NEW:
Tribute to Louise Underwood,
1936-2008
REMINDER: AUGUST is a great time to meet with your U.S.
Representative in his/her District office near your home to seek
support for H.R. 3995. Call to make an appointment today.
---------------------------------------
VOR Weekly E-Mail Update
August 22, 2008
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==========================================
PROPOSED DD ACT REGULATIONS
OPPORTUNITY FOR PUBLIC COMMENT EXTENDED
1. Background information relating to comment opportunity
2. Summary of VOR’s Comments and Concerns
3. National news articles relating to P&A abuses
A. A Death in the Family: Aided by advocates,
William Bruce left the hospital – only to kill his mother
B. Book Review: Wrong Prescription - How the
emptying of state-run mental hospitals produced a social
disaster
Coming Up: State News, including Oregon, California and New
Mexico
==========================================
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1. Background information relating to comment opportunity
--------------------------------------------------------------------------------------------------
In April, the federal government released draft regulations
relating to the Developmental Disabilities Assistance and Bill
of Rights Act (DD Act) of 2000. The opportunity for
organizations and individuals to submit written comments was
recently extended to September 29, 2008.
The DD Act is the federal law which creates and authorizes for
funding state Protection and Advocacy agencies, and state DD
Councils.
VOR submitted its official comments on June 5, but will be
taking advantage of the extended deadline to submit additional
comments. Of interest is a discussion in the proposed regulation
about the importance of “informed consent” in class action
litigation. Informed consent is at the heart of H.R. 3995; VOR’s
written comments draw heavily on our advocacy work justifying
the need for H.R. 3995. Of serious concern to VOR in the
proposed regulation are proposals to significantly expand P&A’s
authority with regard to investigations. A summary of VOR’s
concerns are shared below.
To access the proposed regulation, visit,
http://frwebgate5.access.gpo.gov/cgi-bin/PDFgate.cgi?WAISdocID=349236155966+0+1+0&WAISaction=retrieve
To submit comments, send them by mail to arrive by September 29,
2008 to:
Patricia Morissey, Commissioner
Administration on Developmental Disabilities
Administration for Children and Families
370 L'Enfant Promenade, SW., Mail Stop: HHH 405D
Washington, DC 20447
Electronic submissions
Go to, http://www.regulations.acf.hhs.gov.
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2. Summary of VOR’s Comments and Concerns
--------------------------------------------------------------------------------------------------
On June 5, 2008, VOR submitted its comments in response to the
proposed DD Act of 2000 regulations.
Of particular interest to VOR was the request for comments on
what criteria should be applied or clearance process should be
followed in order to ensure “informed consent” to include an
individual as a member of a class in a class action lawsuit. Of
course, this question parallels very closely VOR’s objectives
with regard to H.R. 3995:
“As HHS recognizes, ‘Informed Consent’ should be ‘a cornerstone
of class action lawsuits to protect the rights of individuals
who may choose to be or not to be members of a potential class’
with legal guardians, where appointed, having an important role.
Providing prospective class members and their legal guardians
with an opportunity to make an informed decision with regard to
their legal representation is the right thing to do . . . the
residents of ICFs/MR and their legal guardians know far more
about the quality of their living arrangements and where they
wish to reside than the attorneys who bring them for ideological
reasons. At a minimum, the wishes of the residents and guardians
should be respected through a right to decide whether or not to
be included in the suit.
“Despite the overwhelming opposition of parents and guardians in
many of these suits, in the context of P&A class action lawsuits
involving ICFs/MR, thousands of individuals have become
‘captive’ class members, often without notice and never with
prior consent.” [VOR Comments, June 5, 2008 (excerpts, emphasis
in original)].
VOR’s comments also support enhanced program accountability and
indicators of progress, and STRONGLY oppose the apparent
“significant expansion of unfettered, unjustified and dangerous
discretion which this proposed rule leaves in the hands of state
Protection and Advocacy agencies. Taken to its extreme, the
combination of definitions and provisions of authority will
allow P&A to access family homes to investigate the care
provided by family caregivers, thus giving to the P&As authority
not enjoyed by local police departments in ‘communities.’” [VOR
Comments, June 5, 2008 (excerpts)].
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3. National news articles relating to P&A Abuses
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======================================================
Here’s the news that follows:
A. A Death in the Family: Aided by advocates, William Bruce
left the hospital – only to kill his mother.
B. Book Review: Wrong Prescription - How the emptying of
state-run mental hospitals produced a social disaster
======================================================
--------------------------------------------------------------------------------------------------
A. A Death in the Family:
Aided by advocates, William Bruce left the hospital – only to
kill his mother
--------------------------------------------------------------------------------------------------
Wall Street Journal
August 16, 2008
By ELIZABETH BERNSTEIN and NATHAN KOPPEL
On June 20, 2006, William Bruce approached his mother as she
worked at her desk at home and struck killing blows to her head
with a hatchet.
Two months earlier, William, a 24-year-old schizophrenic, had
been released from Riverview Psychiatric Center in Augusta,
Maine, against the recommendations of his doctors. "Very
dangerous indeed for release to the community," wrote one in
William's record.
But the doctor's
notes also show that William's release was backed by
government-funded patient advocates. According to medical
records, the advocates -- none of them physicians -- appear to
have fought for his right to refuse treatment, to have coached
him on how to answer doctors' questions and to have resisted the
medical staff's efforts to contact his parents. As one doctor
wrote, William told him his advocates believed he is "not a
danger, and should be released."
William's father, Joe
Bruce, obtained his son's medical records from Riverview eight
months after the killing. "I read through the records and I just
remember crying all the way through," Joe Bruce says. "My God,
these people knew exactly what they were sending home to us."
Helen Bailey, one of William's advocates, declined to discuss
the details of his case but says the handling of it was
consistent with her professional duties. "My job is to get the
patient's voice into the mix where decisions are made," says Ms.
Bailey, an attorney with Maine's Disability Rights Center in
Augusta. "No matter how psychotic, that voice is still worthy of
being heard. I have not had the person who is so out of it that
they can't communicate what they want." She added that the
records reflect the doctors' perception of what happened.
The story of William
Bruce -- based on medical records made available to The Wall
Street Journal -- as well as interviews with relatives, doctors,
advocates and hospital administrators brings into sharp focus
the impact of a little-known government-funded advocacy program
for psychiatric patients.
Attempt to Curb
Abuses
Congress created the
national Protection and Advocacy for Individuals with Mental
Illness program, or PAIMI, in 1986 to curb abuse and neglect of
the mentally ill, primarily in institutions. In the 1960s and
1970s, many abuses were uncovered at hospitals, where patients
were physically restrained, neglected or overmedicated.
The PAIMI program, operated by the Substance Abuse and Mental
Health Services Administration with a 2008 budget of $34.8
million a year, funds protection-and-advocacy agencies in each
state. Typically nonprofits, these groups sometimes receive
supplemental funding from states. According to a 2007 SAMHSA
report, the agencies served 19,000 people in 2006.
Some doctors,
hospital administrators and mental-health veterans argue that
advocates are endangering the mentally ill and the public by too
often fighting for patients' right to refuse treatment. Many
advocates "have a strong bias," says Robert Liberman, a director
of a psychiatric rehabilitation program at the University of
California, Los Angeles.
"I don't know if they
are doing people a service when they assert the right of
mentally-ill individuals to remain psychotic," says Ron Honberg,
director of policy and legal affairs for the National Alliance
on Mental Illness, an education, support and advocacy group.
Proponents of patient
advocates say they're essential to protecting the rights of the
mentally ill. The National Disability Rights Network, which
provides lobbying and other services for the patient-advocacy
system, says advocates play a critical oversight role.
They cite the 2006
sentencing of the owners of a Kansas treatment facility on
charges that they subjected patients to forced labor and
involuntary servitude, and a class-action lawsuit alleging that
female patients of the Lincoln Regional Center in Nebraska were
raped and assaulted by a male staff member. The latter case was
settled in 2007 with the hospital, which denied liability,
agreeing to more thoroughly investigate assault complaints.
The mentally ill are
"very vulnerable," says Curt Decker, executive director of the
National Disability Rights Network. "There needs to be an
external, independent, legally based advocacy system to make
sure they are being treated fairly, equitably and safely."
John Morrow, senior
public health advisor at SAMHSA, declined to discuss the Bruce
case. But he says advocates serve a very important function, and
that the organization has resolved thousands of cases of abuse
and neglect.
In recent years,
there has been a wave of legislative efforts, many inspired by
violent crimes, to make it easier to mandate treatment for the
mentally ill. Advocates have blunted those efforts in
California, New Mexico and Michigan.
In Michigan,
advocates successfully pushed for limits to a 2005 law --
proposed after a schizophrenic killed a young man -- mandating
outpatient treatment. "They have a left-wing,
individual-rights-at-all-costs agenda," says Virg Bernero, mayor
of Lansing, Mich., who helped pass the law when he was a state
legislator.
"Our legal mandate is
to protect the rights of individuals," says Elmer Cerano,
executive director of Michigan's PAIMI chapter. But, he says,
"rights are limited when it comes to safety."
Despite advocates'
objections, Joe Bruce -- with the help of his pro-bono attorney,
Robert Owen of Fulbright & Jaworski LLP in New York --
successfully lobbied the Maine legislature to pass three bills.
One gives mental-health professionals greater leeway to disclose
patient information to those who may be affected by that
person's conduct. Another makes it easier to medicate
involuntarily committed patients.
William Bruce grew up
in Caratunk, Maine, a picturesque town of about 110 residents
nestled in the state's northern hills. His father, a rugged,
talkative man, worked as a senior technician for the Maine
Department of Transportation. His mother, Amy, served as the
town's treasurer. The oldest of three boys, William grew up in a
100-year-old farmhouse that sits on the banks of the winding,
rock-strewn Pleasant Pond Stream.
Even when Willy -- as
he was known as a boy -- was young, "there was just something
different about him," his father says. Although cute and
energetic, William was hyperactive and deeply self-centered, his
father says. And he could turn suddenly violent: When he was
four, he pushed his younger brother down the stairs. At five, he
broke the same brother's leg, his father says.
As an adolescent,
William was handsome, popular with girls and deeply troubled,
attempting suicide at 14. He would sometimes see therapists, but
would quit and stop taking any prescribed medication, Joe says.
William's behavior
particularly pained his mother. Tanned and athletic, Amy loved
kids, often hugging her own and opening her home to neighborhood
children. But Joe says she was seldom able to emotionally
connect with her eldest son, and repeatedly blamed herself for
his problems.
After dropping out of
high school, getting his equivalency degree and serving in the
Army, William bounced among low-level jobs and had a few minor
brushes with the law. On Christmas Eve, 2003, Joe says William
had his first psychotic episode in a Target store, telling his
father that the security cameras were monitoring him.
But he refused to
seek treatment, and his family couldn't insist. Maine, like many
states, requires that the mentally ill pose a substantial risk
of harm to themselves or others, based on recent evidence, to be
involuntarily committed.
In March 2005, after
William threatened two men with a loaded AK-47 assault rifle --
his father is a licensed gun dealer -- William went to a
psychiatric facility in Bangor. He was eventually released but
stopped taking his medicine.
William deteriorated.
Sometimes he walked into neighbors' homes unannounced. Once he
put his mother in a headlock. In January 2006, William punched
his father in the face, screaming, "You have disobeyed direct
orders from a superior officer in the CIA." He was sent on Feb.
6, to Riverview, an extended-care psychiatric facility.
'An Awful, Awful
Feeling'
"We were certain he
would be released," Joe Bruce says. Waiting for that day "was an
awful, awful feeling."
A few weeks after
William Bruce's admission, psychiatrist Jeffrey Fliesser wrote
that William was hostile, paranoid and "dangerous to others
without additional observation and active attempts to treat
him," an opinion he reiterated over the next five weeks. The
doctor also wrote that he urged William, now diagnosed with
paranoid schizophrenia, to take medication, but William refused.
Dr. Fliesser declined to comment about the case for this story.
William began working
with advocates employed by the Maine Disability Rights Center,
which receives funding from the federal PAIMI program as well as
state and private sources.
According to a
nurse's treatment record dated March 23, Ms. Bailey, the
advocate, told Riverview administrators she saw no documentation
showing that William should remain hospitalized. Trish Callahan,
another advocate, suggested that William "may actually be
getting worse by remaining here," the nurse's record says.
"I repeatedly
explained to the patient, his advocates and other team members,
his paranoid psychosis will not likely improve without
medication therapy," Dr. Fliesser wrote in his notes. Ms. Bailey
says she gives legal opinions, not clinical ones, and notes that
her job is to represent the client's wishes.
By the beginning of
April, William Bruce's case was "in a high state of contention,"
wrote Daniel Filene, a psychiatrist who had taken over the case.
On April 6, Trish Callahan, another advocate, attended a meeting
with William's treatment team. She stressed that William should
be discharged and that his summer job prospects were being
harmed by his continued hospitalization, Dr. Filene's notes say.
According to these
notes, Dr. Filene suggested to William that he take trips
outside the hospital. When William voiced reluctance to venture
out, Ms. Callahan told William, "They want to see that you can
play nicely in the community. Just say 'Yes.' " He did. Dr.
Filene asked William if there was a risk he would refuse to
return to the hospital from a community trip. "Ms. Callahan told
him, 'Just say no,' and Mr. B. replied, 'No,' " the doctor wrote
in his notes.
Dr. Filene wrote that
he asked William for permission to speak to his mother and his
previous mental-health providers. Ms. Callahan said there would
be no benefit and that William's parents were "a negative force
in his life." William refused to give consent, Dr. Filene's
notes say. On April 11, Dr. Filene wrote that William said his
advocates were telling him that he is "not a danger and should
be released."
Ms. Callahan didn't
respond to requests seeking comment. Dr. Filene declined to
comment about the case for this story.
"I think the
advocates overstepped their bounds," says Riverview
Superintendent David Proffitt. William "was relying on the
people whose purpose it was to ensure his civil rights were
being exercised, and unfortunately that interfered with his
other right, which was to get medical care."
Ms. Bailey, Ms.
Callahan's superior, doesn't believe the advocates prevented
William from getting medical care. "There is nothing in the
William Bruce case that is contrary to the way we do business,"
she says, adding that it is the hospital's responsibility to try
to have a patient committed or forcibly medicated.
William Gets
Released
More generally, Ms.
Bailey says it isn't a given that families of the mentally ill
should be involved in decisions involving their care. "There are
some God damn nasty families out there," she says. SAMHSA
declined to comment on the case, as did the Maine Department of
Health & Human Services.
In the end, Dr. Filene wrote that while he recommended William
stay at Riverview, William appeared very unlikely to meet
Maine's legal criteria for further involuntary hospitalization
beyond his court-ordered commitment term, which expired at the
end of April. On April 20, 2006, William was discharged.
William was soon back
home. He hid steak and butcher knives in his bedroom and spent
hours pacing in the driveway, giggling and babbling
unintelligibly to himself. Joe began calling to check on his
wife several times a day. "It was the worst we'd ever seen him,"
he says.
On June 20, two
months after his son's release, Joe Bruce returned home from his
office to find his wife's battered, bloodied body. William was
gone.
"My son has killed my
wife," Joe told the 911 dispatcher, later adding that he was
arming himself in self-defense.
According to the
medical examiner's report, Amy died of multiple blunt-force
trauma and chop injuries to her head. She was 47 years old.
Police arrested
William Bruce at his grandparents' house and later charged him
with killing his mother. He told a psychologist that the Pope
told him to kill his mother because she was involved with al
Qaeda and Saddam Hussein. Joe Bruce became William's legal
guardian and gained access to his medical records.
When police returned
Amy Bruce's purse to Joe, he found an unsent letter she had
written to her eldest son.
"I've always had this
horrible feeling that I've let you down in some way," she wrote.
"The only wish I have is that someday we can look each other
straight in the eyes and say I'm sorry and I love you more than
life itself." She added: "I will not give up on you ever."
In March 2007,
William was found not criminally responsible by reason of
insanity and was committed to Riverview again, this time
indefinitely. At the end of 2007, faced with the possibility of
being restrained and medicated against his will, William agreed
to take Abilify, an antipsychotic drug. Within weeks, his mental
status improved.
'I Blame Myself'
William Bruce, now
26, is strikingly handsome, his dark hair slicked back. Sitting
in a Riverview conference room on July 23, he spoke courteously
but deliberately. It was the first time he has been interviewed
about his case.
"I blame the illness,
and I blame myself," William said of his mother's death. "The
guilt is...," he paused, struggling to find a word "...tough."
William said the
first time he came to Riverview, he refused to believe he was
mentally ill and approached the advocates because he wanted out.
"They helped me
immensely with getting out of the hospital, so I was very
happy," he said. He later added, "The advocates didn't protect
me from myself, unfortunately."
These days, William
is taking criminal-justice classes online through Colorado
Technical University. He points proudly to his 3.94 grade-point
average and says he hopes to attend law school to learn more
about mental-health laws. William and his father talk on the
phone almost every day.
"He stood by me the
whole time despite the horrible tragedy...despite what I did,"
William said. "I am the man I am today because of my dad."
While William
believes patients deserve some protection, he said he
understands his father's fight to strengthen commitment and
treatment laws.
That fight took
another turn last month, when Ms. Bailey and another attorney
filed a lawsuit that could undermine portions of a law Joe
supported. The suit, filed in U.S. District Court in Maine, is
directed at the law which makes it easier for hospitals to
compel patients to take medication.
"There are times when
people should be committed," William said. "Institutions can
really help. Medicine can help."
"None of this would
have happened if I had been medicated."
--------------------------------------------------------------------------------------------------
B. Book Review: Wrong Prescription –
How the emptying of state-run mental hospitals produced a social
disaster
--------------------------------------------------------------------------------------------------
Wall Street Journal
By PAUL MCHUGH
June 14, 2008; Page W10
About the author: Dr. McHugh is a University Distinguished
Service Professor of Psychiatry at Johns Hopkins University. His
book "Try to Remember: Psychiatry's Clash Over Memory, Meaning,
and Mind" will be published in October.
The Book: The Insanity Offense, By E. Fuller Torrey, Norton, 265
pages, $24.95
Summary: This book looks at the deinstitutionalization of the
mentally ill, an experiment that also failed.
There are times and situations that call for prophets. Not
fortunetellers or soothsayers, but biblical prophets like Amos
or Jeremiah who furiously proclaim the old truths, puncture our
pretensions and predict from current tribulations worse to come
if what lies deeper than sin -- idolatrous worship of false gods
-- continues. E. Fuller Torrey, a psychiatrist who cares for
patients with schizophrenia and manic-depression, is to my mind
the doctor nearest in character to an ancient Hebrew prophet.
In "The Insanity Offense," he describes the grim consequences --
in death, violence and suffering -- of laws that, beginning in
the late 1960s, released the seriously mentally ill from the
oversight of state mental-health services and permitted them to
wander away from the treatment and protection they desperately
needed. Dr. Torrey identifies an unholy alliance of rash
conservatives seeking to save public money by abandoning a
traditional state obligation and self-righteous liberals
defining the neglect of these patients as "defending their civil
rights." We need prophets to confront such alliances -- anything
less will fail -- and in this splendid book we hear one.
"The Insanity Offense" is "about one of the great social
disasters of recent American history," Dr. Torrey writes. "It
began within the lifetime of many of us, is continuing, and
today affects approximately 400,000 individuals and their
families. In the annals of twentieth-century American history,
it should be included among the greatest calamities."
Some of the background should be familiar. From the mid-19th
century right up until the 1960s, state governments accepted
responsibility for the care and treatment of the seriously
mentally ill. This arrangement came about because in the 1840s
such civic crusaders as Dorothea Dix (in what may be the first
piece of social research ever conducted in America) revealed the
special ordeal of delusional and distressed mental patients:
They tended to lose their way in life and, because of their
unpredictable and occasionally violent propensities, filled the
country's jails, workhouses and shelters, where they often
suffered ugly mistreatment. Dix reported to the Massachusetts
legislature in 1843 on "the present state of Insane Persons
confined within this Commonwealth, in cages, cellars, stalls,
pens! Chained, naked, beaten with rods, and lashed into
obedience!"
The state mental-hospital system was founded to care for these
patients. Though psychiatrists before the mid-20th century could
offer them little more than shelter and protection, even that
modest level of care was far from inconsequential: It kept the
patients and the community from harm. State mental hospitals
stood as beacons of a public obligation.
By the 1950s, though, these hospitals had become overcrowded and
were themselves prompting calls for reform. It was a missed
opportunity: Much could have been accomplished if psychiatric
leaders at the time had moved quickly to repair a failing system
and to educate the public about serious mental illness. The
discovery of "anti-psychotic" phenothiazines and
"anti-depressants" meant that the symptoms of these patients
could be greatly relieved and their dangerous behavior much
reduced if such medications were used properly. Steps could have
been taken to address the concerns of the growing civil-rights
movement and ensure that long-confined patients were not victims
of neglect. And the increasing zeal for fiscal restraint and tax
reform in state government should have been met head-on with a
frank discussion about the costs and benefits of shouldering
responsibility for some of our most vulnerable citizens.
Instead, psychiatric leaders at the time offered little or no
defense. Worst of all, they failed to explain why state
responsibility should continue, no matter what changed in the
settings for patient services, so that the mentally ill would be
monitored and not slip from sight. Patients with schizophrenia
and manic-depression, it should have been explained, often lack
any sense of their own mental disorders and so need regular
supervision to sustain their treatment.
Why the psychiatric establishment failed to meet these
challenges is not obvious. Many doctors wilted before criticism
of state-hospital services and mustered weak arguments to defend
them. Many others at the time were absorbed in the psychotherapy
of patients with milder mental disorders and had little interest
in the seriously mentally ill, whose care they were happy to
leave to the state and others. As a result, laws were passed in
the late 1960s with the direct intent of emptying state
hospitals, releasing the patients and saving money --
consequences be damned.
The new laws deprived psychiatrists of the authority to hold
patients under surveillance. In the past, psychiatrists could
keep patients in a hospital if they were "of such mental
condition . . . [as being] in need of supervision, treatment,
care, or restraint." Now patients could not be held unless
"immediately" or "imminently" dangerous to themselves or others.
The harrowing effects were evident almost immediately, and Dr.
Torrey recounts them in vivid detail in "The Insanity Offense."
First he offers plenty of statistics to indicate the state of
the problem as it exists today -- citing, for instance, the
number of seriously mentally ill who are in prison (218,000) or
homeless (175,000) at any given time. But just as "numbers are
too abstract" to convey the magnitude of a large-scale tragedy
such as an earthquake or flood, he says, the true horror that
resulted from the "deinstitutionalization" of the seriously
mentally ill is best conveyed by individual stories.
Dr. Torrey recounts murder after murder by mentally ill
patients, each of whom was actively avoiding treatment. We learn
about William Bruce, who was diagnosed with schizophrenia and
hospitalized but refused to take his medication. His mother
"tried to get help everywhere," a friend related, but "at each
phase she was turned away because he never hurt anyone." Bruce
bludgeoned his mother to death in 2006 and slit her throat.
The most awful example was the murder last year of 32 students
and faculty at Virginia Tech by Cho Seung-Hui, a 23-year-old
student who had been court-identified as in need of treatment
but allowed by the college to attend classes because the school
would not treat mentally ill students -- even those suffering
from schizophrenia -- unless the students requested it. Mr. Cho
could not be involuntarily committed because he was not an
"imminent danger" to himself or others and was not
"substantially unable to care for himself." As Dr. Torrey
writes: "This is one of the most stringent state commitment
statutes in the United States and another example of how changes
in mental illness laws in the 1970s and 1980s continue to have
real consequences."
Given the difficulty of committing the seriously mentally ill
for involuntary treatment, our jails and prisons have become de
facto mental institutions. Dr. Torrey's data indicate that more
than 30% of inmates are mentally ill. He also describes the
abuse they suffer in these brutal environments and the increase
in suicides by mentally ill prisoners. The hellish scenes
described by Dorothea Dix in 1843 have returned -- with a
vengeance, given the huge increase in the American population
since the mid-19th century.
What is to be done? "The Insanity Offense" calls for a restoring
of some central state responsibility for these patients in ways
that would permit monitoring them regularly, keeping them on
their medications and insisting on a protected-care setting if
they relapse. It is not necessary to reopen all the old state
hospitals: The programs that are needed could be carried out in
clinic offices with backup, shorter-stay hospital beds.
Dr. Torrey points to successes in a few states. He particularly
endorses a program in Wisconsin that provides outpatient
tracking and regular medication treatment along with resources
for ready involuntary commitments when either treatment fails or
the patient becomes unable to control behavioral outbursts.
The issue is whether the public can be rallied to support these
reforms. One obstacle: Legions of lawyers are opposed to such
changes, claiming that they are infringements on "civil
liberty." More than a few such lawyers are heard to proclaim
that the violence and murder committed by mentally ill people
are "the price we must pay for democracy." Here is idolatry of
the most blatant kind -- with human sacrifice, no less -- and
hence our need for the fury of a prophet.
--------------------------------------
Tamie Hopp
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