Daley turns focus toward Gary

Richard M. Daley has kept a low profile since leaving office in 2011.

That doesn't mean he has lost interest in urban issues. The former mayor has turned his attention in a surprising direction, beyond Chicago's borders to one of the most intractable urban tragedies in America: the collapse of Gary, Ind.

"I always believe no part of America should be forgotten, and I think Gary has been forgotten," Daley said.

Daley is using his influence at the University of Chicago, where he is a distinguished senior fellow, to push a modest but growing amount of manpower toward Gary Mayor Karen Freeman-Wilson.

With guidance from Daley and Freeman-Wilson, University of Chicago graduate students are trying to figure out what to do with Gary's abandoned buildings and how to promote greater use of technology to help the city accomplish more with less, among other projects.

The hope is that the students will go on to help other cities after graduation. If successful, the U. of C.-Gary partnership could be replicated in other industrial towns grappling with decline.

Gary spans about 55 square miles, nearly a quarter of the size of Chicago. Yet the steel town's population has plummeted to an estimated 80,000, meaning the city has lost about half its people since 1960. The city's problems have mounted, including abandoned buildings and homes, sagging infrastructure and a declining budget to pay for services.

Outsiders have tried to fix Gary since at least the Lyndon B. Johnson administration. Freeman-Wilson, a former Indiana attorney general, judge and Harvard College and Harvard Law School graduate, has reinvigorated Gary's renewal efforts. And she's unafraid to ask for help.

Immediately after winning the 2011 Democratic primary, Freeman-Wilson called Daley for advice. They met, and Daley invited her to be the first guest speaker at his lecture series at the University of Chicago's Harris School of Public Policy, where Daley has a five-year appointment.

This quarter, 11 students from the university's public policy, business and social services schools are getting course credit for working on projects for Gary.

"It was Mayor Daley's idea," Freeman-Wilson said as she rode from a meeting on Chicago's West Side to Gary. "I had always envisioned getting the support and work from (University of Chicago Law School) alums, because there were issues around codes and things of that nature. It was not until the mayor came up with the idea of using students from the (Harris) School of Public Policy that I said, 'Oh yeah, that would work. That would work very well.'"

Daley does not teach a class at the University of Chicago. He runs an occasional lecture series.

Carol Brown, his last policy chief at City Hall, leads the program and the class, which is called the "Urban Revitalization Project: City of Gary, Ind." Grants from the Chicago-based Joyce and MacArthur foundations help pay administrative costs, including Brown's salary and that of a part-time assistant.

Last quarter's class was divided into three project teams. One team is cataloging Gary's abandoned buildings, which are magnets for crime and eyesores that further depress surrounding property values. Another is trying to recruit pro bono legal and consulting services for the city. And a third is trying to craft a strategy to clean up front stoops and empty lots one block at a time. This quarter's class also is tackling untapped funding opportunities and economic development.

Freeman-Wilson said a major benefit of the partnership is the fresh ideas from students "who aren't jaded by the limitations of government, whereas a 20-year employee might say, 'Oh, no, we can't do that in government because we don't have X, Y and Z.'"

Already their work has prompted more widespread use among Gary employees of a technology that stores and analyzes geographic data. City workers are now using the technology to map potholes, fallen tree limbs and illegal dump sites. That way work crews can be dispatched to neighborhoods where the problems are most severe.

"This partnership encourages urban planners to think broadly about regions instead of cities — greater Chicago instead of the city of Chicago," said Stephen Paul O'Hara, a historian at Xavier University who wrote a book about Gary.

The students operate as consultants. They gather best practices and ideas from cities around the country and then recommend a course of action. At the end of each 10-week quarter, students present their recommendations to Daley, Freeman-Wilson and their staffs. Their grades are based on those presentations and supporting reports.

"I will tell you, it never stops getting nerve-wracking," second-year graduate student Jocelyn Hare said of presenting to Daley. "But it gets easier."

Last spring, Hare, 32, responded to an email seeking student volunteers to conduct preliminary research to test the idea of a partnership. Hare then interned for the city of Gary during the summer. The Harris school paid her $15 an hour. She then enrolled in the first class in the fall and again this winter, when it was opened to graduate students outside of Harris for the first time.

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Off-duty Chicago police officer dies in SUV rollover on Skyway

(Tribune illustration)

By Peter Nickeas




Tribune reporter

8:17 a.m. CST, February 16, 2013

A 31-year-old off-duty Chicago police officer died when the SUV she was driving rolled over on the Chicago Skyway late Friday, according to authorities.

The officer's older sister works in the section of the Chicago Police Department that investigates fatal accidents and answered the phone when officers on the Skyway called to notify them of the wreck, police said.

Shaunda Bond, 31, was pronounced dead at 1:15 a.m. at the Cook County medical examiner's office. She lived in the 4100 block of South Michigan Avenue in the Bronzeville neighborhood.

The crash happened about 10:40 p.m. near 81st Street on the Skyway when the 2003 Land Rover SUV Bond was driving flipped over.

Bond was the lone occupant in the SUV, which was the only vehicle involved in the crash.

Bond joined the police department in December 2009 and was assigned to the South Chicago District, which covers the area from 75th Street south to 138th, between roughly Woodlawn Avenue and the state line.

According to a witness interviewed by police, her SUV was seen traveling at a high rate of speed before it hit a concrete barrier and rolled.

pnickeas@tribune.com
Twitter: @peternickeas

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Opera world stages its own awards as faces budget crunch

LONDON (Reuters) – The world of opera, faced with budget cuts and wanting to raise appreciation of opera, has launched its own annual international awards, unveiling a shortlist of finalists in 23 categories.

The Operas, which will be presented at a ceremony in London on April 22, are the brainchild of Opera Magazine and British businessman Harry Hyman.

Opera Magazine editor John Allison said he hoped the awards would bring recognition to opera at a time when many opera houses were struggling to make ends meet due to a decline in private sponsorships and cuts in state subsidies.

English National Opera, one of London’s two principal opera companies, last month announced a loss for 2012 with audience figures down 9 percent and a drop in its public subsidy, while Paris Opera chief Nicolas Joel has publicly decried budget cuts and said he did not intend to renew his contract in 2015.

“Opera houses all over the world are in a lot of difficulty at the moment as everything is being cut and everyone is feeling the pinch. Some smaller houses in the United States have closed,” Allison told Reuters.

“Opera houses work very hard and artists put their life and soul into their work but there are a lot of good performances that come and go and are not recognized. Hopefully these awards will raise opera in everyone’s conscience.”

Allison said the awards also aimed to boost support for new and emerging artists who struggle to make a living from their profession and receive little public recognition.

“Everyone has awards – films, books, music – but there just has not been a set of international awards for opera. We want to change that,” said Allison.

The International Opera Awards, to be known as The Operas, involve 23 categories that recognize “the achievements of all the performers, producers and teams that work in Opera”.

Awards will be given to best female singer, male singer, conductor, opera company, and chorus, and there is also a life-time achievement award and a readers’ award.

Prizes for young singers will come with bursaries attached.

Finalists for the male singer are tenors Aleksandrs Antonenko, Piotr Beczala, Joseph Calleja, Jonas Kaufmann, bass-baritone Luca Pisaroni, and baritone Bryn Terfel.

Female singers in the running for the award are Sarah Connolly, Joyce DiDonato, Evelyn Herlitzius, Catherine Naglestad, Nina Stemme, and Beatrice Uria-Monzon.

The conductors shortlisted are Britons Richard Farnes and Antonio Pappano, Germany’s Ingo Metzmacher and Christian Thielemann, and Italian Nicola Luisotti.

The opera companies running for the prize are Oper Frankfurt, Opera National de Lyon, Staatsoper Stuttgart, Stanislavsky Music Theatre Moscow and Theater an der Wien.

One category unlikely to be seen at the Grammys is accessibility with the Metropolitan Opera in New York, London-based Streetwise Opera, Teatro Sociale in Como, Italy, and Welsh National Opera all vying for that prize.

Allison said more than 1,500 nominations were received from 41 countries with the judging panel made up 10 opera experts ranging from critics and opera house chiefs to singers.

(Reporting by Belinda Goldsmith, editing by Paul Casiato)

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Livestrong Tattoos as Reminder of Personal Connections, Not Tarnished Brand

As Jax Mariash went under the tattoo needle to have “Livestrong” emblazoned on her wrist in bold black letters, she did not think about Lance Armstrong or doping allegations, but rather the 10 people affected by cancer she wanted to commemorate in ink. It was Jan. 22, 2010, exactly a year since the disease had taken the life of her stepfather. After years of wearing yellow Livestrong wristbands, she wanted something permanent.

A lifelong runner, Mariash got the tattoo to mark her 10-10-10 goal to run the Chicago Marathon on Oct. 10, 2010, and fund-raising efforts for Livestrong. Less than three years later, antidoping officials laid out their case against Armstrong — a lengthy account of his practice of doping and bullying. He did not contest the charges and was barred for life from competing in Olympic sports.

“It’s heartbreaking,” Mariash, of Wilson, Wyo., said of the antidoping officials’ report, released in October, and Armstrong’s subsequent confession to Oprah Winfrey. “When I look at the tattoo now, I just think of living strong, and it’s more connected to the cancer fight and optimal health than Lance.”

Mariash is among those dealing with the fallout from Armstrong’s descent. She is not alone in having Livestrong permanently emblazoned on her skin.

Now the tattoos are a complicated, internationally recognized symbol of both an epic crusade against cancer and a cyclist who stood defiant in the face of accusations for years but ultimately admitted to lying.

The Internet abounds with epidermal reminders of the power of the Armstrong and Livestrong brands: the iconic yellow bracelet permanently wrapped around a wrist; block letters stretching along a rib cage; a heart on a foot bearing the word Livestrong; a mural on a back depicting Armstrong with the years of his now-stripped seven Tour de France victories and the phrase “ride with pride.”

While history has provided numerous examples of ill-fated tattoos to commemorate lovers, sports teams, gang membership and bands that break up, the Livestrong image is a complex one, said Michael Atkinson, a sociologist at the University of Toronto who has studied tattoos.

“People often regret the pop culture tattoos, the mass commodified tattoos,” said Atkinson, who has a Guns N’ Roses tattoo as a marker of his younger days. “A lot of people can’t divorce the movement from Lance Armstrong, and the Livestrong movement is a social movement. It’s very real and visceral and embodied in narrative survivorship. But we’re still not at a place where we look at a tattoo on the body and say that it’s a meaningful thing to someone.”

Geoff Livingston, a 40-year-old marketing professional in Washington, D.C., said that since Armstrong’s confession to Winfrey, he has received taunts on Twitter and inquiries at the gym regarding the yellow Livestrong armband tattoo that curls around his right bicep.

“People see it and go, ‘Wow,’ ” he said, “But I’m not going to get rid of it, and I’m not going to stop wearing short sleeves because of it. It’s about my family, not Lance Armstrong.”

Livingston got the tattoo in 2010 to commemorate his brother-in-law, who was told he had cancer and embarked on a fund-raising campaign for the charity. If he could raise $5,000, he agreed to get a tattoo. Within four days, the goal was exceeded, and Livingston went to a tattoo parlor to get his seventh tattoo.

“It’s actually grown in emotional significance for me,” Livingston said of the tattoo. “It brought me closer to my sister. It was a big statement of support.”

For Eddie Bonds, co-owner of Rabbit Bicycle in Hill City, S.D., getting a Livestrong tattoo was also a reflection of the growth of the sport of cycling. His wife, Joey, operates a tattoo parlor in front of their store, and in 2006 she designed a yellow Livestrong band that wraps around his right calf, topped off with a series of small cyclists.

“He kept breaking the Livestrong bands,” Joey Bonds said. “So it made more sense to tattoo it on him.”

“It’s about the cancer, not Lance,” Eddie Bonds said.

That was also the case for Jeremy Nienhouse, a 37-year old in Denver, Colo., who used a Livestrong tattoo to commemorate his own triumph over testicular cancer.

Given the diagnosis in 2004, Nienhouse had three rounds of chemotherapy, which ended on March 15, 2005, the date he had tattooed on his left arm the day after his five-year anniversary of being cancer free in 2010. It reads: “3-15-05” and “LIVESTRONG” on the image of a yellow band.

Nienhouse said he had heard about Livestrong and Armstrong’s own battle with the cancer around the time he learned he had cancer, which alerted him to the fact that even though he was young and healthy, he, too, could have cancer.

“On a personal level,” Nienhouse said, “he sounds like kind of a jerk. But if he hadn’t been in the public eye, I don’t know if I would have been diagnosed when I had been.”

Nienhouse said he had no plans to have the tattoo removed.

As for Mariash, she said she read every page of the antidoping officials’ report. She soon donated her Livestrong shirts, shorts and running gear. She watched Armstrong’s confession to Winfrey and wondered if his apology was an effort to reduce his ban from the sport or a genuine appeal to those who showed their support to him and now wear a visible sign of it.

“People called me ‘Miss Livestrong,’ ” Mariash said. “It was part of my identity.”

She also said she did not plan to have her tattoo removed.

“I wanted to show it’s forever,” she said. “Cancer isn’t something that just goes away from people. I wanted to show this is permanent and keep people remembering the fight.”

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Illinois corporate tax credits swelled to $161 million 2011

When lawmakers raised taxes on Illinois residents and businesses, they also increased corporate income tax breaks for a select group of companies.

In 2011, businesses were eligible to claim about $161 million in tax credits — double from the prior year — mostly because of the increase to 5 percent from 3 percent in the state's personal income tax rate, which is a factor in determining the value of the incentives. The boost marked the largest increase in the Economic Development for a Growing Economy tax credit program, the state's main economic development program, since its creation in 1999.

Deere & Co., Boeing Co. and Caterpillar Inc., whose leader severely criticized lawmakers for tax hikes, were among dozens of companies that received more robust tax breaks. Some companies' deals also allowed them to be in line to receive tax incentives even while laying off workers or lowering wages.

The EDGE program allows a business to claim a credit against its corporate income tax liability if it agrees to create and/or retain jobs and make an investment in the state of at least $1 million, for companies with fewer than 100 workers, and at least $5 million for larger companies.

Once accepted into the program, which typically lasts 10 years, a company applies on an annual basis for a tax credit certificate, similar to a voucher, which it can claim when it files its taxes.

Marcelyn Love, a spokeswoman with the Department of Commerce and Economic Opportunity, which administers the program, said that under the tax credit program companies make investments and employ workers, practices that otherwise would not have occurred without the credits.

"Both the private investment and the increased employment significantly increase tax revenue collection for the state in excess of the credits given," Love said in an email. Far from adding to the tax burden, she added, these incentives actually generate revenue for the state. "Further, most of these tax credits pay for themselves within two years."

The certificates are the only way to gauge the potential cost and scope of the program, because tax filings are not public. The Tribune obtained the 2011 certificates data, the latest year available, under the state's Freedom of Information Act. Companies have as many as five years to redeem a certificate.

After a deal is finalized, a company has two years to meet its side of the bargain and begin applying for certificates. Thus, the increase in the total value of 2011 tax breaks is also the result of companies receiving certificates for the first time. For example, Ford Motor Co. began applying for its certificates in 2010 from a 2007 deal.

During Gov. Pat Quinn's administration, companies have received increasingly larger deals. Many have been for retaining jobs, according to a Tribune analysis. In 2011, Sears Holdings Corp. was offered a tax credit package worth $150 million over 10 years to keep its headquarters in the state and retain at least 4,250 full-time jobs. The company, which after the deal was announced revealed that it was closing 125 stores nationwide, has yet to apply for a certificate. Five of those stores were in Illinois. State officials have said that during a recession, when few jobs are created, it's important to focus on retaining workers.

Chris Brathwaite, a Sears spokesman, said the company's employment level at its headquarters is higher than the more than 6,000 jobs it had when the deal was approved, but he declined to provide figures.

In general, the value of a certificate equals the number of jobs created and/or retained, multiplied by wages tied to those jobs and the state's personal income tax rate.

That means companies that didn't add one worker and kept wages at the 2010 rate received a 67 percent boost to their 2011 corporate income tax break. Just like individuals, corporations also registered a tax rate increase in 2011. Lawmakers set the new corporate income tax rate at 7 percent, up from 4.8 percent. The increases in breaks partially offset that hike.

The formula under which companies become eligible to receive tax breaks was aimed at encouraging job creation and increasing employee wages. Still, the 2011 data revealed that some companies made deals to allow job cuts and still qualify for incentives, a practice known as "normal attrition."

A case in point is Motorola Mobility. For the past two years, Motorola Mobility has qualified for certificates worth a total of $22.6 million while slowly chipping away at its workforce. Late last year, the smartphone-maker, which was acquired by Google Inc. in May, announced it was laying off 20 percent of its global workforce. Locally, the company cut hundreds of workers, bringing its Illinois head count to about 2,300, a figure that would make it ineligible for a 2013 certificate unless it boosts its workforce before the end of the year.

The Department of Commerce and Economic Opportunity said the EDGE program played a crucial role in keeping Motorola Mobility in Illinois after it was acquired by Google. Its presence, the agency said, is drawing more technology investment and jobs to the state.

A state lawmaker wants the state to end the wiggle room practice, cap at $100 million the annual amount of tax breaks awarded and remove the investment bar so more small and medium-size businesses can qualify for breaks.

"Large multinationals are getting all the breaks," said Rep. Jack Franks, D-Marengo, adding that his focus is to modernize the program and increase accountability.

Franks' House Bill 1336 would also limit the length of the tax breaks to five years and require that companies pay workers at least the median salary of their occupation as determined by federal data. The bill also eliminates the provision requiring companies to make a capital investment in the state of at least $1 million or $5 million, depending on their size. And it creates a nine-member board to oversee the deals, with members appointed by the governor and approved by the state Senate.

Franks said that the Department of Commerce and Economic Opportunity shouldn't promote the program while also negotiating deals with companies, because it creates a conflict of interest.

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Hundreds hurt when 10-ton meteor explodes over Russia

CHELYABINSK, Russia -- More than 500 people were injured when a meteor shot across the sky and exploded over central Russia on Friday, sending fireballs crashing to Earth, shattering windows and damaging buildings.

Russia's Academy of Sciences estimates size of Urals meteor at 10 tons, according to the Associated Press.

People heading to work in Chelyabinsk heard what sounded like an explosion, saw a bright light and then felt a shockwave according to a Reuters correspondent in the industrial city 950 miles east of Moscow.

A fireball blazed across the horizon, leaving a long white trail in its wake which could be seen as far as 125 miles away in Yekaterinburg. Car alarms went off, windows shattered and mobile phone networks were interrupted.

"I was driving to work, it was quite dark, but it suddenly became as bright as if it was day," said Viktor Prokofiev, 36, a resident of Yekaterinburg in the Urals Mountains.

"I felt like I was blinded by headlights," he said.

No fatalities were reported but President Vladimir Putin, who was due to host Finance Ministry officials from the Group of 20 nations in Moscow, and Prime Minister Dmitry Medvedev were informed.

A local ministry official said such incidents were extremely rare and Friday's events might have been linked to an asteroid the size of an Olympic swimming pool due to pass Earth at a distance of 17,100 miles but this was not confirmed.

Russia's space agency Roscosmos said the meteor was travelling at a speed of 19 miles per second and that such events were hard to predict. The Interior Ministry said the meteor explosion had caused a sonic boom.

Russia's Emergencies Ministry said 514 people had sought medical help, mainly for light injuries caused by flying glass, and that 112 of those were kept in hospital. Search groups were set up to look for the remains of the meteor.

"There have never been any cases of meteorites breaking up at such a low level over Russia before," said Yuri Burenko, head of the Chelyabinsk branch of the Emergencies Ministry.

WINDOWS BREAK, FRAMES BUCKLE

Windows were shattered on Chelyabinsk's central Lenin Street and some of the frames of shop fronts buckled.

A loud noise, resembling an explosion, rang out at around 12:20 a.m. ET. The shockwave could be felt in apartment buildings in the industrial city's center.

"I was standing at a bus stop, seeing off my girlfriend," said Andrei, a local resident who did not give his second name. "Then there was a flash and I saw a trail of smoke across the sky and felt a shockwave that smashed windows."

A wall was damaged at the Chelyabinsk Zinc Plant but a spokeswoman said there was no environmental threat.

Although such events are rare, a meteor is thought to have devastated an area of more than 1,250 miles in Siberia in 1908, smashing windows as far as 125 miles from the point of impact.

The Emergencies Ministry described Friday's events as a "meteor shower in the form of fireballs" and said background radiation levels were normal. It urged residents not to panic.

Chelyabinsk city authorities urged people to stay indoors unless they needed to pick up their children from schools and kindergartens. They said what sounded like a blast had been heard at an altitude of 32,800 feet.

The U.S. space agency NASA has said an asteroid known as 2012 DA14, about 46 meters in diameter, would have an encounter with Earth closer than any asteroid since scientists began routinely monitoring them about 15 years ago.

Television, weather and communications satellites fly about 500 miles higher. The moon is 14 times farther away.

Reuters

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Work starts on Seaside Heights, NJ, boardwalk

SEASIDE HEIGHTS, N.J. (AP) — The sounds shaking the ground in Seaside Heights aren’t from nightclubs.

The town featured in the MTV reality show “Jersey Shore” has started rebuilding the boardwalk that was destroyed by Superstorm Sandy.

Heavy equipment began drilling holes in the sand and pounding pilings into the ground Friday. It’s the first phase of a project that could ultimately cost $ 6 million to $ 7 million.

Mayor Bill Akers says the mile-long walkway should be done by May 10, but amenities like railings, lighting and ramps will come after that.

Many residents turned out to see the start of the work. They expressed hope that the place where they vacationed as children and came to settle down will recapture what made it so special to them.

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Doctor and Patient: Afraid to Speak Up to Medical Power

The slender, weather-beaten, elderly Polish immigrant had been diagnosed with lung cancer nearly a year earlier and was receiving chemotherapy as part of a clinical trial. I was a surgical consultant, called in to help control the fluid that kept accumulating in his lungs.

During one visit, he motioned for me to come closer. His voice was hoarse from a tumor that spread, and the constant hissing from his humidified oxygen mask meant I had to press my face nearly against his to understand his words.

“This is getting harder, doctor,” he rasped. “I’m not sure I’m up to anymore chemo.”

I was not the only doctor that he confided to. But what I quickly learned was that none of us was eager to broach the topic of stopping treatment with his primary cancer doctor.

That doctor was a rising superstar in the world of oncology, a brilliant physician-researcher who had helped discover treatments for other cancers and who had been recruited to lead our hospital’s then lackluster cancer center. Within a few months of the doctor’s arrival, the once sleepy department began offering a dazzling array of experimental drugs. Calls came in from outside doctors eager to send their patients in for treatment, and every patient who was seen was promptly enrolled in one of more than a dozen well-documented treatment protocols.

But now, no doctors felt comfortable suggesting anything but the most cutting-edge, aggressive treatments.

Even the No. 2 doctor in the cancer center, Robin to the chief’s cancer-battling Batman, was momentarily taken aback when I suggested we reconsider the patient’s chemotherapy plan. “I don’t want to tell him,” he said, eyes widening. He reeled off his chief’s vast accomplishments. “I mean, who am I to tell him what to do?”

We stood for a moment in silence before he pointed his index finger at me. “You tell him,” he said with a smile. “You tell him to consider stopping treatment.”

Memories of this conversation came flooding back last week when I read an essay on the problems posed by hierarchies within the medical profession.

For several decades, medical educators and sociologists have documented the existence of hierarchies and an intense awareness of rank among doctors. The bulk of studies have focused on medical education, a process often likened to military and religious training, with elder patriarchs imposing the hair shirt of shame on acolytes unable to incorporate a profession’s accepted values and behaviors. Aspiring doctors quickly learn whose opinions, experiences and voices count, and it is rarely their own. Ask a group of interns who’ve been on the wards for but a week, and they will quickly raise their hands up to the level of their heads to indicate their teachers’ status and importance, then lower them toward their feet to demonstrate their own.

It turns out that this keen awareness of ranking is not limited to students and interns. Other research has shown that fully trained physicians are acutely aware of a tacit professional hierarchy based on specialties, like primary care versus neurosurgery, or even on diseases different specialists might treat, like hemorrhoids and constipation versus heart attacks and certain cancers.

But while such professional preoccupation with privilege can make for interesting sociological fodder, the real issue, warns the author of a courageous essay published recently in The New England Journal of Medicine, is that such an overly developed sense of hierarchy comes at an unacceptable price: good patient care.

Dr. Ranjana Srivastava, a medical oncologist at the Monash Medical Centre in Melbourne, Australia, recalls a patient she helped to care for who died after an operation. Before the surgery, Dr. Srivastava had been hesitant to voice her concerns, assuming that the patient’s surgeon must be “unequivocally right, unassailable, or simply not worth antagonizing.” When she confesses her earlier uncertainty to the surgeon after the patient’s death, Dr. Srivastava learns that the surgeon had been just as loath to question her expertise and had assumed that her silence before the surgery meant she agreed with his plan to operate.

“Each of us was trying our best to help a patient, but we were also respecting the boundaries and hierarchy imposed by our professional culture,” Dr. Srivastava said. “The tragedy was that the patient died, when speaking up would have made all the difference.”

Compounding the problem is an increasing sense of self-doubt among many doctors. With rapid advances in treatment, there is often no single correct “answer” for a patient’s problem, and doctors, struggling to stay up-to-date in their own particular specialty niches, are more tentative about making suggestions that cross over to other doctors’ “turf.” Even as some clinicians attempt to compensate by organizing multidisciplinary meetings, inviting doctors from all specialties to discuss a patient’s therapeutic options, “there will inevitably be a hierarchy at those meetings of who is speaking,” Dr. Srivastava noted. “And it won’t always be the ones who know the most about the patient who will be taking the lead.”

It is the potentially disastrous repercussions for patients that make this overly developed awareness of rank and boundaries a critical issue in medicine. Recent efforts to raise safety standards and improve patient care have shown that teams are a critical ingredient for success. But simply organizing multidisciplinary lineups of clinicians isn’t enough. What is required are teams that recognize the importance of all voices and encourage active and open debate.

Since their patient’s death, Dr. Srivastava and the surgeon have worked together to discuss patient cases, articulate questions and describe their own uncertainties to each other and in patients’ notes. “We have tried to remain cognizant of the fact that we are susceptible to thinking about hierarchy,” Dr. Srivastava said. “We have tried to remember that sometimes, despite our best intentions, we do not speak up for our patients because we are fearful of the consequences.”

That was certainly true for my lung cancer patient. Like all the other doctors involved in his care, I hesitated to talk to the chief medical oncologist. I questioned my own credentials, my lack of expertise in this particular area of oncology and even my own clinical judgment. When the patient appeared to fare better, requiring less oxygen and joking and laughing more than I had ever seen in the past, I took his improvement to be yet another sign that my attempt to talk about holding back chemotherapy was surely some surgical folly.

But a couple of days later, the humidified oxygen mask came back on. And not long after that, the patient again asked for me to come close.

This time he said: “I’m tired. I want to stop the chemo.”

Just before he died, a little over a week later, he was off all treatment except for what might make him comfortable. He thanked me and the other doctors for our care, but really, we should have thanked him and apologized. Because he had pushed us out of our comfortable, well-delineated professional zones. He had prodded us to talk to one another. And he showed us how to work as a team in order to do, at last, what we should have done weeks earlier.

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Push for online sales tax picks up in Congress

U.S. states could collect millions of dollars in online sales taxes, with members of both parties in Congress sponsoring legislation Thursday that would resolve states' decades-long struggle to tax businesses beyond their borders.

"Small businesses and states alike are suffering from the inability to collect due -- not new -- taxes from purchases made online," said Rep. Steve Womack, R-Ark., adding the legislation is a "bipartisan, bicameral, common-sense solution that promotes states' rights and levels the playing field for our Main Street businesses."

Legislation on the Amazon tax, named for the colossal Internet retailer, has languished for years.

In 1992 the Supreme Court decided the patchwork of state tax laws made it too difficult for online retailers to collect and remit sales taxes. So states can tax Internet only sales made by companies with a physical presence in the states. That means online retailers such as Amazon.com Inc. collect sales tax in some states and not in others.

The bills introduced on Thursday reconcile differences in legislation that the House of Representatives and Senate considered last year. The nearly identical details in the bills and strong bipartisan support mean the final bill could be sent to President Barack Obama this year.

Members of Congress recently assured state lawmakers they would pass a law in 2013.

In the last decade, Internet sales have gone from 1.6 percent of all U.S. retail sales to more than 5 percent, according to Commerce Department data, a proportion that will likely grow as shoppers make more purchases on handheld devices. In the third quarter of 2012,  "e-commerce" sales were $57 billion, the department said.

Large Internet retailers are worried the tax could drive up the cost of doing business. They would also have to create new systems and software to collect the surcharges, adding to their costs. Amazon said in July it prefers having the tax issue resolved at the federal level.

When the 2007-09 recession caused states' revenues to collapse, Republican and Democratic governors backed the tax as a financial solution that would not require federal aid.

A leader in the Republican party, Virginia Gov. Bob McDonnell went so far as to figure online tax revenue into his recent plan for overhauling the state's transportation funding.

"The revenue states are losing out on is legally owed, but because of a pre-Internet Supreme Court ruling, states aren't able to collect it," Sen. Deb Peters, R-S.D., said in a statement.

States and cities say they can recoup billions of dollars with the tax. Fitch Ratings estimates put the states' loss at $11 billion.

Some states are considering their own legislation. Florida is debating a bill that advocates say could bring the state more than $400 million.

Small retailers, meanwhile, have said the sales tax will will allow them to compete with massive online retailers.

"While store owners collect and remit state and local sales taxes their digital competitors are off the hook -- and benefiting because of it," said David French, the National Retail Federation's senior vice president for government relations, in a statement.

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'Blade Runner' Olympian Oscar Pistorius charged with murder

Double-amputee Olympic athlete Oscar Pistorius was arrested on Thursday, after a woman was shot dead in his home in Pretoria, South Africa. (Feb. 14)

JOHANNESBURG -- South African "Blade Runner" Oscar Pistorius, a double amputee who became one of the biggest names in world athletics, was charged on Thursday with shooting dead his girlfriend at his home in Pretoria.

Police said they had opened a murder case after a 30-year-old woman was found dead at the track star's house after an incident in the upmarket Silverlakes gated complex on the outskirts of the capital.

"At this stage he is on his way to a district surgeon for medical examination," police brigadier Denise Beukes told reporters outside the heavily guarded residential complex.

Pistorius and his girlfriend, Reeva Steenkamp, had been the only people in the house at the time of the shooting, Beukes, said, and witnesses had been interviewed about the incident, which happened in the early hours of the morning.

"We are talking about neighbors and people that heard things earlier in the evening and when the shooting took place," she said. Earlier, police said a 9mm pistol had been found at the scene.

"When a person has been accused of a crime like murder they look at things like testing under the figure nails, taking a blood alcohol sample and all kinds of other test that are done. They are standard medical tests," Beukes said.

Pistorius is due to appear in a Pretoria court after 1200 GMT.

Before the murder charge was announced, Johannesburg's Talk Radio 702 said the 26-year-old may have mistaken Steenkamp for a burglar.

South Africa has some of the world's highest rates of violent crime, and many home owners have weapons to defend themselves against intruders, although Pistorius' complex is surrounded by a three meter high wall and electric fence.

In 2004, Springbok rugby player Rudi Visagie shot dead his 19-year-old daughter after he mistakenly thought she was a robber trying to steal his car in the middle of the night.

VALENTINE'S DAY

Steenkamp, a model and regular on the South African party circuit, was reported to have been dating Pistorius for a year, and there had been little to suggest their relationship was in trouble.

In the social pages of last weekend's Sunday Independent she described him as having "impeccable" taste.

"His gifts are always thoughtful," she was quoted as saying.

Some of her last Twitter postings indicated she was looking forward to celebrating Valentine's Day on Thursday with him.

"What do you have up your sleeve for your love tomorrow???" she posted.

However, Beukes said the police were aware of previous incidents at the house of a "domestic nature", and recent media interviews with Pistorius revealed he kept an assortment of weapons in his home.

"Cricket and baseball bats lay behind the door, a pistol by his bed and a machine gun by a window," Britain's Daily Mail wrote in a profile published last year.

He was arrested in 2009 for assault after slamming a door on a woman and spent a night in police custody. Family and friends said it was just an accident and the charges were later dropped.

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