The Mammogram Assault

Last week I felt assaulted: not on the street, nor in a dark parking structure, alley or another risky location. Instead, this feeling of having been assaulted happened to me in a hospital.
It happened during a routine screening mammogram.When I was 32 years old, after more than a year of misdiagnoses, a different doctor than the first ordered a mammogram that saved my life. For years after undergoing experimental radical radiation treatment, I would come to tears during a mammogram. Some of it was pain from the pressure of the test on my scarred breast tissue. Some of it was my fear of being told: “The cancer has recurred.”

Today, I’m a veteran of mammograms. I receive them annually. And I will have one again next year. I believe that women should not hesitate to have their first screening mammograms, and then regular ones thereafter as recommended by reputable guidelines and in consultation with their doctors about their level of risk.

That being said, I’m angry! While I waited for my mammogram last week, another woman in her 50s joined me in the waiting room. Clad in a floral cotton mammography shawl, she was trying not to cry. She’d just completed her mammogram and was waiting to hear if another view would be needed. I commiserated with her about the chilly air conditioning in the waiting room and I smiled, hoping to provide distraction or encourage her to share what was going on emotionally for parking guidance system. She smiled back, but it was plain something was wrong.

In my experience, if you need an MRI the radiologists act as if they can’t do enough for you: music of your choice, some gentle words, a tap on the knee, and a call button to use at any time, for any reason. Yet here’s a test that is also scary at best, quite painful for many women, and the message this tearful woman got was the equivalent of “Next! Come on! Woman up!”

As she rose reluctantly, she glanced at me and acknowledged my encouragement. Her lips tightened, clearly disappointed, she trudged out of the waiting room for another “view” — a euphemism for what she would experience. Minutes later she returned, weak and short of breath. Her face was ashen, her eyes red. She went into the changing room, closed the colorful, flowery curtain (chosen, no doubt, to make us all feel better), and then cried softly.

As I thought about whether I should interrupt this woman and try to talk with her some more, the technician called me for my mammogram. I waited a moment; my waiting room companion’s crying had subsided. “Maybe it isn’t my business,” I thought, But surely it was someone’s.

The technician didn’t walk with me, as several others had done in years past, smiling and endeavoring to relax me. No, she was gone, and I wandered the hallway to find the right room. There was no time for small talk, just a few questions about my history and then we got started – my birthdate, doctor’s name and my own. Missing was a gentle touch on my shoulder as some technicians had ventured in previous years. Absent was any assurance that “This won’t take long” or “Tell me right away if this hurts too much.”

While I like efficiency when having my car serviced or ordering lunch on a short break, I decided this technician could use some guidance. “There’s a lot of scarring on my right side from radical radiation, so you’ll want to move slowly,” I said. She may have nodded, but nothing was said.

She placed my arm across the machine then grabbed my right (radiated) breast, poked, stretched, squeezed and pressed without hesitation. The clear acrylic pressure plate descended, without hesitation, until pain tore through my breast and into my shoulder. Then down a bit more. “Don’t breathe,” she said, stepping behind the radiation barrier.

I braced myself, stepped forward, she positioned me, lowered the pressure plate rapidly rather than gently as others had so proficiently done in the past. I yelped in pain. She uttered something that may have been “sorry” but sounded more like, “Oh.” She did not release me from my prison of pain nor ask if I’d like to step back. She continued: the pressure was made more intense. “Just let it be over.”

“Don’t breathe,” she said stepping behind the radiation barrier. For several long, long seconds I hung there, up on my toes, feeling as if I would surely faint. And I’m no shrinking violet.

No good wishes passed between us as I left the room, walked unsteadily back to the waiting room, and sat to wait as the woman had before me, to find out if another ‘view’ was necessary. “If so,” I thought, “another technician will have to do it this time.” But I was dismissed – one of the lucky ones. Tears welled in my eyes for the first time in years. Maybe they were for parking guidance system, but I suspect for the woman before me too.Now, I’m a big believer that a little discomfort (even a lot sometimes) is better than a poorly performed medical test. For many women, mammography is not very painful. Yet, there is nothing about the test itself that makes consideration and competence mutually exclusive.

Mammography, as is common with MRIs, should be done with compassion. “Would you like to rest between views?” and “We have one more to do. How are you feeling?” are the kinds of questions mammography patients need to hear.Imagine if you will that, without warning or tenderness, someone grabs, stretches, pushes and squeezes a man’s testicles between two plates for a medical test. Obviously, the very thought is appalling. It would be inhumane. And so is any such treatment with mammogram patients.

The next time you go for a mammogram (or go with someone you love), observe the behavior at the reception desk and the body language of the technician. Is everyone just trying to get to lunch hour or beat the traffic? How is emotional expression dealt with in the waiting room? If the technician shows no interest in your concerns, insist that she does so. Let her know if a breast is sensitive — and how she can help you endure the discomfort. If she isn’t receptive — ask for a different technician. If you’ve been treated like I was, then when it’s over (though preferably before) tell the person in charge and inform your doctor, as I did, so that other women won’t suffer from indifference or incompetence.

You are the customer. Sure you’re fearful, and that’s a big part of the reason why most of us don’t think to insist on a best practices mammogram. Many women I’ve talked with consider mammography pain as something they must tolerate for a greater good. To some extent and for many women, that’s true. But there is absolutely no reason why you should feel that you as an individual have been ignored and your pain belittled. No one should be trembling as they leave, feeling violated and fearful of the next mammogram they must endure.

A mammography unit that won’t do its best to make you comfortable shouldn’t be in business. You wouldn’t normally volunteer for a colonoscopy where they had run out of anesthetic — so why volunteer to be abused during a mammogram because they don’t train their technicians properly?

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Carlisle Dispatch Center transition plan released

A transition plan released Tuesday details what to expect should the borough council decide to transfer police dispatch operations from Carlisle Police Department to the county.

A meeting was also announced for 6:30 p.m. Aug. 29, at the borough building, 53. W. South St. At that meeting council is expected to make its decision concerning the transfer and the lieutenant structure of the department.At the direction of the council in June, Borough Manager Matt Candland, Police Chief Stephen Margeson and Mayor William “Doc” Kronenberg worked out the parking guidance system .The question of whether the department should have one lieutenant or two, however, remains a sticking point.

Kronenberg and Margeson recommend retaining the current two lieutenant structure. That structure was put in place 23 years ago after a study recommended the creation of two divisions — field operations and administrative services.They said most of the lieutenant’s responsibilities would remain even if dispatch is transferred to the county. The lieutenants are also part of the management team which deals with personnel issues and, with three members, is available at all times for critical events.

“We do not advocate keeping it the same simply because that’s the way we have always done it, but rather because it works well,” Margeson writes in the plan document.Margeson and Kronenberg said the department would need to be completely restructured if a position is eliminated.

The decision would affect the accreditation of the department, which they said is a demanding and time-consuming process, and would take officers from patrols and investigations to work on administrative tasks.However, he writes, most of the tasks assigned to the administrative lieutenant can be reassigned to other borough departments or transferred to the county 911 center should council approve the transfer of dispatch operations. The “few remaining” tasks would be taken on by the chief of police or administrative personnel, who will also have reduced work loads as a result of the transfer.

Candland also recommends that an additional patrol officer be hired with the savings through the elimination of the second lieutenant position “This would allow for enhanced community policing and patrol,” he wrote.

It goes on to describe the process by which phone calls would be handled. When a resident calls 911, a dispatcher at the county would dispatch the call immediately rather than transfer the call to the Carlisle dispatch.Residents would still be able to call the dispatch number, 243-5252, for routine business or to report a non-emergency. Those calls would be answered by a police department administrative staff member who would either resolve the issue or transfer the call to the county’s non-emergency dispatch.

The transition would be “relatively simple and seamless to non-uniformed borough staff,” according to the report. The staff would have to be trained in the use of the radios, public works would take over maintenance at the police station, and the borough’s information technology department would take over IT issues.

Based on the recommendations in the report, the transition plan offers two alternatives — neither of which directly addressed the costs of maintaining the second lieutenant position. The alternatives consider the costs of the radio system and the records system fixed since both will need to be replaced in the next few years whether dispatch is moved or not.

The first alternative, which recommends the purchase of the C-Net records management system, would have a net cost of $215,500 in the first year with possible savings of as much as $99,500 in 2015, depending on the number of administrative full-time employees retained.The second alternative, which recommends the purchase of the Cody records management system, would cost $308,000 in the first year, but show net savings of up to $93,200 in 2015 depending on staffing.

The Hermon-based company, he said, does things like keep its locomotive running unattended to allow single-person crews on its trains and to save paying two-man rail crews for the few hours it would take to do basic brake tests.

“If you know the industry, you know the safety protocols in place have been arrived at through trial and error through the last 160 years, and you realize that what is involved is arrogance and disrespect to the traditions of the industry,” Stem said. “They were willing to gamble the lives of communities to save an hour or two.

Ed Burkhardt, president of the parent company that owns MMA, Rail World Inc., did not return messages seeking comment Tuesday. Robert Grindrod, MMA’s president, has declined to comment on all matters pertaining to the parking system.

Burkhardt previously dismissed claims that the accident was created by the train having a one-man crew as “a red herring.” He has consistently defended the railroad’s practices as safe.

Investigators of the Lac-Megantic tragedy have said it is too early to determine what caused the crash, North America’s worst rail disaster in two decades. Two big questions are whether the lone engineer applied sufficient hand brakes when he parked the train for the night and why the fuel in the rail cars was so volatile, creating huge explosions and a deadly wall of fire after derailing.

The train had 72 cars of light crude oil when it derailed in Lac-Megantic, killing 47 people. It had been parked for the night, one of its engines running to keep its airbrake system charged, on a steep grade in the nearby town of Nantes by the engineer more than an hour before the accident. Nantes firefighters have said that the engine was shut off after they doused a fire per the standard operating procedure dictated by MMA, Canadian media has reported.

The Federal Railroad Administration emergency order Friday banned parking unattended trains carrying hazardous materials on main rail lines unless government authorized.The order requires railroads to submit guidelines to FRA for securing unattended trains hauling hazardous materials and mandates that workers aboard trains transporting hazardous materials must report to dispatchers the number of hand brakes applied, the train’s tonnage and length, the track’s grade and terrain, among other things.

Active shooter training

Shots rang out in the parking lot of Unicoi County High School on Wednesday morning. As several of their classmates in the parking lot fell wounded, two students ran screaming toward the school. Trailing not far behind was a pair of armed men, intent on entering the occupied high school. But this nightmare scenario was not real. Instead, it was the culmination of active shooter response training that local law enforcement officials have been taking part in all week.

With the start of the 2013-14 Unicoi County school year a little more than a week away, officials with the Unicoi County Sheriff’s Department, Erwin Police Department, Tennessee Bureau of Investigation, Tennessee Highway Patrol, the local Emergency Management Agency, Unicoi County Schools system and local fire and emergency medical services took to the grounds of the high school to put several days of active shooter training into action. The students were portrayed by students in the Unicoi County High School Drama Club.

The training was conducted by the Piney Flats-based Shooters Edge. Shooters Edge General Manager Don Reimer said Wednesday’s “mass casualty exercise” was conducted to simulate two active shooters attempting the infiltrate the parking guidance system. Two run-throughs of the exercise were conducted Wednesday morning.

Reimer said the first run-through went “too well,” as the student resource officer stationed at the high school was able to take out both of the armed individuals as they approached the building. “The first one, the SRO did such a fantastic job that he actually took out both of the bad guys,” Reimer said. “But the exercise would have been over in 10 seconds, and that’s not really how it’s probably going to happen.”

During the second run-through, the SRO was able to wound one of the gunmen before being wounded himself. The second assailant was able to enter the school. As officers quickly responded to take control of the situation, a group of around 15 screaming students fled from the building. Reimer said Wednesday’s exercise, which was organized to simulate an actual active shooter situation as closely as possible, will serve as a “measuring stick” to determine what areas, such as response time and planning, local officials may or may not need to improve upon.

“What you had is, basically, us trying to enact a real-world situation,” Reimer said. “These guys came in, they did their thing, then they breached the door and they went in. If you remember Sandy Hook, he breached the door and he went in and, by the time law enforcement arrived, all the damage was done.”

Reimer said he was impressed by not only the responses of the SRO and other officers, but also by the cooperation among the agencies that took part in the training and exercise. Unicoi County Director of Schools Denise Brown said this was the first time local officials had conducted such an exercise, adding that the training was necessary to prepare for disaster.

“I’m very proud of how the sheriff’s department, Erwin Police and our SROs did today,” Brown said. “I don’t think you’re ever 100 percent prepared, but I think the more that you can practice, the more that you make sure your plans and the people you work closely with — the sheriff’s department, the town of Erwin and MedicOne — you’ve got to make sure everybody knows your plans and you’re on the same page.”

Unicoi County Sheriff Mike Hensley, who described the scenario as “frightening,” said the active shooter training was necessary to ensure the safety of county students and educators, as a school shooting could happen anywhere.“I’m the sheriff, and I’m responsible for the safety of every citizen in this county,” Hensley said. “I’d rather be proactive as parking sensor. Of course, this training we’re doing is a proactive approach but, actually, we’re reactive because of what happened in Connecticut.”

Like Brown, Hensley said Wednesday’s exercise was needed to make certain that area officials are on the same page in case an active shooter situation was to play out for real, adding that steps learned during the training can be applied to each of Unicoi County’s schools. He also said he would like to see such training added to each officer’s required annual in-service training.

“There’s no way you simulate every scenario that could happen, but that’s just like police training itself,” Hensley said. “It gives us an idea of which direction to go. The more you practice, the better you get.”UCSD Chief Deputy Frank Rogers said the training should not only give members of the community “peace of mind,” but he said officials hope it will act as a deterrent to those who may look to carry out such acts since officers are prepared to respond.

A trained, full-time officer was placed in each Unicoi County school after students returned from the 2012 Christmas Break. Hensley spearheaded this effort and worked with local school and police officials to ensure a countywide SRO program came to fruition in response to the December 2012 Sandy Hook Elementary School shooting in Newtown, Conn. Although the county and town of Erwin are still going through their respective budgetary processes for the 2013-14 fiscal year, Hensley said he expects the SRO program to continue in the 2013-14 school year.

A 30-day contract extension between BART management and two of BART’s employee unions — Service Employees International Union Local 1021 and Amalgamated Transit Union Local 1555 — expires Sunday night and there is no sign yet that an agreement is likely before then.

Metropolitan Transportation Commission spokesman John Goodwin said that the MTC is creating a strike contingency plan that is “largely the same” as the approach used during the first strike.

BART officials said the agency provides about 400,000 rides daily, with slightly lower ridership during the summer months. However, BART spokeswoman Alicia Trost said a strike in August would impact more riders than the one during the holiday week in July.

A conference call was held Tuesday with leaders of Bay Area transit systems including AC Transit, BART, the San Francisco Municipal Transportation Agency, the Golden Gate Bridge Highway and Transportation District and the San Francisco Bay Ferry. Caltrans, the California Highway Patrol and Oakland and San Francisco city officials also participated, Goodwin said.

In defense of public-private partnerships

Pitchforks raised, a mob of critics pounced on an article I wrote recently for the New York Times in which I dared to assert that the city of Detroit could have benefited from selling or leasing some of its infrastructure assets to private investors in return for large, up-front payments, a reduced debt load and a chance to improve public services under a more efficient, business-minded operating model.

My essay advocated a new wave of public-private partnerships (P3s) for U.S. cities — and I cited several prominent success stories, among them the Chicago Metered Parking System, which transferred 36,000 on-street parking meters to a concession run by Chicago Parking Meters LLC (CPM), a company backed by private equity investors. The 75-year contract, commenced in 2010, delivered $1.15 billion to the city and has been cited as a model for how to run a municipal parking guidance system.

Not so fast, say the detractors, including Reuters’ MuniLand blogger Cate Long. They carped that the article did not mention that I represented investors in several of the P3 transactions described, including CPM (even though my professional bio highlights my role in each of the deals – the Times has since updated the piece accordingly). More seriously, they claim that the CPM partnership has been an abject failure. “The city got ripped off, and continues to get ripped off each day because of this travesty,” said one responder. MuniLand’s Long called it a “municipal scam.”

In fact, this “scam” helped Chicago rank number one in the world for on-street parking in a 2011 IBM Global Parking and Transportation Survey. Among 20 major cities surveyed worldwide, Chicago drivers needed the shortest time to find a space, had the fewest tickets and fewest disputes over spaces, and suffered the least emotional and economic pain over parking, which as any driver will attest, is high praise. In its 2011 Annual Privatization Report, Reason Foundation noted that CPM’s “state-of-the-art maintenance system makes it one of the most sophisticated operations in the U.S.” Reason added, “The Windy City is now an international leader” in parking.

How did such accolades occur in so short a time? Perhaps it’s because CPM invested $35 million in upgrades, replacing the old single-space meters with 5,000 pay stations that accept credit and debit cards, feature an online refund option and provide 24-hour customer service. Drivers will soon be able to digitally feed the meters with their smartphones. The advent of CPM also helped to expose what the Chicago Sun-Times called “widespread disability parking abuses,” with “able-bodied people using relatives’ placards, fake placards and even stolen placards to park for free,” sometimes for days. The practice caused both the city and CPM to lose millions of dollars in revenue, leading to passage of Public Act 097-0845, which established strict criteria for free parking and to reduce incidence of fraud. Reason Foundation noted that under CPM, local residents and small business owners —  including those in Chicago’s ethnic communities — reported a marked increase in available spaces in their neighborhoods.

Chicagoans have benefited in other ways from public-private partnerships, including those involving the Grant Park parking garages and Chicago Skyway toll bridge. A report entitled “Examining Parking Privatization as a Fiscal Solution” published in Government Finance Review stated, “The money received in these deals has been used to pay off debt associated with building Millennium Park, improving the infrastructure of neighborhood parks, funding programs for low-income residents, settling budget deficits, and establishing a long-term reserve fund.” Noting the enormous expenditures needed to renovate the city’s troubled parking system, the report concluded that “Maintaining these garages would have become a significant burden on the city. Leasing the garages allowed Chicago to place the repair obligations on the private operator and free up capital for other projects.”

The hue-and-cry over my article illustrates a fundamental fallacy of those who would bash P3 deals — that they dupe cities to hand over crown-jewel assets to Wall Street barracudas. Nothing could be further from the truth. Municipalities retain control over the assets they lease and over any payments owed to the concessionaire over the life of the concession. P3s are subject to strict procurement laws — and any increases in fees are governed by strict regulatory approval.  Control over the underlying assets remains with the municipality. The concession contracts impose stringent performance standards on the operator which, if not performed, allow the municipality to terminate the concession. Many P3s also include a revenue share with the municipality.

What is certain is that most cities can’t provide the level of investment needed to create and maintain infrastructure and related services that are fit for 21st century usage. The professional management and innovative technology a private operator brings to public infrastructure is value enhancing. Meanwhile, it’s the investors who assume the risk in taking over delivery of services for many decades to come. Even then, returns on P3 investments are a far cry from the alpha earned on hedge funds, more in line with an investor-owned electric utility.

And there’s another point: P3 deals rehabilitate more than public conveniences. Often, the transactions deliver vital services for sanitation, transportation or healthcare. For a partnership structured to privatize the municipal water and waste systems of Bayonne, New Jersey — another deal in which I advised investors — the private capital used to fund the concession was critical in replacing decades-old pipes and meters. In this case, serious public safety concerns – including main breaks, contamination and boil water advisories — were addressed by a P3.

For Detroit, the die is cast. As a result of its Chapter 9 filing, the Motor City will have to sell some of its non-core assets to cover $18 billion in liabilities. Let’s hope that Detroit’s emergency manager is able to partner up with some patient, long-view investors willing to invest in the city’s future for generations. And may other strapped towns avert their own bankruptcies by welcoming more private investment in public infrastructure. For any U.S. city today not even to consider a P3 option would be the real scam.

Son of drug smuggler who faked his own murder

More than 30 years after one of South Florida’s biggest marijuana smugglers faked his own death to try to avoid prison, federal authorities have charged his son with operating a multimillion-dollar pill mill in a ritzy Fort Lauderale neighborhood.

Back in the 1970s, the Boyd Brothers — John Darrell Boyd and Tracey Boyd — were among the most flamboyant traffickers in the region. After they were indicted in 1977 on charges they smuggled massive amounts of pot from Colombia through Florida, the brothers fled and hid for years before they were caught and served prison terms.

Earlier this month, Darrell’s son, Jason Boyd, 43, of Davie, was arrested on charges he masterminded a “cash cow” pill mill conspiracy that illegally prescribed oxycodone pain pills to “patients” and drug dealers. If convicted of drug and money-laundering charges, Boyd faces up to 30 years in prison and forfeiture of more than $4.25 million, two homes and other assets.

The same family once embroiled in the notorious marijuana flows through South Florida in the 1970s is now suspected of getting caught up in the region’s latest form of drug abuse. One judge called the latest allegation far more than “an isolated instance of misjudgment.”

Though neither Boyd’s father nor uncle have been charged with anything related to the clinic, agents heard them talking on phone calls that were secretly intercepted, prosecutors said during a detention hearing for Jason Boyd last week in federal court in Fort Lauderdale.

Boyd employed “virtually his entire family” at the Intracoastal Medical Groups Inc. clinic on Intracoastal Drive, which brought in $1.5 million a year and prescribed 1.3 million highly addictive pain pills, federal prosecutor Julia Vaglienti told the parking guidance system.

One family member’s job was to make sure that patients with out-of-state license plates parked in the nearby Galleria Mall parking lot to avoid drawing attention to the clinic, federal authorities said. Some no-show “patients” got prescriptions without even going to the clinic, agents said.

Sources familiar with the clinic, who spoke on condition of anonymity, said Tracey Boyd worked at the clinic and Darrell Boyd sometimes stopped by to pick up money.Darrell Boyd, now 69, faked his own murder in October 1980 by leaving his station wagon, pierced with bullet holes and splattered with blood, on a deserted swamp road in Collier County — a case featured in a 2011 Discovery Channel documentary “I Faked My Own Death.”

Boyd said he made it look like he returned gunfire from an attacker, then dragged his cowboy boots along the ground to the edge of the swamp, hoping investigators would think his body was eaten by alligators.

“That was the entire deal, that I would [make it look like] I get shot there, they throw my body out there, the alligators would eat me, nobody would ever find me, they couldn’t prove anything,” Boyd said in the documentary.Authorities didn’t buy the hoax and found him in 1983 living under an assumed name in a suburb of Buffalo, N.Y. Agents arrested him after getting him out of the house with a fake phone call from a school claiming his child was sick and needed to be picked up. His brother was caught in Miami Beach a few weeks later, and both men served four years on the marijuana smuggling charges.

The bearded duo cemented their notoriety in the 1970s when they delivered $10,000 in $20 bills to a muscular dystrophy telethon in Fort Lauderdale with a note they didn’t expect would be read live on TV: “For the kids, from the blockade runners.”More recently, Darrell Boyd served more than three years in state prison for Medicaid fraud. He was released in 2011 and is on probation until 2021. No one answered the door at his Emerald Hills home in Hollywood last week, and no one responded to a note left seeking an interview.

The younger Boyd will remain locked up while the drug case against him and six co-defendants is pending, Chief U.S. Magistrate Judge Barry Seltzer ruled Thursday. Seltzer ruled that Jason Boyd, who has prior drug and credit-card fraud convictions, is a flight risk and a danger to the community.Boyd’s attorney, Arthur Calvin, argued in court that investigators misunderstood Boyd’s role in the clinic. He said Boyd had sold the clinic and was working as a consultant only to help the new owner.

“Everything is easily explained,” Calvin said. “I don’t think he’s in the jeopardy the government says he’s in.”Federal authorities said Boyd has “no legitimate source of income” but made a lot of money from the clinic, much of which remains unaccounted for, and they think he was trying to hide his assets. Property seized during the raids included $10,000 in cash; two boats he appeared to own, though only one was in his name; and several vehicles, many of which were registered in other people’s names though Boyd kept the titles, prosecutors said. He also paid $1,000 a month to rent a warehouse that contained more cars and ATVs, agents said.

Among the evidence Seltzer mentioned in deciding to keep Boyd locked up was another federal judge’s 2007 ruling that Boyd “showed a fundamental lack of respect for the law” and that his testimony about how he purchased a $320,000 home and a BMW was not credible and violated the terms of his release from federal prison. He had been sentenced to 18 months for credit-card fraud and was sent back to prison in 2007 for violating the terms of his release.

Boyd set up the clinic in December 2008, shortly after he was freed, prosecutors said. He removed himself as an officer after a 2010 change in state law that required pain-management clinics to be owned by a physician, though Boyd continued to control the operation and monitored it from a video camera security system installed at his home, prosecutors said. He was secretly recorded issuing orders, they said.”You can’t do much managing watching clients come and go [via a camera],” Boyd’s attorney Calvin told the judge.

Cash deposits to 18 bank accounts linked to Boyd’s businesses totaled about $4.2 million, prosecutors said. Boyd declared $250,000 income last year, and his girlfriend, who has not been charged, was paid $144,000 from the clinic though she has not worked there since 2009, agents testified.Boyd also funneled money to other family members employed at the clinic, prosecutors said. Boyd ran a neighboring business, Fleet Media, where some of the pill mill money was kept, agents said.

The federal Drug Enforcement Administration and Broward Sheriff’s Office began an undercover investigation of the clinic in 2012, and a manager told an undercover agent it made about $10,000 a day charging new patients $350 a visit and $250 for follow-ups.In wiretapped phone calls in late 2012, agents said they reaped evidence that staff were making fake Florida identification cards for patients from out of state and creating false MRI reports to help make the clinic seem legitimate.

A doctor who worked at the clinic and is also charged in the indictment told agents that 60 to 70 percent of the business was not legitimate. “Dr. Vijay Chowdhary told agents that it would be medically impossible for patients to take the amounts of oxycodone that were being prescribed and to survive,” Seltzer wrote.

“Given Boyd’s disregard of the court’s directives and supervision, his lack of respect for the law, his unaccounted-for wealth, the strong evidence of his guilt and the lengthy sentence he would face upon conviction, [I do] not believe that he would be likely to appear if released on bond,” Judge Seltzer wrote. “Against the backdrop of his criminal record, Boyd’s oxycodone operation cannot properly be viewed as an isolated instance of misjudgment.”

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Eddie Lampert’s Warring Divisions Model Adds to the Troubles

Every year the presidents of Sears Holdings’ (SHLD) many business units trudge across the company’s sprawling headquarters in Hoffman Estates, Ill., to a conference room in Building B, where they ask Eddie Lampert for money. The leaders have made these solitary treks since 2008, when Lampert, a reclusive hedge fund billionaire, splintered the company into more than 30 units. Each meeting starts quietly: When the executive arrives, Lampert’s top consiglieri are there, waiting around a U-shaped table, according to interviews with a half-dozen former employees who attended these sessions. An assistant walks in, turns on a screen on the opposite wall, and an image of Lampert flickers to life.

The Sears chairman, who lives in a $38 million mansion in South Florida and visits the campus no more than twice a year (he hates flying), is usually staring at his computer when the camera goes live, according to attendees.

The executive in the hot seat will begin clicking through a PowerPoint presentation meant to impress. Often he’ll boast an overly ambitious target—“We can definitely grow 20 percent this year!”—without so much as a glance from Lampert, 50, whose preference is to peck out e-mails or scroll through a spreadsheet during the talks. Not until the executive makes a mistake does the Sears chief look up, unleashing a torrent of questions that can go on for hours.

In January, eight years after Lampert masterminded Kmart’s $12 billion buyout of Sears in 2005, the board appointed him chief executive officer of the 120-year-old retailer. The company had gone through four CEOs since the merger, yet former executives say Lampert has long been running the show. Since the takeover, Sears Holdings’ sales have dropped from $49.1 billion to $39.9 billion, and its stock has sunk 64 percent. Its cash recently fell to a 10-year low. Although it has plenty of assets to unload before bankruptcy looms, the odds of a turnaround grow longer every quarter. “The way it’s being managed, it doesn’t work,” says Mary Ross Gilbert, a managing director at investment bank Imperial Capital. “They’re going to continue to parking guidance system.”

Plagued by the realities threatening many retail stores, Sears also faces a unique problem: Lampert. Many of its troubles can be traced to an organizational model the chairman implemented five years ago, an idea he has said will save the company. Lampert runs Sears like a hedge fund portfolio, with dozens of autonomous businesses competing for his attention and money. An outspoken advocate of free-market economics and fan of the novelist Ayn Rand, he created the model because he expected the invisible hand of the market to drive better results. If the company’s leaders were told to act selfishly, he argued, they would run their divisions in a rational manner, boosting overall performance.

Instead, the divisions turned against each other—and Sears and Kmart, the overarching brands, suffered. Interviews with more than 40 former executives, many of whom sat at the highest levels of the company, paint a picture of a business that’s ravaged by infighting as its divisions battle over fewer resources. (Many declined to go on the record for a variety of reasons, including fear of angering Lampert.) Shaunak Dave, a former executive who left in 2012 and is now at sports marketing agency Revolution, says the model created a “warring tribes” culture. “If you were in a different business unit, we were in two competing companies,” he says. “Cooperation and collaboration aren’t there.”

Although Lampert is notoriously media-averse, he agreed to answer questions about Sears’s organizational model via e-mail. “Decentralized systems and structures work better than centralized ones because they produce better information over time,” Lampert writes. “The downside is that, to some, it appears messier than centralized systems.” Lampert adds that the structure enables him to evaluate the individual parts of Sears, so he can collect “significantly better information and drive decision-making and accountability at a more appropriate level.”

Lampert created the model because he wanted deeper data, which he could use to analyze the company’s assets. It’s why he hired Paul DePodesta, the Harvard-educated statistician immortalized by Michael Lewis in his book Moneyball: The Art of Winning an Unfair Game, to join Sears’s board. He wanted to use nontraditional metrics to gain an edge, like DePodesta did for the Oakland Athletics in Moneyball and is trying to repeat in his current job with the New York Mets.

At their meeting Wednesday, Martinsburg Planning Commission members unanimously approved a much revised site plan for a new hotel on Foxcroft Avenue next to the Holiday Inn.

Fred Freitag of Winchester-based PHRA, the engineering firm for the project, told Planning Commission members that originally a 120-room hotel Springhill Suites Marriott was planned for the site in 2007, but the plans were pushed back because of the economic recession. Since then, the plans have been revised eight times.Although shown on the plans distributed by the city’s planning department, access to the new hotel would be via the Holiday Inn parking lot only. There would be no access from Foxcroft Avenue.

Freitag said the stormwater management would be different than originally planned, which called for one large runoff pond. Now, three small sediment ponds are planned as well as a rain tank.

“The tank would catch the hotel’s roof runoff and could be used for irrigation and cleaned to be used in the hotel’s laundry,” he said. “We want to catch the water and improve its quality before it runs across our site.”Michael Covell, Martinsburg’s engineer and planner, said more work needs to be done on the new hotel’s stormwater management plans, but they are progressing.

The planning department is in the process of revising the city’s stormwater management ordinance, and related zoning ordinance and subdivision regulations to meet strict pollution and sediment limits recently imposed by the U.S. Environmental Protection Agency as part of its Chesapeake Bay restoration program and to comply with Martinsburg’s Municipal Separate Storm Sewer System .

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