BY MICHAEL AMON
June 17, 2008 p. A6

As lawmakers consider overhauling the state’s doctor discipline system, records show that New York – more than any other state – relies on medical investigations conducted elsewhere to punish physicians.

What’s more, among the 10 states with the most doctors, New York ranks ninth for punishing physicians through its own investigations, sanctioning 2.10 doctors per 1,000 in 2007. Florida, by contrast, disciplined 5.91 doctors per 1,000.

Of the 311 disciplinary actions taken by the New York Board for Professional Medical Conduct in 2007, 173, or 56 percent, did not stem from in-state probes but from “reciprocal actions” – sanctions taken against doctors punished first by other states. Called “piggybacking” by reform groups, these actions require minimal investigation and are rarely challenged by physicians.

“It becomes an issue of productivity,” said Arthur Levin, director of the Center for Medical Consumers in Manhattan. “When we want to look at how proactive New York is, all we know is that they’re very good at finding the bad doctors in other states but not necessarily here.”

Numbers may hinder effort

New York actually punished more doctors than any state but Illinois last year, but those figures include the piggybacked investigations. Patient advocates say the statistics make New York’s physician discipline board look deceptively aggressive and could hurt efforts to change the system, including Gov. David A. Paterson’s proposal now being considered by the legislature.

Claudia Hutton, a state Department of Health spokeswoman, said New York punishes fewer doctors on its own because under state law, investigators must prove at least two instances of negligence or wrongdoing – not one as in many other states. She also said staffing levels were stagnant at the Office of Professional Medical Conduct, which investigates cases for the Board for Professional Medical Conduct.

“We do the best we can with our staffing levels,” Hutton said, noting that OPMC received funding to hire 15 more investigators this year, bringing the total to 84. “I think you will see different numbers over the next few years.”

Hutton added that it’s important for the state to pursue actions against doctors sanctioned elsewhere. “We don’t want that physician returning here to practice,” Hutton said.

Paterson’s plan

Paterson’s bill would encourage more local probes by allowing the Office of Professional Medical Conduct to use malpractice histories to initiate cases. It also would make public the names of doctors charged with wrongdoing and make it easier to go after doctors who refuse to turn over records for probes. The law was proposed following criticism that OPMC and the Department of Health were too lenient with Dr. Harvey Finkelstein, the Long Island doctor accused of reusing syringes.

The proposal’s chances are unclear, legislative aides and advocates say. Legislative leaders and the governor’s representatives today will try to hammer out an agreement.

Taking a closer look

“When New York is touted as the state with the highest numbers, it makes it harder to make the case for reform,” said Blair Horner, legislative director of the New York Public Interest Research Group. “You have to look at the numbers a little harder.”

New York is not alone in pursuing out-of-state cases. Since 2003, when Dallas-based trade group the Federation of State Medical Boards began alerting states to sanctions of doctors with multiple licenses, reciprocal actions have risen 37 percent. The actions are universally praised for preventing bad doctors from jumping from state to state.

“You can’t be against reciprocal actions, they’re a good thing,” said David Swankin, president of the Citizens Advocacy Center in Washington, D.C. “The question is – what are they doing besides reciprocals?”

New York has long piggybacked on the work of other state’s doctor-disciplinary systems. Since 2004, 61 percent of its sanctions have been initiated in other states. From 1990 to 2006, New York, along with Pennsylvania and Hawaii, were the only states to punish more out-of-state doctors than in-state ones, according to the National Practitioners Data Bank.

One explanation: New York’s medical schools train about 15 percent of the nation’s doctors. They often keep a medical license here but practice – and get disciplined – somewhere else.

When a New York-licensed doctor is sanctioned elsewhere, the state moves quickly to restrict their practice here, Hutton said. Three full-time OPMC staff members and one part-timer are assigned to handle reciprocal actions.

Out-of-state probes easier

Disciplinary cases from other states are easier to process, Hutton said. They don’t have to be reinvestigated by New York staff. Instead, the out-of-state action is reviewed to ensure that it constituted misconduct under New York law. The doctor can challenge the findings, but most do not, Hutton said.

As for punishing fewer doctors than other big states, one reason may be that New York places hundreds of physicians with substance abuse problems into a monitoring system that is the nation’s most extensive. The roughly 1,400 doctors now in the system are required to get treatment and to allow doctors chosen by the state to track their progress, Hutton said. In other states, many of those doctors would have been disciplined.

“New York has a more progressive model, and frankly I believe in the long run it provides for better care for more patients,” said Dr. Michael Rosenberg, president of the Medical Society of the State of New York.

Staffing levels an issue

Finally, Hutton blamed staffing levels, saying the number of investigators had remained flat at around 69 for several years, even as complaints surged from 6,275 in 2003 to more than 7,300 in 2005 – second only to Florida. Each complaint, she said, must be investigated, taking an average of 230 days.

Even without the staff increase this year, though, New York had the second-largest investigative team in the country, behind only California.

Other states appear more productive with smaller staffs. The State Medical Board of Ohio regulates 40,000 doctors – half as many as New York. But with 21 investigators, it disciplined 160 physicians in locally generated cases last year, compared with 138 in New York. North Carolina, with 10 investigators, disciplined 129 doctors on its own initiative last year, while cutting in half the number of reciprocal actions it took from 83 in 2006 to 41.

North Carolina Medical Board spokeswoman Jean Fisher Brinkley said questions had been raised about whether reciprocal actions “were the best use of resources.” With more locally generated cases, she said, “the relevance to people in our state was greater.”

BEHIND NEW YORK’S DOCTOR DISCIPLINE SYSTEM

Much more than other states with a lot of doctors, New York issues sanctions that stem from other states’ investigations – cases known as “reciprocal” or piggyback actions.

Critics say it exaggerates the state’s doctor discipline statistics and hurts chances for toughening the system.

State says it pursues reciprocal actions to keep bad doctors from returning to New York.

State generates fewer in-state doctor-discipline cases than other states. One reason: New York must prove two bad acts by doctors here before punishment kicks in – many other states require just one.

THE PROCESS

The New York physician discipline process can begin several ways.

The Office of Professional Medical Conduct can file charges when it learns that a doctor has been disciplined in another state or convicted of a crime. The charges are reviewed to ensure that they constitute misconduct under the state’s Public Health Law.

Then doctors are offered a settlement agreement but have the right to a hearing before the Board of Professional Medical Conduct. Most waive the hearing and settle, officials said.

Doctors can also be investigated when a complaint is filed by a member of the public. Each complaint is checked by one of 84 investigators.

Most of the more than 7,000 complaints filed each year are dismissed but they can lead to formal charges. After being charged, doctors are offered a chance to settle, or plead guilty. They also have the right to a hearing before a three-member panel made up of two doctors and a non-doctor. The burden of proof is preponderance of the evidence.

BY MICHAEL AMON AND RIDGELY OCHS
Sept. 23, 2007 p. A7
Benjamin Landa and Bent Philipson have built the largest nursing home network in the state with good timing, smart business moves and the right contacts.

In 1987, Landa bought his first nursing home – a facility in Far Rockaway – from his late father’s estate. A few years later, as he acquired more nursing homes, he started raising money for political candidates from both major parties. By 1994, he was a top fundraiser for future Gov. George Pataki said Jeffrey Weisenfeld, a former Pataki aide.

Then in 1996, Pataki named Landa to the Public Health Council, a state board with broad powers to approve health care facility projects, including nursing homes. That year, Landa teamed up with Philipson, who was a supervisor in one of his nursing homes.

During Landa’s eight-year tenure on the council, Landa,Philipson or their wives secured the purchase of 20 nursing homes and became the state’s leading players in the nursing home industry. They now run 25 facilities.

“Their approach is new,” said Neil Heyman, president of the Southern New York Association, a trade group of 64 nursing homes. He added that nursing homes in New York historically had been family run businesses. “They are part of a general trend toward giving nursing home organizations corporate names and structures.”

SentosaCare does not own or run the facilities, which have about 80 investors with Landa, Philipson or their spouses as the common denominator. Rather, the company centralizes administrative functions and provides a brand-name marketing tool.

Their strategy is the only way to, in effect, form a nursing home chain in New York state, said health care experts. Legislation passed after Medicaid fraud and patient abuse scandals in the 1970s required all nursing home investors to be vetted by the state. The laws essentially banned publicly-traded nursing home chains because of the impossibility of vetting thousands of investors behind publicly traded companies.

As the group grew, many nursing home owners said Landa’s council position and friendship with Pataki helped his projects.

In 2003, the owners of 15 nursing homes complained to the Health Department about a replacement facility for Landa’s Brookhaven Rehabilitation and Health Care Center in Far Rockaway being pushed ahead of their own languishing construction projects.

“We are mystified and disturbed that Brookhaven’s application might be given expedited treatment over those other worthy providers,” wrote Carl S. Young, president of the New York Association of Homes and Services for the Aging, in a May 21, 2003, letter to the State Hospital Review and Planning Council, which reviews nursing home projects before the Public Health Council. The project has not moved forward.

Landa recused himself from decisions on his projects and said his council post was “irrelevant to my business strategy.”

Landa said the Pataki administration, generally, was “detrimental to my company’s bottom line,” with its insistence on cuts to Medicaid reimbursements. But Landa’s net worth increased from $7 million to $65 million while Pataki was governor, according to documents filed with the state health department.

A Pataki spokesman did not return calls seeking comment.

Landa, 51, and Philipson, 41, made their flurry of nursing home purchases in the late 1990s, just as many older operators were retiring and cashing out, said Richard Herrick, the president of the New York State Health Facilities Association.

Herrick said he had never seen a group of investors in New York buy so many nursing homes so quickly. State health department records indicate that the facilities’ annual revenues are at least $450 million.

BY MICHAEL AMON
April 26, 2009 Sunday p. A3
Trusted by his colleagues, loved by his family, Bill Parente was the picture of respectability.

He wore conservative suits and drove a Mercedes sedan.

His law office on Lexington Avenue was decorated with more than a dozen photographs of his wife, Betty, and daughters, Stephanie, 19, and Catherine, 11, whom he talked about endlessly. He kept the books for a group of solo law practitioners who shared a suite of offices.

And a small group of friends who entrusted Parente with millions of dollars to invest in commercial bridge loans always received their quarterly payments on time.

People trusted him.

“What Bill said, I believed. Bill’s word was good enough for me,” said Manhattan attorney Jonathan Bachrach, who shared office space with Parente for 12 years but was not an investor.

But in mid-December, Parente’s trustworthy veneer began to crack.

Skittish over the Wall Street crisis and the Bernard Madoff scandal, some investors asked for their money back. Parente stalled. He issued checks but asked that they not be cashed.

“He would give me some story, he made various excuses,” said one investor, Bruce Montague, a Bayside attorney.

Finally, on April 16, Parente gave Montague and other investors the green light to cash their checks. They began bouncing Monday morning – up to $20 million all told, associates say – as Parente lay dead with his family in a suburban Maryland hotel room.

Police say Parente killed his wife and Catherine some time after breakfast. He then waited several hours for his other daughter to return to the room and killed her, too. He then went out, bought a set of knives and killed himself.

It was a stunning end for what a friend called “the all-American family,” a tragedy that no one has been able to explain. The only clue so far is William Parente’s financial problems, which the FBI is investigating.

‘My little miracles’

William and Betty Parente’s relationship had been tested by infertility and then her battle with breast cancer, challenges that friends said made them a stronger and more loving couple. Their children were the center of their world.

“I never knew a man to be more proud of his children than Bill was,” Bachrach said. “His girls were practically all he ever talked about.”

William Michael Parente grew up in the Bay Ridge section of Brooklyn, the only child of a New York State Police trooper, Willie Parente and his wife, Roccolyn. He was drawn to the study of law at an early age, said his cousin Jean Russo Grace of Coram. As children playing at their families’ shared Long Beach bungalow, Bill never got into trouble, she recalled.

“He always played by the rules,” Grace said.

But Willie Parente’s police wages weren’t enough to send his son to college, so Bill turned to his uncle, Anthony J. Russo, a top aide to then-U.S. Attorney Herbert Brownell. Russo paid Parente’s way through Brooklyn College and then Brooklyn Law School, Grace said.

As a law student in the early 1970s, Parente was introduced to Betty Mazzarella, a fellow Bay Ridge native. They dated for several years before marrying in 1977, Grace said.

They stayed in Bay Ridge, renting an apartment near their extended family. The couple planned to have a big family, friends and family said. But their attempts to conceive were unsuccessful for so long that Betty began to worry she may never have children. “They just kept trying and if it would happen, it was meant to be,” Grace said. “If they could have, they would have had 10 kids.”

Then, at the end of 1988, Betty became pregnant with Stephanie at the age of 39. Betty quit her job as a legal secretary, and Bill left a law partnership near Wall Street and moved into a solo practice in midtown.

It was at this time, says a close friend who spoke on condition of anonymity, that Bill Parente also began soliciting investments for bridge loans, primarily from other attorneys.

In 1997, Catherine was born. Betty was 47, and the pregnancy came as a shock, Grace said.

“Betty was so proud,” said Joanne Schulter, 42, of Staten Island, who photographed the Parente family for 18 years. “When she had Cat, it was such a miracle.”

That’s how she thought of her daughters, said Robert Krener, 64, who sold them their ranch-style home on First Street and lives next door.

“She called her girls, ‘My little miracles,’” Krener said.

Living well

To neighbors, friends and family, the Parentes seemed to be thriving.

His law practice and investment business furnished the family with a comfortable life: a well-appointed suburban home, a summer residence in the Hamptons, designer clothes for his daughters, two Mercedes-Benz cars, a $40,000 private college education for Stephanie.

Betty cared for the children, served on the PTA and volunteered at St. Joseph’s parish. She was gregarious and energetic, said friends who called her Betty Boop.

“This was the all-American family,” said attorney Michael Eidman, who worked in the same suite for 12 years with Parente.

At his Manhattan office on the Avenue of the Americas, fellow attorneys viewed Parente as a hardworking family man. He was unfailingly polite to his longtime secretary Lucille Gribbin and worked long though not excessive hours. He didn’t even curse, nor join others for drinks after work, Eidman said.

“He’s a guy who if there was a 9 o’clock meeting, he would be there at 9 o’clock,” Eidman said.

Keeping up with roots

The family worked hard to keep in touch with their Brooklyn roots. Krener said Betty returned to Bay Ridge often to pick up Italian pastries for holidays. They made an annual pilgrimage to the neighborhood around Thanksgiving to have portraits taken of the girls, who often wore matching designer outfits, Schulter said.

After the death of his father in 1994, Bill Parente often visited his mother, who went by Lee, in the Bay Ridge apartment where he had grown up. When she died a year ago at the age of 92, said Grace, “he took it very, very bad. He got very quiet.”

A banker of sorts

All this time, Parente was involved in what he told a small circle of friends and colleagues was the high-risk field of bridge loans. When construction projects needed funding as they awaited permit approval, he would provide the money at an interest rate of 15 percent, a typical rate for such a loan, said the close friend.

“He essentially worked as a bank,” the friend said, raising money from private investors to make loans.

“He seemed straightforward,” Montague said, adding: “It all seemed above board until he started to delay me.”

Montague said he got returns of 10 percent to 15 percent annually on the hundreds of thousands of dollars that he invested and he got checks regularly from a bank account.

When Montague said he wanted his money back in December, Parente took the news calmly but moved slowly. In late March, Parente sent Montague six checks totaling his current investment of $450,000, but asked him to not cash them.

Montague said he began to wonder if Parente was running a “Madoff-type” scam. On April 16, Montague got him on the phone. “I said, ‘Bill, I can’t wait anymore,’” Montague said. “He said ‘Go ahead, the money cleared, go ahead and deposit them.’”

The next day, Parente was on his way south with Betty and Catherine, to see Stephanie at Loyola College in Maryland. The Parentes often made the 215-mile car trip to pick her up and drop her off, Schulter said. Although she had her own car, they would bring her home so “they wouldn’t have to worry that she was driving on her own,” she said.

But this was a surprise trip to see Stephanie. They checked in to the Sheraton Hotel and settled in for the weekend.

On Tuesday morning, Montague got a phone call from a Chase bank. The two checks he had deposited bounced.

He said he called Parente and got voice mail and then called a friend of Parente’s, who had been getting calls from frantic investors all morning.

“There were checks bouncing all over the place,” said the friend, who tried to call Parente but found his voice mail was full. “No one could reach Bill.”

This story was reported by PERVAIZ SHALLWANI and staff writers MICHAEL AMON, MATTHEW CHAYES and ANDREW STRICKLER. It was written by AMON.

BY MICHAEL AMON
March 16, 2008 P. A8
Cloistered in his Manhattan apartment last Sunday, Gov. Eliot Spitzer listened as his wife, Silda Wall, and his closest adviser, Lloyd Constantine, urged him not to resign.

Allegations that he used high-priced call girls would be public in less than 24 hours, but Wall and Constantine argued that Spitzer could weather a sex scandal, just as other politicians with popular platforms had, according to several knowledgeable sources.

Look at President Bill Clinton, they said, whose poll numbers remained high despite impeachment efforts. And remember, they told Spitzer, that he was elected with nearly 70 percent of the vote in 2006.

Spitzer initially heeded their advice, but by Tuesday evening – after several public relations firms told him there was no way to repair his image – he had decided he had no choice but to resign, said advisers who spoke on condition of anonymity. But Wall and Constantine continued pleading with him to remain in office, advisers said, right up until Wednesday morning when he delivered his resignation on national television.

“I am deeply sorry that I did not live up to what was expected of me,” he said.

Spitzer officially hands over power to Lt. Gov. David Paterson tomorrow at 1 p.m., but friends and aides say he has not been in charge since Wednesday, rarely leaving his apartment and forgoing his daily jogs in Central Park.

The seeds of his spectacular fall were sown last year, when a routine report filed by his bank sparked a federal investigation into unusual transfers from his account to “shell” companies for a prostitution ring. His fate was sealed after wiretaps caught him arranging a Feb. 13 tryst in Washington.

It was an especially ignominious end for Democrat Spitzer, the square-jawed former prosecutor who swept into the Executive Mansion 14 months ago vowing to clean house. The reforms he promised had hit a series of setbacks – a nationwide furor over a proposal to give driver’s licenses to undocumented immigrants; and a probe into using the State Police to spy on his rival, State Senate Majority Leader Joseph Bruno, a Republican.

Yet many believed Spitzer was making a comeback. The Republican Senate majority had shrunk to a single seat with a win last month by Spitzer’s hand-picked candidate. He had raised $3 million in the second half of 2007.

Though he could not know it, any momentum Spitzer had was effectively stopped on Thursday, March 6, when the leaders of the Emperors Club VIP, an alleged international prostitution ring, were arraigned in federal court in Manhattan.

Up to $5,500 an hour

According to federal prosecutors, the Emperors Club VIP catered to those willing – and able – to pay up to $5,500 to spend an hour with the attractive women who could be chosen from an online gallery.

With its elements of sex, wealth and intrigue, news of the arrests spread as far as Australia, where a story headlined “Elite Escorts Busted” ran in the March 9 Sunday Mail. But few knew the true focus of that investigation: an alleged sometime john known in court papers as “Client 9″ who was actually the governor of New York.

The FBI and the IRS had begun investigating Spitzer in October, law enforcement sources said, when two banks reported unusual activity. First, North Fork reported that Spitzer had tried to break down large wire transfers into amounts smaller than $10,000, seemingly to get around federal reporting rules, sources said. Spitzer then unsuccessfully asked North Fork to remove his name from the wire transfers.

In another case, HSBC reported that a group of companies that had established accounts were apparently shells – under the names QAT Consulting Group, QAT International, and Protech Consultants – that might be involved in some sort of illegal activities.

The unusual bank activity might have gone unnoticed – hundreds of thousands of such reports are filed a year – but the HSBC and North Fork reports ended up with the same analyst at an IRS office in Hauppauge, sources said.

By January, a judge had authorized tapping Emperors Club phones. On Feb. 13, when Spitzer was in Washington to testify before the House Financial Services Committee, he was overheard making elaborate arrangements for a successful rendezvous with a prostitute with the pseudonym “Kristen.” Sources said he’d had seven or eight dates with Emperors Club call girls in the last year.

On Friday, March 7, federal investigators told Spitzer that he’d been overheard on wiretaps. But over the next two days, he appeared to behave as if nothing was amiss, conducting conference calls and attending public events, according to aides and his public schedule.

On Saturday, apparently unaware that a New York Times reporter was outside his Fifth Avenue apartment, he went for a jog. He and his wife, Silda Wall Spitzer, took their dogs for a walk, the Times reported.

Later, Spitzer traveled on Amtrak to Washington, D.C., for the annual Gridiron Club dinner, where he swapped jokes with media executives like News Corp.’s Rupert Murdoch and Donald Graham of The Washington Post, said Stanford Lipsey, the Buffalo News publisher who invited the governor. Spitzer shook countless hands and watched President George W. Bush perform a self-mocking song-and-dance number.

“He had a terrific time,” Lipsey recalled.

He seemed ‘very keyed up”

Pollster Lee Miringoff said he chatted with Spitzer for about 10 minutes about the governor’s low approval ratings. Spitzer assured him that by November, his numbers would rise, Miringoff said. But Spitzer seemed subtly off.

“He was very keyed up, but in a manicky kind of way,” Miringoff said. “I asked a question, and before I got two words in, I was getting an answer. … He really was very much dominating the conversation.”

Spitzer left the party at midnight and spent the night in Washington. Though he had taken the train there, he came back by car on Sunday, aides said.

The illusion that everything was still OK began falling apart.

The Times began making inquiries Sunday, aides said, and that afternoon, Spitzer told his wife of 20 years and three teenage daughters about the accusations. He then informed top aides, and intense discussions about the governor’s options began at his apartment.

That afternoon, Gerald Lefcourt, a prominent New York City defense attorney, spotted Spitzer and his youngest daughter walking the dog through Central Park. Spitzer didn’t seem to have any security detail around him, Lefcourt said, and he seemed dejected.

Back in the apartment, Constantine and Wall began urging Spitzer to fight the inevitable calls for his resignation, but no decision was made. On Monday morning, top aide Richard Baum told staff of the controversy, and Spitzer called Lt. Gov. David Paterson.

So many reporters showed up for Spitzer’s news conference Monday that some were turned away for fear of violating fire codes. News Web sites crashed. Cable networks flashed endless footage of the governor as newscasters wondered aloud: Would he resign?

An hour late, the governor and his wife arrived, glassy-eyed and looking dazed. Wall stared at the text of the short speech Spitzer read from as he apologized for what he vaguely called a “private matter.”

“I have acted in a way that violates my obligations to my family and that violates my – or any – sense of right and wrong,” he said.

Declining to take questions, he and his wife quickly left the room.

In Spitzer’s office, the atmosphere was “funereal,” said one staffer. On Wall Street, where Spitzer had collected scalps from his days as attorney general, there were cheers, including on the floor of the New York Stock Exchange.

In Albany, the reaction was more complicated. Shock, fascination, confusion, and of course, some delight at the downfall of the man who called himself a “steamroller.”

“Everyone was glued to their BlackBerries,” a legislative aide said.

Calls for governor’s resignation

The political equation for the unpopular governor quickly became clear. Republican lawmakers began calling for his resignation, and soon, some Democrats joined the chorus.

On Monday night, many Democrats began preparing for Spitzer’s resignation. The exclusive neighborhood outside his apartment – Mayor Michael Bloomberg’s home and the Metropolitan Museum of Art are nearby – became clogged with reporters, satellite trucks and curious onlookers.

Instead, Spitzer appeared to dig in. He canceled all events and hired a high-powered white-collar defense attorney. Friends and colleagues came and went, but neither Spitzer nor his wife emerged from their home. He tried to hire public relations firms, said one source, but they turned him down – there was nothing they could do.

By Tuesday afternoon, sources said, Spitzer reached the decision nearly everyone predicted: He could not continue as governor and must resign. Preparing for the end, he wrote his last speech as a politician and took a few calls.

“We’re all a group of friends, still, and we’re trying to take care of each other,” said one confidant.

On Wednesday morning, Spitzer and his wife stood again, wan and humiliated, before a bank of cameras. He apologized, confirmed he was resigning and said, someday, he would work again for the public good – “outside of politics.”

He did not take questions. The couple walked out, not touching, and it was over.

This article was reported by MELANIE LEFKOWITZ, ROBERT E. KESSLER, CRAIG GORDON, DAN JANISON, JAMES T. MADORE, ANTHONY M. DESTEFANO and MICHAEL AMON. It was written by AMON.

BY MICHAEL AMON
Feb. 27, 2008 P. A4
The Child Protective Services workers assigned to investigate a complaint against Leatrice Brewer on Friday did not know of her extensive criminal record, mental health history and frequent appearances in Family Court, Nassau County officials said yesterday.

Blocking their efforts: a combination of Nassau Department of Social Services policies and state and federal laws that do not allow the sharing of personal information across government agencies.

“We are unable to capture the information that we want,” said Mary Curtis, the deputy county executive for health and human services.

State privacy laws blocked the agency from contacting the county Department of Mental Health, Chemical Dependency and Developmental Disability to act on the warnings from family and friends that Brewer was mentally ill, said Karen Garber, program coordinator for the Department of Social Services.

Nassau officials said they don’t know whether having access to a comprehensive history of Brewer’s hundreds of contacts with at least 12 government agencies and nonprofit social service providers would have prevented the drowning of her three young children Sunday.

Nevertheless, they are training new scrutiny on policies that limit the investigative scope of CPS workers to the complaint before them – and prevent them from tapping other agencies for important insights such as drug use, criminal behavior and mental health.

“It’s very difficult to deal with one component of a person in a vacuum,” Garber said. “It makes it difficult to come up with an appropriate plan for a person.”

On Friday, when the father of Brewer’s two sons complained that she was threatening the children, CPS caseworkers did not know or were prevented from knowing the following pieces of information:

She had been arrested seven times in the last seven years.

She had been referred for a mental health evaluation this month when she reapplied for welfare benefits.

She had been referred to nonprofit organizations that provide mental health and substance abuse programs.

She was involved in heated child custody disputes with two ex-boyfriends who had accused her of neglect.

The limited information available to caseworkers included a history of her contacts with CPS. It showed six of the nine cases opened against her were unfounded, while the other three involved relatively minor infractions, officials said.

“Generally speaking, the children seemed well cared for,” Curtis said. “They were clothed, they were fed, they were going to school, the apartment was well taken care of.”

In April 2003, when the first CPS case was opened on Brewer, caseworkers could not take into account that she had been charged with felony assault and criminal possession of a weapon that month. The charge was later reduced to harassment in September 2003 and she served 4 days in jail. The social services complaint, which officials declined to disclose, was determined to be unfounded and closed in August that year, officials said.

Of the first seven cases opened against Brewer, six were unfounded complaints, officials said. But the two most recent cases, both opened in the last year, showed evidence that she did not adequately supervise the children, though officials said CPS workers may not have had enough information to take appropriate action.

On June 20, an anonymous caller alerted social services to Brewer, who was sleeping in her car while her kids played unattended in a school playground, officials said. Then, on Oct. 20, her oldest child, Jewell Ward, 6, told a caseworker that she was supervising her younger brothers while her mother was out.

Both cases were closed, the most recent on Dec. 12, Garber said, after a caseworker admonished Brewer to not leave her children home alone.

A CHRONOLOGY OF COMPLAINTS

Nassau County Child Protective Services opened 10 cases in the last five years on Leatrice Brewer and her children. Six were closed as “unfounded,” three were closed after neglect was “indicated,” then remedied, and the most recent remains open.

APRIL 15, 2003 County opens first case on Brewer and treatment of her oldest child, Jewell Ward, then 1. Closed on Aug. 4, 2003, as unfounded.

JAN. 13, 2004 Nassau police respond to a 911 call at Brewer’s home and arrest her boyfriend, Innocent Demesyeux, for allegedly assaulting her in front of her two children. Child Protective Services also responds and finds “inadequate guardianship.” Caseworkers visit Brewer and children 10 times, and case is closed on March 11, after Brewer obtains an order of protection against Demesyeux. He pleaded guilty to misdemeanor attempted assault.

DEC. 22, 2004 Neglect case opened for undisclosed reasons. Case closed on March 22, 2005, as unfounded.

OCT. 20, 2005 Police respond to 911 call made by Brewer. After doing laundry in the basement, she returned upstairs to find her two children missing. Police contact CPS but soon learn that the children’s great-grandmother had taken the children. Complaint was deemed unfounded on Dec. 12.

JAN. 7, 2006 Police respond to 911 call by the children’s great-grandmother, who said Brewer had slapped Jewell. CPS is contacted. Police and caseworkers find no physical injuries or marks indicating abuse. County officials say state law allows corporal punishment. Case deemed unfounded on April 7.

SEPT. 26, 2006 Neglect case opened for undisclosed reasons. Case closed on Oct. 21 as unfounded.

MARCH 15, 2007 Neglect case opened for undisclosed reasons. Case closed as unfounded.

JUNE 20, 2007 An anonymous caller reported that Brewer was sleeping in her car as her children played in a school playground. CPS caseworkers visited Brewer “a handful of times” and cited her for inadequate supervision. No action was deemed needed and the case was closed on August 7.

OCT. 20, 2007 After an undisclosed caller reported Brewer for leaving her children at home, a CPS caseworker interviewed Jewell, who said she often makes popcorn for her brothers and watches scary movies when her mother is gone. CPS cited Brewer for inadequate supervision and advised Brewer to not leave her children at home alone, telling her to ask neighbors for help.

FEB. 22 Innocent Demesyeux, father of Brewer’s two sons, called the State Central Registry for child abuse to report that Brewer “is threatening to put the children outside” on a cold, snowy day, is using drugs and is leaving the children home alone. Two CPS caseworkers visit the home that day, but find no one home. A caseworker is assigned to visit Sunday, by which time the children are dead.

BY MICHAEL AMON
Nov. 17, 2007 P. A4
State and Nassau health authorities could have subpoenaed the medical records of a Plainview doctor who they say may have exposed hundreds of patients to bloodborne diseases by reusing syringes, but decided instead to negotiate a voluntary agreement – a process that ended up taking eight months.

State Department of Health officials – who have come under mounting criticism for not more quickly making public the lapses in infection control by Dr. Harvey Finkelstein – said yesterday they planned as far back as October 2006 to notify all of the physician’s patients that they were at risk for hepatitis B and C, and HIV.

Finkelstein initially agreed to provide some names, but not nearly as many as authorities wanted, and he hired attorneys to fight the broad notification. Still, the state decided against issuing subpoenas.

“Just because you issue a subpoena doesn’t mean you get what you want,” said state Health Department spokeswoman Claudia Hutton. “It could get tied up in court, where a judge could say ‘You’re nuts.’ We wanted to cast as wide a net as possible and we wanted his cooperation to do that as quickly as possible.”

Acting Nassau Health Commissioner Abby Greenberg, who suggested to the state the idea of subpoenaing the records early this year, ultimately agreed with the state’s decision, a spokeswoman said. Attempts to reach Nassau County Executive Thomas Suozzi, who has criticized Finkelstein for hiring a lawyer and delaying the notification process, were unsuccessful.

But negotiating with Finkelstein’s attorneys did not produce a list of names until July.

Elected officials have blasted state and county health departments for taking nearly three years to make public Finkelstein’s infection control lapses. In January 2005, health officials witnessed Finkelstein using syringes multiple times, which can contaminate multidose medicine vials.

“The notification process was outrageously long,” said state Sen. Carl Marcellino (R-Oyster Bay), who has a constituent who contracted hepatitis C in Finkelstein’s office.

State Sen. Kemp Hannon (R-Garden City), chairman of the Senate Health Committee, announced yesterday that he would hold hearings in December to determine why the notification process took so long.

And two upstate legislators announced a bill yesterday requiring the state health commissioner to notify all patients of physicians who engage in “reckless conduct” such as reusing syringes and infecting patients.

Hutton said the health department staff “truly don’t believe” that they could have notified patients and the public faster than they did.

“There are some who would argue we went overboard by doing this letter because the risk of transmission is so low,” Hutton said. “We would argue that patients have a right to know if they are put at any risk.”

Finkelstein, 52, was not cited for violations by the Office of Professional Medical Conduct in September, though he agreed to have his infection control procedures monitored for three years.

Finkelstein gave the state Health Department patient names in early 2005, allowing the state to notify 98 patients who had been injected around the same time as two hepatitis C cases were caused.

After much internal debate over several months, the health department decided on Oct. 6, 2006, to notify all of Finkelstein’s patients, and the physician balked, officials said. He hired lawyers to fight the request, which he believed would affect his business, officials said.

“Initially Dr. Finkelstein was very cooperative,” Hutton said. “Then later on he retained an attorney and was not as cooperative.”

Andy Kraus, a spokesman for Finkelstein, said that the health department’s initial request was “nearly impossible” to fulfill because it asked for “thousands” of records going back more than a decade.

While the state needed permission to look at the records kept at Finkelstein’s private office, which is not licensed by the state, they had easier access to records at the state-licensed clinics where he had given injections. They quickly learned, however, that infection controls in those facilities were fine, and they didn’t need patients names.

But they still wanted to check his private office records – all of them. By the end of October 2006, Finkelstein agreed to turn over the names and addresses of about 272 patients who were “most at risk,” Kraus said.

That wasn’t good enough, Hutton said, and the two sides agreed to meet on March 7 in Great Neck. A month later, state health officials wrote a letter to Finkelstein’s lawyer, asking for a smaller number of names – those who had received injections since Finkelstein’s Plainview practice was launched in January 2000.

After asking for deadline extensions, the law firm supplied the names electronically in June and July. The state then needed four months to convert the records to its computer system – for searching purposes – and to have its notification letter cleared by lawyers. This week, the letters began to arrive at the homes of 628 patients, all but 12 on Long Island. All were urged to get tested for hepatitis B and C, and HIV.

THE LETTER

Part of a State Health Dept. letter to lawyer for Dr. Harvey Finkelstein, dated April 5, 2007, in which the department requested the names of the doctor’s patients because they may have been exposed to diseases because of reused syringes. The names were not turned over at that time, and the state declined to pursue the case with a subpoena:

“After reviewing the information obtained during the epidemiologic investigation and at the March 7, 2007 meeting, the NYSDOH has decided to notify Dr. Finkelstein’s patients who received any type of injection at his Plainview, New York practice site from the practice’s opening in 1999 through January 14, 2005. … The NYSDOH reiterates its request for all available contact and procedure information for Dr. Finkelstein’s patients who received any type of injection at his Plainview, New York practice site since it opened in 1999 through January 14, 2005. The list, preferably in electronic format, should include each patient’s name, date of birth, full mailing address and telephone number, if available.”

KEY DATES

DECEMBER 2004 Nassau County Health Department nurse notices that two of the year’s more than 1,000 cases of hepatitis C were people who had both received injections from Dr. Harvey Finkelstein.

JANUARY 2005 State investigators visit Finkelstein’s pain management clinic in Plainview and watch him work.

JAN. 31, 2005 State sends Finkelstein a letter with recommendations to improve his infection control practices.

MAY 23, 2005 State Health Department sends letters to 98 Finkelstein patients who had received injections around the same time as two patients who had contracted hepatitis C.

MAY 30, 2006 State and county health departments hold conference call on the case with the federal Centers for Disease Control.

JULY TO OCTOBER 2006 State discusses notifying all patients

who had received injections from Finkelstein between Jan. 1, 2000, and Jan. 15, 2005.

OCT. 6, 2006 State asks Finkelstein for thousands of his patients’ names.

MARCH 7, 2007 State Health Department officials and a Nassau County health department nurse meet with Finkelstein and his lawyers in Great Neck.

APRIL 5, 2007 In letter to Finkelstein’s attorney, Jean Quarrier, a state Health Department attorney, and Barbara Wallace, director of the department’s bureau of communicable disease control, the state again says it has “decided to notify” Finkelstein’s patients. It asks for contact information for Finkelstein’s injection patients from 2000-2005 and that it be sent “as soon as possible.”

NOV. 10, 2007 State sends letters to 628 people who received injections at Finkelstein’s practice from Jan. 1, 2000 to Jan. 15, 2005.

State and local health officials have provided phone numbers for former patients of Dr. Harvey Finkelstein who are concerned they may have been exposed to hepatitis B or C, or HIV.

BY MICHAEL AMON
April 2, 2008 p. A22
ALBANY – In the days after his report touched off the Choppergate scandal, Attorney General Andrew Cuomo picked up the phone and made a delicate call.

On the other line was Sandy Dopp, a close friend of 20 years and the wife of Darren Dopp, the Eliot Spitzer spokesman suspended after Cuomo’s report in July on the use of the New York State Police to smear Senate Majority Leader Joseph Bruno. Cuomo named Darren Dopp – who did not speak to his investigators – as one of several officials who acted inappropriately.

On the phone with Sandy Dopp, Cuomo told her that her husband was taking too much blame for the scandal and should tell his side of the story to the attorney general’s office, said three people familiar with that call. Cuomo made multiple calls to Sandy Dopp last August and September.

But aides said Cuomo only discussed personal issues with Sandy Dopp and they contend there was nothing improper about the calls because Darren Dopp’s lawyers did not object. The calls offer a fuller picture of attempts to speak to Dopp, who eventually contradicted Spitzer’s denials of involvement in Choppergate.

The calls to Sandy Dopp came at the same time that a number of investigatory agencies were jockeying for interviews with her husband. Cuomo’s chief of staff, Steven Cohen, was negotiating an interview with Darren Dopp through his attorney, Terence Kindlon, as were Albany prosecutors, the Public Integrity Commission and the Senate Investigations Committee.

The phone calls briefly intrigued Albany prosecutors, who questioned Sandy Dopp about them in February during their Choppergate probe. District Attorney David Soares said he found nothing improper, and the calls were not part of his Choppergate report.

Because calling the wife of a witness represented by counsel could, under certain conditions, violate New York State ethics laws, Cuomo took elaborate precautions before calling Sandy Dopp, even though she was a close friend, his aides said. A top aide sat in on each call last summer, and Darren Dopp’s lawyers did not object, Cohen said. Those efforts complied with the law, experts said.

The calls came at a rough time for the Dopps, whom Cuomo had counted as friends since Darren’s stint working as an aide for his father, Gov. Mario Cuomo. Darren was the only Spitzer staffer punished for Choppergate, and friends said they were worried.

“Sandy was, you know, very upset, understandably, by everything that was happening around her,” said Kindlon.

In the calls, Sandy Dopp complained to Cuomo that her husband was being made “the fall guy,” said Cohen, who sat next to Cuomo during some calls. Cohen quoted Cuomo replying that: “All one can ever do in such situations is tell the truth – the truth will set you free.”

According to people familiar with the calls, Cuomo also replied that he could reopen his investigation and hear Darren Dopp’s side of the story. Cuomo’s aides disputed that version of events, however.

Cohen said the calls were “humanitarian” and related to “how the Dopp family was coping.” In a rare public statement, Dopp said his wife “very much appreciated the Attorney General’s concern and graciousness during a difficult time.”

Through his attorney, Dopp declined the attorney general’s office’s overtures last year and instead spoke with county prosecutors and the Public Integrity Commission.

BY MICHAEL AMON
Jan. 21, 2009 p. A3

Before Flight 1549 ditched into the Hudson River, the Federal Aviation Administration had ordered heightened inspection procedures for the type of engine on that aircraft, saying it was prone to a rare type of stall, federal records show.

News of the Dec. 31 FAA Airworthiness Directive yesterday came as federal investigators said they were probing a Jan. 13 mid-flight engine stall on the Airbus A320 just two days before it crash-landed in the Hudson River alongside Manhattan on Thursday. The crew corrected the Jan. 13 problem in the air and safely completed its journey from LaGuardia Airport to Charlotte.

National Transportation Safety Board investigators want to talk to the pilot of that flight, said spokesman Peter Knudson. But he said nothing so far found has contradicted the working theory that a bird strike caused the plane’s engines to shut down Thursday. The directive warned such compressor stalls – a disruption of airflow into the engine causing an abrupt shutdown and violent shuddering of the plane – were “likely to exist or develop on” the CFM56-5B engine series, two of which powered Flight 1549. The warning was issued without a public comment period because “an unsafe condition exists,” the directive said.

Experts said such stalls are unusual in modern jet engines.

“We have not found any indications of anomalies or malfunctions with the aircraft from the time it left the gate in LaGuardia [last Thursday\] to the point at which the pilots reported a bird strike and a loss of engine power,” Knudson said.

The FAA directive ordered airlines to conduct detailed inspections when both engines record temperatures above a certain threshold and required the removal of at least one of those engines, even if it passes inspection. Officials would not say whether Flight 1549’s engine turbines underwent the required inspection with an optical instrument that allows maintenance workers to see inside the engine.

“It’s like colonoscopy, almost. You can look down in there and see if there is any damage to the blades,” said Ted Steffens, an airline maintenance expert with Expert Aviation Consulting in Indiana.

Rick Kennedy, a spokesman for GE-Aviation, which co-owns engine manufacturer CFM International, said 12 of the more than 3,000 CFM56-5B series engines had running temperatures above the threshold. All of them were older, like those on Flight 1549, and some were no longer in service.

About 10 aircraft with such engines experienced compressor stalls last year, leading CFM International to issue a safety bulletin, he said. But he said compressor stalls are unrelated to what occurred on Flight 1549.

Spokesmen for the FAA and US Airways declined to comment. Airbus did not respond to messages.

Aviation experts said the plane’s apparent engine stall problems were likely a coincidence with little significance for the probe. John Cox, a former US Airways pilot and now president of Safety Operating Systems, a Washington aviation consulting firm, said a susceptibility to compressor stalls “would not affect the ability to take a bird strike,” especially since the plane’s engines were not designed to handle ingestion of large birds like the Canada geese suspected in Thursday’s crash.

The cockpit voice recorder, flight data recorder and transcripts of air traffic control conversations show that the plane lost power to both engines about one second after the pilots reported a bird strike.

Meanwhile, the search for the plane’s missing right engine appeared to progress yesterday afternoon, as police boats spotted an object about the same size as the lost engine about 60 feet deep in the middle of the river off West 52nd Street, New York City police said. Divers are to resume the search today.

On a large salvage barge at Weeks Marine in Jersey City yesterday, inspectors opened the aircraft’s nose cone to examine electrical devices inside. They drew large red circles on the nose portion of the fuselage, apparently to indicate possible bird strikes.

Staff writers Andrew Strickler and Anthony M. DeStefano contributed to this story.

BY MICHAEL AMON
July 30, 2009 p. A3
As Warren Hance desperately tried Sunday to call back his sister, Diane Schuler, her cell phone lay useless on the side of the New York State Thruway. It had been inexplicably abandoned after she told him she was disoriented and having trouble seeing, State Police said.

Investigators said yesterday they believe Schuler, of West Babylon, had crossed the Tappan Zee Bridge into Westchester County and stopped the minivan in a pull-off area just after the tolls to call her brother.

That’s apparently the last contact anyone had with Schuler before she drove her Ford minivan the wrong way on the Taconic State Parkway, causing a fiery crash that killed eight people, said State Police Investigator James Boyle.

The dead include Schuler, 36, and her daughter, Erin, 2, of West Babylon; Hance’s daughters, Emma, 8, Alyson, 7, and Kate, 5, of Floral Park; and three Yonkers men in an SUV, Daniel Longo, 74, Michael Bastardi, 81, and his son Guy Bastardi, 49.

The lone survivor, Schuler’s son, Bryan, 5, continued to recover yesterday at Westchester Medical Center in Valhalla, N.Y., a hospital spokesman said.

The crash came just a half-hour after Hance and family friends frantically called State Police around 1 p.m. and asked them to look for the red Ford Windstar minivan Schuler was driving. Two troopers were assigned to the search immediately, Boyle said.

Investigators are not sure how Schuler’s cell phone ended up in the pull-off area, but Boyle said she probably called Hance from there just before 1 p.m. Sunday. That’s because Emma Hance, in a brief talk with her father, said they were near the Tappan Zee Bridge and saw exits for Tarrytown and Sleepy Hollow. Signs for those places are visible from the pull off.

The phone was discovered Sunday by a motorist from New Jersey who turned it in to the Palisades Parkway police. New York State Police investigators got the cell phone Monday but haven’t looked at what numbers Schuler dialed, as they await subpoenas. Police said the family has been cooperative but technically only a subpoena gives them legal authority to get cell phone records.

Schuler’s behavior has puzzled investigators because she appeared to be a healthy and responsible mother and professional advertising saleswoman for Cablevision, which owns Newsday.

Hunter Lake Campground owner Ann Scott said Schuler left with her husband, Danny Schuler, a security guard at Old Bethpage Village, late Sunday morning and there appeared to be nothing wrong.

Boyle said Danny Schuler was headed for a fishing trip in another part of Sullivan County and was out of cell phone range when Schuler said she became ill.

Police are awaiting toxicology tests on Schuler’s autopsy, hoping the results will provide a medical explanation for the crash. She had no known medical problems.

Police are trying to retrace Schuler’s steps after she crossed the Tappan Zee Bridge, but have not heard from any witnesses who saw her before she turned onto the Taconic. Police asked anyone who saw a red 2003 Ford Windstar minivan around midday on Sunday driving or stopped in the area of the Thruway, the Saw Mill River Parkway or the Taconic State Parkway to contact the New York State Police in Hawthorne at 914-769-2600.

With Matthew Chayes

By Michael Amon
Feb. 9, 2009 p. A8
Last May, a youth baseball league offered a complete makeover of a Seaford baseball field owned by the Levittown school district — new artificial turf, a T-ball field, fences, light towers and bleachers. All at no cost to taxpayers.

“It was kind of a no-brainer,” said district superintendent Herman Sirois. The improvements, proposed by the Levittown Seaford Wantagh Athletic Association, and carried out before last summer’s season, were unanimously approved as a gift by the Board of Education on May 13, meeting minutes show.

Now those field improvements are part of a federal probe into what investigators say was a $370-million Ponzi scheme run by Nicholas Cosmo, the president of Hauppauge investment firm Agape World Inc., who was a league board member. Sirois, in an interview last week, said federal officials have not contacted the district, but he would forward all documents regarding the improvements to prosecutors investigating the case.

Cosmo, who is being held on a federal mail-fraud charge in the alleged scam, spent or lost at least $135 million of investors’ money, federal authorities said, including about $300,000 for operating expenses and capital improvements for a youth baseball league he founded. That league, National Tournament Baseball, is the travel part of the Levittown Seaford Wantagh Athletic Association’s baseball program, according to the league Web site.

Federal authorities say Agape purported to be a high-interest lender but in fact made few loans and paid investors with funds from new investors.

Richard Barry, the Levittown Seaford Wantagh Athletic Association’s board vice president, proposed the improvements, Sirois said. Barry, who also is Agape’s executive vice president, has not been accused of any wrongdoing.

Representatives for the U.S. Postal Inspection Service, which has filed the charge against Cosmo, and federal prosecutors declined to comment.

Barry did not respond to messages.

Cosmo’s attorneys declined to comment. Cosmo remains in jail until prosecutors and his attorneys agree upon a bail package. No new court date has been scheduled.

An unsigned statement on the athletic association Web site titled “An urgent message to all members” said it was severing ties to Cosmo. “Mr. Cosmo has been a participant and sponsor of LSWAA activities and over the past several years has donated or provided goods and services to our organization,” the statement said. “LSWAA has never been given any information which would lead the Board of Directors to question the source of these funds.”

Cosmo’s name has been removed from the association’s Web site. According to the federal complaint against him, the Seaford field had a sign citing Agape as a sponsor. The sign is no longer there.

League president Richard Danetti and other board members did not respond to messages.

Sirois said improvements were presented before the alleged Ponzi scheme was unraveled. “There was no reason for us to believe there was anything untoward,” Sirois said.

The school district doesn’t know the value of the improvements or whether they were paid for by Agape, Cosmo or the athletic association, Sirois said.

Sirois said he checked with legal counsel, who said the district probably faced no liability as Agape investors seek their money. “If the gift was accepted in good faith and there’s no cash involved . . . we don’t have anything to return,” he said.

If a link is found between the money used for field improvements and the alleged Ponzi scheme, investors could sue the school district for the fair market value of the improvements, arguing the district “obtained value they didn’t pay for,” said David Gehn, a Manhattan securities attorney with experience investigating Ponzi schemes.