agrees there are legitimate MLMs. The difference between a legitimate business and pyramid scheme comes down to products.

If the company and its distributors make money primarily from the sale of products to end-users (and not boxes of product accumulating in a distributor's garage), it's OK.

By contrast, a pyramid scheme compensates those at the top of the pyramid with participation fees paid by those recruited at the bottom. It eventually collapses when the scheme can't recruit more people.

But identifying a pyramid scheme can be difficult because MLMs typically have product sales, along with recruitment fees and recruitment incentives.

"It gets cloudy when you have a situation where you have fees being paid for both," said Monica Vaca, assistant director of the FTC's division of marketing practices. "It's very nuanced."

While prosecuting an MLM can seem somewhat of a judgment call, cases have a common factor: deceptive promises about how much money distributors will earn, Vaca said.

In the Fortune Hi-Tech Marketing case filed last month, C. Steven Baker, director of the FTC's Midwest region, said, "These defendants were promising people that if they worked hard they could make lots of money. But it was a rigged game, and the vast majority of people lost money."

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