Experts: No link between Asperger's, violence

NEW YORK (AP) — While an official has said that the 20-year-old gunman in the Connecticut school shooting had Asperger's syndrome, experts say there is no connection between the disorder and violence.

Asperger's is a mild form of autism often characterized by social awkwardness.

"There really is no clear association between Asperger's and violent behavior," said psychologist Elizabeth Laugeson, an assistant clinical professor at the University of California, Los Angeles.

Little is known about Adam Lanza, identified by police as the shooter in the Friday massacre at a Newtown, Conn., elementary school. He fatally shot his mother before going to the school and killing 20 young children, six adults and himself, authorities said.

A law enforcement official, speaking on condition of anonymity because the person was not authorized to discuss the unfolding investigation, said Lanza had been diagnosed with Asperger's.

High school classmates and others have described him as bright but painfully shy, anxious and a loner. Those kinds of symptoms are consistent with Asperger's, said psychologist Eric Butter of Nationwide Children's Hospital in Columbus, Ohio, who treats autism, including Asperger's, but has no knowledge of Lanza's case.

Research suggests people with autism do have a higher rate of aggressive behavior — outbursts, shoving or pushing or angry shouting — than the general population, he said.

"But we are not talking about the kind of planned and intentional type of violence we have seen at Newtown," he said in an email.

"These types of tragedies have occurred at the hands of individuals with many different types of personalities and psychological profiles," he added.

Autism is a developmental disorder that can range from mild to severe. Asperger's generally is thought of as a mild form. Both autism and Asperger's can be characterized by poor social skills, repetitive behavior or interests and problems communicating. Unlike classic autism, Asperger's does not typically involve delays in mental development or speech.

Experts say those with autism and related disorders are sometimes diagnosed with other mental health problems, such as depression, anxiety, bipolar disorder or obsessive-compulsive disorder.

"I think it's far more likely that what happened may have more to do with some other kind of mental health condition like depression or anxiety rather than Asperger's," Laugeson said.

She said those with Asperger's tend to focus on rules and be very law-abiding.

"There's something more to this," she said. "We just don't know what that is yet."

After much debate, the term Asperger's is being dropped from the diagnostic manual used by the nation's psychiatrists. In changes approved earlier this month, Asperger's will be incorporated under the umbrella term "autism spectrum disorder" for all the ranges of autism.

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AP Writer Matt Apuzzo contributed to this report.

___

Online:

Asperger's information: http://1.usa.gov/3tGSp5

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Grandmother stabbed to death with BBQ fork, LAPD says

Police are trying to determine a motive after a 22-year-old man allegedly killed his grandmother Sunday using a barbecue fork.

Los Angeles Police Department Lt. Paul Vernon called the incident in Mission Hills "especially sad and tragic."

The suspect, identified as Joe Calderon, was raised by his
grandparents and stabbed his grandmother at their Mission Hills home
Sunday morning, police said.

Investigators believe Calderon fought with his grandparents Saturday
night and, after his grandfather went to work Sunday, again argued with
his grandmother, Vernon said. This time, the suspect allegedly began
beating his grandmother, who called her daughter for help.

When the daughter arrived at the home in the 11100 block of Rincon
Avenue, Calderon "confronted her" outside the home "with a long metal
stick," Vernon said. She went around the corner and called police about 9
a.m.

Responding officers detained Calderon, whom Vernon said had blood on his hands.

The grandmother was found dead in the kitchen, Vernon said. Her name
has not been released, though authorities described her as a woman in
her 70s. It was unclear what relationship her daughter is to the suspect.

Vernon said investigators found several possible weapons at the
scene, including the barbecue fork that "appeared to have blood on the
prongs." Forensic tests will be conducted to determine if the utensil
was in fact the murder weapon, he added.

ALSO:

Full coverage: Connecticut school shooting 

More rain, snow coming to Southern California

Fashion Island shooting: 'Luck was on our side,' police say

— Andrew Blankstein and Kate Mather

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Syrians Airstrike Kills Palestinian Refugees

DAMASCUS, Syria — Government forces for the first time hit Syria’s largest Palestinian refugee neighborhood with airstrikes on Sunday, killing at least eight people in the Yarmouk district of Damascus and driving dozens of formerly pro-government Palestinian fighters to defect to the rebels, fighters there said.

The New York Times

For many Yarmouk residents — refugees from conflict with Israel and their descendants — the attacks shattered what was left of the Syrian government’s claim to be a champion and protector of Palestinians.

New signs emerged on Sunday of political pressure on President Bashar al-Assad. Mr. Assad’s vice president was quoted as saying that neither side could win the war and calling for “new partners” in a unity government, a possible sign that at least some in the government were exploring new ways out of the crisis. The comments came as two close allies, the government of Iran and the leader of the Lebanese Shiite group Hezbollah, appeared to slightly temper their support.

In Yarmouk, burned body parts littered the ground at the Sheik Abdul Qader mosque, which had offered shelter to Palestinians and others displaced by fighting in other areas. Minutes before, a Syrian fighter jet fired rockets at the camp. Women, crying children and white-bearded men thronged the streets with hurriedly packed bags, not sure where to look for safety.

For many Yarmouk residents — refugees from conflict with Israel and their descendants — the attacks shattered what was left of the Syrian government’s claim to be a champion and protector of Palestinians, a position the Assad family relied upon as a source of domestic and international legitimacy in more than 40 years of iron-fisted rule.

“For decades the Assad regime was talking about the Palestinians’ rights,” said a Palestinian refugee who gave his name as Abu Ammar as he debated whether to flee with his wife and five children from the camp, on the southern edge of Damascus. “But Bashar al-Assad has killed more of us today than Israel did in its latest war on Gaza.”

He added: “What does Bashar expect from us after today? All of us will be Free Syrian Army fighters.”

The Palestinian militant group and political party Hamas has broken with Mr. Assad over his crackdown on what began as a peaceful protest movement, and while most Palestinian parties still profess neutrality, a growing number of Palestinians support — and have even joined — the rebels.

The Syrian government long held the loyalty of hundreds of thousands of Palestinian refugees, giving them health care, education and access to professional careers, among other rights denied by other Arab host countries. But those policies also gave Palestinians a stake and sense of belonging in Syria that have led many to support the uprising.

Several of Mr. Assad’s allies signaled a new push for a peaceful solution. Iran’s Foreign Ministry called for an end to military action, the release of political prisoners and a broad-based dialogue to form a transitional government that would hold free elections, Iran’s state news agency reported.

Mr. Assad’s vice president, Farouk al-Sharaa, said that neither the government nor the rebels could end the conflict militarily, the pro-Syrian Lebanese newspaper Al Akhbar reported. And he called for a solution involving a cease-fire and brokered by international leaders that would establish a “national unity government with wide powers.”

He added that the battle was for the country’s very existence, not “the survival of an individual or a regime,” and that Syria’s leaders “cannot achieve change without new partners.”

The impact of the statements was unclear. Mr. Sharaa, a Sunni Muslim like most of the rebels, has been floated by the Arab League as a possible successor, but many of Mr. Assad’s opponents reject any dealings with leaders of the current government.

In neighboring Lebanon, Hassan Nasrallah, the leader of Hezbollah, appeared to acknowledge for the first time that the Syrian uprising is at least in part driven by popular sentiment.

“Today, in Syria,” he said in a videotaped address at a graduation ceremony, “there is a big part of the population with the Syrian regime and a part against it, and the latter armed themselves to fight the regime.”

An employee of The New York Times reported from Damascus, and Anne Barnard from Beirut, Lebanon. Hania Mourtada contributed reporting from Beirut, and Hala Droubi from Dubai.

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Be Careful When Downloading Your Twitter Archive

Twitter is rolling out the long-awaited feature of downloading your entire tweet history, it seems, but be careful. You might not like what you find in there. Sometimes we remember our tweets with rose-colored lenses.

RELATED: ‘Human Virus’ Snakes Through Twitter

The Next Web was the first to notice a few users posting about being able to download their tweet history this weekend. Not everyone can do it, though. Twitter is slow-rolling the new feature, so only a limited number of people have access to the option. To check if you’re one of the lucky few, go to your settings page. At the very bottom there should be a new section with a big button offering you the chance to download your archive. Twitter will send you an email with three different compression files of your tweet history after a few minutes. You’ll decompress a .html file and be able to sort through all the dumb stuff you’ve said on Twitter by month and by year. 

RELATED: Twitter Finally Grows Up

The Verge has the best screen shots of what the process looks like. One of their readers even posted a link to his history in the comments of their post. You can check it out here if you’re interested to see what the feature is like. Just don’t judge the poor guy too harshly. 

RELATED: Sexy Piggy Banks, Analogies and Haley Barbour

We don’t have the option to download our archive yet. We checked. And, in case you think you’re clever, we checked to see if you could game the url to get your history by subbing in your username into the Verge commenter’s URL. You can’t, unfortunately. 

RELATED: Arm Wrestling, Strangers and Pricey Prophylactics

Twitter CEO Dick Costello promised the feature would be here by the end of the year, so it seems like he’s just delivering what he promised. You should get it soon, too. 

Social Media News Headlines – Yahoo! News

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Experts: No link between Asperger's, violence

NEW YORK (AP) — While an official has said that the 20-year-old gunman in the Connecticut school shooting had Asperger's syndrome, experts say there is no connection between the disorder and violence.

Asperger's is a mild form of autism often characterized by social awkwardness.

"There really is no clear association between Asperger's and violent behavior," said psychologist Elizabeth Laugeson, an assistant clinical professor at the University of California, Los Angeles.

Little is known about Adam Lanza, identified by police as the shooter in the Friday massacre at a Newtown, Conn., elementary school. He fatally shot his mother before going to the school and killing 20 young children, six adults and himself, authorities said.

A law enforcement official, speaking on condition of anonymity because the person was not authorized to discuss the unfolding investigation, said Lanza had been diagnosed with Asperger's.

High school classmates and others have described him as bright but painfully shy, anxious and a loner. Those kinds of symptoms are consistent with Asperger's, said psychologist Eric Butter of Nationwide Children's Hospital in Columbus, Ohio, who treats autism, including Asperger's, but has no knowledge of Lanza's case.

Research suggests people with autism do have a higher rate of aggressive behavior — outbursts, shoving or pushing or angry shouting — than the general population, he said.

"But we are not talking about the kind of planned and intentional type of violence we have seen at Newtown," he said in an email.

"These types of tragedies have occurred at the hands of individuals with many different types of personalities and psychological profiles," he added.

Autism is a developmental disorder that can range from mild to severe. Asperger's generally is thought of as a mild form. Both autism and Asperger's can be characterized by poor social skills, repetitive behavior or interests and problems communicating. Unlike classic autism, Asperger's does not typically involve delays in mental development or speech.

Experts say those with autism and related disorders are sometimes diagnosed with other mental health problems, such as depression, anxiety, bipolar disorder or obsessive-compulsive disorder.

"I think it's far more likely that what happened may have more to do with some other kind of mental health condition like depression or anxiety rather than Asperger's," Laugeson said.

She said those with Asperger's tend to focus on rules and be very law-abiding.

"There's something more to this," she said. "We just don't know what that is yet."

After much debate, the term Asperger's is being dropped from the diagnostic manual used by the nation's psychiatrists. In changes approved earlier this month, Asperger's will be incorporated under the umbrella term "autism spectrum disorder" for all the ranges of autism.

__

AP Writer Matt Apuzzo contributed to this report.

___

Online:

Asperger's information: http://1.usa.gov/3tGSp5

Read More..

Innovative housing for the homeless being built in downtown L.A.

The Skid Row Housing Trust has spent decades revitalizing abandoned buildings and hotels in downtown Los Angeles' most destitute neighborhood to serve as shelter for the city's chronically homeless.

But for its latest housing project, the trust abandoned its usual technique for a seemingly elementary construction concept. A 102-unit, $20.5-million complex is being built by stacking pre-outfitted apartments atop one another in a Lego-like fashion, limiting construction costs and fast-forwarding the project timeline. It is believed to be the first multi-tenant residential building in the nation to be constructed this way.

Like all of the Skid Row Housing Trust's 24 homes for the homeless, the sleek and distinctive Star Apartments are meticulously styled to look nothing like typical low-income housing.

The project, designed by award-winning architect Michael Maltzan, will include basketball courts, art centers, community gardens and hundreds of feet of green space. The stacking of apartment units began last week, and the bulk of the construction should be done by mid-January.

"What we're trying to create is something that feels like a microcosm of the city itself," said Maltzan, who has designed two other apartment complexes for the homeless in partnership with the trust.

Unlike dark, drafty and dreary low-income housing, where residents reside in monochromatic buildings, Maltzan's project, he said, infuses color and community with a layout and amenities that force residents to interact. That sense of community, housing trust officials believe, is paramount to rehabilitating the chronically homeless.

Because the pre-fabricated construction method is typically used for single-family homes, planners had to work with officials to clarify regulations and standards for shipping in the pre-constructed apartments, which the architect characterized as a tedious and at times frustrating process.

"The hope is that we've created a replicable pathway for similar projects," Maltzan said last week, as he watched a towering blue crane lift a pre-fabricated apartment unit onto a building platform. "When people look at this building, what they see is a vision of the future."

The Star Apartments will house up to 100 formerly homeless, with an emphasis on residents who are repeat patients at area emergency rooms or who have never received needed treatment for chronic medical conditions, said Mike Alvidrez, executive director of the Skid Row Housing Trust.

Residents will pay 30% of their monthly job or government assistance income as rent but are not required to seek on-site medical treatment, psychiatric counseling, drug or alcohol treatment or therapy as a condition of residency.

"The thought is, how do we help people make the choice that is best for them," said Alvidrez, who stressed the trust's Housing First model — a philosophy that has caught fire nationwide. Alvidrez said the first step to helping someone recover from a chronic drug or alcohol problem is to give them a home and sense of community.

"We're not going to build our way out of homelessness," Alvidrez said. While the housing trust's buildings are now home to more than 1,500 formerly homeless people, some estimates say as many as 51,000 people remain homeless in L.A. County.

The goal of the apartments is to fully rehabilitate residents through on-site social services, community space and professional development. While many eventually leave the housing trust's buildings and move into other homes, if they keep paying rent they're free to stay as long as they'd like. Lawrence Horn, 62, said he spent years on the streets of Los Angeles, afraid that his adult daughter might run into a destitute, shabby and drugged-out version of him while she was out on the town with her friends.

But a confident and polished Horn, in a crisp black shirt and suit, stood behind a lectern in front of about 50 people in the Last Bookstore on Tuesday and captivated them with a frank, 20-minute narrative of his life before and after moving into permanent housing offered by the trust.

Two years ago Horn moved off the streets and into the Carver Hotel, a circular structure designed by Maltzan next to the 10 Freeway. For the last year, he has been learning to become a spokesman for the trust through its resident ambassador program.

"I felt inferior, I felt less than," Horn said of his time living on the street. But now, he said, "my story is no longer a doom-and-gloom story."

wesley.lowrey@latimes.com

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Hillary Clinton Suffers a Concussion After Fainting

WASHINGTON — Secretary of State Hillary Rodham Clinton suffered a concussion early last week after fainting and striking her head, the State Department disclosed on Saturday.

As a result, Mrs. Clinton will not testify as scheduled on Thursday before Congressional committees investigating the September attack on the American diplomatic outpost in Benghazi, Libya.

The fainting episode occurred after Mrs. Clinton, who is being widely discussed as a possible presidential candidate in 2016, became dehydrated because of a stomach virus she contracted during a trip to Europe, according to statements released by Philippe Reines, a close adviser to Mrs. Clinton, and by her doctors.

“Secretary Clinton developed a stomach virus, leading to extreme dehydration, and subsequently fainted,” her doctors, Dr. Lisa Bardack of the Mount Kisco Medical Group and Dr. Gigi El-Bayoumi of George Washington University, said in their statement on Saturday. “Over the course of this week we evaluated her and ultimately determined she had also sustained a concussion.”

One State Department official said Mrs. Clinton fainted when she was alone at her home in Washington but added that the concussion was not diagnosed until Thursday. He said the concussion was not severe.

Acting on the advice of her doctors, Mrs. Clinton will not go to the State Department this week but will work from home, the State Department’s statement said.

William J. Burns and Thomas R. Nides, both deputy secretaries of state, will testify before the Senate Foreign Relations Committee in place of Mrs. Clinton, according to a spokesman for the panel. They are also expected to testify before a House committee about the attack, in which Ambassador J. Christopher Stevens and three other Americans were killed.

Besides the Congressional hearings, the State Department is preparing for an eventful week on the Benghazi attack, which had led to considerable partisan fighting about what precipitated the attack and what arrangements were made to defend the compound.

On Monday, an independent panel that was established to investigate the attack is expected to present its report to the State Department. The panel, called an accountability review board, is led by Thomas R. Pickering, a veteran diplomat. It includes four other members, including Mike Mullen, the retired admiral who formerly served as chairman of the Joint Chiefs of Staff. The board is authorized by a 1986 law intended to strengthen security at United States diplomatic missions.

The State Department plans to share the report with Congress and will also provide its own recommendations on how security for diplomats can be improved. Mr. Pickering and Admiral Mullen are expected to meet with lawmakers in closed sessions on Wednesday.

Then on Thursday, Mr. Burns and Mr. Nides will testify before the Senate committee, which is led by Senator John Kerry, the Massachusetts Democrat who is expected to succeed Mrs. Clinton as secretary of state.

Mrs. Clinton has said that she takes responsibility for the failure to successfully defend the Benghazi compound in the Sept. 11 attack. But she has never been questioned by lawmakers about how decisions were made by the Obama administration to establish the compound and protect it.

When a House oversight committee held a hearing on the Benghazi attack in October, the State Department was represented by a senior management official and a midlevel official from the department’s Bureau of Diplomatic Security. The former chief security officer for the embassy in Libya, Eric A. Nordstrom, told that panel that some of his requests for additional security were ignored. But the State Department’s under secretary for management, Patrick Kennedy, countered that none of the steps proposed by Mr. Nordstrom would have altered the outcome in Benghazi because the embassy was based in Tripoli.

The political debate over the Benghazi attack has already claimed one victim: the ambassador to the United Nations, Susan E. Rice. Ms. Rice had been the Obama administration’s top choice to succeed Mrs. Clinton as secretary of state, but last week she withdrew her name from consideration for the job because of the controversy over her initial description of the attack as a spontaneous demonstration that spun out of control.

On Tuesday, Mrs. Clinton canceled a planned trip to Morocco, where she was expected to formally recognize a new Syrian opposition coalition as the legitimate representative of the Syrian people. President Obama conveyed the recognition instead in an interview with ABC News.

Last week, State Department officials gave a mixed picture about the severity of Mrs. Clinton’s illness. On Wednesday, a State Department spokeswoman, Victoria Nuland, described Mrs. Clinton as having a “very uncomfortable stomach virus.”

The next day, Ms. Nuland said Mrs. Clinton was “under the weather.” Ms. Nuland did say that Mrs. Clinton’s illness had prevented her from making any calls to foreign leaders.

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Huge Wave of Google App Updates Hits iOS, Android

Google just brought iPhone and Android phone users a holiday gift. Google Maps has returned to the iPhone, this time in the form of its own separate app, while Google Currents — the company’s Flipboard-style online magazine app for Android — received a substantial update as well.

Besides the two big updates, about a half-dozen other apps for Android and Google TV received bug fixes and new features, according to Android Police blogger Ryan Whitwam. Here’s a look at what to expect, and where the rough edges still lay.

Google Maps is back

It was technically never there to begin with; the iPhone simply had a “Maps” app included, which used Google Maps’ data. But a few months ago, Apple switched from using Google’s map data to its own, which caused no end of problems as Apple’s data was incorrect much more often. These problems were sometimes hilarious, but in at least one case they were dangerous, as several motorists had to be rescued after becoming stranded inside an Australian national park (where Apple’s maps said the town they were trying to get to was).

Google Maps has also received a thumbs-down from the Victoria police in Australia, but is regarded as more reliable overall. It’s a completely new app this time, and while it has at least one “Android-ism” according to tech expert John Gruber (an Ice Cream Sandwich-style menu button), it’s reported to work well and doesn’t show ads like the YouTube app does.

It does, however, keep asking you to log in to your Google account so that it can track your location data.

Google Currents has a new look and new features

The update to digital magazine app Google Currents brings its features more in line with Google Reader, the tech giant’s online newsreader app which can monitor almost any website for updates. Like Google Reader, Currents can now “star” stories to put them in a separate list, can show which stories you’ve already read, and has a widget to put on your Android home screen. Other added features include new ways to scan editions and stories, and filter out sections you aren’t interested in.

Bugfixes and updates for other Google apps

Google Earth and Google Drive received miscellaneous bugfixes “and other improvements,” while Google Offers (a Groupon competitor) now features a “Greatly improved purchase experience.”

The Google Search app received a slew of additions to its Siri-like Google Now feature, including new cards to help while you are out and about and new voice actions (like asking it to tell you what song is playing nearby). The Field Trip augmented reality app now uses less battery life, and lets you “save cards” and favorite places you visit, as well as report incorrect data to Google. Finally, Google TV Search and PrimeTime for Google TV both received performance and stability updates.

Jared Spurbeck is an open-source software enthusiast, who uses an Android phone and an Ubuntu laptop PC. He has been writing about technology and electronics since 2008.

Linux/Open Source News Headlines – Yahoo! News

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Connecticut Shooting: Hero Teacher Died Saving Students

By Sara Hammel and Mike Fleeman

12/15/2012 at 06:30 PM EST

Out of the chaos and horror emerged an incredible act of selflessness and bravery by one teacher, who spent her final moments trying to protect her young students from harm.

Victoria Soto, 27, a first-grade teacher at Sandy Hook Elementary School in Newtown, Conn., ushered her students into a closet and in so doing placed her body between them and the assailant.

"She was found huddled over her children, her students, doing instinctively what she knew was the right thing," her cousin Jim Wiltsie tells ABC News. "I'm just proud that Vicki had the instincts to protect her kids from harm,” he continued. “It brings peace to know that Vicki was doing what she loved, protecting the children and in our eyes she's a hero.”

Soto was among the six adults – all women – killed in Friday morning's massacre that also took the lives of 20 children – 12 girls and eight boys. The gunman, identified as 20-year-old Adam Lanza, took his own life. His mother was also found killed in a different location.

"It doesn't surprise me at all she would do this," Sabeena Ali, the parent of a girl who was in Soto's class two years ago, tells PEOPLE.

Ali calls Soto a "vibrant woman who loved the kids and would be with the kids and spend time with them and sit on the floor with them. "

Two years later, her daughter – now a third-grader – still idolized Soto.

"Every day there was some new Miss Soto story we had to listen to: 'This is what she did, this is how wonderful she was today,'" says Ali. "She would bring in snacks for the kids and do special days.

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Healthcare crisis: not enough specialists for the poor

The blurry vision began early last year. Roy Lawrence ignored it as long as he could. But after falling off a ladder at his construction job, he knew he had to see a doctor.

He went to a community health clinic in South Los Angeles, where doctors determined he had diabetes and cataracts. The clinic could manage his illness but referred him early this year to the county health system for eye surgery.

Nearly a year later, Lawrence, a Jamaican immigrant without insurance, still is waiting for the operation. His vision has deteriorated so much he is considered legally blind.

PHOTOS: Waiting in vain to be seen

"I want to see again," he said. "I've been waiting a long time."

Lawrence, 49, and patients like him are posing a critical challenge for the planned overhaul of the nation's healthcare system. Federal officials are investing billions in community health centers like the To Help Everyone (T.H.E.) Clinic, where Lawrence's problem was diagnosed, with the hope that they can keep more patients out of high-cost emergency rooms.

But a dearth of specialists available to low-income patients presents one of the bigger hurdles facing the country as it tries to bring spiraling healthcare costs under control. Doctors say meeting new government mandates to keep patients healthy and out of hospitals — a linchpin in reducing medical spending — will be virtually impossible without the ability to make timely patient appointments with specialists.

By the end of the decade, the nation will be short more than 46,000 surgeons and specialists, a nearly tenfold increase from 2010, according to the Assn. of American Medical Colleges. Healthcare reform is expected to worsen the problem as more patients — many with complex and deferred health needs — become insured and seek specialized treatment.

Many of the newly insured will receive Medi-Cal, the government plan for the needy as administered through the state of California. Clinics already struggle to get private specialists to see Medicaid patients because of the low payments to doctors. Last week, an appellate court decision that authorized the state to move forward with 10% cuts in Medi-Cal reimbursement, which could make finding doctors for those patients even more difficult.

"Specialists are paid so poorly that they don't want to take Medi-Cal patients," said Mark Dressner, a Long Beach clinic doctor and president-elect of the California Academy of Family Physicians. "We're really disappointed and concerned what it's going to do for patient access."

The healthcare overhaul includes initiatives aimed at reducing shortages of general medicine professionals but does little to increase the availability of specialists.

In Los Angeles County, the sheer volume of poor or uninsured patients needing specialist services has long overwhelmed the public health system, creating costly inefficiencies and appointment delays that can stretch as long as a year and half.

Patients' conditions often must be dire for them to see a neurologist, cardiologist or other specialist quickly. Community clinics try to bypass the backed-up formal government referral system by pleading, cajoling and negotiating to get less critically ill patients like Lawrence moved up on waiting lists.

"Where needs are absolutely critical, we are able to work out special arrangements," said Rise Phillips, chief executive of T.H.E. Clinic. "That is not the norm. That is, rather, the exception."

At times, clinic staff members are forced to work against one of their key missions by sending patients to emergency rooms to increase the odds of their seeing a specialist more quickly.

The challenge can be seen in Belinda De Leon's cubicle in a small, windowless back corner of T.H.E. Clinic. A referral specialist, De Leon spends her days trying to speed up appointments for the center's clients — and fielding calls from patients wanting to know how much longer they have to wait. At any given time, she's juggling more than 1,000 pending referrals.

One involves uninsured housekeeper Juana Barrera. Barrera, 45, has been waiting since April 2011 to see a gastroenterologist and get a colonoscopy. She has had bleeding off and on and recently started having pain in her stomach.

On a recent visit, she told De Leon she is scared to wait any longer. But she can't afford to pay for the test out of pocket. "I'm hoping it's not anything like cancer," she said.

De Leon promised to update Barrera's referral paperwork to indicate she is experiencing pain. "Hopefully that will help," she said.

Waits for specialist appointments vary dramatically, depending on the type of specialist needed. Patients willing and able to travel across L.A. County to specialty clinics may be able to see a doctor within a month or two. Others who lack transportation and must go to a nearby facility can wait up to a year for a dermatologist or neurologist and up to 18 months for a cardiologist or ophthalmologist.

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