Advanced Breast Cancer May Be Rising Among Young Women, Study Finds

The incidence of advanced breast cancer among younger women, ages 25 to 39, may have increased slightly over the last three decades, according to a study released Tuesday.

But more research is needed to verify the finding, which was based on an analysis of statistics, the study’s authors said. They do not know what may have caused the apparent increase.

Some outside experts questioned whether the increase was real, and expressed concerns that the report would frighten women needlessly.

The study, published in The Journal of the American Medical Association, found that advanced cases climbed to 2.9 per 100,000 younger women in 2009, from 1.53 per 100,000 women in 1976 — an increase of 1.37 cases per 100,000 women in 34 years. The totals were about 250 such cases per year in the mid-1970s, and more than 800 per year in 2009.

Though small, the increase was statistically significant, and the researchers said it was worrisome because it involved cancer that had already spread to organs like the liver or lungs by the time it was diagnosed, which greatly diminishes the odds of survival.

For now, the only advice the researchers can offer to young women is to see a doctor quickly if they notice lumps, pain or other changes in the breast, and not to assume that they cannot have breast cancer because they are young and healthy, or have no family history of the disease.

“Breast cancer can and does occur in younger women,” said Dr. Rebecca H. Johnson, the first author of the study and medical director of the adolescent and young adult oncology program at Seattle Children’s Hospital.

But Dr. Johnson noted that there is no evidence that screening helps younger women who have an average risk for the disease and no symptoms. “We’re certainly not advocating that young women get mammography at an earlier age than is generally specified,” she said.

Expert groups differ about when screening should begin; some say at age 40, others 50.

Breast cancer is not common in younger women; only 1.8 percent of all cases are diagnosed in women from 20 to 34, and 10 percent in women from 35 to 44. However, when it does occur, the disease tends to be more deadly in younger women than in older ones. Researchers are not sure why.

The researchers analyzed data from SEER, a program run by the National Cancer Institute to collect cancer statistics on 28 percent of the population of the United States. The study also used data from the past when SEER was smaller.

The study is based on information from 936,497 women who had breast cancer from 1976 to 2009. Of those, 53,502 were 25 to 39 years old, including 3,438 who had advanced breast cancer, also called metastatic or distant disease.

Younger women were the only ones in whom metastatic disease seemed to have increased, the researchers found.

Dr. Archie Bleyer, a clinical research professor in radiation medicine at the Knight Cancer Institute at the Oregon Health and Science University in Portland who helped write the study, said scientists needed to verify the increase in advanced breast cancer in young women in the United States and find out whether it is occurring in other developed Western countries. “This is the first report of this kind,” he said, adding that researchers had already asked colleagues in Canada to analyze data there.

“We need this to be sure ourselves about this potentially concerning, almost alarming trend,” Dr. Bleyer said. “Then and only then are we really worried about what is the cause, because we’ve got to be sure it’s real.”

Dr. Johnson said her own experience led her to look into the statistics on the disease in young women. She had breast cancer when she was 27; she is now 44. Over the years, friends and colleagues often referred young women with the disease to her for advice.

“It just struck me how many of those people there were,” she said.

Dr. Donald A. Berry, an expert on breast cancer data and a professor of biostatistics at the University of Texas’ M. D. Anderson Cancer Center in Houston, said he was dubious about the finding, even though it was statistically significant, because the size of the apparent increase was so small — 1.37 cases per 100,000 women, over the course of 30 years.

More screening and more precise tests to identify the stage of cancer at the time of diagnosis might account for the increase, he said.

“Not many women aged 25 to 39 get screened, but some do, but it only takes a few to account for a notable increase from one in 100,000,” Dr. Berry said.

Dr. Silvia C. Formenti, a breast cancer expert and the chairwoman of radiation oncology at New York University Langone Medical Center, questioned the study in part because although it found an increased incidence of advanced disease, it did not find the accompanying increase in deaths that would be expected.

A spokeswoman for an advocacy group for young women with breast cancer, Young Survival Coalition, said the organization also wondered whether improved diagnostic and staging tests might explain all or part of the increase.

“We’re looking at this data with caution,” said the spokeswoman, Michelle Esser. “We don’t want to invite panic or alarm.”

She said it was important to note that the findings applied only to women who had metastatic disease at the time of diagnosis, and did not imply that women who already had early-stage cancer faced an increased risk of advanced disease.

Dr. J. Leonard Lichtenfeld
, deputy chief medical officer of the American Cancer Society, said he and an epidemiologist for the society thought the increase was real.

“We want to make sure this is not oversold or that people suddenly get very frightened that we have a huge problem,” Dr. Lichtenfeld said. “We don’t. But we are concerned that over time, we might have a more serious problem than we have today.”

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Bernanke urges Congress to avoid spending cuts

WASHINGTON — Federal Reserve Chairman Ben S. Bernanke urged Congress to avert the new spending cuts set to begin Friday, saying they not only are bad for the economy but fail to deal with the underlying problems of the nation's long-term debt.

"You've made progress in the very near term as far as the budget is concerned," Bernanke told members of the Senate on Tuesday, referring to measures now in place that are expected to reduce the government's red ink for the next several years.

"Where the problem still remains unaddressed is in the longer term. And so it doesn't quite match to be doing tough policies today when the real problem is a somewhat longer-term problem."

At the same time, the Fed chief laid out a case for why the central bank should keep priming the economy with monetary stimulus — despite dissent from within and concerns from outside that the Fed's easy-money policies may be doing more harm than good.

Critics said the Fed was encouraging excessive risk-taking and sowing seeds of future inflation.

In his semiannual testimony to Congress on monetary policy and the economy, Bernanke said the Fed's bond-buying and other efforts to hold down interest rates had helped the housing market and car sales.

The Fed should continue those policies given the weak job market and low rate of inflation, he said, noting that he didn't see much evidence of a stock market bubble.

Diane Swonk, chief economist at Mesirow Financial in Chicago, said of Bernanke's testimony, "Those worried that the Fed may end large-scale asset purchases prematurely should be reassured."

Bernanke's remarks cheered Wall Street as investors and analysts concluded that the Fed's campaign to stimulate economic growth was unlikely to be slowed or halted any time soon.

The Dow Jones industrial average rose 115.96 points, or 0.84%, to close at 13,900.13 on Tuesday. That recouped about half the losses the Dow suffered Monday after the Italian election results reignited worries about the Eurozone debt crisis and unsettled financial markets around the world.

Bernanke also pushed back against accusations that he was soft on inflation.

Responding to Sen. Bob Corker (R-Tenn.), who called Bernanke the "biggest dove" on inflation "since World War II," Bernanke said "my inflation record is the best of any Federal Reserve chairman in the postwar period, or at least one of the best, about 2% average inflation."

The record of the Bernanke years has been notably less stellar on unemployment. The Fed has a dual mandate — to control inflation and to maximize employment. Liberal critics have said Bernanke has done too little to stimulate the economy to bring unemployment down, even as conservatives have accused him of doing too much.

In his testimony, Bernanke repeated his oft-stated concerns about the hardships of millions of unemployed people, particularly those without work for more than six months. He also rebutted the complaint that the Fed's efforts to tackle the nation's high jobless rate have hurt savers, especially seniors, by keeping interest rates at record-low levels.

"The only way to get interest rates up for savers is to get a strong recovery. And the only way to get a strong recovery is to provide adequate support to the recovery," he said.

Right now, that recovery continues at a moderate pace, Bernanke said. He described the flattening of growth in the fourth quarter last year as a "pause" and said "available information suggests that economic growth has picked up again this year."

Although the Fed's stimulus programs drew considerable attention in the two-hour hearing, lawmakers were largely focused on their own problems, most notably the automatic spending cuts that are set to start taking effect Friday.

Several pressed Bernanke for his opinion on whether the economy would be better off with a more targeted round of budget cuts instead of the across-the-board effects of the so-called sequestration.

A more "thoughtful approach" would be better, Bernanke said. But he noted that in the short term, the "effect on growth would probably not be substantially different" if smarter budget cuts were put in place.

The basic problem is that any cut the size of the one planned — about $85 billion this year — probably would reduce economic growth, Bernanke said. He agreed with the Congressional Budget Office's estimate that the budget cuts would slice a sizable 0.6 percentage point from economic growth this year.

Combined with other deficit-reduction policies that already have been put into place, the budget changes are likely to slow economic growth by 1.5 percentage points this year, a significant figure given that the economy has been growing on average just over 2% a year.

"I am not in any way denying the importance of long-run fiscal stability," Bernanke said. "I just think that to some extent, the fiscal policy decisions being made are mismatched with the timing of the problem. The problem is a longer-term problem and should be addressed over a longer time frame."

don.lee@latimes.com

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A cosmic gift to L.A.

One night on Mt. Wilson about 1908, a short, powerfully built man with a handlebar mustache looked through the largest telescope in the world. What he saw transformed him, and would put Los Angeles at the forefront of a movement to make astronomy the people's science.

We may never know whether Col. Griffith J. Griffith saw the rings of Saturn or another celestial object with the then-new 60-inch reflector telescope, but we can be sure that it inspired his vision of a world-class observatory for the people of Los Angeles, allowing the masses a glimpse of the heavens.

"If all mankind could look through that telescope," he said that night, "it would change the world."

PHOTOS: Images of space

Griffith's contribution was not just his namesake observatory, but his rejection of the notion more common in his time that an observatory belonged on a remote mountaintop and should be restricted to scientists.

Griffith sought to make astronomy a public science — a notion embodied by Griffith Observatory, built near what is now the middle of the city, where it is accessible to anyone.

Or, as observatory Director Ed Krupp says: "Location, location, location."

The observatory has embraced this public-spirited view of science in other ways too: From its beginning in the 1930s, it was popularized by Hollywood, becoming a movie icon in its own right.

"Griffith had an inkling of the power of motion pictures and he wanted a motion picture theater of some kind incorporated into this public observatory," Krupp says. "The planetarium hadn't been invented at the time ... and so a movie theater was really the closest thing that he could imagine to an immersive experience in astronomy and in science."

The 1955 film "Rebel Without a Cause" made the observatory an international emblem of the city, but even before the building opened in 1935, it was used to film scenes in Gene Autry's bizarre cowboy-science fiction mash-up "The Phantom Empire," Krupp says. "At the time, the building seemed classic yet futuristic, and that made it a draw for science fiction," Krupp says. "It was, in fact, the palace of Ming the Merciless on the Planet Mongo in the Flash Gordon space opera."

Today, "its stardom attracts a steady stream of visitors from all over the planet," he says.

Griffith and the observatory were a main focus of a program titled "Making Astronomy Public, Los Angeles Style" held during the American Astronomical Society meeting held earlier this year in Long Beach.

Speakers at the meeting sought to expand the conventional view of Griffith, who donated about 3,000 acres for a city park in 1896, shot his wife in the head in 1903 and served two years in prison for assault with a deadly weapon.

He was a despised character in Los Angeles after the shooting, says Anthony Cook, an astronomer at the observatory who spoke at the conference. But although many have questioned whether the observatory was an attempt to buy back the goodwill of the city, Cook says the gift was sincere.

"He came out of San Quentin after two years really a reformed person. He stayed away from alcohol, he actually supported his ex-wife, any philanthropic enterprise that she wanted to do, helped his son maintain caring for her, and also turned his attentions to what he hoped would benefit everybody, which was by developing Griffith Park."

A onetime newspaper reporter who covered mining and became wealthy as an expert on the subject, Griffith remained a popularizer throughout his life. In drafting the observatory's detailed specifications, he had lengthy discussions with George Ellery Hale, who with Andrew Carnegie founded the first astrophysical telescope in Los Angeles, and Walter Adams, who later became director of the Mt. Wilson Observatory.

Although an observatory — or at least a tower with a telescope — had been suggested for the highest point in the park as early as 1897, it wasn't until Griffith's epiphany on Mt. Wilson that he broadened his vision into an ambitious plan for a large observatory and hall of science.

"Griffith was very civic-minded," Cook says. "He wanted to do things unifying the huge, diverse population settled in Los Angeles."

Before Griffith died in 1919, he established a generous trust fund to build an observatory in Griffith Park — when the time was right. Perhaps due to his lingering notoriety, nothing was done until the 1930s, when a handful of major U.S. cities began building the newly invented planetariums. But unlike those being constructed elsewhere, Los Angeles' planetarium would be a part of what is primarily an observatory.

A competition was held for the design of the building — Richard Neutra proposed a sleek Art Deco structure that raises tantalizing possibilities of what might have been — and prominent civic architects John C. Austin and Frederick M. Ashley were chosen.

The result was what the Smithsonian Institution's David DeVorkin — a former observatory tour guide — calls "the hood ornament of Los Angeles."

True to its public aspirations, the observatory emphasized showmanship. The facility's Hollywood connections meant it could tap skilled studio artists and technicians for exhibits and planetarium shows.

The philosophy from the beginning was to turn visitors into observers in a building full of scientific instruments, Krupp says. In fact, the $93-million renovation and expansion of the observatory in 2006 was guided by the concept that the entire building is an instrument.

Krupp returned to Griffith's famous quote on Mt. Wilson: "If all mankind could look through that telescope it would change the world."

It reflects Griffith's view that seeing into the cosmos could affect people personally, and perhaps transform society. That's what makes his observatory so special, Krupp says: "He wanted a place that would make the universe intelligible to the public through personal engagement with the sky."

larry.harnisch@latimes.com

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Global Health: After Measles Success, Rwanda to Get Rubella Vaccine

Rwanda has been so successful at fighting measles that next month it will be the first country to get donor support to move to the next stage — fighting rubella too.

On March 11, it will hold a nationwide three-day vaccination campaign with a combined measles-rubella vaccine, hoping to reach nearly five million children up to age 14. It will then integrate the dual vaccine into its national health service.

Rwanda can do so “because they’ve done such a good job on measles,” said Christine McNab, a spokeswoman for the Measles and Rubella Initiative, which will provide the vaccine and help pay for the campaign.

Rubella, also called German measles, causes a rash that is very similar to the measles rash, making it hard for health workers to tell the difference.

Rubella is generally mild, even in children, but in pregnant women, it can kill the fetus or cause serious birth defects, including blindness, deafness, mental retardation and chronic heart damage.

Ms. McNab said that Rwanda had proved that it can suppress measles and identify rubella, and it would benefit from the newer, more expensive vaccine.

The dual vaccine costs twice as much — 52 cents a dose at Unicef prices, compared with 24 cents for measles alone. (The MMR vaccine that American children get, which also contains a vaccine against mumps, costs Unicef $1.)

More than 90 percent of Rwandan children now are vaccinated twice against measles, and cases have been near zero since 2007.

The tiny country, which was convulsed by Hutu-Tutsi genocide in 1994, is now leading the way in Africa in delivering medical care to its citizens, Ms. McNab said. Three years ago, it was the first African country to introduce shots against human papilloma virus, or HPV, which causes cervical cancer.

In wealthy countries, measles kills a small number of children — usually those whose parents decline vaccination. But in poor countries, measles is a major killer of malnourished infants. Around the world, the initiative estimates, about 158,000 children die of it each year, or about 430 a day.

Every year, an estimated 112,000 children, mostly in Africa, South Asia and the Pacific islands, are born with handicaps caused by their mothers’ rubella infection.

Thanks in part to the initiative — which until last year was known just as the Measles Initiative — measles deaths among children have declined 71 percent since 2000. The initiative is a partnership of many health agencies, vaccine companies, donors and others, but is led by the American Red Cross, the United Nations Foundation, the Centers for Disease Control and Prevention, Unicef and the World Health Organization.

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Bank of America should just play the tape of disputed sales call

It's perhaps not so surprising that a Bank of America customer discovered recurring payments on his credit card bill for a service he swears he never signed up for. This kind of thing happens a lot.

What is surprising is that BofA told the customer to pound sand when he requested proof that he authorized the bank by phone to enroll him in its Credit Protection Plus program, which came with a $212.50 monthly charge.

BofA's stance: Trust us, we're right. We have nothing to prove.

This didn't sit well with Craig Chatfelter, 60, of Lake Hughes after he realized he'd paid more than $4,000 in Credit Protection Plus charges over 19 months — and, yes, he blames himself in part for not having kept closer tabs on his card statements.

"When you phone Bank of America, they say they record all calls," he told me. "OK, so play me the tape. Show me the proof that I really signed up for this.

"I'd never sign up for anything like this," Chatfelter insisted. "Never in a million years. I'm self-employed. I don't sign up for anything that comes with extra fees."

Betty Riess, a BofA spokeswoman, acknowledged that "this is not the type of experience we want customers to have."

However, she was less forthcoming when it came to addressing Chatfelter's reasonable request for proof of his enrollment in the bank's program. More on that in a moment.

Chatfelter, who works as a real estate appraiser, remembers being pitched by the bank for Credit Protection Plus, which can cancel up to 18 monthly credit card payments if you lose your job or are hospitalized.

"They had contacted me because there was an unauthorized payment on my account," he said. "They had me change my card number, which I did."

During the same call, a BofA service rep asked if Chatfelter wanted to sign up for credit protection. He said he declined the offer.

Months passed. It wasn't until last March that Chatfelter noticed the $212.50 charge on his bill. He accepts that he should have spotted it sooner, but said that, like many people, he seldom looked closely at his statement.

Whatever the case, once Chatfelter realized that he'd paid $4,037.50 for the unwanted service, he contacted the bank and canceled his membership in the program. Then he asked for a refund.

A service rep promptly offered to give back six months' worth of payments, or $1,275, which the bank did. The remainder would depend on the outcome of an investigation by the bank.

In April, Chatfelter was informed that "the records maintained by Bank of America indicate that you enrolled for this protection during a customer service call on Sept. 3, 2010."

The bank's records also indicated that Chatfelter was mailed a "welcome package" spelling out the details of the plan.

He wasn't impressed. Chatfelter contacted the bank again to reiterate that he'd never agreed to enroll in the program and that he didn't recall any "welcome package." He once again asked for all his money to be refunded.

In June, BofA sent a letter stating that its records indicated that Chatfelter enrolled in the credit-protection program on Sept. 6, 2010 — three days later than the bank stated in its prior correspondence.

The bank said that it had refunded $1,275 as "a one-time goodwill courtesy" and that "this adjustment is not to be construed at any time or for any purpose as an admission of liability on our part."

"We consider this matter settled," BofA said in its letter to Chatfelter.

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Brown's school funding plan draws mixed reactions

In the Anaheim City School District, where most students are low-income and struggling to learn English, teachers need special training, extra tutoring time and lots of visual materials to help their pupils achieve at grade level.

In the well-heeled Palos Verdes Peninsula Unified School District, poverty and limited English are not widespread problems. But officials there say their student needs include more expensive Advanced Placement classes to challenge them with college-level material in high school.

Who should get more state educational dollars? Last week, school districts got their first glimpse of how that question would be answered under Gov. Jerry Brown's proposed new funding formula: Anaheim would receive an estimated $11,656 per student annually; Palos Verdes would get $8,429 by the time the plan is fully implemented in seven years.

And that disparity draws distinctly different reactions.

"It's great news," said Darren Dang, Anaheim's assistant superintendent of administrative services. "Given our demographics, we'll be getting much-needed resources for our students."

But Lydia Cano, Palos Verdes' deputy superintendent of business services, said she believed the new scheme would shortchange her students. Disadvantaged students already receive a bigger share of state and federal dollars, she said.

"It's not fair," she said. "It will make the divide even bigger."

In the most significant change in four decades in how school dollars would be distributed, Brown is proposing to give all districts a base grant, then add an extra 35% of that for each student who is low-income, struggling with English or in foster care. If such students make up more than 50% of a district's population, another 35% supplement would be given.

The formula is part of Brown's proposed budget, which requires the Legislature's approval.

Under the proposal, the state would do away with most so-called categorical funding — which was earmarked for such specific uses as textbooks, remediation and low-income student aid. Instead, the money would be given directly to districts with no strings attached, to promote Brown's goal of greater local control.

The plan is aimed at reforming what most educators agree is an inequitable, burdensome and overly complex funding system. It is grounded in a 2008 report coauthored by state Board of Education President Michael Kirst that compiled research showing that parental income and English language ability are two critical factors in academic achievement.

Kirst argued that it was more important to help needy students gain grade-level skills than it is to provide college-level work for top-achieving high schoolers. "These are judgments about political priorities," he said.

About 20 states currently distribute extra dollars to needier students, including Rhode Island and New York, according to Margaret Weston of the Public Policy Institute of California. Poor districts in California already receive about 20% more in state and federal dollars than do affluent ones, but Brown's formula would increase that share, she said.

After four years of crippling budget cuts, the Los Angeles Unified School District is expected to receive an estimated boost of $820 more per student over the next two years under Brown's proposal. By 2020, funding is expected to grow to $11,993 per student from $7,509 last year.

L.A. Supt. John Deasy hailed the governor's proposal. "It's morally the right thing to do and educationally the sound thing to do," he said.

Like many administrators, however, Deasy cautioned that it would take a few years of increases to make up for the state's devastating reductions since 2007. New spending could possibly begin in 2015, he said, adding that he would recommend restorations in summer school, counselors, arts and support staff, among other things.

He also said he would make it the district's "policy and practice" to send the state dollars for disadvantaged students directly to their schools to help them. Some officials, such as Dang in Anaheim, have expressed concerns about possible pressure to use the money for salary hikes.

Over the next five years, per-student funding is expected to grow by about $2,700, the state estimates showed. All school districts and charter schools would receive at least as much money this year as last.

In Los Angeles County, funding estimates range from a low of $7,863 per student in the Hermosa Beach City School District to $13,569 for Animo Leadership High, an independent charter school in Inglewood.

Long Beach, San Bernardino City and Santa Ana unified all are estimated to receive funding boosts of $800 to $1,000 per student over the next two years. But the state projects an increase of less than half that for more affluent districts, such as San Marino, Palos Verdes Peninsula and Manhattan Beach unified.

Julie Boucher, San Marino's assistant superintendent of business services, said she was dismayed that Brown was not proposing to first restore general funding that the state has cut since 2007 before allocating additional dollars to specific students.

San Marino's state funding has been slashed by $17 million since 2008 — a total equivalent to 60% of its annual budget. The district has received $3.1 million annually from its nonprofit fundraising foundation and $5.1 million from a parcel tax but still has worked with its employee unions to freeze salaries, require larger contributions for healthcare, cut 26 teaching positions and shorten the school calendar with unpaid furlough days, she said.

"It does not seem equitable given the fact that we're all down," she said of Brown's proposal. "First we need to be made whole. Don't rob Peter to pay Paul."

During a recent visit to Ponderosa Elementary School in Anaheim, however, educators demonstrated how teaching lower-income English learners is more costly and time-consuming.

In Bernadette Grzechowiak's fifth-grade classroom, for instance, students were learning how to find main ideas in a passage about Native Americans. But unlike fluent English speakers, she said, those with limited language skills need far more visual aids — presented every 60 to 90 seconds, according to research. Her room is filled with graphics about colonial America and sentence frames to teach them academic language, such as "One detail that supports the main idea is…"

Grzechowiak said she learned those and other techniques from a district-paid teaching coach.

Ponderosa has also spent $10,000 on a science book series heavy on photos and graphics to help students learning English. And the school has two full-time teachers to provide extra support for struggling students and a bilingual community liaison to help educate the school's largely immigrant parents about their children's academic needs.

"Kids are so hungry and ready to learn," said Maria Villegas, the principal. "It just takes time, opportunity and having a great staff."

teresa.watanabe@latimes.com

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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

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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.

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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.

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'Silver Linings' leads Spirit Awards with 4 prizes

SANTA MONICA, Calif. (AP) — The oddball romance "Silver Linings Playbook" was named best picture Saturday at the Spirit Awards honoring independent film, Hollywood's last pre-game show before the Academy Awards.

"Silver Linings Playbook" led with four wins, including best actress for Jennifer Lawrence and director and screenplay for David O. Russell.

Lawrence is the best-actress favorite at Sunday's Oscars for her role as a young widow in a shaky new relationship with a man fresh from a mental hospital.

"The Sessions" earned two acting prizes, for John Hawkes as a man in an iron lung hoping to lose his virginity and Helen Hunt as the sexual surrogate helping him through it.

The award for best supporting actor went to Matthew McConaughey as a flamboyant stripper in "Magic Mike."

In barely three years, Lawrence has risen from a relative unknown to superstar hero of "The Hunger Games" franchise and potential Oscar winner at just 22. Her quick ascent began with another Spirit Awards nominee, "Winter's Bone," which won the top honor at the 2010 Sundance Film Festival and earned Lawrence her first Oscar nomination.

Lawrence said she loves independent film for the thrill of freezing with the crew in the middle of the night because they all believe in a story.

"That's why I do what I do. I love that feeling. I mean, I'd rather be warm," Lawrence said.

McConaughey, also a best-actor nominee at the Spirit Awards for "Killer Joe," is a Hollywood A-lister but a relative newcomer to key film awards.

"I had to take my pants off to win a trophy," McConaughey said, adding that five of his last six films were independent productions and the "most creative fun of my acting career, hands down."

Hunt, also nominated for supporting actress at the Oscars, was coy backstage about what she'll be doing before Hollywood's big night.

"I will be eating breakfast and getting dressed," Hunt said of her day at the Oscars, where she previously won as best actress for "As Good as It Gets." ''I don't have any plans, but I'm going to put a dress on."

"Silver Linings Playbook" filmmaker Russell noted that his initial trip to the Spirit Awards was 19 years ago, when he won the prize for best first film for "Spanking the Monkey."

His son Matthew, an inspiration for "Silver Linings" because of his battle with bipolar disorder, was a year old at the time, and was in the crowd to watch his father claim his awards.

"He gave me this movie, so I want to thank him, Matthew, for this movie," Russell said.

"Silver Linings Playbook" centers on the relationship between a man (Bradley Cooper) just out of a mental hospital and a young widow (Lawrence). The film is up for best picture at the Oscars, where Russell is nominated for adapted screenplay and director and Cooper and Lawrence are in the running for the lead-acting honors.

The film's producers said they had expected fellow Oscar best-picture nominee "Beasts of the Southern Wild" to win the top Spirit Award and that they have no expectations of winning the big prize at the Oscars, where Ben Affleck's CIA thriller "Argo" is the best-picture favorite.

But they gushed praise for filmmaker Russell.

"Your brilliance as a filmmaker is without peer. Your spirit of collaboration knows no bounds," said producer Jonathan Gordon.

Russell said backstage that he was thrilled to go the Oscars, or as he called it, the "World Series," but he also has no illusions about winning there.

"Thank God, Monday, I'm going back to work," Russell said. "That's how you avoid the postpartum depression."

Hawkes won the supporting-actor Spirit Award two years ago as Lawrence's co-star in "Winter's Bone," a role that also earned him an Oscar nomination. He missed out on an Oscar slot this time but said that independent film is a "big part of my life, and I'm really happy for that. ... 'The Sessions' is a truly independent film made for very little money and shot very quickly."

Austrian writer-director Michael Haneke's old-age love story "Amour" won for best international film, a possible prelude to the Oscars, where his film is the favorite to win the foreign-language prize and is nominated for best picture.

"I have the impression I am the oldest man in the room," the 70-year-old Haneke joked in a room filled with young filmmakers.

The ceremony was hosted by Adam Samberg at the awards' usual venue, a tent along the beach in Santa Monica just west of Los Angeles. It is presented by Film Independent, a group of filmmakers, industry professionals and cinema buffs. The show was aired later Saturday on IFC.

Among other winners:

— Best first film: "The Perks of Being a Wallflower," from director Stephen Chbosky, who adapted the picture from his novel.

— First screenplay: "Safety Not Guaranteed," Derek Connolly.

— Cinematography: "Beasts of the Southern Wild," Ben Richardson.

— Documentary: "The Invisible War," directed by Kirby Dick.

— John Cassavetes Award for best film made for less than $500,000: "Middle of Nowhere," directed by Ava DuVernay.

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AP Movie Writer Christy Lemire contributed to this report.

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