Well: Think Like a Doctor: A Confused and Terrified Patient

The Challenge: Can you solve the mystery of a middle-aged man recovering from a serious illness who suddenly becomes frightened and confused?

Every month the Diagnosis column of The New York Times Magazine asks Well readers to sift through a difficult case and solve a diagnostic riddle. Below you will find a summary of a case involving a 55-year-old man well on his way to recovering from a series of illnesses when he suddenly becomes confused and paranoid. I will provide you with the main medical notes, labs and imaging results available to the doctor who made the diagnosis.

The first reader to figure out this case will get a signed copy of my book, “Every Patient Tells a Story,” along with the satisfaction of knowing you solved a case of Sherlockian complexity. Good luck.

The Presenting Problem:

A 55-year-old man who is recovering from a devastating injury in a rehabilitation facility suddenly becomes confused, frightened and paranoid.

The Patient’s Story:

The patient, who was recovering from a terrible injury and was too weak to walk, had been found on the floor of his room at the extended care facility, raving that there were people out to get him. He was taken to the emergency room at the Waterbury Hospital in Connecticut, where he was diagnosed with a urinary tract infection and admitted to the hospital for treatment. Doctors thought his delirium was caused by the infection, but after 24 hours, despite receiving the appropriate antibiotics, the patient remained disoriented and frightened.

A Sister’s Visit:

The man’s sister came to visit him on his second day in the hospital. As she walked into the room she was immediately struck by her brother’s distress.

“Get me out of here!” the man shouted from his hospital bed. “They are coming to get me. I gotta get out of here!”

His brown eyes darted from side to side as if searching for his would-be attackers. His arms and legs shook with fear. He looked terrified.

For the past few months, the man had been in and out of the hospital, but he had been getting better — at least he had been improving the last time his sister saw him, the week before. She hurried into the bustling hallway and found a nurse. “What the hell is going on with my brother?” she demanded.

A Long Series of Illnesses:

Three months earlier, the patient had been admitted to that same hospital with delirium tremens. After years of alcohol abuse, he had suddenly stopped drinking a couple of days before, and his body was wracked by the sudden loss of the chemical he had become addicted to. He’d spent an entire week in the hospital but finally recovered. He was sent home, but he didn’t stay there for long.

The following week, when his sister hadn’t heard from him for a couple of days, she forced her way into his home. There she found him, unconscious, in the basement, at the bottom of his staircase. He had fallen, and it looked as if he may have been there for two, possibly three, days. He was close to death. Indeed, in the ambulance on the way to the hospital, his heart had stopped. Rapid action by the E.M.T.’s brought his heart back to life, and he made it to the hospital.

There the extent of the damage became clear. The man’s kidneys had stopped working, and his body chemistry was completely out of whack. He had a severe concussion. And he’d had a heart attack.

He remained in the intensive care unit for nearly three weeks, and in the hospital another two weeks. Even after these weeks of care and recovery, the toll of his injury was terrible. His kidneys were not working, so he required dialysis three times a week. He had needed a machine to help him breathe for so long that he now had to get oxygen through a hole that had been cut into his throat. His arms and legs were so weak that he could not even lift them, and because he was unable even to swallow, he had to be fed through a tube that went directly into his stomach.

Finally, after five weeks in the hospital, he was well enough to be moved to a short-term rehabilitation hospital to complete the long road to recovery. But he was still far from healthy. The laughing, swaggering, Harley-riding man his sister had known until that terrible fall seemed a distant memory, though she saw that he was slowly getting better. He had even started to smile and make jokes. He was confident, he had told her, that with a lot of hard work he could get back to normal. So was she; she knew he was tough.

Back to the Hospital:

The patient had been at the rehab facility for just over two weeks when the staff noticed a sudden change in him. He had stopped smiling and was no longer making jokes. Instead, he talked about people that no one else could see. And he was worried that they wanted to harm him. When he remained confused for a second day, they sent him to the emergency room.

You can see the records from that E.R. visit here.

The man told the E.R. doctor that he knew he was having hallucinations. He thought they had started when he had begun taking a pill to help him sleep a couple of days earlier. It seemed a reasonable explanation, since the medication was known to cause delirium in some people. The hospital psychiatrist took him off that medication and sent him back to rehab that evening with a different sleeping pill.

Back to the Hospital, Again:

Two days later, the patient was back in the emergency room. He was still seeing things that weren’t there, but now he was quite confused as well. He knew his name but couldn’t remember what day or month it was, or even what year. And he had no idea where he was, or where he had just come from.

When the medical team saw the patient after he had been admitted, he was unable to provide any useful medical history. His medical records outlined his earlier hospitalizations, and records from the nursing home filled in additional details. The patient had a history of high blood pressure, depression and alcoholism. He was on a long list of medications. And he had been confused for the past several days.

On examination, he had no fever, although a couple of hours earlier his temperature had been 100.0 degrees. His heart was racing, and his blood pressure was sky high. His arms and legs were weak and swollen. His legs were shaking, and his reflexes were very brisk. Indeed, when his ankle was flexed suddenly, it continued to jerk back and forth on its own three or four times before stopping, a phenomenon known as clonus.

His labs were unchanged from the previous visit except for his urine, which showed signs of a serious infection. A CT scan of the brain was unremarkable, as was a chest X-ray. He was started on an intravenous antibiotic to treat the infection. The thinking was that perhaps the infection was causing the patient’s confusion.

You can see the notes from that second hospital visit here.

His sister had come to visit him the next day, when he was as confused as he had ever been. He was now trembling all over and looked scared to death, terrified. He was certain he was being pursued.

That is when she confronted the nurse, demanding to know what was going on with her brother. The nurse didn’t know. No one did. His urinary tract infection was being treated with antibiotics, but he continued to have a rapid heart rate and elevated blood pressure, along with terrifying hallucinations.

Solving the Mystery:

Can you figure out why this man was so confused and tremulous? I have provided you with all the data available to the doctor who made the diagnosis. The case is not easy — that is why it is here. I’ll post the answer on Friday.

Friday Feb. 8 4:13 p.m. | Updated Thanks for all your responses. You can read about the winner at “Think Like a Doctor: A Confused and Terrified Patient Solved.”

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Rules and Regulations: Post your questions and diagnosis in the comments section below.. The correct answer will appear Friday on Well. The winner will be contacted. Reader comments may also appear in a coming issue of The New York Times Magazine.

Correction: The patient’s eyes were brown, not blue.

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Execs off the hook at S&P

You may have heard last week about a couple of big lawsuits brought by federal and state governments, alleging that the credit rating agency Standard & Poor's concocted a fraudulent scheme that contributed to trillions of dollars in investment losses and the cratering of pretty much the entire world financial system.

Those are serious charges, and the federal government's demand for $5 billion in penalties isn't peanuts. Yet there's something bloodless about the lawsuits, for the simple reason that they don't point the finger at any particular person who was responsible for these dastardly doings.

For example, you won't find the name Harold McGraw III anywhere in the court papers. Who?

McGraw was chairman, chief executive and president of McGraw-Hill, S&P's parent company, in the period at issue, 2004 to 2007. (He's still in place today.) Did he profit from S&P's wrongdoing? Let's assume so: he not only owns 10 million company shares but received $44.5 million in compensation over those years, according to corporate disclosures. Did he know or care about what was happening at S&P? One would hope so because it was by far the most profitable domain in his empire, contributing an average of more than 70% of McGraw-Hill's operating profit.

Harold McGraw's largest business unit engaged in an "egregious" fraud that "goes to the very heart" of the financial crisis, Atty. Gen. Eric H. Holder Jr. said. But prosecutors have made no effort to hold him, or anyone else, directly responsible for what was done at S&P.

These new lawsuits replay the only story uglier than the financial meltdown itself, which is the government's pathetic record at prosecuting the crimes that produced it.

For companies can't do things like manipulate numbers on spreadsheets, lie about their "independent" judgment, and fire employees who try to rectify such errors. Only people can.

In accordance with the government's standard approach to financial crisis justice, no flesh-and-blood people are on the hook in these cases. Only companies, which (more's the pity) can't be put in jail for their wrongdoing. Yet it's only people who can profit from such conniving.

The lawsuits name a few executives here and there, and identify others by initials (presumably they're the ones who cooperated with regulators). But the overall impression is that something happened at S&P, and some individuals were involved, but they were all swept up in some inchoate historical event that requires, nevertheless, that S&P fork over $5 billion. That's what makes reading these legal papers resemble getting through all of "War and Peace" without ever meeting Napoleon.

"We've had the greatest explosion of elite white collar crime in history and the weakest criminal justice response," observes William K. Black, who helped put financial wrongdoers behind bars as a thrift regulator after the savings-and-loan collapse of the 1980s. "There's reason to believe they're not unrelated."

To be fair, the S&P lawsuits — they include the federal case filed in Los Angeles and actions by more than a dozen states, including California — amount to a more aggressive regulatory attack than any mounted thus far. Their target is an indisputably major player in the meltdown.

The $5-billion penalty sought by the U.S. Justice Department would be a pittance compared with the damage done to investors and the general economy by S&P. But as the equivalent of about six years of corporate profits, it would be enough to reduce McGraw-Hill's Manhattan headquarters to a smoking hole in the ground — if you think there's any chance the government can make the claim stick. California Atty. Gen. Kamala Harris seeks redress of at least $1.4 billion in investment losses incurred by the California Public Employees' Retirement System and other state agencies on S&P-rated securities.

The essence of the governments' fraud claim is that S&P held itself out to be an independent and objective appraiser of investment securities, especially the residential mortgage-backed bonds that were hot investment vehicles during the housing bubble. But it wasn't.

To a great extent, the investors who took S&P at its word knew they were acting on faith. The firm, like the other major credit agencies, Moody's and Fitch, were paid for their ratings by the investment banks issuing the securities, a flagrant conflict of interest. S&P charged the bankers up to $750,000 to rate really oddball paper.

The lawsuits allege that as early as 2004, S&P began tailoring its ratings to keep those clients happy by exaggerating the safety of their securities. S&P allegedly allowed issuing bankers to browbeat analysts for better ratings. The firm delayed or suppressed changes in its analytical software that would reveal that huge swaths of the high-rated deals were heading south. It cheaped out on hiring enough analysts to keep up with the mounting need for accurate updates. Analysts emailed each other with complaints about the corrupting of their objectivity, while executives signaled, essentially, that they should put a sock in it.

Nevertheless, McGraw-Hill's annual reports every year from 2004 through 2007 touted S&P's stature as a "provider of independent credit ratings," even though it was then allegedly tailoring its procedures for the issuers' benefit.

When the firm could no longer delay the inevitable, it downgraded hundreds of billions of dollars worth of mortgage securities in a torrent — 9,000 in the second half of 2007, an additional 6,300 in early 2008, including some deals it had graced with AAA ratings only a few months before. Many investors were bound by law to rely on these ratings in choosing securities for their portfolios. The flood of downgrades made a bad market much, much worse.

None of this is news. The role of the rating agencies in the meltdown was documented thoroughly by the Financial Crisis Inquiry Commission, headed by former California Treasurer Phil Angelides, in January 2011 and by a Senate subcommittee under Sen. Carl Levin (D-Mich.) a few months later. Any aficionado of our financial train wreck can repeat many of the emails cited in the lawsuit from memory.

S&P's response to the lawsuits is standard: The firm wasn't cooking its numbers but was relying on "the same ... mortgage data available to the rest of the market," it said last week. Yet S&P held itself out to be experts — if all it was doing was repeating what everybody else knew, than who needed its opinion? Any investment bank could have dragged any nimrods off the street and gotten an opinion for —I'd wager —a lot less than $750,000.

No one should doubt that the federal and state prosecutors poured their souls into these cases. The California lawsuit followed nearly two years of investigation, interrogation and compiling of documents. And there are hints that investigations of Moody's may be continuing.

But the key question sidestepped by the new lawsuits is why no individuals are being brought to book for what were, in every way, the plots and designs of individual people, acting to slake their own greed and ambition. This is another example of what UC Irvine criminologist Henry Pontell calls "the trivialization of criminal fraud."

"This is essentially a criminal fraud case," Pontell told me. "The only difference between civil and criminal cases is that they [the prosecutors] can spend a lot less on civil cases because the burden of proof is lower."

That speaks to the impoverishment of our white collar prosecutorial corps since 9/11, when the best and brightest were diverted to anti-terrorism cases and not replaced. By normalizing major corporate fraud cases as merely matters for civil fines, however, this trend has destroyed the deterrent effect of the justice system.

"Persuasive anecdotal evidence exists that the prospect of criminal penalties is an effective deterrent" to wrongdoing in the corporate suite, Pontell said. "Upper-class businesspersons fear shame and fear incarceration. Paying fines? No problem — that's a cost of doing business. If anything, it's anti-deterrence."

That's true. It's a good bet that after fighting the government to a draw, McGraw-Hill will settle these lawsuits for much less than $5 billion and S&P will retain its plausible deniability in the next meltdown. The deterrent effect will be zero.

What would really deter wrongdoing? It would be an outcome that prompts a CEO of the future to instruct his underlings: "You better be on the straight and narrow, because the last thing in the world I want is to end up in jail like Harold McGraw."

That might work.

Michael Hiltzik's column appears Sundays and Wednesdays. Reach him at mhiltzik@latimes.com, read past columns at latimes.com/hiltzik, check out facebook.com/hiltzik and follow @latimeshiltzik on Twitter.

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FBI searches Las Vegas home of fugitive

Federal and local authorities served a search warrant at the Las Vegas home of an ex-police officer sought in connection with a series of shootings in Southern California, but said the suspect was not located.

FBI spokeswoman Laura Eimiller confirmed agents and Las Vegas police searched the home Thursday as part of the ongoing investigation into Christopher Jordan Dorner, 33, but did not elaborate as to what was recovered. The surrounding neighborhood was cleared as a precaution, she said.

No one was home at the time, Eimiller said.

PHOTOS: Manhunt for ex-LAPD officer

Several law enforcement agencies are involved in the ongoing manhunt for Dorner and alerts have been issued all across California and in Nevada, warning Dorner was considered "armed and extremely dangerous." Dorner was believed to be carrying multiple weapons, including an assault rifle.

In California, a SWAT team clad in military fatigues spent Thursday afternoon combing the mountain community of Big Bear after Dorner's burned-out truck was found on a forest road. Authorities were going door-to-door and checking all vehicles coming and going from the mountain.

Dorner, who was fired from the LAPD in 2009, is suspected of shooting three police officers, one of whom died, in Riverside County early Thursday.

PHOTOS: Manhunt for ex-LAPD officer

He also is suspected of killing a couple who were found shot in a car in Orange County earlier this week. One of the victims was the daughter of a former LAPD captain named in a lengthy online manifesto that law enforcement officials attributed to Dorner.

The Los Angeles Police Department had dispatched units across the region to protect at least 40 officers and others named in the document, which threatened "unconventional and asymmetrial warfare" against police.

Dorner received awards for his expertise with a rifle and pistol, according to military records obtained by The Times. He received an Iraq Campaign Medal and was a member of a mobile inshore undersea warfare unit.

Riverside Police Chief Sergio Diaz, calling the attack on his officers a "cowardly ambush," said Dorner is suspected of opening fire with a rifle about 1:30 a.m. Thursday as he pulled up to two police officers waiting at a traffic light.

The attack was carried out about 20 minutes after Dorner wounded an LAPD officer in a shooting in nearby Corona, police said.

Early Thursday, two women delivering the Los Angeles Times in Torrance were shot by Los Angeles police who were headed to the home of a police captain named in the manifesto.

The women, shot in the 19500 block of Redbeam Avenue, were taken to area hospitals, Torrance Police Lt. Devin Chase said. One suffered a minor wound, and the other was struck twice and listed in stable condition, LAPD Chief Charlie Beck told reporters.

"Tragically," Beck said, "we believe this is a case of mistaken identity."

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Ex-LA cop, murder suspect sent CNN anchor parcel

LOS ANGELES (AP) — Law enforcement officials are inspecting a package CNN's Anderson Cooper received from a former Los Angeles police officer who allegedly killed three in a shooting spree.

CNN spokeswoman Shimrit Sheetrit said Thursday that a parcel containing a note, a DVD and a bullet hole-riddled memento were sent by Christopher Dorner and addressed to Cooper's office.

LAPD Cmdr. Andrew Smith says LAPD robbery-homicide detectives will inspect the package for clues.

The package arrived Feb. 1, days before the first two killings Dorner is accused of.

It contained a note on it that read, in part, "I never lied."

Dorner was fired from the LAPD in 2008 for making false statements.

A coin typically given out as a souvenir by the police chief was also in the package, and riddled with bullet holes.

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Daniel Doctoroff Enlists Bloomberg in A.L.S. Research

Nicole Bengiveno/The New York Times

Daniel L. Doctoroff, second from right, chief executive of Bloomberg L.P., at Columbia University’s Motor Neuron Center.

Daniel L. Doctoroff watched in pain as his father developed a limp one day, was found to have Lou Gehrig’s disease, and died within two years. Then an uncle also developed symptoms of the same disease, and died soon after.

Now Mr. Doctoroff, like many other relatives of Lou Gehrig’s disease victims, worries that he or his children may someday develop the illness.

But unlike many, he is in a position to try to do something about it. At a time when scientists are making rapid gains in the genetic roots of many diseases, Mr. Doctoroff, a former deputy mayor and private equity investor, is working with Mayor Michael R. Bloomberg and a private equity director, David M. Rubenstein, to put together a $25 million package of donations to support research to try to cure this rare and usually fatal degenerative neurological illness.

“This is a devastating disease,” Mr. Doctoroff said in an interview this week in the glass high-rise on the Upper East Side that houses Bloomberg L.P., the mayor’s media and financial information company, where Mr. Doctoroff is now chief executive. “Up to now, there’s been basically no hope. I have the resources, and I think it’s my obligation to do that.”

The gift is part of a wave of investment based on the booming field of genomic analysis. The money will go to a project called Target A.L.S., a consortium of at least 18 laboratories, including ones at Columbia and at Johns Hopkins, the mayor’s alma mater, working to find biological “targets,” like gene mutations, and the biochemical changes they cause in the spinal cord, that could be used to test potential drug therapies for the disease, formally known as amyotrophic lateral sclerosis.

It comes on top of a previous $15 million gift by Mr. Doctoroff, Bloomberg Philanthropies and other donors. By comparison, the National Institutes of Health, the single largest source of research financing for the disease, expects to give $44 million in 2013.

This is not Mr. Bloomberg’s first time supporting charitable causes that are dear to his close associates. The mayor quietly gave at least $1 million to put the name of his top deputy mayor, Patricia E. Harris, on a new academic center at her alma mater, Franklin & Marshall College in Lancaster, Pa.

Mr. Doctoroff said the conversation about A.L.S. in which he got Mr. Bloomberg involved “lasted about five seconds.” He declined to say what share of the money each of the three donors was giving.

Mr. Rubenstein, a founder of the Carlyle Group, said Wednesday that he had long been fascinated with A.L.S. because of its association with Gehrig, the baseball player who died of it. He wondered why more than 70 years later so little progress had been made in treating it.

He said he jumped at the chance to join in because he thought that A.L.S. research was underfinanced owing to the rarity of the disease, and that even a small amount of money could make a big difference.

In the Bloomberg administration, where he was deputy mayor for economic development and rebuilding from 2002 to 2008, Mr. Doctoroff was best known for his dogged — and ultimately dashed — attempt to bring the 2012 Olympics to New York City. (London got the Games.) Now that he has left City Hall, he no longer rides his bike to work — he says the 2.6-mile route from the Upper West Side to his office is too short — but he sometimes runs.

At Bloomberg, he sits in front of a conference room with walls of hot-pink glass, while carp swim in a giant fish tank nearby. He keeps no family photos or other personal mementos on his desk, and talking about his family’s disease history does not seem easy for him.

A.L.S. is rare, with about 2 new cases diagnosed a year per 100,000 people, according to the A.L.S. Association. A vast majority of cases are “sporadic,” in people who have no family history, while only 5 to 10 percent of cases are inherited. There appear to be no racial, ethnic or socioeconomic predispositions.

There is some speculation about environmental factors, like exposure to toxic chemicals and high physical activity that athletes might endure, “but nothing firm,” said Christopher E. Henderson, a researcher at Columbia and the Target A.L.S. project’s scientific director. Some researchers suspect a link between A.L.S. and head trauma suffered by professional football players.

Mr. Doctoroff’s father, Martin, an appeals court judge in Michigan, received the diagnosis in 2000 and died in 2002. One of Martin Doctoroff’s brothers, Michael, was found to have the disease in 2009 and died in 2010.

“When my father contracted the disease and passed away, it was very easy to chalk it up to bad luck,” Mr. Doctoroff said. “When my uncle got it, it obviously had broader implications.”

Given his family history, Mr. Doctoroff estimates that there is a 50-50 chance that he has the gene, C9orf72, that could lead to A.L.S. But he has chosen not to be tested, which would have implications not just for him but for his three children. “It’s very personal, but I’m not sure that I want to know,” he said.

Even when family members develop the disease, it can occur at vastly different ages, so he could still be in suspense even after testing. “Assuming you have the gene, you don’t know when you would actually get the disease,” he said. His uncle was 71. His father was 66. He is now 54.

Sheelagh McNeill contributed reporting.

This article has been revised to reflect the following correction:

Correction: February 8, 2013

Because of an editing error, a picture caption on Thursday with an article about efforts by Daniel L. Doctoroff, a former deputy mayor of New York, to research Lou Gehrig’s disease misstated his title at Bloomberg L.P. in some editions. He is the chief executive, not the executive director.

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South Korea firm aims for the sky in L.A.

Ambitious South Korean enterprises continue to make noise on the global economic stage.

Electronics giant Samsung is giving Apple fits in markets across the globe with its hot-selling smartphones and tablets. Seoul-based Hyundai and Kia have been among the world's fastest-growing automakers in recent years. Portly singer Psy put South Korea on the pop culture map with his monster hit “Gangnam Style,” which has become the most popular video of all time on YouTube with nearly 1.3 billion views.

So it was only natural that South Korea's top airline, Korean Air, on Thursday took the wraps off its design for a dramatic, skyline-changing tower for downtown Los Angeles. The $1-billion skyscraper is to become the tallest building west of the Mississippi River — and a symbol of South Korea's status as an up-and-coming economic powerhouse.

The 73-story hotel and office building will include 900 guest rooms, double-decker elevators and an observation deck that will afford views of the Pacific Ocean. Slated to replace the old Wilshire Grand Hotel at Wilshire Boulevard at Figueroa Street, the new building will be slightly taller than the nearby U.S. Bank Tower, which has held the title of tallest building west of Chicago since 1989.

Originally planned as two smaller towers when it was announced four years ago, the Korean Air plan has morphed into a single tower that will give the Seoul company bragging rights to the highest skyscraper on the West Coast.

Experts said that's in keeping with South Korea's hard-charging business ethos. The skyscraper, currently dubbed the Wilshire Grand, is an outgrowth of a competitive corporate culture that has come to dominate the South Korean economy over the last 30 years, according to UC Riverside Ethnic Studies professor Edward Taehan Chang.

After the nation endured poverty, dictatorship and political unrest during much of the 20th century, attaining superlatives has become part of the country's fabric, Chang said. Corporations strive to dominate their industries, while younger generations take pride in the near universality of South Korea's popular culture.

“They always want to reach for No. 1 status,” Chang said. “The rapid economic growth has been about striving for the top spot.”

Korean Air is already at work dismantling the closed 1950s-era Wilshire Grand Hotel to make way for the glass-clad tower, which is expected to be completed in 2017. Korean Air has provided airline service to Los Angeles for more than 40 years and has owned the Wilshire Grand since 1989.

Korean Air is the flagship company of Hanjin Group, one of South Korea's largest conglomerates. Hanjin has interests in land, sea and air transportation as well as construction, heavy industry, finance and information services. A high-end hotel fits well with Korean Air's operations in Los Angeles: The company makes parts for airplanes, flies the planes here as the busiest Asian carrier at Los Angeles International Airport, runs travel agencies that book the tickets and operates a catering business that serves the food on the planes.

“The new Wilshire Grand is an investment that makes sense, and we are excited to continue our relationship with this great city,” Korean Air Chairman Y.H. Cho said Thursday at the offices of AC Martin Partners, the project's architect.

The sail-shaped skyscraper will light up at night and dwarf many of its neighbors. Most of the building will be devoted to a hotel, though an operator has yet to be named. Arriving guests would be whisked by high-speed elevators to the “sky lobby” on the 70th floor for check-in.

According to the plan, the 71st floor will be a restaurant. The floor above that will house window-washing gear and engineering equipment, clearing the top floor for an infinity swimming pool and observation deck.

Near street level will be about three floors of restaurants and shops, topped by 30 floors of offices for rent. Elevators will be double-decked, carrying two stacked cabs of passengers for additional capacity during peak hours.

Perched at the very top of the building will be a decorative “crown” and a mast-like spire that will have embedded LED lighting that can change colors. The display will be eye-catching and visible for miles, but it will not be used for advertising, said Christopher Martin, chief executive of AC Martin.

“It's not Coke bottles, it's art,” he said.

With the spire reaching to 1,100 feet, the Wilshire Grand would become one of the tallest structures in the country, surpassing the 1,046-foot Chrysler Building in New York, which has 77 stories.

The contemporary design of the Wilshire Grand, with its floor-to-ceiling windows, is intended to set it apart from surrounding granite-clad office towers, said architect David Martin, who is Christopher Martin's cousin.

He hopes the building, which is to include 400,000 square feet of office space, will reflect the city better than the last generation of skyscrapers does. The Wilshire Grand, for instance, will have operable windows in its guest rooms and offices.

“This is about the culture and climate of L.A.,” Martin said. “We are creating a sense of place, only it's 1,000 feet up in the air.”

AC Martin also designed the Figueroa-at-Wilshire high-rise across the street from the Wilshire Grand in 1990. The family firm was the primary architect of Los Angles City Hall in the 1920s.

Work on the new skyscraper will create 11,000 union construction jobs, Korean Air's Cho said, and employ 1,700 workers when it opens in four years. The project has obtained most development approvals from L.A. city officials.

Cho, who lives in Seoul and has a home in Newport Beach, is on the board of trustees at USC, where his children attended college and where he obtained his MBA.

“L.A. is like a second home,” Cho said.

The 936-room Wilshire Grand, built in 1952, was originally a Hotel Statler and later a Hilton. Once one of the city's best hotels, it was most recently a mid-market inn catering to conventioneers and tour groups from overseas before it closed at the end of 2011.

The property is a few blocks north of Staples Center.

roger.vincent@latimes.com

Times staff writer Frank Shyong contributed to this story.

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L.A. County Sheriff's Department intends to fire seven deputies

Seven Los Angeles County sheriff's deputies have been notified that the department intends to fire them for belonging to a secret law enforcement clique that allegedly celebrated shootings and branded its members with matching tattoos, officials said.

The Times reported last year about the existence of the clique, dubbed the Jump Out Boys, and the discovery of a pamphlet that described the group's creed, which required aggressive policing and awarded tattoo modifications for police shootings.

The seven worked on an elite gang-enforcement team that patrols neighborhoods where violence is high. The team makes a priority of taking guns off the street, officials said.

The Sheriff's Department has a long history of secret cliques with members of the groups having reached high-ranking positions within the agency. Sheriff officials have sought to crack down on the groups, fearing that they tarnished the department's reputation and encouraged unethical conduct.

In the case of the Jump Out Boys, sheriff's investigators did not uncover any criminal behavior. But, sources said, the group clashed with department policies and image.

Their tattoos, for instance, depicted an oversize skull with a wide, toothy grimace and glowing red eyes. A bandanna with the unit's acronym is wrapped around the skull. A bony hand clasps a revolver. Smoke would be tattooed over the gun's barrel for members who were involved in at least one shooting, officials said.

One member, who spoke to The Times and requested anonymity, said the group promoted only hard work and bravery. He dismissed concerns about the group's tattoo, noting that deputies throughout the department get matching tattoos. He said there was nothing sinister about their creed or conduct. The deputy, who was notified of the department's intent to terminate him, read The Times several passages from the pamphlet, which he said supported proactive policing.

"We are alpha dogs who think and act like the wolf, but never become the wolf," one passage stated, comparing criminals to wolves. Another passage stated, "We are not afraid to get our hands dirty without any disgrace, dishonor or hesitation... sometimes (members) need to do the things they don't want to in order to get where they want to be."

Department spokesman Steve Whitmore said starting the termination process shows that Sheriff Lee Baca "does not take any of this lightly and will move forward with the appropriate action."

Investigators were less concerned about the tattoos, and more focused on the suspected admiration they showed for officer-involved shootings, which are expected to be events of last resort. The deputy told The Times, however, that investigators reviewed their shootings and arrests and found nothing unlawful.

"We get called a gang within the badge? It's unfair," he said. "People want to say you have a tattoo. So do fraternities. Go to Yale. Are they a gang?.... Boy Scouts have patches and they have mission statements, and so do we."

"We do not glorify shootings," he continued. "What we do is commend and honor the shootings. I have to remember them because it can happen any time, any day. I don't want to forget them because I'm glad I'm alive."

If the firings are upheld, it would be one of the largest terminations over one incident in the department's history. In 2011, the department fired about half a dozen deputies who were also said to have formed a clique. Those deputies worked on the third floor of Men's Central Jail and allegedly threw gang-like three-finger hand signs. They were fired after they fought two fellow deputies at an employee Christmas party and allegedly punched a female deputy in the face.

As part of the widening federal investigation of the Sheriff's Department, a criminal grand jury recently subpoenaed the agency for materials relating to deputy cliques, specifically citing several of the groups including the "3000 boys" and the Jump Out Boys.

When the pamphlet revealing the existence of the Jump Out Boys was initially found, officials didn't know if the group was real. But eventually, one member came forward and named the others, according to an official who asked for anonymity because he was not authorized to speak to the media.

The seven deputies can fight the department's decision to fire them.

robert.faturechi@latimes.com

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Selena Gomez works the front row at Neo show

NEW YORK (AP) — Selena Gomez sat front and center at the fashion show to preview the first collection in her collaboration with Adidas' streetwear Neo label.

But the runway at Wednesday evening's show was a next-gen catwalk: Teenager bloggers were charged with styling the outfits instead of industry professionals.

Gomez thanked them as she stood on stage at the end of the show. She was flanked by models in denim shorts, Bermudas, slouchy sweats and T-shirts that read "Pirate Love." There were a few graffiti prints sprinkled in, and some varsity jackets.

The clothes, mostly in sunny yellow, bright pink and navy, were more surf than sport, which is Adidas' normal niche.

The show was very briefly interrupted by a protester trying to hand out leaflets about sweatshops.

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Psychiatric Hospitals Alter Rules on Patient Smoking

MANDEVILLE, La. — Annelle S., 64, who has paranoid schizophrenia, took an urgent drag on a cigarette at a supervised outdoor smoke break at Southeast Louisiana Hospital.

“It’s mandatory to smoke,” she explained. “It’s a mental institution, and we have to smoke by law.”

That was 18 months ago, and Annelle’s confusion was understandable. Until recently, Louisiana law required psychiatric hospitals to accommodate smokers — unlike rules banning smoking at most other health facilities. The law was changed last year, and by March 30, smoking is supposed to end at Louisiana’s two remaining state psychiatric hospitals.

After decades in which smoking by people with mental illness was supported and even encouraged — a legacy that experts say is causing patients to die prematurely from smoking-related illnesses — Louisiana’s move reflects a growing effort by federal, state and other health officials to reverse course.

But these efforts are hardly simple given the longstanding obstacles.

Hospitals often used cigarettes as incentives or rewards for taking medicine, following rules or attending therapy. Some programs still do. And smoking was endorsed by advocates for people with mental illness and family members, who sometimes sued to preserve smoking rights, considering cigarettes one of the few pleasures patients were allowed.

New data from the Centers for Disease Control and Prevention shows that the nearly 46 million adults with mental illness have a smoking rate 70 percent higher than those without mental illness, and consume about a third of the cigarettes in the country, though they make up one-fifth of the adult population.

People with psychiatric disorders are often “smoking heavier, their puffs are longer and they’re smoking it down to the end of the cigarette,” said William Riley, chief of the Science of Research and Technology Branch at the National Cancer Institute. With some diagnoses, like schizophrenia, rates are especially high.

A report by the National Association of State Mental Health Program Directors said data suggested that people with the most serious mental illnesses die on average 25 years earlier than the general population, with many from smoking-exacerbated conditions like heart or lung disease.

Now more treatment facilities are banning smoking, with some finding it easier than expected. Others still allow it, usually outside on their grounds during scheduled times. About a fifth of state hospitals are not smoke-free, a survey issued in 2012 by the State Mental Health Program Directors association found. Occasionally, hospitals that banned smoking have reinstated it to avoid losing patients.

Moreover, smoking is so deeply ingrained that smoke-free hospitals can only dent the problem; many patients are now hospitalized only for short stints and resume smoking later.

New research suggests scientific underpinnings for some of the affinity, said Dr. Nora D. Volkow, director of the National Institute on Drug Abuse. Nicotine has antidepressant effects and, for people with schizophrenia, helps dampen extraneous thoughts and voices, she and other experts said.

Other chemicals in cigarette smoke set off a perilous cycle, causing some medications to be metabolized faster, making them less effective and allowing symptoms to return. Because patients feel sicker, they may seek even more comfort from nicotine. “You may think, ‘Well, I need to smoke more,’ ” said Dr. Steven Schroeder, a professor of health and health care at the University of California, San Francisco.

Then, as smoking increases, “blood levels of their medication go down, and they end up back in the hospital,” said Judith Prochaska, an associate professor of medicine at Stanford University’s Prevention Research Center.

Socially, smoking provides “cover rituals for patients having psychiatric symptoms,” said Dr. Rona Hu, medical director of the acute psychiatric inpatient unit at Stanford Hospital in Palo Alto, Calif. “You tamp the box, you kind of play with the lighter, you can exhale and look into the middle distance and not look like you’re hallucinating.”

Dr. Thomas R. Frieden, director of the C.D.C., said hospitals had historically resisted going smoke-free, fearing it would interfere with treatment. “In my very first job as an aide in a psychiatric hospital,” he said, “if patients behaved better they got additional cigarettes.”

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Pitfalls seen in growth of part-time work

Although the state's unemployment rate is at its lowest level in almost four years and the number of employed Californians is growing, labor experts see a different reality: Full-time work has faded in many industries.

Nubia Calderón Barillas, 32, left a job in retail in May for a housekeeping job at the Holiday Inn LAX that promised better pay and steady work.

But nearly nine months later, the mother of three said, she rarely works more than two days a week. She has asked for more hours, she said, but to no avail, even in an industry that set a new peak employment level last year.

"It's been difficult lately," she said. "I practically didn't work all of December except for the holidays."

California employers picked up the rate of hiring during 2012 — at times at nearly twice the rate of the country as a whole. But a significant portion of those jobs are less than full time, according to federal data released last week.

The number of people involuntarily working part time nationwide has grown to 7.9 million, an 80% increase from 2006, data from the Bureau of Labor Statistics show.

That trend is particularly pronounced in the Golden State, which saw the number of involuntary part-time workers swell to 1.3 million, up 126% from 585,100 in 2006. Only four other states, Nevada and Florida among them, had higher rates of involuntary part-time workers.

Various industries are increasingly relying on part-time workers and other contingent employees, such as temporary workers, to save money, said Michael Bernick, a Milken Institute fellow who studies labor markets.

"As you have more and more costs associated with full-time workers in terms of healthcare or other costs, employers look for alternative ways to reduce costs," Bernick said. "One way is on-demand and part-time work."

The increase isn't limited to industries that typically employ part-time workers, such as leisure and hospitality. Other sectors with strong job growth, such as professional and business services, have also seen a rise in part-time workers as employers aim to keep payroll costs down, Bernick said.

Nationwide, the number of involuntary part-time workers in professional and business services, which includes white-collar occupations such as accountants and lawyers, nearly doubled to 711,000 last year from 367,000 in 2007. A sector-by-sector breakdown is unavailable for California because the sample size of the household survey that the federal data rely on is too small.

Part-time work is common in California's leisure and hospitality sector, which added almost 61,000 jobs since December 2011, accounting for more than a quarter of the state's net jobs created in that time period.

Growth of low-wage industries such as hospitality provides work opportunities for people with limited education, even if the work is only part time, said Jerry Nickelsburg, senior economist at the UCLA Anderson Forecast.

"We shouldn't look with dismay" on the rapid growth of a sector that is so dependent on part-time work, he said. "If that were the only sector we were growing, then that would be worrisome."

Tom Walsh, president of Unite Here Local 11, a union representing hospitality workers in Los Angeles and Orange counties, said in negotiations with employers, his group has pushed for workers' hours to be maximized.

Although full-time work sometimes isn't ensured, Walsh said, employers are urged to give part-time workers as many hours as possible.

"I think it's an example of certain employers being penny wise but pound foolish," he said. "They figure they can save money by having more part-time workers and having low pay. If they don't change that, folks are going to take jobs somewhere else the first chance they get."

The long-term implication of part-time work, economists said, is growing wage disparities and the risk of dampening consumer spending, a major driver of the economy. Part-time workers also are more likely to rely on state aid, such as food stamps, to make ends meet.

Kellie Flowers moved to Los Angeles late last year hoping to find work as an event coordinator or wardrobe stylist.

But full-time work has been elusive, even with a college degree.

The 30-year-old Virginia native managed to land two part-time jobs when she first relocated, one at a Manhattan Beach boutique and the other at a running store.

She earned $10 per hour at both jobs but didn't have benefits or health insurance.

"It was very hard working two jobs," she said. "You definitely don't have any spending money."

Flowers recently started a new job, selling spa packages, on commission. She sells between six to 10 a day, earning $15 for each.

"I'm going to look for other jobs that make me happier. Until then I just need to make money," she said.

Meanwhile, Barillas, the Holiday Inn housekeeper, said she hopes she'll eventually work more hours.

She and her husband are falling behind on utility bills at the one-bedroom Koreatown apartment they share with their three children. She recently applied for food stamps, a decision she said was embarrassing.

"I've always had work," she said. "I used to think people on food stamps just didn't want to work, but now I find myself with the need to ask for help."

ricardo.lopez2@latimes.com

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