Surgeon infected patients during heart procedure, Cedars-Sinai admits

A heart surgeon at Cedars-Sinai Medical Center unwittingly infected five patients during valve replacement surgeries earlier this year, causing four of the patients to need a second operation.

The infections occurred after tiny tears in the latex surgical gloves routinely worn by the doctor allowed bacteria from a skin inflammation on his hand to pass into the patients' hearts, according to the hospital. The patients survived the second operation and are still recovering, hospital officials said.

The outbreak led to investigations by the hospital and both the L.A. County and California departments of public health. The federal Centers for Disease Control and Prevention was also consulted.

Hospital officials called it a "very unusual occurrence" probably caused by an unfortunate confluence of events: the nature of the surgery, the microscopic rips in the gloves and the surgeon's skin condition. Valve replacement requires the surgeon to use thick sutures and tie more than 100 knots, which can cause extra stress on the gloves, they said.

Nevertheless, the hospital's goal is to have zero infections, said Harry Sax, vice chairman of the hospital's department of surgery. "Any hospital-acquired infection is unacceptable," he said.

The infections raise questions about what health conditions should prevent a surgeon from operating and how to get the best protection from surgical gloves. Surgeons with open sores or known infections aren't supposed to operate, but there is no national standard on what to do if they have skin inflammation, said Rekha Murthy, medical director of the hospital's epidemiology department. She added that there were also no national standards on types of gloves used, whether to wear double gloves or how many times surgeons should change those gloves during a procedure.

Healthcare-acquired infections are very common throughout the United States. Each year, infections cause 99,000 deaths in the country, including about 12,000 in California. Hospitals in the state are required to report certain infections to the California Department of Public Health. That reporting makes the public more aware of the quality of care provided at local hospitals and is an important tool for reducing infections, said Debby Rogers, deputy director of the department's Center for Health Care Quality.

Cedars-Sinai has low rates for hospital-acquired infections compared with the state and national average but has not performed as well on other surgical quality measures recently, according to the Leapfrog Group, an employer-backed nonprofit focused on healthcare quality. The organization gave the hospital a C rating last month on its national report card, down from an A in June, though it was not related to the infection outbreak.

"Clearly this hospital is making attempts to reduce infections, but they have more work to do," said Leah Binder, Leapfrog's chief executive.

Cedars-Sinai Medical Center conducts about 360 valve replacement surgeries each year and said infections occur in fewer than 1% of its cases — lower than the national average.

The hospital learned about the problem in June after three patients who had undergone valve replacement surgery showed signs of infection. Doctors diagnosed the patients with an infection called endocarditis. Concerned there might be a connection among the cases, epidemiologists analyzed the bacteria, staphylococcus epidermidis, and determined that it was an identical strain and therefore must have come from a single source. "It led to the question of gee, I wonder where it came from?" Murthy said.

Epidemiologists homed in on the surgeon with the skin inflammation. The bacteria matched, and then they made a surprising discovery: microscopic tears in the gloves typically worn by surgeons after performing valve replacement surgery. The surgeon, whose name was not released, was not allowed to operate again until he healed. He is still a member of the medical staff but no longer performs surgeries at the hospital.

The hospital soon found the same infection in two more patients. Officials also reached out to 67 patients who had heart valve replacements with the same surgeon but didn't find any other cases. One of the five infected patients was treated with antibiotics, and the other four had new valve replacement surgeries. Sax said the hospital apologized to the patients and has continued to monitor their health. The hospital has also covered the cost of their care, including follow-up treatment and all the related surgeries.

All surgeons doing valve replacements are now required to change gloves more frequently, officials said. Some surgeons are wearing double gloves during the operations, Sax said.

Following the outbreak, Cedars-Sinai did the proper follow-up to ensure the safety of their patients, said Dawn Terashita, a medical epidemiologist with L.A. County, who was notified in September. What occurred at Cedars-Sinai was an unintentional consequence of the surgery, she said.

"There is no way to keep a room entirely sterile and all the people in it sterile," she said. "You will always have risk of infection."

anna.gorman@latimes.com

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New Crowdfunding Site Seeks to Protect Backers of Industrial Design

Entrepreneur Jamie Siminoff wants to build more credibility into crowdfunding — so he’s launching a new platform that takes responsibility for ensuring the viability of new projects.

The crowdfunding process, pioneered by sites like Kickstarter, has had its share of huge successes, as well as failures. The problem, says Siminoff, is that when a venture fails, the funders are left holding the bag. That’s all well and good if you were investing in an artist’s crazy project. It’s much more of a problem if you thought you were pre-ordering a nearly finished gadget.

The biggest culprit for these kinds of issues are physical products. Witness the anger unleashed when Kickstarter darling Pebble announced a further delay alongside underwhelming color choices.

This kind of issue is why Kickstarter recently made some changes, undertaking a combination of education and rule revision. They reminded consumers that Kickstarter is not a store while requiring that all projects disclose risks and challenges, as well as forbidding renderings and concept videos in hardware products.

Siminoff’s answer is Christie Street, a crowdfunding site devoted exclusively to physical products. The promise of Christie Street is that it will vet the projects that it launches carefully, and provide guarantees of progress along the way. The idea is that these protections will make consumers feel safer about the products they’re backing. “We built something that we felt we needed,” he says.

Christie Street, named for the New Jersey road where Edison’s workshop was located, will require that all funders go through an auditing process before they are allowed to go live. Siminoff says that the idea will be to check for basic viability, a kind of sanity test.

“You look at the chips they say they want to use, the size of components that will need to fit in, and so on,” he says, “You check that things conform to what’s available on the market.” From there, they also perform third-party audits of the places where the product will be manufactured, and look at things like production cost and likely shipping time, to ensure that all of this seems realistic.

It’s an all-or-nothing audit. Either the new project meets Christie Street’s approval or it doesn’t. “Our feeling is that the customer that’s buying doesn’t have the sophistication to make the right decision [about whether a design's production targets are reliable],” says Siminoff, “The only way is create a place where you can trust to buy.”

Even after the initial approval, Christie Street stays involved in the project. Successfully funded projects get their money in stages, with Christie Street holding the rest in escrow. Inventors get one-third of the money on funding, one-third of the money once they have a production-ready prototype, and the final one-third when they have a golden prototype, which means they are ready for full manufacturing.

If at any time along the way the project fails, Christie Street will can the project and refund the remaining money to investors.

What constitutes failure? Siminoff ticks off four conditions.

First, the inventor could for whatever reason announce that they couldn’t finish.

Second, if the project ends up more than six months late. “This forces people to be more careful with their delivery dates,” says Siminoff.

Third, if the product falls short of what was promised. “If the pre-production sample is more than 15 percent worse than what was promised, we will not allowed you to manufacture the product,” says Siminoff. (For example, if you promised me 512GB and only delivered 256.)

Last, says Siminoff there are other nuances that they’ll have to work out as the site develops. For example, if a product ends up requiring significant redesign, then Christie Street might end up withholding funds. “Design is a tougher one to quantify,” he says, “but it’s important that the design overall fits what was promised to the customer.”

For the extra cautious, Christie Street goes even further than the refund of remaining money. For 10 percent of their pledge value, backers can insure their entire pledge. If the project goes wrong they’ll get all of it back. Combine that with a pledge from inventors that the product will retail for at least 10 percent more than the pledge amount, and you can either take a 10 percent discount for some additional risk or pay full retail, with a money-back guarantee.

In effect, Christie Street is navigating a space between crowfunding sites like Kickstarter and Indiegogo, which expect backers to handle a lot of their own due diligence while allowing the inventors to be entrepreneurs, and crowdsourcing design sites like Quirky, which handles all of the business elements in-house.

Christie Street is an effort at drawing the lines of trust in a new way, one tied directly to the realities of post-industrial product design. Rather than a blanket ban on renderings and early designs, or a Wild West ‘anything goes’ approach, they instead seeks to tame the parts where production can go really wrong, in the devilish details of prototyping and manufacturing. It leaves questions of whether or not the thing is cool to the wisdom of the crowds, while taking on the question of whether or not the thing is possible.

This is obviously a lot more intervention between middleman and inventor than you’d see on a site like Indigegogo or Kickstarter. Siminoff says that they can still take the same 5 percent cut as their competitors because physical products tend to be involved higher dollar-value projects from the start. “If all goes well, we’ll be doing 10 to 15 live projects a months a year from now,” he says, “We think we can be profitable in the product world.”

“We’re not trying to make it where inventors are just be a name on a product,” says Siminoff, “We still want them to be entrepreneur and build this thing. We just want to make sure that they don’t fail in a way that hurts the customer.”

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TNT’s “Leverage” could end this month, producer warns

LOS ANGELES (TheWrap.com) – This could end up being a very un-merry Christmas for “Leverage” fans.

Dean Devlin, executive producer of the TNT drama, penned an open letter to the show’s viewers on Thursday, telling them that he and fellow “Leverage” executive producer John Rogers crafted the show’s Season 5 finale – airing December 25 – as a series finale, because it just might be.

TNT has not yet decided whether it will renew the series, which stars Timothy Hutton as the leader of a squad of shady characters who use their skills to right corporate and government injustices. And judging from the tone of Devlin’s letter, he’s not terribly confident that they will.

“As of the writing of this letter, we still do not know if there will be a season six of our show. Just as we didn’t know when we created the last three episodes which are about to air,” Devlin wrote. “Because of this uncertainty, John Rogers and I decided to end this season with the episode we had planned to make to end the series, way back when we shot the pilot. So, the episode that will air on Christmas is, in fact, the series finale we had always envisioned.”

Of course, should “Leverage” get the go-ahead for a sixth season, Devlin notes, “Everyone involved with the show, from the cast, the crew, the writers and producers, would like nothing more than to continue telling these stories. But, in case we do not get that opportunity we felt that, creatively, after 77 episodes, we owed it to you, our fans, to end the show properly.”

The December 25 episode, according to Devlin, is “the most powerful episode we’ve ever done.”

So far this season, “Leverage” has averaged 3.5 million total viewers, down 11 percent from last season’s average, with 1.3 million in the 18-49 demographic most important to advertisers, an 18 percent decline from last season.

TV News Headlines – Yahoo! News

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You for Sale: Company Envisions ‘Vaults’ for Personal Data

Peter DaSilva for The New York Times

Michael Fertik, the founder and chief executive of Reputation.com, at its offices in Redwood City, Calif., where he has amassed a database of information collected on millions of consumers.

“YOU are walking around naked on the Internet and you need some clothes,” says Michael Fertik. “I am going to sell you some.”

Naked? Not exactly, but close.

Mr. Fertik, 34, is the chief executive of Reputation.com, a company that helps people manage their online reputations. From his perch here in Silicon Valley, he views the digital screens in our lives, the smartphones and the tablets, the desktops and the laptops, as windows of a house. People go about their lives on the inside, he says, while dozens of marketing and analytics companies watch through the windows, sizing them up like peeping Toms.

By now many Americans are learning that they are living in a surveillance economy. “Information resellers,” also known as “data brokers,” have collected hundreds to thousands of details — what we buy, our race or ethnicity, our finances and health concerns, our Web activities and social networks — on almost every American adult. Other companies that specialize in ranking consumers use computer algorithms to covertly score Internet users, identifying some as “high-value” consumers worthy of receiving pitches for premium credit cards and other offers, while dismissing others as a waste of time and marketing money. Yet another type of company, called an ad-trading platform, profiles Internet users and auctions off online access to them to marketers in a practice called “real-time bidding.”

As these practices have come to light, several members of Congress, and federal agencies, have opened investigations.

At least for now, however, these companies typically do not permit consumers to see the records or marketing scores that have been compiled about them. And that is perfectly legal.

Now, Mr. Fertik, the loquacious, lion-maned founder of Reputation.com, says he has the free-market solution. He calls it a “data vault,” or “a bank for other people’s data.”

Here at Reputation.com’s headquarters, a vast open-plan office decorated with industrial-looking metal struts and reclaimed wood — a discreet homage to the lab where Thomas Edison invented the light bulb — his company has amassed a database on millions of consumers. Mr. Fertik plans to use it to sell people on the idea of taking control of their own marketing profiles. To succeed, he will have to persuade people that they must take charge of their digital personas.

Pointing out the potential hazards posed by data brokers and the like is part of Mr. Fertik’s M.O. Covert online profiling and scoring, he says, may unfairly exclude certain Internet users from marketing offers that could affect their financial, educational or health opportunities — a practice Mr. Fertik calls “Weblining.” He plans to market Reputation.com’s data vault, scheduled to open for business early next year, as an antidote.

“A data privacy vault,” he says, “is a way to control yourself as a person.”

Reputation.com is at the forefront of a nascent industry called “personal identity management.” The company’s business model for its vault service involves collecting data about consumers’ marketing preferences and giving them the option to share the information on a limited basis with certain companies in exchange for coupons, say, or status upgrades. In turn, participating companies will get access both to potential customers who welcome their pitches and to details about the exact products and services those people are seeking. In theory, the data vault would earn money as a kind of authorization supervisor, managing the permissions that marketers would need to access information about Reputation.com’s clients.

To some, the idea seems a bit quixotic.

Reputation.com, with $67 million in venture capital, is not making a profit. Although the company’s “privacy” products, like removing clients’ personal information from list broker and marketing databases, are popular, its reputation management techniques can be controversial. For instance, it offers services meant to make negative commentary about individual or corporate clients less visible on the Web.

And there are other hurdles, like competition. A few companies, like Personal, have already introduced vault services. Also, a number of other enterprises have tried — and quickly failed — to sell consumers on data lockers.

Even so, Mr. Fertik contends Reputation.com has the answer. The company already has several hundred thousand paying customers, he says, and patents on software that can identify consumers’ information online and score their reputations. He intends to show clients their scores and advise them on how to improve them.

“You can’t just build a vault and wish that vendors cared enough about your data to pay for it,” Mr. Fertik says. “You have to build a business that gives you the lift to accumulate a data set and attract consumers, the science to create insights that are valuable to vendors, and the power to impose restrictions on the companies who consume your data.”

THE consumer data trade is large and largely unregulated.

Companies and organizations in the United States spend more than $2 billion a year on third-party data about individuals, according to a report last year on personal identity management from Forrester Research, a market research firm. They spend billions more on credit data, market research and customer data analytics, the report said.

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Supreme Court to rule on California's Prop. 8 ban on gay marriage

Justices will rule for the first time on same-sex marriage by deciding the constitutionality of Prop. 8.

The Supreme Court announced Friday it will rule for the first time on same-sex marriage by deciding the constitutionality of California’s Proposition 8, the voter initiative that limited marriage to a man and a woman.

The justices also said they would decide whether legally married gay couples have a right to equal benefits under federal law.

The California case raises the broad question of whether gays and lesbians have an equal right to marry.

FULL COVERAGE: The battle over gay marriage 

If the justices had turned down the appeal from the defenders of Prop. 8, it would have allowed gay marriages to resume in California, but without setting a national precedent.

Now, the high court has agreed to decide whether a state’s ban on same-sex marriages violates the U.S. Constitution. The court’s intervention came just one month after voters in three states — Maine, Maryland and Washington — approved gay marriages. This brought the total to nine states having legalized same-sex marriages. 

But the justices also left themselves a way out. They said they would consider whether the defenders of Prop. 8 had legal standing to bring their appeal.

The justices made the announcement after meeting behind closed doors. They did not say which justices voted to hear the appeals.

Last year, the U.S. 9^th Circuit Court of Appeals struck down Prop. 8, but it did so on a narrow basis. Judge Stephen Reinhardt reasoned that the voter initiative was unconstitutional because it took away from gays and lesbians a right to marry that they had won before the state Supreme Court.

The justices now will have at least three options before them: They could reverse the 9^th Circuit and uphold Prop. 8, thereby making it clear that the definition of marriage will be left to the discretion of each state and its voters.

They could rule broadly that denying gays and lesbians the fundamental right to marry violates the Constitution’s guarantee of equal protection of the laws. Such a decision would open the door to gay marriages nationwide.

Or as a third option, they could follow the approach set by the 9^th Circuit and strike down Prop. 8 in a way that limits the ruling to California only.

In the other gay-marriage cases, the court will decide the constitutionality of part of the Defense of Marriage Act  that denies federal benefits to legally married couples. Judges in New England, New York and California have ruled this provision unconstitutional.

The justices are expected to hear arguments in the two sets of gay marriage cases in March and issue decisions by late June.

FULL COVERAGE: The battle over gay marriage 

Follow Politics Now on Twitter and Facebook

david.savage@latimes.com

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Video: A Magical Nighttime Journey Through a Fluorescent Reef

A coral reef is a world of kaleidoscopic shape and color. To see one at night, illuminated by its own fluorescence, is even more marvelous still.

This luminous parade was filmed off the coast of Egypt by Lynn Miner and Steffen Beyer, the founders of FireDiveGear, who custom-build photographic equipment for marine biologists and other undersea explorers.

Miner and Beyer dive in the blackness of night, with the only illumination coming from their own lights. These shine at a wavelength between 450 and 470 nanometers, a blue hue that is the only wavelength to penetrate below the sea’s upper waters.

In a sense, FireDiveGear’s lamps mimic sunlight as it’s experienced by life at those depths, only much, much brighter. With the right filters, it’s then possible to see what happens when light shines on reef dwellers. Their pigments become excited and emit photons, the phenomenon known as fluorescence.

“If you hit them with intense blue light, they shine back in purple, yellow, green, red, all the different colors,” explains Miner. “You don’t see those colors if you’re diving with a white light.”

As Al Dove on Deep Sea News describes, the biological function of fluorescence isn’t certain. Depending on the creature, it could have some purpose tied to the visual sensitivity of marine organisms to fluorescent light.

Deep-sea fluorescence could also be a fluke, a coincidental side-effect of other photochemical processes. All that’s certain is that fluorescence, what biologist Mikhail Matz of the University of Texas at Austin calls “the secret color of the deep,” is gorgeous.

“It’s an alternate universe. It’s absolutely a whole other world,” said Miner. “These stunningly beautiful creatures, the colors of these tropical fish — it’s hard to imagine. It’s hard to describe how beautiful they are, the brightness, the diversity.”

Like many divers, Miner is dismayed by the state of coral reefs in the early 21st century. Disease outbreaks, rising temperatures and human development threaten corals around the world.

Yet as Miner and Beyer’s videos make clear, for all that coral reefs have suffered, extraordinary beauty still remains.

More of FireDiveGear’s videos can be found on their YouTube page.

Video: FireDiveGear/YouTube

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Nurse who took prank call about royal Kate found dead

LONDON (Reuters) – A nurse who answered a prank call at the London hospital that was treating Prince William‘s pregnant wife Kate for morning sickness has been found dead, the hospital said on Friday, in a suspected suicide.

The death comes days after the King Edward VII hospital apologized for being duped by an Australian radio station and relaying details about Kate’s condition which made headlines around the globe.

“It is with very deep sadness that we confirm the tragic death of a member of our nursing staff, Jacintha Saldanha,” John Lofthouse, the King Edward’s chief executive told reporters outside the central London hospital.

“We can confirm that Jacintha was recently the victim of a hoax call to the hospital. The hospital had been supporting her throughout this difficult time.”

Police said they had been called at 9:35 a.m. (4:35 a.m. EDT) about a woman found unconscious at an address near the hospital. The woman was pronounced dead after ambulance staff arrived.

Police said the death was being treated as unexplained but they we’re not looking for anyone else, indicating the nurse had taken her own life.

William and Kate, who left the hospital on Thursday, said they were “deeply saddened” by the death of the nurse, who was married with two children.

“Their Royal Highnesses were looked after so wonderfully well at all times by everybody at King Edward VII Hospital, and their thoughts and prayers are with Jacintha Saldanha’s family, friends and colleagues at this very sad time,” a statement from William’s office said.

CONFIDENTIAL DETAILS

The radio station launched its stunt in the wake of a frenzy of media attention in Britain and worldwide after officials announced Kate was pregnant with a future British king or queen.

Two presenters from Australia’s 2Day radio station called the hospital early on Tuesday British time, pretending to be William’s grandmother Queen Elizabeth and his father, the heir-to-the throne Prince Charles.

Despite unconvincing accents, presenters Michael Christian and Mel Greig were put through to the ward where Kate was being treated and were given details about how she was faring.

Saldanha had answered the call as it was early morning and there were no receptionists on duty, and had passed it to a nurse on the ward. Saldanha, who had worked at the hospital for four years, had not been facing any disciplinary action, a source said.

“She was an excellent nurse and well-respected and popular with all of her colleagues,” Lofthouse said.

William’s office said there had been no royal complaint about the breach of confidentiality, although the hospital said it was reviewing its “telephone protocols”.

“On the contrary, we offered our full and heartfelt support to the nurses involved and hospital staff at all times,” a royal spokesman said.

William’s father, Prince Charles, had made light of the intrusion, joking to reporters after the incident: “How do you know I’m not a radio station?’

The private hospital is one of Britain’s most exclusive and has a history of treating members of the royal family, including the Queen’s husband Philip who was admitted in June for a bladder infection after taking part in a jubilee pageant on the Thames river.

PRESENTERS “SHOCKED”

The prank call and its tragic aftermath comes as Britain’s own media scrambles to agree a new system of self regulation and avoid state intervention following a damning inquiry into reporting practices.

A recording of the call was widely available on the Internet and many newspapers printed a transcript of the call.

The Australian radio station and its owner Southern Cross Austereo said the presenters were shocked and would stay off their show until further notice out of respect for Saldanha’s death.

“Southern Cross Austereo (SCA) and 2Day FM are deeply saddened by the tragic news of the death of nurse Jacintha Saldanha from King Edward VII’s Hospital and we extend our deepest sympathies to her family.

“Chief Executive Officer Rhys Holleran has spoken with the presenters, they are both deeply shocked and at this time we have agreed that they not comment about the circumstances,” an SCA statement said.

The two presenters deleted their Twitter accounts shortly after the news broke and there was widespread condemnation of their actions on the social media website.

“Remember that #RoyalPrank …? Yeah, the girl you humiliated is dead. You must feel great,” one wrote.

Facebook tribute pages swiftly set up after the nurse’s death attracted messages of sympathy, some echoing calls for the radio station to pay compensation to her family and for the presenters to resign.

Saldanha’s body was removed from the red brick, five-storey building where it was found, and transferred to a small private ambulance, shortly after the hospital confirmed her death, a Reuters reporter at the scene said.

She had been staying in staff accommodation in the building, away from her family in the city of Bristol, western England, a source said.

Her family said they were deeply saddened and asked for media to respect their privacy “at this difficult time”, in a statement released by police.

(Additional reporting by Peter Schwartzstein and Michael Holden; Editing by Louise Ireland)

Celebrity News Headlines – Yahoo! News

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The New Old Age Blog: A Son Lost, a Mother Found

My friend Yvonne was already at the front door when I woke, so at first I didn’t realize that my mother was missing.

It was less than a week after my son Spencer died. Since that day, a constant stream of friends had been coming and going, bringing casseroles and soup, love, support and chatter. Mom hated it.

My 94-year-old mother, who has vascular dementia, has been living in my home in upstate New York for the past few years. Like many with dementia, mom is courteous but, underneath, irascible. Pride defines her, especially pride in her Phi Beta Kappa intellect. She hates to be confronted with how she has become, as she calls it, “stupid.”

The parade of strangers confused her. She had to be polite, field solicitous questions, endure mundane comments. She could not remember what was going on or why people were there. It must have been stressful and annoying.

That night, like every night since the state troopers brought the news, I woke hourly, tumbling in panic. As if it were not too late to save my son. Mom knew something was wrong, but she could not remember what. As I overslept that morning, she must have decided enough was enough. She was going home.

In a cold sky, the sun blazed over tall pines. As I opened the door, the dogs raced out to greet Yvonne and her two housecleaners. Yvonne often brags about her cleaning duo. They were her gift to me. They were going to clean my house before the funeral reception, which was scheduled for later that week. This was a very big gift because, like my mother before me, I am a very bad housekeeper.

Mom’s door was shut. I cautioned the housecleaners to avoid her room as I showed them around. Yvonne went to the kitchen to listen to the 37 unheard messages on my answering machine; the housecleaners went out to their van to get their instruments of dirt removal.

I ducked into Mom’s room to warn her about the upcoming noise. The bed was unmade; the floor was littered with crumpled tissues; the room was empty.

Normally, I would have freaked out right then. I knew Mom was not in the house, because I had just shown the whole house to the cleaners. Although Mom doesn’t wander like some dementia patients, she does on occasion run away. But I could not muster a shred of anxiety.

“Yvonne,” I called, “did you see my mother outside?”

Yvonne popped her head into the living room, eyebrows raised.“Outside? No!” She was alarmed. “Is she missing?”

“Yeah,” I said wearily, “I’ll look.” I stepped out onto the front porch, tightening the belt of my bathrobe and turning up the collar. Maybe she had walked off into the woods. The dogs danced around my legs, wanting breakfast.

I had no space left in my body to care. Either we would find her, or we would not. Either she was alive, or she was not. My child was gone. How could I care about anything ever again?

Then I saw my car was missing. My mouth fell open and my eyeballs rolled up to the right, gazing blindly at the abandoned bird’s nest on top of the porch light: What had I done with the keys?

Mom likes to run away in the car when she is angry. She used to do it a lot when my father was still alive — every time they fought. Since Mom took off in my car almost a year ago, after we had had a fight, I’d kept the keys hidden. Except for this week; this week, I had forgotten.

I was reverting to old habits. I had left the doors unlocked and the keys in the cupholder next to the driver’s seat. Exactly like Mom used to do.

“Uh-oh,” I said aloud. Mom was still capable of driving, even though she did not know where she was going. I just really, really hoped that she didn’t hurt anybody on the road. I pulled out my cellphone, about to call the police.

“Celia!” Yvonne shouted from the kitchen. She hurried up behind me, excited. “They found your mother. There are two messages on your machine.”

At that very moment, Mom was holed up at the College Diner in New Paltz, a 20-minute drive over the mountain, through the fields, left over the Wallkill River and away down Main Street.

Yvonne called the diner. They promised to keep the car keys until someone arrived. By that time, Yvonne had to go to work. She drove my friend Elizabeth to the diner, and Elizabeth drove Mom home in my car.

Half an hour later, they walked in the front door. Mom’s cheeks were rouged by the chill air and her eyes sparkled, her white hair riffing with static electricity. “Hello, hello,” she sang out. “Here we are.” She was wearing the flannel nightgown and robe I had dressed her in the night before. It was covered by her oversized purple parka, and her bare feet were shoved into sneakers.

I started laughing as soon as I saw her. I couldn’t help it. Elizabeth and Mom started laughing too. “You had a big adventure,” I said, hugging them both. “How are you?”

“I’m just marvelous,” said my mother. Mom always feels great after doing something rakish. We settled her on the sofa with her feet on the ottoman. By the time I got her blanket tucked in around her shoulders, she had fallen asleep.

Elizabeth couldn’t stop laughing as she described the scene. “Your mother was holding court in this big booth. She was sitting there in her nightgown and her parka, talking to everybody, with this plate of toast and coffee and, like, three of the staff hovering around her.”

The waitress said Mom seemed “a little disoriented” when she got there. Mom said she was meeting a friend for breakfast, but since she was wearing a nightgown and didn’t know whom she was meeting or where she lived, the staff thought there might be a problem. They convinced Mom to let them look in the glove compartment of the car, where they found my name and number.

It was then that I realized I was laughing – something I’d thought I would never be able to do again. “Elizabeth, Elizabeth, I’m laughing,” I said.

“Ha, ha, ha,” laughed Elizabeth, holding her belly.

“Ha, ha, ha,” I laughed, rolling on the floor.

And she who gave me life, who had suffered the death of my child and the extinction of her own intellect, snoozed on: oblivious, jubilant, still herself, still mine.

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Wealth Matters: Protect Yourself from Investment Fraud This Madoff Day

From left, Marc S. Drier, Bernard L. Madoff and R. Allen Stanford. Their fraudulent schemes collapsed in late 2008 and early 2009.

THIS is the time of year when most people think of gifts and holiday gatherings. I couldn’t help thinking of frauds past.

Four years ago this week, Marc S. Dreier, a high-flying lawyer, was arrested and later charged with defrauding his clients of $700 million. A few days later, Bernard L. Madoff’s fraud was uncovered. Totaling an estimated $65 billion, Mr. Madoff’s fraud was in a class by itself. And then, a short time afterward, some of the brokers who had been selling fraudulent certificates of deposit for R. Allen Stanford began to turn on him; he was arrested in February 2009 and later convicted of a $7 billion fraud.

These schemes collapsed with the economy in 2008. But on their anniversaries, it may be a good time to ask whether you have done all you can to lower your risk of being caught up in a similar fraud. Call it Madoff Day (celebrated on Dec. 11, the day of his arrest).

Protecting yourself against fraud, or simply bad advice, is easier said than done. The most common advice is to make sure your money is held by an independent custodian or firm whose job is to keep your money safe. That wasn’t the case with either the Madoff or Stanford fraud. But that is only one small step.

So what else can investors do to protect themselves, not only from unscrupulous advisers but also from rushing into an investment that is clearly too good to be true?

Marc H. Simon, a lawyer who lost two years of bonuses, his job and months of unreimbursed expenses when Mr. Dreier’s law firm collapsed, said he has thought a lot about what he could have done differently.

Mr. Simon said that six or seven years before the fraud was uncovered, he knew of inconsistencies in the firm’s 401(k) plans. But the big red flag should have been that Mr. Dreier had sole control over every major decision at the law firm. Still, that had been Mr. Dreier’s pitch: work for him and don’t worry about the irksome details partners typically face.

“People like Drier and Madoff were highly intelligent individuals, they were very charismatic and they were giving people what they wanted,” Mr. Simon said. “It is harder to bring into question those who are providing you something you want.”

Randall A. Pulman, a lawyer in San Antonio who represents many victims of Mr. Stanford’s fraud, agreed that the will to believe was what ensnared people.

“For you and me, it’s too good to be true,” he said. “For the guy who has been working in the oil fields, how is he supposed to know?”

Of course, fraud and just plain bad advice are not limited to the poor or unsophisticated. Robert P. Rittereiser, the former chief financial officer of Merrill Lynch and former chief executive of E. F. Hutton, is working as the receiver for two funds suing J. Ezra Merkin, a former money manager who steered money to Mr. Madoff. Mr. Rittereiser did not think investors in Mr. Merkin’s funds knew that their money was simply being passed on to Mr. Madoff. But even if they did, they may not have seen anything to be concerned about.

“They were investing money and getting appropriate returns for the kind of fund it was,” Mr. Rittereiser said. “Most of them had a relationship of some kind and confidence with Merkin and the people he was dealing with.”

So how do you protect yourself? The first step would seem to be picking an honest adviser. The good news is that only about 7 percent of advisers have disciplinary records, said Nicholas W. Stuller, president and chief executive of AdviceIQ, a company that evaluates advisers. The bad news is that those violations appear only after someone has filed a complaint.

Mr. Stuller’s company, which has now approved some 2,400 advisers, rejects anyone with any type of infraction — from a securities fine to a misdemeanor for getting into a fight. He said this policy might keep some good advisers off the site, but his goal is to search the records of federal and state regulators to find advisers he knows are clean.

“There are advisers who have significant negative disciplinary history with one regulator but appear to be pristine with another regulator,” Mr. Stuller said. “There was a guy in Minnesota who was stealing insurance premiums. In his enforcement record, it says, ‘We’re going to alert Finra,’ but his Finra record is clean,” he said, referring to the Financial Industry Regulatory Authority. “That’s where the regulators don’t talk to each other.”

AdviceIQ’s main competitor, BrightScope, takes a different approach. It notes disciplinary actions taken against advisers but leaves it up to the consumer to go to regulators to determine what the violations were.

“We want the consumer to go to the source data, because there is a lot of liability in publishing that,” said Mike Alfred, co-founder and chief executive of BrightScope. “Many of these folks are good advisers, and they’ll take care of you. But what if they had one crazy client who put all his money in Internet stocks in 2000 and then sued?”

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18 arrested in federal crackdown on gang that operated near USC

Federal authorities on Thursday announced a sweeping racketeering indictment against a Mexican Mafia-controlled gang that operated in an L.A. neighborhood just north of USC and was allegedly involved in at least one slaying, drug sales, extortion and robberies.

Eighteen members of the Harpys gang, also known as the Harpys-Dead End gang, were arrested Thursday morning on charges in three federal indictments resulting from “Operation Roman Empire.”

Those arrested include Vianna Roman, 37, daughter of a Mexican Mafia member, Danny Roman, who allegedly controlled the gang while serving a life sentence at Pelican Bay State Prison.

A total of 29 defendants were named in the racketeering indictment, eight of whom were already in state custody. Among them is Miguel Delgado, 18, accused of committing armed robbery against three USC students.

Federal prosecutors alleged that Vianna Roman and her husband, Aaron Soto, 40, traveled to and from Pelican Bay passing along orders from Danny Roman and collecting taxes to be funneled to him through profits the gang made through dealing in methamphetamine, cocaine, crack cocaine and heroin and through extorting businesses, including swap-meet vendors, via threats of violence.

Members of the gang are suspected in the slaying of one gang member who owed a debt, as well as plotting to kill a witness slated to testify against a gang member in a state court case, according to the indictment.

The gang has previously been targeted by the Los Angeles city attorney’s office in injunctions alleging the gang’s members were engaged in shakedowns, robberies, vandalism and murder. A judge issued a court order in 1998 that barred 30 of the gang’s members from associating with one another in the area.

At the time, one business owner said the Harpys asked for $150 to $180 a month for protection from the gang.

The gang controlled an area southwest of downtown that spanned from Normandie Avenue to Figueroa Street and Washington Boulevard to Jefferson Boulevard. Over the course of the operation, authorities seized 8½ pounds of methamphetamine, approximately one-half pound of heroin, approximately one pound of cocaine, 23 pounds of marijuana and 22 guns, according to a press release from the U.S. attorney's office.

If convicted of the racketeering charges, all but one of the defendants face a maximum sentence of life in prison, prosecutors said.

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