November 2008

“Alex & Me,” Irene Pepperberg’s memoir of her 30-year scientific collaboration with an African gray parrot, was written for the legions of Alex’s fans, the (probably) millions whose lives he and she touched with their groundbreaking work on nonhuman communication. Alex — for anyone who missed the commemorations last year in The Economist, Nature, The New York Times and on the radio and TV — could label more than a hundred objects and understood the concept of categories, as well as bigger-smaller, same-different and absence. (The Guardian called Alex “smarter than the average U.S. president.”) To anyone who’s dreamed of talking with the animals, Dr. Doolittle style, Alex was a revelation.


For a technical analysis of his feats, you’ll want to read Pepperberg’s book “The Alex Studies,” published in 2000. The present book, in contrast, is largely celebratory — light on science, heavy on cute animal stories and heartwarming in its depiction of what was either a fruitful professional collaboration or a weirdly dependent friendship, or both. Still, it isn’t all billing and cooing: a strain of “I’ll show them” runs through the text. Accusations against the scientific establishment, which at first denied Pepperberg funding, publication, prestigious appointments and professional respect, propel the narrative.

Pepperberg’s basic biography ought to be rousing (nerdy girl abandons career in chemistry to pursue animal intelligence; is rejected by establishment; achieves international acclaim). But she tells her own story with far less emotion than she does Alex’s. There’s much that Pepperberg is unwilling to reveal — about her cold and controlling parents, her failed marriage and her relationships with colleagues. That’s the author’s prerogative, but it leaves a reader wondering how she ended up in her 50s, alone and jobless, reduced to eating 14 tofu meals a week (to save money, not the earth). Her approach to herself is neither scientific nor humanistic: the woman remains an enigma.

Alex, on the other hand, is a delight — a one-pound, three-dimensional force of nature. Mischievous and cocky, he also gets bored and frustrated. (And who wouldn’t, when asked to repeat tasks 60 times to ensure statistical significance?) He shouts out correct answers when his colleagues (other birds) fail to produce them. If Pepperberg inadvertently greets another bird first in the morning, Alex sulks all day and refuses to cooperate. He demands food, toys, showers, a transfer to his gym.
This ornery reviewer tried to resist Alex’s charms on principle (the principle that says any author who keeps telling us how remarkable her subject is cannot possibly be right). But his achievements got the better of me. During one training session, Alex repeatedly asked for a nut, a request that Pepperberg refused (work comes first). Finally, Alex looked at her and said, slowly, “Want a nut. Nnn . . . uh . . . tuh.”

“I was stunned,” Pepperberg writes. “It was as if he were saying, ‘Hey, stupid, do I have to spell it out for you?’ ” Alex had leaped from phonemes to sound out a complete word — a major leap in cognitive processing. Perching near a harried accountant, Alex asks over and over if she wants a nut, wants corn, wants water. Frustrated by the noes, he asks, “Well, what do you want?” Mimicry? Maybe. Still, it made me laugh.
After performing major surgery on Alex, a doctor hands him, wrapped in a towel, to an overwrought Pepperberg. Alex “opened an eye, blinked, and said in a tremulous voice, ‘Wanna go back.’ ” It’s a phrase Alex routinely used to mean “I’m done with this, take me back to my cage.” The scene is both wrenching — Alex had been near death — and creepy, evoking the talking bundle in “Eraserhead.”

Pepperberg frames her story with Alex’s death: the sudden shock of it, and the emotional abyss into which she fell. Ever the scientist, she wonders why she felt so strongly. The answer she comes up with is both simple — her friend was dead — and complex. At long last, and buoyed by the outpouring of support from people around the world, she could express the emotions she’d kept in check for 30 years, the better to convince the scientific establishment that she was a serious researcher generating valid and groundbreaking data (some had called her claims about animal minds “vacuous”). When Alex died, that weight lifted.

BUT in revealing how Alex lived, and the day-to-day workings of her lab, Pepperberg may soon find herself open to fresh criticism. Her book raises an important question: why, if Alex has the cognitive skills of a young child, and even seems to grasp such concepts as love, would anyone confine him to a cage in a lab? Why run him through the drills, or scold him for getting answers “wrong”? (“You turkey,” he’d say, mimicking his trainers, or “Say better!”) During a stint at M.I.T.’s Media Lab, Pepperberg worked on a device, designed for gray parrot owners, that projects terrifying images of predators when their pets’ vocalizations “exceeded the desired level.” She doesn’t comment on the morality of either confining a highly intelligent creatureor scaring it into submission. She deals with the question of animal rights in just one sentence: while acknowledging it would be cruel to adopt a gray and leave it alone all day, “that doesn’t mean grays or other animals have wide-ranging political rights.”
Alex was a celebrity, and this book will surely please his legions of fans. Meanwhile, supporters of Pepperberg, who continues her research with other grays, will remind critics that we’d have no inkling of parrot intelligence without Alex’s sacrifice.
Elizabeth Royte, a frequent contributor to the Book Review, is the author of “Garbage Land: On the Secret Trail of Trash” and “Bottlemania: How Water Went on Sale and Why We Bought It.”


By ELIZABETH ROYTE (NYT, November 9, 2008)


In a mountainous kingdom in what is now southeastern Turkey, there lived in the eighth century B.C. a royal official, Kuttamuwa, who oversaw the completion of an inscribed stone monument, or stele, to be erected upon his death. The words instructed mourners to commemorate his life and afterlife with feasts “for my soul that is in this stele.”

University of Chicago archaeologists who made the discovery last summer in ruins of a walled city near the Syrian border said the stele provided the first written evidence that the people in this region held to the religious concept of the soul apart from the body. By contrast, Semitic contemporaries, including the Israelites, believed that the body and soul were inseparable, which for them made cremation unthinkable, as noted in the Bible.
Circumstantial evidence, archaeologists said, indicated that the people at Sam’al, the ancient city, practiced cremation. The site is known today as Zincirli (pronounced ZIN-jeer-lee).
Other scholars said the find could lead to important insights into the dynamics of cultural contact and exchange in the borderlands of antiquity where Indo-European and Semitic people interacted in the Iron Age.

The official’s name, for example, is Indo-European: no surprise, as previous investigations there had turned up names and writing in the Luwian language from the north. But the stele also bears southern influences. The writing is in a script derived from the Phoenician alphabet and a Semitic language that appears to be an archaic variant of Aramaic.

The discovery and its implications were described last week in interviews with archaeologists and a linguist at the University of Chicago, who excavated and translated the inscription.
“Normally, in the Semitic cultures, the soul of a person, their vital essence, adheres to the bones of the deceased,” said David Schloen, an archaeologist at the university’s Oriental Institute and director of the excavations. “But here we have a culture that believed the soul is not in the corpse but has been transferred to the mortuary stone.”

A translation of the inscription by Dennis Pardee, a professor of Near Eastern languages and civilization at Chicago, reads in part: “I, Kuttamuwa, servant of [the king] Panamuwa, am the one who oversaw the production of this stele for myself while still living. I placed it in an eternal chamber [?] and established a feast at this chamber: a bull for [the god] Hadad, a ram for [the god] Shamash and a ram for my soul that is in this stele.”


Dr. Pardee said the word used for soul, nabsh, was Aramaic, a language spoken throughout northern Syria and parts of Mesopotamia in the eighth century. But the inscription seemed to be a previously unrecognized dialect. In Hebrew, a related language, the word for soul is nefesh.
In addition to the writing, a pictorial scene chiseled into the well-preserved stele depicts the culture’s view of the afterlife. A bearded man wearing a tasseled cap, presumably Kuttamuwa, raises a cup of wine and sits before a table laden with food, bread and roast duck in a stone bowl.
In other societies of the region, scholars say, this was an invitation to bring customary offerings of food and drink to the tomb of the deceased. Here family and descendants supposedly feasted before a stone slab in a kind of chapel. Archaeologists have found no traces there of a tomb or bodily remains.
Joseph Wegner, an Egyptologist at the University of Pennsylvania, who was not involved in the research, said cult offerings to the dead were common in the Middle East, but not the idea of a soul separate from the body — except in Egypt.
In ancient Egypt, Dr. Wegner noted, the human entity has separate components. The body is important, and the elite went to great expense to mummify and entomb it for eternity. In death, though, a life force or spirit known as ka was immortal, and a soul known as ba, which was linked to personal attributes, fled the body after death.
Dr. Wegner said the concept of a soul held by the people at Sam’al “sounds vaguely Egyptian in its nature.” But there was nothing in history or archaeology, he added, to suggest that the Egyptian civilization had a direct influence on this border kingdom.
Other scholars are expected to weigh in after Dr. Schloen and Dr. Pardee describe their findings later this week in Boston at meetings of the American Schools of Oriental Research and the Society of Biblical Literature.
Lawrence E. Stager, an archaeologist at Harvard who excavates in Israel, said that from what he had learned so far the stele illustrated “to a great degree the mixed cultural heritage in the region at that time” and was likely to prompt “new and exciting discoveries in years to come.”
Gil Stein, director of the Oriental Institute, said the stele was a “rare and most informative discovery in having written evidence together with artistic and archaeological evidence from the Iron Age.”
The 800-pound basalt stele, three feet tall and two feet wide, was found in the third season of excavations at Zincirli by the Neubauer Expedition of the Oriental Institute. The work is expected to continue for seven more years, supported in large part by the Neubauer Family Foundation of Chicago.
The site, near the town of Islahiye in Gaziantep province, was controlled at one time by the Hittite Empire in central Turkey, then became the capital of a small independent kingdom. In the eighth century, the city was still the seat of kings, including Panamuwa, but they were by then apparently subservient to the Assyrian Empire. After that empire’s collapse, the city’s fortunes declined, and the place was abandoned late in the seventh century.
A German expedition, from 1888 to 1902, was the first to explore the city’s past. It uncovered thick city walls of stone and mud brick and monumental gates lined with sculpture and inscriptions. These provided the first direct evidence of Indo-European influence on the kingdom.
After the Germans suspended operations, the ruins lay unworked until the Chicago team began digging in 2006, concentrating on the city beyond the central citadel, which had been the focus of the German research. Much of the 100-acre site has now been mapped by remote-sensing magnetic technology capable of detecting buried structures.
This summer, on July 21, workers excavating what appeared to be a large dwelling came upon the rounded top of the stele and saw the first line of the inscription. Dr. Schloen and Amir Fink, a doctoral student in archaeology at Tel Aviv University, bent over to read.
Almost immediately, they and others on the team recognized that the words were Semitic and the name of the king was familiar; it had appeared in the inscriptions found by the Germans. As the entire stele was exposed, Dr. Schloen said, the team made a rough translation, and this was later completed and refined by Dr. Pardee.
Then the archaeologists examined more closely every aspect of the small, square room in which the stele stood in a corner by a stone wall. Fragments of offering bowls to the type depicted in the stele were on the floor. Remains of two bread ovens were found.
“Our best guess is that this was originally a kitchen annexed to a larger dwelling,” Dr. Schloen said. “The room was remodeled as a shrine or chapel — a mortuary chapel for Kuttamuwa, probably in his own home.”
They found no signs of a burial in the city’s ruins. At other ancient sites on the Turkish-Syrian border, cremation urns have been dated to the same period. So the archaeologists surmised that cremation was also practiced at Sam’al.
Dr. Stager of Harvard said the evidence so far, the spread of languages and especially the writing on stone about a royal official’s soul reflected the give-and-take of mixed cultures, part Indo-European, part Semitic, at a borderland in antiquity.

By JOHN NOBLE WILFORD (NYT, November 18, 2008)

URUMQI, China — An exhibit on the first floor of the museum here gives the government’s unambiguous take on the history of this border region: “Xinjiang has been an inalienable part of the territory of China,” says one prominent sign.


But walk upstairs to the second floor, and the ancient corpses on display seem to tell a different story.
One called the Loulan Beauty lies on her back with her shoulder-length hair matted down, her lips pursed in death, her high cheekbones and long nose the most obvious signs that she is not what one thinks of as Chinese.

The Loulan Beauty is one of more than 200 remarkably well-preserved mummies discovered in the western deserts here over the last few decades. The ancient bodies have become protagonists in a very contemporary political dispute over who should control the Xinjiang Uighur Autonomous Region.
The Chinese authorities here face an intermittent separatist movement of nationalist Uighurs, a Turkic-speaking Muslim people who number nine million in Xinjiang.

At the heart of the matter lie these questions: Who first settled this inhospitable part of western China? And for how long has the oil-rich region been part of the Chinese empire?
Uighur nationalists have gleaned evidence from the mummies, whose corpses span thousands of years, to support historical claims to the region.
Foreign scholars say that at the very least, the Tarim mummies — named after the vast Tarim Basin where they were found — show that Xinjiang has always been a melting pot, a place where people from various corners of Eurasia founded societies and where cultures overlapped.

Contact between peoples was particularly frequent in the heyday of the Silk Road, when camel caravans transported goods that flowed from as far away as the Mediterranean. “It’s historically been a place where cultures have mixed together,” said Yidilisi Abuduresula, 58, a Uighur archaeologist in Xinjiang working on the mummies.
The Tarim mummies seem to indicate that the very first people to settle the area came from the west — down from the steppes of Central Asia and even farther afield — and not from the fertile plains and river valleys of the Chinese interior. The oldest, like the Loulan Beauty, date back 3,800 years.
Some Uighurs have latched on to the fact that the oldest mummies are most likely from the west as evidence that Xinjiang has belonged to the Uighurs throughout history. A modern, nationalistic pop song praising the Loulan Beauty has even become popular.
“The people found in Loulan were Uighur people, according to the materials,” said a Uighur tour guide in the city of Kashgar who spoke on condition of anonymity for fear of running afoul of the Chinese authorities. “The nationalities of Xinjiang are very complicated. There have been many since ancient times.”
Scholars generally agree that Uighurs did not migrate to what is now Xinjiang from Central Asia until the 10th century. But, uncomfortably for the Chinese authorities, evidence from the mummies also offers a far more nuanced history of settlement than the official Chinese version.
By that official account, Zhang Qian, a general of the Han dynasty, led a military expedition to Xinjiang in the second century B.C. His presence is often cited by the ethnic Han Chinese when making historical claims to the region.

The mummies show, though, that humans entered the region thousands of years earlier, and almost certainly from the west.
What is indisputable is that the Tarim mummies are among the greatest recent archaeological finds in China, perhaps the world.
Four are in glass display cases in the main museum here in Urumqi, the regional capital. Their skin is parched and blackened from the wear and tear of thousands of years, but their bodies are strikingly intact, preserved by the dry climate of the western desert.
Some foreign scholars say the Chinese government, eager to assert a narrative of longtime Chinese dominance of Xinjiang, is unwilling to face the fact that the mummies provide evidence of heterogeneity throughout the region’s history of human settlement.
As a result, they say, the government has been unwilling to give broad access to foreign scientists to conduct genetic tests on the mummies.
“In terms of advanced scientific research on the mummies, it’s just not happening,” said Victor H. Mair, a professor of Chinese language and literature at the University of Pennsylvania who has been at the forefront of foreign scholarship of the mummies.
Mr. Mair first spotted one of the mummies, a red-haired corpse called the Cherchen Man, in the back room of a museum in Urumqi while leading a tour of Americans there in 1988, the first year the mummies were put on display.
Since then, he says that he has been obsessed with pinpointing the origins of the mummies, intent on proving a theory dear to him: that the movement of peoples throughout history is far more common than previously thought.
Mr. Mair has assembled various groups of scholars to do research on the mummies. In 1993, the Chinese government tried to prevent Mr. Mair from leaving China with 52 tissue samples after having authorized him to go to Xinjiang and to collect them.
But a Chinese researcher managed to slip a half-dozen vials to Mr. Mair. From those samples, an Italian geneticist concluded in 1995 that at least two of the mummies had a European genetic marker.
The Chinese government in recent years has allowed genetic research on the mummies to be conducted only by Chinese scientists.
Jin Li, a well-known geneticist at Fudan University in Shanghai, tested the mummies in conjunction with a 2007 National Geographic documentary. He concluded that some of the oldest mummies had East Asian and even South Asian markers, though the documentary said further testing needed to be done.
Mr. Mair has disputed any suggestion that the mummies were from East Asia. He believes that East Asian migrants did not appear in the Tarim Basin until much later than the Loulan Beauty and her people.
The oldest mummies, he says, were probably Tocharians, herders who traveled eastward across the Central Asian steppes and whose language belonged to the Indo-European family. A second wave of migrants came from what is now Iran.
The theory that the earliest mummies came from the west of what is now modern China is supported by other scholars as well. A textile expert, Elizabeth Wayland Barber, in a book called “The Mummies of Urumchi,” wrote that the kind of cloth discovered in the oldest grave sites can be traced to the Caucasus.
Han Kangxin, a physical anthropologist, has also concluded that the earliest settlers were not Asians. He has studied the skulls of the mummies, and says that genetic tests can be unreliable.
“It’s very clear that these are of Europoid or Caucasoid origins,” Mr. Han, now retired, said in an interview in his apartment in Beijing.
Of the hundreds of mummies discovered, there are some that are East Asian, but they are not as ancient as the Loulan Beauty or the Cherchen Man.
The most prominent Chinese grave sites were discovered at a place called Astana, believed to be a former military outpost. The findings at the site span the Jin to the Han dynasties, from the third to the 10th centuries.
Further clouding the picture, a mummy from the Lop Nur area, the 2,000-year-old Yingpan Man, was unearthed with artifacts associated with an entirely different part of the globe. He was wearing a hemp death mask with gold foil and a red robe decorated with naked angelic figures and antelopes — all hallmarks of a Hellenistic civilization.
Despite the political issues, excavations of the grave sites are continuing.
Mr. Abuduresula, the Uighur archaeologist, made a trip in late September to the desert site at Xiaohe, where 350 graves have been discovered. The bottom layer of graves dates back nearly 4,000 years. More recent graves point to a matriarchal herding society that worshiped cows, Mr. Abuduresula said.
Somewhere in those sands, he said, archaeologists have discovered a woman as striking as the Loulan Beauty. She is called the Xiaohe Princess, and even her eyelashes are intact.

* By EDWARD WONG (NYT, November 19, 2008)

ROME — First Google Earth turned millions of Internet users into virtual travelers who could fly to any spot on the globe. Then its Sky feature took them to other galaxies. Now Google Earth has embraced a frontier dating back 17 centuries: ancient Rome under Constantine the Great.


Soaring above a virtual reconstruction of the Forum and the Palatine Hill or zooming into the Colosseum to get a lion’s-eye view of the stands, Google Earth’s 400 million users will be able to explore the ancient capital as easily “as any city can be explored today,” Michael T. Jones, chief technology officer of Google Earth, said Wednesday at a news conference at Rome’s city hall.
Ancient Rome 3D, as the new feature is known, is a digital elaboration of some 7,000 buildings recreating Rome circa A.D. 320, at the height of Constantine’s empire, when more than a million inhabitants lived within the city’s Aurelian walls.
In Google Earth-speak it is a “layer” to which visitors gain access through its Gallery database of images and information. “In this case the layer is above ground and not below where it should be” from an archaeological point of view, said Bernard Frischer, the director of the University of Virginia’s Institute for Advanced Technology in the Humanities.
Google had planned to activate the feature on Wednesday morning, but a spokesman said there would be a short delay because of technical difficulties. By Wednesday night, however, the feature was up and running. (Web visitors in the United States can watch a video demonstration of the feature at
For nearly three decades Professor Frischer has been the driving force of an effort to bring ancient Rome to virtual life. The Google Earth feature is based on his Rome Reborn 1.0, a 3-D reconstruction first developed in 1996 at the University of California, Los Angeles, and fine-tuned over the years with partners in the United States and Europe.
Of the 7,000 buildings in the 1.0 version, around 250 are extremely detailed. (Thirty-one of them are based on 1:1 scale models built at U.C.L.A.) The others are sketchier and derived from a 3-D scan of data collected from a plaster model of ancient Rome at the Museum of Roman Civilization here.
Archaeologists and scholars verified the data used to create the virtual reconstruction, although debates continue about individual buildings. “We’re happy when scholars disagree with us,” Professor Frischer said. “It makes for good scholarship.”
The Rome Reborn model went through various incarnations over the years as the technology improved. Originally it was developed to be screened in theaters for viewers wearing 3-D glasses or on powerful computers at the universities contributing to the project, rather than run on the Internet. That all changed in June 2007, when Professor Frischer presented Rome Reborn at a news conference in Rome. The next day he received a call from Google Earth.
“The poetry was good, but it was caught in a tree,” said Mr. Jones of Google Earth. “So we asked if we could help to make it better.” It took several months for Google engineers to format the data “and do Google things so that everyone can see it,” he said.
To experience Ancient Rome 3D, a user must install the Google Earth software at, select the Gallery folder on the left side of the screen and then click on “Ancient Rome 3D.”
Past Perfect Productions, a company that specializes in 3-D cultural heritage models, owns the global and exclusive commercial rights to Rome Reborn and collaborated with the Institute for Advanced Technology in the Humanities and Google Earth on this project.
Joel Myers, Past Perfect’s chief executive, said the Roman theme had proved popular for his company. “Ancient Rome is a symbol of Western civilization, but it’s also got that fantasy element, what with gladiators, centurions and brutal or crazy emperors,” he said. He cited an audio guide that Past Perfect produced with 3-D reconstructions of the Colosseum and another it plans to release soon on the Forum.
In recent years films like “Gladiator” and the HBO series “Rome” have also stirred popular interest in the city. And on Nov. 20 “3D Rewind Rome,” a high-tech show based on the University of California simulation, is to open in a theater near the Colosseum.
Rome’s mayor, Gianni Alemanno, suggested Wednesday that the Google Earth feature could gratify tourists who are disappointed to find that the city’s ancient monuments are in ruins. “They may not be enough to involve the tourist in the experience of Roman civilization,” he said. “The public needs the hook-up with virtual reality.”
Information bubbles in the Google Earth feature provide details for more than 250 buildings, and more advanced information is also available through links to Platner and Ashby’s Topographical Dictionary of Ancient Rome, Stanford’s Digital Forma Urbis Romae Project, the German Archaeological Institute catalog and many other scholarly sources
Professor Frischer said that now that Ancient Rome 3D would be available to millions, he hoped it would become a scholarly work in progress, open to changes and contributions from other scholars. “The great thing about digital technology,” he said, is that it can be updated constantly “and supports different opinions.”
Mr. Jones of Google Earth said that the company would like to present 3-D tours of other historical cities but that it was up to historical experts to provide the scholarship. “When archaeologists rise up, we’re ready to share their research with the world,” he said. “There’s no shortage of cities or civilizations that deserve to be understood in the same way.”
Meanwhile a 2.0 version of Rome Reborn is under development, and the project could expand to show Rome in different eras. “There’s always something to discover,” Professor Frischer said. He paused, then added, “Please don’t make me say it, but, after all, Rome wasn’t built in a day.”


By ELISABETTA POVOLEDO (NYT, November 13, 2008)


It was an occasional diversion among a certain crowd at Patchogue-Medford High School, students said: Drink a few beers, then go looking for people to mug, whether for money or just for kicks.


Friends of Jeffrey Conroy, a star athlete at the school, say he was known to do it, too. And last Saturday night, after drinking in a park in the Long Island hamlet of Medford, Mr. Conroy, 17, and six other teenagers declared that they were going to attack “a Mexican” and headed to the more ethnically diverse village of Patchogue to hunt, according to friends and the authorities.

They found their target in Marcelo Lucero, a serious-minded, 37-year-old immigrant from a poor village in Ecuador who had lived in the United States for 16 years, mostly in Patchogue, and worked in a dry cleaning store, sending savings home to support his mother, a cancer survivor.


After the boys surrounded, taunted and punched Mr. Lucero, the authorities say, Mr. Conroy plunged a knife into his victim’s chest, fatally wounding him.

The attack has horrified and puzzled many in this comfortable Suffolk County village of 11,700. Prosecutors have labeled it a hate crime and County Executive Steve Levy called the defendants, who have pleaded not guilty, “white supremacists.” And some immigrant advocates on Long Island have described the attack as a reflection of widespread anti-Latino sentiment and racial intolerance in Suffolk County.

Interviews with business owners, students, government officials and immigrants in the area suggest that illegal immigration has been a wellspring for anger and tension in the neighborhood, with day laborers drawing the greatest fire. Indeed, a number of people — adults and students alike — drew sharp distinctions between assimilated immigrants, who they said should be welcomed as friends and neighbors, and newly arrived illegal immigrants, who they said do not belong.

“No disrespect here, but I’m a firm believer that if you want to come to this country, you should have a job waiting for you,” said the co-owner of the Medford Shooting Range, who gave only his first name, Charlie, and is known by the nickname Charlie Range.

He said he was offended by the behavior of some day laborers — throwing trash in the street, urinating in the bushes, hooting at passing women — and complained that illegal immigrants were crowding rental apartments and swelling the ranks of criminal gangs.

“How do you stop the illegal alien influx?” he wondered aloud. “How do you stop the rain?”

Thousands of immigrants from Latin America have flowed into Long Island in the past two decades, attracted by employment opportunities, particularly in the construction industry, which until recently was booming. Patchogue’s Latino population has risen sharply during this time, village officials say, with Ecuadoreans now being the single largest Latino group.

According to the 2000 census, Latinos were 24 percent of Patchogue’s population, up from 14 percent in 1990, and government officials say the percentage has continued to grow. In just the past five years, the Latino student population of the Patchogue-Medford School District has risen to 24 percent from about 4 percent, said Michael H. Mostow, the district’s superintendent.

Anti-immigrant hostility has led to several highly publicized attacks in recent years in Suffolk County, including the near-death beating of two Mexican day laborers in 2001 and the burning of a Mexican family’s house in 2003, both in the nearby town of Farmingville.

Immigrant advocates have accused some local politicians, particularly Mr. Levy, of helping to fuel anti-immigrant sentiment by promoting tough policies against illegal immigration. But Mr. Levy said this week that the attack on Mr. Lucero “wasn’t a question of any county policy or legislation; it was a question of bad people doing horrific things.”

For all the parsing of motives and rationales in the case, many Latino immigrants here describe Suffolk County as a place where daily life can be a struggle for acceptance in a predominantly white population, particularly in this time of economic crisis. Rocio Ponce, a Brentwood resident and real-estate agent from Ecuador, said that many residents had developed a hatred against recent Latino immigrants “because they think they’re coming to take their jobs.”

Latinos say the attack against Mr. Lucero, if not his murder, was foretold. Some report being threatened and physically harassed in the streets, with bottles thrown at them and their car windows smashed during the night. Anti-immigrant epithets and racially motivated bullying are common in the hallways of the schools, children say.

“They tell us to go get a green card, ‘Go back to your community!’ ” said Pamela Guncay, 14, an Ecuadorean-American born in the United States.

Many Latinos, particularly those who are here illegally, say they would never report such incidents because they do not trust the police and fear deportation.

“We’re here to work, we’re not here to do any damage,” pleaded César Angamarca, 45, who rents a room in a small house where Mr. Lucero lived. “We’re working honorably.”

Friends of Mr. Conroy and the other suspects insisted that the defendants were not racist and said they were shocked that a frivolous escapade by bored, drunken teenagers had quickly turned tragic. They pointed out that one of the defendants, José Pacheco, 17, is the son of an African-American mother and a Puerto Rican father, and that Mr. Conroy counted Latino and black classmates among his closest buddies.

“They were good kids,” said Sean Ruga, 19, who graduated from the high school in 2006 and remained friends with the defendants. “It’s not something I could see them capable of doing.”

Mr. Pacheco’s uncle, Jerry Dumas, said his nephew was with the group because he was looking for a ride home and would not have knowingly joined an attack against a Latino, especially considering his ethnic heritage. He also said that Mr. Pacheco’s parents had themselves been apparent victims of violent racism: When they moved into the Patchogue area in the early 1990s, Mr. Dumas said, their house was burned down twice.

Mr. Conroy was the best known of the defendants and, according to prosecutors, the leader of the group. He was on the school’s lacrosse and wrestling teams, according to his friends, and his lawyer, William J. Keahon, said he had received “a number” of offers of college athletic scholarships.

Jeffrey Francis, 18, who is black, said Mr. Conroy befriended him soon after he transferred into the school this fall. They were on the wrestling team together, he said.

Acquaintances of the defendants said it was not unusual for groups of students from the high school to go out looking for people to mug. “It was just for fun, or for money,” said Taylor Fallica, 15, a student at the high school who said he was a friend of Mr. Conroy and the other defendants.

A friend who said he had been hanging out with the seven defendants in the park that night said there had not been much in the way of a plan before the group set out.

“We were just chilling, having a few beers,” said the friend, who requested anonymity because he had also been interviewed by the police and feared making contradictory statements.

Toward midnight, he recalled, “they said they were going to go jump a Mexican,” and they left.

Mr. Lucero had come to the United States to help support his family in Gualaceo, Ecuador, said his brother, Joselo, 34, in an interview this week in Patchogue, where he lives. Their father had died when they were young and Marcelo assumed the role of father figure in the family, Joselo said.

Marcelo Lucero was a hard worker and had little social life, according to his brother and a resident in a house where he rented a room. When Joselo joined Marcelo in Patchogue in the mid-1990s, the older brother frequently counseled him on how to take care of himself and be safe.

“He was a like a protector,” Joselo recalled. “He told me: ‘You have to be a man here. There’s no mom here anymore.’ ”

As the mob descended, Mr. Lucero’s friend managed to escape and contact the police, who rounded up the suspects minutes later.

Mr. Conroy was charged with first-degree manslaughter as a hate crime and first-degree gang assault; the others were charged with first-degree gang assault. They were arraigned on Monday and the case was sent to a grand jury, which began reviewing evidence on Thursday, according to a spokesman for the Suffolk County district attorney’s office.

Joselo Lucero said his priorities were now to get his brother’s body back to Ecuador for burial and to ensure that justice was served. But he said he felt no bitterness or vengefulness toward his brother’s attackers.

“I don’t really feel hate,” he said.

“I feel sorry for the families, in some way, because they have to be responsible for their kids.”

Since Mr. Lucero’s death, local officials have almost universally played down any suggestion that ethnic and racial tension had been prevalent in the community. Nonetheless, local, county and state officials have responded to the killing with various plans, including the introduction of sensitivity task forces, outreach programs in the Latino community and community forums.

“It is imperative that we bridge the divide,” Patchogue’s mayor, Paul V. Pontieri Jr., said on Thursday, “and realize that the things we have in common far outnumber those that divide us.”

By KIRK SEMPLE (NYT,November 14, 2008)

Words have consequences. Steve Levy, the Suffolk County executive, is learning that the hard way during a horrible week. Seven teenagers were arrested and charged in the fatal stabbing last Saturday of Marcelo Lucero, an Ecuadorean immigrant, on a street in the Long Island village of Patchogue.

The apparent lynching caused shock and anger across the country. Politicians, religious leaders and villagers gathered Wednesday in Patchogue to console the victim’s relatives and to condemn racial hatred. Mr. Lucero’s brother, Joselo, spoke movingly in English and Spanish of how strangers’ words of support had made him feel like part of a larger family.

Mr. Levy was not there. He later called Joselo Lucero, who asked him to please stay away from public remembrances.

Mr. Levy’s past harsh words and actions against undocumented workers have now left him cornered with a tragically limited ability to lead the county in confronting a brutal act that surely pains him as much as anyone.

Local lawmakers often complain about immigration, but Mr. Levy went much farther than most. He founded a national organization to lobby for crackdowns. He went on “Lou Dobbs.” He tried to deputize county police to make immigration arrests and to rid the county work force of employees without papers. He sought to drive day laborers from local streets, yet rigidly opposed efforts to create hiring sites. Even as tensions simmered in places like Farmingville, a hot spot for anti-immigrant resentment, Mr. Levy would not budge.

He parroted extremist talking points, going so far as to raise the alarm, utterly false, that illegal immigrants’ “anchor babies” were forcing Southampton Hospital to close its maternity ward. He denounces racist hatred, yet his words have made him a hero in pockets of Long Island where veins of racism run deep.

All that came back to haunt Mr. Levy this week, when an evil act underscored the need to draw together. Immigrant advocates assailed him for having poisoned the atmosphere. Some called for his resignation. With tactless self-pity, Mr. Levy complained to Newsday that the killing would have been a one-day story anywhere but his home turf. He laments that people overlook his recent, far more measured tone on the issue. He insists that people have a distorted picture of him. Mr. Levy needs to realize that distortions cut both ways.

* Editorial (NYT, November 14, 2008)

Soon after Antonio Torres, a husky 19-year-old farmworker, suffered catastrophic injuries in a car accident last June, a Phoenix hospital began making plans for his repatriation to Mexico. Mr. Torres was comatose and connected to a ventilator. He was also a legal immigrant whose family lives and works in the purple alfalfa fields of this southwestern town. But he was uninsured. So the hospital disregarded the strenuous objections of his grief-stricken parents and sent Mr. Torres on a four-hour journey over the California border into Mexicali.


For days, Mr. Torres languished in a busy emergency room there, but his parents, Jesús and Gloria Torres, were not about to give up on him. Although many uninsured immigrants have been repatriated by American hospitals, few have seen their journey take the U-turn that the Torreses engineered for their son. They found a hospital in California willing to treat him, loaded him into a donated ambulance and drove him back into the United States as a potentially deadly infection raged through his system.

By summer’s end, despite the grimmest of prognoses from the hospital in Phoenix, Mr. Torres had not only survived but thrived. Newly discharged from rehabilitation in California, he was haltingly walking, talking and, hoisting his cane to his shoulder like a rifle, performing a silent, comic, effortful imitation of a marching soldier.

“In Arizona, apparently, they see us as beasts of burden that can be dumped back over the border when we have outlived our usefulness,” the elder Mr. Torres, who is 47, said in Spanish. “But we outwitted them. We were not going to let our son die. And look at him now!”

Antonio Torres’s experience sharply illustrates the haphazard way in which the American health care system handles cases involving uninsured immigrants who are gravely injured or seriously ill. Whether these patients receive sustained care in this country or are privately deported by a hospital depends on what emergency room they initially visit.

There is only limited federal financing for these fragile patients, and no governmental oversight of what happens to them. Instead, it is left to individual hospitals, many of whom see themselves as stranded at the crossroads of a failed immigration policy and a failed health care system, to cut through a thicket of financial, legal and ethical concerns.

That creates a burden. “It’s a killer,” said Brian Conway, spokesman for the Greater New York Hospital Association. But it also establishes the potential for neglectful and unethical if not illegal behavior by hospitals.

“The opportunity to turn your back is there,” said Dr. Stephen Larson, a migrant health expert and physician at the Hospital of the University of Pennsylvania. “You’re given an out by there not being formal regulations. The question is whether or not litigation, or prosecution, catches up and hospitals start to be held liable.”

In October, the California Medical Association, responding to an article in The New York Times about the medical deportation of a brain-injured Guatemalan, passed a resolution opposing the forced repatriation of patients. The American Medical Association is to take up the matter on Sunday at a national meeting in Orlando.

“While we empathize with hospitals that must provide uncompensated care to undocumented immigrants,” said Dr. Robert Margolin, a trustee of the California association, “we overwhelmingly oppose the practice of repatriating patients without their consent.”

An examination by The Times of cases across the country involving seriously injured and ill immigrants shows patients at the mercy of hospitals and hospitals at the mercy of a system that provides neither compensation nor guidance. Taken together, the cases reveal a playbook of improvised responses, from aggressive to compassionate.

In the case of Elliott Bustamante, a hospital in Tucson moved speedily, and ultimately unsuccessfully, to transfer a sickly infant to Mexico, ignoring the mother’s opposition and the fact that Elliott was an American citizen born with Down syndrome and a heart problem at that very hospital.

In the case of Kong Fong Yu, in contrast, a Manhattan hospital has proceeded less decisively, keeping Mr. Yu, a stroke victim, as a boarder for 18 months now as it grapples with whether to send him back to China or to subsidize him in a nursing home indefinitely.

And in the case of Darwin Castro, an illegal immigrant from Honduras, an Oklahoma City hospital forwent repatriation yet discharged Mr. Castro, a brain-injured patient who needed 24-hour care, to a young relative who also happened to be an illegal immigrant, living in the shadows and ill-equipped to care for him.

The Dilemma

Hospitals consider these fragile patients to be a vexing challenge. Theirs are protracted, expensive cases that force hospitals to make fateful decisions or assume long-term responsibility for needy immigrants who are, essentially, left at their doorsteps.

The two American hospitals treating Antonio Torres approached his case from distinctly different perspectives. St. Joseph’s in Phoenix, with a focus on keeping down the rising cost of uncompensated care, repatriates about eight uninsured patients a month.

“We’re trying to be good stewards of the resources we have,” said Sister Margaret McBride, a hospital vice president. “We’re trying to make sure that the acute-care hospital is available for individuals who need acute care. We can’t keep someone forever.”

By contrast, the other hospital, El Centro Regional Medical Center in California, said it never sends an immigrant over the border. “We don’t export patients,” said David R. Green, its chief executive. “I can understand the frustrations of other hospitals, but the flip side is the human being element.”

Hospitals are required to screen and treat all those who arrive at their emergency rooms. But they receive only partial compensation for illegal immigrants, through emergency Medicaid and, for the last few years, through Section 1011 of the Medicare Modernization Act of 2003, a program that expired in October. That partial coverage ends when the patient is stabilized.

But hospitals are also required to discharge safely patients who need continuing care, leading to their quandary: they generally cannot find nursing homes to accept illegal immigrants, or legal ones with less than five years’ residency, because long-term care is not covered by emergency Medicaid.

Some states and localities provide their own long-term care coverage for uninsured immigrants, and those exceptions demonstrate the demand. In California, the Medi-Cal program spent about $20 million on about 460 patients last year. In New York City, illegal immigrants occupy about a fifth of the 1,389 beds in the public nursing home on Roosevelt Island.

Hospitals have limited options in discharging immigrant patients who need continuing care: keeping them indefinitely, with or without providing rehabilitation; finding them charity beds or subsidizing them at nursing homes; sending them home to relatives; or repatriating them.

“We have to be very, very creative,” said Cara Pacione, director of social work at Mount Sinai Hospital in Chicago.

Foreign consular officials say that areas with longstanding immigrant populations tend to handle such patients more humanely — with the exception of Arizona, where hostility toward illegal immigrants is high and state financing for their care is low.

“We put an asterisk by Arizona,” said a Mexican diplomat in Washington.

Hospitals need consulates’ assistance in finding relatives and health care options in patients’ homelands as well as in obtaining travel documents. The relationship is complicated and often contentious, as expressed bluntly by Alan Kelly, vice president of Scottsdale Healthcare in Arizona.

“The Mexican consulate here is — how do I put it? — obstructionist,” Mr. Kelly said.

He described the situation with illegal immigrant patients as he sees it: “Somebody falls out of a walnut tree. They show up in our Trauma One center. We don’t have any problem with treating or stabilizing them. It’s the humane thing to do. That’s not where the costs run up. The costs run up after they’re moved out of the trauma unit into a regular bed. Nobody, no nursing home, wants to take them. Then, it’s like, ‘Mexican government, take responsibility for your own citizens!’ But you play games with them. They turn away. They basically say, ‘No habla.’ ”

Mexican officials, unsurprisingly, see it differently. “We cooperate with the families, not with the hospital,” Jorge Solchaga, a Mexican consular official in Phoenix, said. “Our principal objective is to help our compatriots.”

Still, Mr. Solchaga said that his office worked collaboratively with hospitals and oversaw 80 medical repatriations from Phoenix to Mexico in 2007.

An Infant at Risk

Elliott Bustamante was born at University Medical Center in Tucson on March 14, 2007, with Down syndrome and a heart defect. Two days later, when he was in neonatal intensive care, the hospital made arrangements to transfer him to a hospital in Mexico.

The fact that he was a United States citizen was immaterial, the hospital’s spokeswoman, Katie Riley, said. The hospital’s policy is to transfer patients to their “community of residence” for continuing care, Ms. Riley said. And Elliott’s parents, the hospital believed, were residents of Mexico, as indicated by their Mexican driver’s licenses. Also, the hospital said, the mother initially told a social worker, through an interpreter, that she was visiting Tucson when she went into labor. Therefore, the hospital said, it was in the baby’s interest, from a continuity of care perspective, to move him to Mexico.

But Gricelda Mejía Medehuari, Elliott’s mother, said that either the hospital misunderstood her or that she failed to express herself accurately.

Ms. Medehuari said that she had been living in Tucson for about a year prior to Elliott’s birth, and that her husband had been working construction there for two years. The hospital also said that Ms. Medehuari initially agreed to her baby’s transfer, then “equivocated.”

Ms. Medehuari said she was pressured: “We were so scared. They said we had no rights, the baby neither. They said they would send the baby with or without me. When Elliott was two weeks, they told me to gather my things because the baby was leaving in 15 minutes with a lady. It was very ugly. We contacted the Mexican consulate. They got us a lawyer.”

The lawyer, Fernando Gaxiola, asked the hospital to delay sending the baby across the border, and faxed a letter saying that he would be seeking court protection to avert “the abduction of my client under the guise of medical care.” A hospital lawyer, he said, told him that it was too late, that the baby was already heading to the airport.

Mr. Gaxiola summoned the police, who called the hospital, which ended up switching gears and bringing the baby back to University Medical Center.

Nine days later, the hospital asked a judge to order Elliott’s parents to consent to his transfer to Mexico. His parents had made no arrangements to pay $28,000 in hospital charges or to transfer their child, the hospital said. Legally, the hospital argued, the baby could be considered to be trespassing.

Eventually, after the Arizona Medicaid system approved Elliott for coverage, University Medical Center was reimbursed for the baby’s care and dropped its effort to send him to Mexico. “The medical pretext for the transfer disappeared once they found the money,” Mr. Gaxiola said.

Ms. Riley, the University Medical Center spokeswoman, said Elliott’s case “is not representative of U.M.C.’s long history of successful medical transfers of patients both to and from northern Mexico, but it does underline the complex dilemmas that border hospitals face every day.”

New Yorker in Limbo

Hospitals in New York City face equally complex dilemmas, with the added dimension of a more diverse immigrant population and prospective repatriations to Africa and Asia. The case of Kong Fong Yu has stymied a community hospital in Lower Manhattan.

Mr. Yu, 53, suffered a stroke on May 14, 2007. He awoke with slurred speech and then collapsed on his bathroom floor. By the time he arrived at New York Downtown Hospital, it was too late to try to reverse damage to the brain, the hospital said in court papers.

The hospital admitted Mr. Yu for tests and to regulate his high blood pressure, which he had been treating with Chinese herbs. Almost immediately, Mr. Yu was considered medically stable and ready for discharge to a skilled nursing home. But since he was uninsured and ineligible for Medicaid, no nursing home would take him. He had no relatives in the United States.

So he stayed, and stayed. And he was not the only one. Jeffrey Menkes, the hospital’s president, said Downtown housed a few uninsured immigrants like Mr. Yu at any given moment, which costs the hospital $1.5 million to $2 million annually. It also costs patients like Mr. Yu the chance to receive the intensive rehabilitation that they need.

Mr. Yu, according to a hospital document, can “perform some independent activities of daily living, including turning in bed and feeding himself.” But he is “dependent on staff for other daily necessities” and suffers from “limited cognition and limited independent judgment.”

One day last summer, he lay in his fourth floor bed watching a soundless “Clifford the Big Red Dog” cartoon with his roommate, a tiny, elderly Chinese man who has been boarding at the hospital for years.

Mr. Yu said that he entered the United States legally 11 years ago and then overstayed his visa to work “on the black market” as a cook. Speaking in Mandarin that was translated by a hospital employee, Mr. Yu said he was grateful to Downtown. “American hospitals are very humane,” he said. “I have no money. This hospital is giving me food, a bed and care.”

But the hospital does not want him to stay indefinitely. Last winter, Mr. Menkes said, at a moment when he had patients “stacked up in the emergency room,” he realized that he needed to find a way to discharge patients like Mr. Yu. Shortly thereafter, the hospital went to court to get a guardian appointed.

“He is utilizing valuable hospital resources,” the hospital said, “when the hospital is overburdened and cannot and is not equipped to provide rehabilitation or long-term care.”

When Katherine B. Huang, a Chinese-American lawyer, was appointed his guardian last spring, the hospital planned to transfer Mr. Yu to a Brooklyn nursing home and support his stay. Ms. Huang sought to clarify what the hospital was promising.

“I said, ‘You’re going to pay for him for the rest of his life?’ ” she recounted. “I said, ‘Does your negotiated rate with the nursing home cover his rehabilitation and health care needs, too? What about burial costs?’ I mean, you have to think this all through. They told me the lawyers were hammering it out.”

But the hospital later changed course.

In late September, Mr. Yu entered the courtroom of New York State Supreme Court Judge Lottie E. Wilkins on a taxi-yellow gurney. Dressed in a hospital gown, he smoothed his thin hair and saluted the judge in English. Squeezing a small rubber ball for exercise, he was then wheeled behind closed doors, accompanied by his guardian, for what Judge Wilkins called a status conference, closed to the news media.

No record was made of the proceeding. But the guardian said that she learned then that the hospital was contemplating sending him back to his relatives in China.

“All of a sudden, it became, ‘Great, the family wants him back,’ after the hospital repeatedly told me the family did not,” Ms. Huang, the guardian, said.

The hospital declined to discuss the case, citing patient confidentiality. Mr. Menkes said, “We are not going to force people back” to their homelands.

Whether, as a person declared incapacitated by the court, Mr. Yu possesses the ability to consent to a repatriation remains to be seen. Ms. Huang said the case lay on ground ungoverned by guidelines, where hospitals are neither required to nor prohibited from doing anything with such patients.

“My position is that I need to look out for what is in his best interest,” Ms. Huang said.

After the September hearing, The Times contacted Mr. Yu’s 30-year-old son in Ningbo, China. The son, Cheng Jun Yu, said he and his mother had been estranged from Mr. Yu since he left for the United States. “The family situation wasn’t merry,” the son said.

“We do not wish for him to return,” he continued. “He will be a burden for me, and I do not have the time or resources to care for him. My mother has established a new family, and I do not wish for this matter to disrupt her life. If they want to send him back, they will have to negotiate with the Chinese government to see if the government will care for him.”

Into the Unknown

Hospitals say the federal government ignores the burden posed by these patients. In fact, Immigration and Customs Enforcement does not assume any responsibility for the health care of illegal immigrants unless they are in federal immigration detention, said a spokeswoman, Kelly Nantel, and it does not get involved in repatriations undertaken by hospitals.

For some hospitals, such repatriations are routine, for others a last resort. And, just as some forcibly repatriate patients, others do so only with consent — although consent is a murky concept when patients are told they have no alternative. While some hospitals pay for an immigrant’s repatriation and for their care in their homelands; others never make any inquiries into how deported patients have fared.

“We don’t do any follow-up,” said Sister McBride at St. Joseph’s in Phoenix.

Even patients at hospitals that never repatriate immigrants can find themselves embroiled in discharge plans of considerable complexity, as the case of Darwin Castro demonstrates.

One day last May, Mr. Castro, a 21-year-old illegal immigrant from Honduras, was getting a ride home from his construction job in Oklahoma City when the driver crashed into a tree. By the time he arrived at the Oklahoma University hospital, he was in shock from extreme blood loss and rushed into an operating room for surgery on a badly wounded liver. He also suffered a traumatic brain injury, facial and arm cuts and a broken hand.

Alerted by Honduran friends to the accident, Mr. Castro’s cousin, Wilmer Ubener Reaños, 25, called the hospital from New Orleans, where he too worked in construction. Mr. Reaños asked a bilingual colleague for help in communicating with the hospital. From that point forward, the colleague, David Ruiz, became the family liaison, and the hospital believed that David — listed in the records with no last name — was the patient’s cousin.

After six weeks, Mr. Castro was ready for discharge, said Allen Poston, the hospital spokesman. With a feeding tube and bladder catheter, Mr. Castro needed round-the-clock care but the hospital failed to find him a charity bed in a nursing home. Since it never repatriates patients, the only other option was to discharge Mr. Castro to his relative in New Orleans, Mr. Poston said.

In this case, though, the relative was an illegal immigrant who worked a 12-hour day and shared a room in a boarding house with another laborer. The hospital, Mr. Reaños said, had no idea where it was sending Mr. Castro. And Mr. Reaños had no idea what delicate condition his cousin was in, that he was barely ambulatory, brain-injured and could not talk, he said.

An air ambulance flew Mr. Castro to New Orleans and delivered him to David Ruiz. Several hours later, when Mr. Reaños got off work and arrived to pick him up, he found Mr. Castro sitting in his own waste in a wheelchair, groggy and unresponsive.

“He was so dirty,” he said. “I cleaned him. I changed his diaper. But that was all I could do. I did not know how to feed him, how to open the tube. I felt like they left me completely in the lurch. All I could do was cry.”

Mr. Reaños later learned that the transport company had trained Mr. Ruiz to use the medical equipment but Mr. Ruiz had not understood the instructions.

After two days, Mr. Castro appeared “on the verge of death,” Mr. Reaños said. He called an ambulance, and the cost of Mr. Castro’s care was thus shifted from Oklahoma to Louisiana, where a New Orleans hospital taught Mr. Reaños how to take care of him.

That proved arduous. Mr. Castro could not be left alone. Although his cousin assembled a patchwork community of caretakers, he missed so much work that he lost his job. Then his landlady kicked him out because his cousin “smelled sick,” he said.

At wit’s end, Mr. Reaños made plans to repatriate his cousin himself. He raised the money for a single ticket, but not enough for an escort. Through the Honduran consul, he arranged for a flight attendant to look after his cousin en route. But that arrangement disintegrated during a change of planes in Houston. When Mr. Castro did not arrive as scheduled in Honduras, his cousin furiously worked the phones, eventually discovering that Mr. Castro had been abandoned in the Houston airport. It took several more days for him to get back to his homeland.

By the time Mr. Castro arrived on Aug. 4, his suitcase, medical records and wheelchair had been lost in transit. He was exhausted, incoherent and too weak to stand, his aunt, Nolvia Rodríguez, said. But she took him into her modest home, and Mr. Castro has improved, Ms. Rodríguez said. A nurse in the neighborhood is helping out, and a clinic is tending to his medical issues when the family, which does not have a car, scrounges together the money to get him to the city.

To Mexico and Back

Antonio Torres’s journey through the American — and Mexican — health care systems began at dawn on June 7, when the 19-year-old, driving to work across a rutted, gravelly dirt road on the ranch where his family lives, flipped his pick-up truck. He was found, unconscious, about 150 feet from his vehicle by a ranch hand.

For two decades, his father, Jesús, a legal immigrant, had lived on both sides of the border, harvesting the fields of Arizona while traveling regularly to visit his family in northern Mexico. Last year, his wife, Gloria, and their four children received their green cards and joined him in a farmworkers’ community outside Gila Bend.

That June morning, the Torreses followed behind an ambulance that took Antonio to St. Joseph’s, the flagship hospital of Catholic Healthcare West, where he was admitted to the intensive care unit with a severe traumatic brain injury, bruised lungs and abdominal injuries. Two days later, his parents, “frozen with fear,” the elder Mr. Torres said, were unprepared for a hospital social worker’s frank assessment of their son’s prognosis.

“She said there was no hope for our son and that it would be best to unplug him,” Mr. Torres said. “She said, ‘You have to think what kind of life this is, hooked up to a ventilator. And if he wakes up, he will not be able to do much.’ When we said, ‘No!’ the social worker said that, well, then, without insurance, they couldn’t keep him.”

According to the social worker’s notes, the hospital anticipated that the patient would need long-term ventilator care and that, as a legal immigrant with less than five years in this country, he would not qualify for Arizona’s Medicaid coverage.

Five days after the accident, the social worker, using an interpreter, called the public hospital in Mexicali to arrange Antonio Torres’s repatriation. “Patient accepted for admission,” her notes say.

The following day, the notes add, “Parents upset.”

During that time, the elder Mr. Torres contacted Tom Espinoza, a Hispanic leader in Phoenix who had been battling the hospital’s repatriation of another comatose legal immigrant. Accompanying them to a meeting at the hospital, Mr. Espinoza, president of the Raza Development Fund, pledged to raise money for Antonio Torres’s care.

“Picture this,” he said. “It’s probably in a six-by-eight room. The social worker says, ‘Gee, that would be like taking money and throwing it down a black hole because this kid is going to die.’ I’ve got Mom and Dad crying, and she says that other patients would be better suited for that kind of investment.”

“At the end of the day,” Mr. Espinoza continued, “I realized it was not about the dignity of a person, it was about a bottom line.”

The hospital delayed the repatriation for a few days, giving the elder Mr. Torres time to search for a nursing home. He came up empty, so the hospital moved to repatriate his son even though he was not only comatose and dependent on a ventilator but also had a very high white blood cell count, indicating infection.

Antonio Torres had pneumonia. A hospital physician temporarily blocked his transfer.

Two days later, early on June 20, his white blood cell count was still too high to meet the physician’s condition for transfer, according to the social worker’s notes. Nonetheless, a few hours later, with the same physician’s consent, Antonio Torres was placed on a portable ventilator for his departure.

Sister McBride said St. Joseph patients were transferred to Mexico during “a window of time” when they are stable but “still acute” because Mexican hospitals did not want them “down the phase of recovery.”

But Dr. Caleb Cienfuegos, director of the public hospital in Mexicali, said, referring to the younger Mr. Torres, “I personally would not have transferred the patient in that state.”

Accompanied by his mother, Mr. Torres traveled by ambulance to Calexico, Calif., a four-hour drive; his father, and reporters from La Voz, a Spanish-language weekly published by Mr. Espinoza’s wife, accompanied them in cars. At the border, Mr. Torres was wheeled from the air-conditioned American ambulance to a sweltering, World War II-era Mexican Red Cross vehicle.

The Torreses said that officials from St. Joseph’s told them that the Hospital General in Mexicali had a room waiting for their son. The social worker’s notes indicate that, through an interpreter, she had four conversations with a Dr. Dueñas, chief of the emergency room; the notes refer to him twice as “Dr. Urgencias,” or Dr. Emergency.

Interviewed at the bustling Mexicali hospital in early September, Dr. Mario Dueñas said that he did not recall the conversations. “But I would say the same thing to anybody: that my emergency room is open and ready for any patient from anywhere,” he said. “I cannot promise anyone a bed.”

The hospital director, Dr. Cienfuegos, said American hospitals generally made formal arrangements with him directly and not with his emergency room.

Both doctors were surprised to learn that the patient was a legal resident of the United States. “Generally, they send us the undocumented, the ‘wetbacks,’ ” Dr. Dueñas said.

Antonio Torres spent several days in the emergency room before a bed opened up in a crowded ward. His parents said Mexican doctors advised them to take their son back to the United States if possible. Through their church, the Jehovah’s Witnesses, the parents made contact with a church leader in El Centro, Calif., who took them under his wing, introduced them to the local hospital and raised money for “the best ambulances in the border area,” the elder Mr. Torres said.

Within a week, his son was on his way back to the United States, where the El Centro hospital was waiting to take him in and write off his care as charity.

“Our mission here is to provide health care access to our community,” Mr. Green, president of the city-owned hospital, said, “and anyone who comes to our E.R. is considered part of our community.

“This was a kid who came to this country legally, worked here legally and had an accident,” he continued. “For God’s sake, don’t we take care of our folk? To me, this case shows one of the disastrously broken pieces of our health care system.”

Mr. Torres arrived from Mexico in septic shock, a potentially fatal condition caused by overwhelming infection. After 18 days at El Centro, he woke forcefully from his coma. “They took out his trach tube, he cleared his throat and said, ‘Where’s my mom?’ ” his father said. “We cried with surprise. We cried with joy. You could have paddled away on our tears. Then, after that, he improved every day. He didn’t take baby steps. He jumped. He leaped.”

Told of the progress that the younger Mr. Torres had made, Sister McBride said, “That’s wonderful,” adding that she thought it testament to the emergency care at her hospital. “Maybe if he had been in a different setting, he may not have survived,” she said.

The Torreses have filed a detailed complaint against St. Joseph’s with the Arizona health department, and the matter is under investigation.

Mr. Torres, an Arizona taxpayer who did not qualify for his state’s Medicaid program, ended up qualifying for California’s simply because his parents had established residency by renting an apartment in El Centro on the advice of their Jehovah’s Witness friend. That enabled the hospital there to transfer him after a month to an intensive rehabilitation program in San Diego, which discharged him at summer’s end.

Now Mr. Torres walks with a cane and speaks slurred but comprehensible Spanish. He is itching to climb back onto a combine and cut alfalfa alongside his father. For the moment, though, he is commuting with his mother from Arizona to California for therapy.

In September, as he waited for his first session, he reached slowly into his pocket, pulled out his wallet and removed a picture of himself as a toddler. “Dangerous child,” his father said teasingly, and Mr. Torres flashed his lopsided smile.

The physical therapist, Darryl Murdoch, asked Mr. Torres how he had injured himself. “I don’t remember,” he said.

“That’s normal,” Mr. Murdoch answered gently.

Back in Arizona, Mr. Torres sat stolidly for hours on a worn couch in the concrete barracks-style housing where his family lives, letting the conversation swirl around him. Sitting beside him, a younger cousin held his hand, and toyed with a slingshot. His teenage sister wandered in and out with girlfriends. Crickets chirped loudly as a pinkish dusk settled on the dusty landscape outside.

“Imagine if I had said, ‘O.K., disconnect him,’ ” Jesús Torres said.

* By DEBORAH SONTAG (NYT, November 9, 2008)
Pilar Conci contributed reporting from New York, and Tina Lee from Ningbo, China.

THE federal government is giving General Motors, Ford and Chrysler $25 billion in low-interest loans, and the companies are asking for up to $25 billion more. These same companies have spent millions of dollars lobbying against federal fuel-economy standards and are suing to overturn the emissions standards imposed by California and other states. In exchange for the loans, Congress should first insist that the automakers stop fighting these standards. But it should also make sure that better outcomes will result from these billions than just fuel-efficient cars.


The Obama administration should ask the companies, as a condition of financial assistance, to begin shifting from being just automakers to becoming innovative “transportmakers.” As Barack Obama’s new chief of staff, Rahm Emanuel, recently said: “You don’t ever want a crisis to go to waste. It’s an opportunity to do important things you would otherwise avoid.”

As transportmakers, the companies could produce vehicles for high-speed train and bus systems that would improve our travel options, reduce global warming, conserve energy, minimize accidents and generally improve the way we live.

This better way forward has been kicking around Washington for more than 35 years. In a prescient 1972 article in The Atlantic, Stewart Udall, an interior secretary under John F. Kennedy and Lyndon B. Johnson, warned of America’s excessive dependence on cars and called for this approach.

At a time when almost no politicians and industry leaders were paying attention to this problem, Mr. Udall made a bleak but accurate prediction. He wrote that “the oil needs of the other industrialized countries are growing faster than ours” and that this “surge of demand will soon begin to send shock waves through the American economy and transportation system.”

“Unless we exercise foresight and devise growth-limits policies for the auto industry, events will thrust us into a crisis that will lead to a substantial erosion of our domestic oil supply as well as the independence it provides us with,” Mr. Udall wrote. He predicted that the cost of petroleum imports would “give the Middle Eastern suppliers a dangerous leverage over our transportation system as well.”

But Mr. Udall recognized that the country could not afford the economic consequences of losing all of the automobile industry’s jobs and profits. He proposed that the auto companies branch out into “exciting new variants of ground transportation” to produce minibuses, “people movers,” urban mass transit and high-speed intercity trains. Instead of expanding the Interstate highway system, he suggested that the road construction industry take on “huge new programs to construct mass transit systems.” And he called for building “more compact, sensitively planned communities” rather than continuing urban sprawl.

As we now know, warnings like these went unheeded, and Americans became ever more car-dependent. And now, the auto industry is asking for government money that promises, even with more fuel-efficient cars, to give us more of the same. Instead of supporting companies that want to put as many cars on the road as possible, we need a transformational strategy.

As part of its loan package, the government should insist on the development of “transportmaker business plans” from the car companies, with specific timelines for developing more fuel-efficient cars. The companies should also provide detailed plans to transform some of their factories into research and manufacturing centers for the development of light-rail cars and high-speed trains and buses. (In some cases, these could run on existing tracks and on the median strips of Interstate highways; in others, entirely new lanes and tracks would be built.)

Even before Mr. Udall, there was ample precedent for these ideas. In the early 1930s, G.M. joined with other companies to develop the Burlington Zephyr, a radically innovative train that broke world speed records and cut train travel times in half. During World War II, the auto companies converted their factories to build not only military trucks and jeeps, but also airplanes, weapons, tanks and other vehicles. Ford’s Willow Run plant built thousands of B-24 bombers, becoming the world’s biggest bomber plant.

The research and production capacity that the car companies built during the 20th century could be adapted for the needs of the 21st. But other companies should be able to bid for the same opportunities.

Stewart Udall rejected the view that American prosperity depended on Detroit producing ever more cars. The financial crisis gives us a second chance to make his vision happen.

* By ROBERT GOODMAN (NYT,November 16, 2008)
Robert Goodman, a professor of environmental design at Hampshire College, is the author, most recently, of “The Luck Business.”

A man delivering food to the homebound elderly was shot and killed in the lobby of an apartment building in Brownsville, Brooklyn, on Monday morning, the police said.


Whether the shooting was part of a robbery was not immediately known. The victim, Imonil Aminov, 55, worked as a deliveryman for the Jewish Association for Services for the Aged, which brings food to Brownsville and East New York through the city’s Department for the Aging, said Aileen Gitelson, chief executive officer of the Jewish Association.

The shooter, who was seen fleeing the scene, was described by the police as a black man in his 20s, wearing a black hooded sweatshirt. The police said they were reviewing footage from surveillance cameras, but it was not clear whether the shooting had been captured.


Mr. Aminov was filling in for another worker on Monday, Ms. Gitelson said. He had a wife and three daughters, and came to the country from Tajikistan in 1989, working various jobs, including stints as a hot-dog vendor and a livery driver, his family said. After an accident while working as a livery driver left him unemployed, he started work with the meal-delivery program in August, his family said.

“He was delivering food to poor people, and they shot him down,” said his wife, Nadezhda Aminov.

The shooting occurred shortly after 10:15 a.m. at 341 Dumont Avenue in the Brownsville Houses, the police said. Mr. Aminov was shot once in the chest. He was pronounced dead shortly after his arrival at Brookdale University Hospital and Medical Center, the police said.


The shooting seemed unusual, even in the sometimes dangerous world of food deliveries. Robberies of food deliverymen, especially those employed by Chinese restaurants, while not routine, are far from unheard of in the city. But the shooting of a deliveryman working for a nonprofit organization on behalf of the elderly left many wondering what could have motivated the shooting.

Delivery drivers for the Jewish Association occasionally carry cash, picking up voluntary contributions once a week, Ms. Gitelson said. But, she said, the donations are very small and are usually collected at week’s end.

Mr. Aminov, who drove a truck marked “Nutritional Meals Delivered to Homebound Seniors,” had just made his delivery to Gertie Johnson, 73, a meal of pasta and broccoli, Ms. Johnson said.

“He’s a very nice man,” Ms. Johnson said. “I hate it so bad.”

After he left the food with her granddaughter and made a second delivery, “We heard a bang,” Ms. Johnson said. “I said, ‘Was that a shot?’ ”

Ms. Johnson said her granddaughter replied, “It sounds like a shot.” The granddaughter looked out and saw Mr. Aminov lying in the hall, Ms. Johnson said.

Another resident, Bernadette Jones, said she heard a noise, “like something dropped” in the hallway. About two minutes later, her 20-year-old daughter, Kady, opened the apartment door to go to the store, and screamed.

Bernadette Jones said Mr. Aminov’s glasses and black cap were still on and, not seeing any blood, she assumed he had had a heart attack. Another neighbor lifted Mr. Aminov’s hand, but it flopped back to the floor, she said.

Ms. Jones said that across the hall from her apartment, a woman screamed, “God, what did they do? He just brought me my lunch.”

Another neighbor, Martha Surgener, 68, believed he was new to Brownsville because he arrived at her home early.

“They bring nice meals — chicken, beef stew, all kinds of things,” she said. “They can’t go around killing people like that. It’s a depressing day. It’s crazy.”

Accounts varied as to how often Mr. Aminov, who lived in the Starrett City complex in East New York, Brooklyn, visited the Brownsville Houses. Some tenants said they had seen him before. But Mr. Aminov’s nephew, Arthur Leviyeva, 28, said Mr. Aminov feared the Brownsville Houses and had refused to go there on Monday, only to be ordered to go by a dispatcher. “He saw it as a very dangerous place,” Mr. Leviyeva said. “Maybe he was trying to fight them and they shot him in the heart.”

Ms. Gitelson said she did not know of any such exchange between Mr. Aminov and a dispatcher.

“If someone refuses to work, they just refuse to work,” she said, and added that she had never heard of a driver refusing to enter a neighborhood. “We deliver I don’t know how many meals a year,” she said. “I’ve never heard it.”

A co-worker, Anita Acevedo, 44, said Mr. Aminov was a popular and eager deliveryman, nicknamed “Running Man.”

“He took the meals and he would just run with them,” Ms. Acevedo said. “Everybody loved him here.”

All drivers are routinely warned of possible danger in neighborhoods with high rates of crime, she said.

“I would tell the guys, ‘Guys if there’s ever anything, please give up what you have,’ ” Ms. Acevedo said. “ ‘Don’t resist.’ ”

* By MICHAEL WILSON (NYT, November 11, 2008)
Ann Farmer, Karen Zraick and Carolyn Wilder contributed reporting.

FOR the American automobile industry, the years since the glory days of the 1950s and ’60s have been a period of decline. Ever since the oil crises and the Japanese import invasion of the 1970s, the automakers have repeatedly flirted with financial ruin.


They stayed afloat, at times quite profitably, by shifting their focus to sport utility vehicles and big pickup trucks, which indulged the desires of consumers for larger and more powerful vehicles. They deluded themselves into thinking they had created a successful strategy, when what they had really created was a protected and precarious perch.

Bankruptcy, then, might be well deserved, were it not for the risk of the complete collapse of the companies. The industry must be bailed out by the federal government. There are hundreds of thousands of jobs at stake, and a strong domestic manufacturing sector is important for security reasons.

Scarce American dollars, however, must be invested in the larger public interest. The best bailout is one that weans us off oil and sets us on a path to reduced carbon emissions. Congress and President-elect Barack Obama are not qualified to protect shareholders’ interests, nor can they build a better car. But they can ensure that society benefits from our investment in the automobile industry.

One way to do that would be to establish a price floor of $3.50 per gallon on gasoline. If the price drops below that, as it recently has, the federal government would impose a variable tax to bring the price up to $3.50. If the price goes above $3.50, then the tax disappears. The money raised by the variable tax would be used, at least in the short term, to provide loan guarantees to the auto companies. (To ease the burden of higher gasoline prices on low-income taxpayers, some of the revenue would be provided to them as tax credits or vouchers.)

A price floor for gasoline would ease the bailout’s burden on taxpayers. At current prices, a floor of $3.50 per gallon would generate more than $17 billion in one month — a big chunk of a $25 billion bailout. If, without the floor, gasoline averaged $2.50 per gallon over the next year, revenues would amount to $140 billion. That money could pay for a sound transportation policy agenda beyond the bailout.

To receive some of the money raised by this tax, the car makers would be required to produce large numbers of affordable, durable, safe, fuel-efficient, low-carbon vehicles within the next five years. They would also have to relinquish their fight against California’s clean car standards and accept national greenhouse gas standards for vehicles. The companies should also be required to sell a certain number of near-zero emission cars — electric, plug-in hybrids and fuel-cell vehicles.

The $3.50 price floor for gasoline would help sell these fuel-efficient cars. The higher the price of gas, the greater the demand for Detroit’s new, improved fleet. The price floor could be indexed to inflation, so that it rises over time, and it could be applied to diesel fuel, to avoid a widespread substitution from gas to diesel. A comparable price floor for oil could be calculated, to reduce the risk of manipulation of crude pricing.

The declining fortunes of the domestic automakers have paralyzed energy and environmental debates and stymied oil and climate policy for more than a generation. We’ve been down this road before. In 1980, Chrysler was reported to be within hours of bankruptcy, and Congress bailed out the company with $1.5 billion in loan guarantees and a package of concessions — from lenders, unions and others — worth billions more.

This time, the government has to be smart, steering the country to a more sustainable future.

Daniel Sperling, the director of the Institute of Transportation Studies at the University of California, Davis, and Deborah Gordon, a transportation policy consultant, are the authors of the forthcoming “Two Billion Cars: Driving Toward Sustainability.”




How fast do you drive?
When it comes to speeding, many American motorists don’t worry about safety. They just worry about getting caught.


Those are the findings by researchers from Purdue University who surveyed nearly 1,000 motorists about speed limits and driving habits. They found that many drivers are cynical about the safety benefits of driving within speed limits, and many think they can drive safely while speeding as long as they won’t get caught, according to the report in Transportation Research Part F: Traffic Psychology and Behaviour.

“So the faster you think you can go before getting a ticket, the more likely you are to think safety’s not compromised at higher speeds,” said Fred Mannering, a professor of civil engineering at Purdue, in a press release. “For whatever reason, respect for speed limits seems to have deteriorated.”

Dr. Mannering used a series of mathematical equations to calculate the probability of speeding, based on data from a survey of 988 motorists in Tippecanoe County, Ind. The survey findings were consistent with other research that has shown two-thirds of all drivers regularly exceed posted speed limits, and roughly one-third report driving at least 10 m.p.h. faster than most other vehicles.

The latest research asked participants: “At what point do you feel speeding becomes a threat to the personal safety of you and your family?” The motorists were given three choices: 5 m.p.h., 10 m.p.h. or 20 m.p.h. over the speed limit.

The survey was taken before and after a 2004 media campaign launched in the county stressing the dangers of speeding that included radio and newspaper messages.

More than a third of the drivers in the survey thought it was safe to drive 20 m.p.h. over the speed limit. Overall, the vast majority of respondents said they thought it was safe to speed, with 79 percent saying it was safe to exceed the limit by 10 m.p.h. or more.

The research showed the media campaign relating to the dangers of speeding had no statistically significant impact on drivers’ views on speeding and safety. For most drivers, a “safe” speed is typically just beyond the point where they believe they are at risk for getting a ticket. That means that motorists who believe they won’t get a ticket until they go 10 m.p.h. above the speed limit are 27 percent more likely to drive up to 20 m.p.h. above the speed limit.

Notably, getting stopped for speeding didn’t seem to have an effect on whether or not a person speeds again. Both men and women drivers who had been stopped for speeding in the last year were 25 percent more likely to believe that it is safe to drive up to 20 m.p.h. faster than the speed limit, compared to those who hadn’t been ticketed.

“This is probably because people who habitually speed are not significantly deterred by being stopped for speeding,” Dr. Mannering said. “They might become slightly more conservative, but it doesn’t slow them down to the level of people who are inherently more conservative.”

To learn more about Dr. Manning’s research, read “Yes, Accidents Happen. But Why?,” published in The Times last year.

* Stuart Isett for The New York Times; November 10, 2008

COSMETIC doctors have nicknames for the days on which they offer deals on anti-wrinkle shots.


Dr. Don Mehrabi, a dermatologist in Beverly Hills, Calif., advertises his weekly promotion as “Botox Fridays,” the days on which he lowers his fees by about 30 percent for smoothing out frown lines and crow’s feet.

On other days of the week, he gives a 10 percent discount to clients who choose a combination of Botox Cosmetic and injections of Juvéderm, a gel that plumps the skin.

“That percentage off might actually increase because of the economy,” said Dr. Mehrabi, who posts his deals on his Web site, “We are contemplating going up to 20 percent.”

In light of drastic consumer cutbacks on spending, some dermatologists, facial surgeons and plastic surgeons are promoting the kinds of markdowns, coupons or two-fers you might expect to find in supermarket circulars — complete with restrictions like “offer not good with any other promotion.”

And it’s not just injection specials. The Web sites of some surgeons list promotions like $500 off a single operation or $1,000 off a combination of body or facial surgeries.

Consumers pay cash up front for cosmetic procedures and, because the treatments are medically unnecessary, they are typically not covered by insurance, which explains why doctors’ marketing efforts can resemble a department store white sale.

“Giving $1,000 off, you are going to see more of that,” said Dr. Lawrence S. Reed, a plastic surgeon in Manhattan who does not offer deals on surgery. Dr. Reed said that all upscale businesses — including plastic surgeons’ offices — are seeking creative marketing strategies to stay afloat.

“You have got to do things to get people into your fancy restaurants, your fancy car dealerships, your plastic surgeon’s office, your dermatologist’s office,” he said.

To be sure, most cosmetic doctors are neither flamboyantly advertising discounts on operations nor marketing fire sales on injections. But the economy has taken a toll on cosmetic practices. Competition from an increased number of doctors entering the cosmetic market has also stimulated more aggressive marketing.

In private consultations with patients, many plastic surgeons are reducing their fees.

“I can’t imagine anyone’s not doing that,” said Dr. James H. Wells, a plastic surgeon in Long Beach, Calif. He recently asked 80 colleagues via e-mail messages how they are adapting to the economic downturn. “They are now willing to discount things anywhere from 10 to 15, 20, 25 percent,” he said.

But such price-cutting blurs the line between the tactics of commerce and the practice of medicine, in which physicians have traditionally encouraged treatments based on a patient’s condition or concerns, not on the doctor’s bottom line.

Some plastic surgeons said that incentives like discounts, treatment packages or two-for-one deals could induce people who had not previously considered it to have an injection or an operation, or to have more procedures, potentially increasing their risk of medical complications. Promotions in which existing clients receive discounts or special treatment for sending friends to their doctors can also be ethically fraught.

“It skews the caution of proper decision-making,” said Dr. Adam Searle, a plastic surgeon in London who is a former president of the British Association of Aesthetic Plastic Surgeons. His group has warned against discounts. “It simply reduces it to a commodity and that’s dangerous,” he said.

But economic realities are pushing practices once considered unseemly into the mainstream.

Sixty-two percent of plastic surgeons who responded to a questionnaire from the American Society of Plastic Surgeons reported that they had performed fewer cosmetic procedures in the first six months of this year compared with the same period last year, according to a study the group released last week.

In response, the plastic surgery society added a forum to its annual conference, which was last weekend in Chicago, entitled: “Survival Strategies for Tough Economic Times.” Some speakers at the event recommended that doctors expand their client bases by joining school boards, churches, synagogues, rotary clubs, symphony and museum groups, and breast cancer fund-raisers. Others encouraged doctors to introduce package deals and offer promotions to existing clients who refer their friends.

Plastic surgeons traditionally reduce their fees for operations on related areas of the anatomy — such as a face-lift and an eyelift — that can be performed in one session, said Dr. Mauro C. Romita, a plastic surgeon in Manhattan. It is also standard practice for doctors to offer discounts on Botox if a patient is having the treatment in more than one area of the face, he said.

But discounting is going public this year.

Under a three-month promotion that ended last Friday, people who bought Restylane, a facial filler, could receive a $50 rebate for one syringe or a $100 rebate for two syringes from Medicis, the brand’s distributor in the United States. The tag line for the promotion: “The economy may not be looking its best, but you can.” More than 20,000 people redeemed rebate coupons.

Individual doctors are devising their own deals.

Dr. Christine A. Hamori, a plastic surgeon in Duxbury, Mass., said she recently mailed a two-fer invitation — designed and printed by her Medicis sales representative — to about 3,500 clients. In October, clients could buy two syringes for the price of one $600 syringe of Restylane or one $800 syringe of Perlane, another filler, Dr. Hamori said.

Seventy-five people came in for injections; many of them requested additional treatments. In a month in which few people had signed up for expensive operations, those coming in for the injection special filled up her schedule, she said. “The response was tremendous,” Dr. Hamori said.

And some pharmaceutical companies offer volume discounts to select doctors.

Dr. Hamori said that when she recently bought 50 vials of Botox, a sales representative from Allergan, which makes Botox, added another 50 vials free. Each vial costs about $500, she said.

Dr. Mehrabi said that he received one free syringe of a filler called Radiesse from BioForm Medical, the product manufacturer, for every syringe he had sold in September.

Adam D. Gridley, the senior vice president for corporate development at BioForm, wrote in an e-mail message that the company does not comment publicly “on specific programs and doctor metrics.” Jonah Shacknai, the chief executive of Medicis, said that only a few doctors across the country are participating in his company’s program to introduce patients to the effects of two syringes. Caroline Van Hove, vice president for corporate communications at Allergan, wrote in an e-mail message that the company does not provide free vials of Botox Cosmetic as a reward for buying the product.

Some doctors are also lowering their charges for larger procedures.

Dr. Hamori said she has been reducing her surgical fees in a range of 5 to 10 percent.

In Indianapolis, Dr. W. Gregory Chernoff, a facial surgeon, decided to lower his prices a few months ago after he noticed a slowdown in face-lifts and hair transplant patients. He calls the 15- to 20-percent reduction in surgical fees a “professional courtesy.”

“We do not want to be a Kmart of cosmetic surgery,” said Dr. Chernoff, who has also posted holiday special offers, good until Nov. 28, on his Web site. “That word ‘discount’ is shunned within our profession.”

Dr. Wells, a former president of the American Society of Plastic Surgeons, said that many of his colleagues are now trying to figure out how to provide “value added” services to entice clients. He predicted that more doctors will start offering a free anti-wrinkle shot or laser treatment for people having cosmetic surgery. But some doctors may go too far, he said.

“My conjecture is we are going to see people go over the line,” Dr. Wells said.

Along the hallways of the plastic surgery conference in Chicago, Dr. Wells toted one of his favorite books, “Cowboy Values,” an ode to the moral code of the Old West. As his coda to an interview about cosmetic surgery marketing, Dr. Wells opened the book and read a passage aloud to a reporter: “You never really know the measure of a man until there is adversity or money on the table.”


* Text by NATASHA SINGER (NYT;November 6, 2008)



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