The Indianapolis Star from Indianapolis, Indiana • Page 2

A2 THE INDIANAPOLIS STAR WEDNESDAY, DECEMBER 29, 1993 Wk.i mil WHALE Continued from Page 1 concerns about the drive fishery method. It would be of assistance to us to understand why you feel this method of 'herding' animals is less acceptable than other methods," Shea wrote. Animal-rights activists charge that whales and dolphins, who live in family pods, are terrorized In those drives because they are aware that their family members are being slaughtered. Earth Island provided a videotape of one such herding, in which the water of the cove was turned red with blood and animals thrashed about. The zoo had hoped to establish a breeding program with the false killer whales.

Shea has said that if the zoo for some reason is not able to find additional whales, including a mate for Hoshi, she eventually would be moved to a new home with other false killer whales. concerns whether the collection of animals through a drive fishery operation is humane." the agency wrote to the zoo last month. "This additional information is necessary for NMFS (the federal fisheries service) to ascertain whether activities were conducted in compliance with (the zoo's permit) and whether the subject pseudorcas may be imported to the Indianapolis Zoo from Japan, the letter says. Earlier this year, Shea said the zoo had no intention of obtaining pseudorcas via the drive fishery method. He also noted, however, that the same technique has been used to drive errant whales back to sea and out of San Francisco Bay.

In that instance, the procedure was applauded as a humane response, he added. In correspondence with the national fisheries agency, Shea also questioned the fisheries agency's "It is our understanding that they They want that option," Smullen said. That would involve amending the zoo's import permit, originally issued in 1988 for six false killer whales. It had obtained two of the animals, but one of them, Tsuki. died In 1992 of pneumonia.

Hoshi, a 7-or 8-year-old female, remains at the zoo. If the zoo wants to import animals captured in a drive fishery, the method and the specific application will be reviewed by the Marine Mammal Commission, an out-side-government body that would make a recommendation to the fisheries service. In addition, there would be a 30-day comment period. Earth Island representatives have said the group's attorneys would kick into gear to argue against any attempt to import animals captured using that method. Roy Shea, executive director of the zoo, last week indicated the zoo has in mind for import some specific animals that already have been captured.

He declined to say how many or where they were. "I don't have to tell you that," he said. He said he did not want to release too much Information because of potential opposition, particularly from animal-rights activists. He also said he did not know how the animals were captured. In correspondence between Shea and the fisheries service, there are indications the fisheries service at the least has questions about how the animals were captured and whether the zoo can document the capture.

"Your letter did not describe the method of the Initial taking of these animals, or state whether this method of taking was part of a drive fishery. We have serious i 4 ft'' Today's Star Contents WORLD Radiation experiment victims should be compensated, says Energy secretary. A3 Saddam's family, aides now under suspicion after assassination try against Iraqi leader. A5 Russian Parliament is a picture of confusion as factions scramble to form alliances. A5 NATION William Shirer, author of The Rise and Fall of the Third Reich, dies at 89.

A4 Judge orders prosecutors to rewrite four of five indictments against senator. A7 State Department formally announces choice of Strobe Talbott as top aide. A7 CITYSTATE Scott Newman opens his GOP campaign for Marion County prosecutor with an attack on the incumbent Democrat. E1 Property tax controls will be introduced again in 1994 legislature, but chances for major reform are slim. E1 Skating academy in city boasts one of the largest groups heading to national figure skating competition next week.

E1 Money raised is helping South-side woman defend herself against criminal child neglect charge. E1 State Medicaid director complains that group homes are spreading misleading information to protect excessive profits. E1 Money seizure claims by Indianapolis man against Drug Enforcement Administration agents are restored by federal appeals court. E3 Christian Church (Disciples of Christ) is looking to lease Downtown office space after finding a buyer for its aging headquarters in Irvington. E3 FOOD An instant party with a culinary flair is possible when you know where to shop on the way home for convenience dishes.

CI Good luck comes from what you eat on New Year's Day, or so the saying goes. Each country or region has its own good luck food. C1 SUNRISE Local nurse finds a common bond with a new play at the Phoenix Theatre it's about her family. D1 Actor Liam Neeson was hand-picked by Steven Spielberg for the starring role in the film Schindler's List. D3 Dr.

Kenneth Cooper was called a heretic when he introduced aerobics several years ago; now he's called a pioneer in preventive medicine. D5 It involves the use of underwater noise-making devices to herd the false killer whales into a cove. Some animals may be selected for zoos by representatives, and others may be slaughtered by fishermen. The method is particularly used in Japan, where the meat is used for food. Animal-rights activists, including Earth Island, have lobbied the federal government to formally recognize that method of capture as inhumane.

Currently, the method is not permitted and no one has ever asked to import animals captured using that method, said Scott Smullen, spokesman for the National Marine Fisheries Service. The Indianapolis Zoo has indicated that it might be the first, he said. MEDICAID Continued from Page 1 families in violation of the U.S. Constitution. State officials say they're merely giving more thorough reviews to requests that used to get almost automatic approval.

Legally, the state cannot pay for home care that is more costly than care in an institution, said James M. Verdier, Indiana's Medicaid chief. That's happening now, he said, and with the state trying to rein In skyrocketing Medicaid costs, it can't afford those costs. Health care providers and advocates say the cuts could result In more hospitalizations, illnesses and Institutionalization, especially for children. "Everything I've found out indicates it's cheaper to do this at home than in a nursing home," Falk said.

"The only question Is not which is cheaper. There also has to be a question of what is medically proper." Concern for care Born prematurely, Tilas Taylor spends his days in a baby seat, attached to oxygen and a heart rate monitor. He can't stand or talk. A shunt drains excess fluid from his head. He receives many kinds of medication, and his airway must be suctioned clear regularly, sometimes as often as every 20 minutes.

His mother. Joyce Fields, used to be a factory worker, then a day care employee. She found herself in a full-time job taking care of Tilas after he and his twin brother, Taurean (now a normal, bouncy 3-year-old), were born. Tilas' problems took their toll, contributing to his parents' divorce. Fields moved the family from South Bend to Indianapolis to be closer to the experts at Riley Hospital for Children, where Tilas underwent his latest surgery.

"I'm determined not to let him go into a nursing home," she says. "I don't want to deal with, and contend with, not knowing what's going on." On a recent night. Tilas coughed and wasn't able to breathe. Hearing the sudden silence, his mother suctioned him to open the breathing tube. Who in a nursing home, she wonders, would be listening as she does? "With incidents like that, 1 could lose him." Children like Tilas are not the most expensive for Medicaid.

Infants sent home on ventilators are. Dr. Veda Ackerman, a pediatric pulmonologist who directs the home ventilator program at Riley, said that until recently the state routinely approved 12 hours per day of home nursing care for children sent home on ventilators. Home care must be authorized again every three months, and virtually every authorization now comes back "with hours dramatically decreased," usually to 40 a week, Ackerman said. So far, she said, appeals have resulted in "compromise" levels.

But she worries that over time, shorter hours of nursing coverage will result in more health problems. In nursing homes, she says, "They get custodial care. They get turned, they get fed, but they (nursing homes) don't have the resources to give what a parent can give." Putting people in nursirtg homes is not what Medicaid is after, Verdier says; but the program cannot pay for unlimited care, either. In some instances, he says, the state is paying to set up mini-hospital rooms in private homes that cost more than institutional care. Ballooning costs There's no mystery why Medicaid officials have taken a hard look at home health care.

While Medicaid now covers home health services for about three times as many patients as In 1984, the cost of covering those patients has risen from Just under $2.1 million then to $43 million in fiscal 1993. According to the state, 5,663 patients received hone nursing Bombs kill 4 in N.Y. state; 1 man sought Associated Press Cheektowaga. N.Y. A series of bombs hidden in toolboxes exploded Tuesday In widely scattered parts of upstate New York, killing at least four people and wounding several others.

Authorities were hunting for a man who they said had links to all the victims. The toolboxes containing the bombs apparently came in cardboard boxes with the words "Liberty Iron Works" on them, a Buffalo police dispatcher said. No one was immediately arrested, but police said they were looking for one person in particular. "We are zeroing In on a person, but I cannot divulge whom at this time," said Thomas Staebell, Erie County sheriff's chief of patrol. "All the folks Injured and killed have some connection with the person we are looking at." Authorities released a composite photograph of the man.

He is a white male in his 40s, with glasses, a mustache and a weak eye or possibly a glass eye. At least two people were killed at an armored car company building in Cheektowaga. seven miles east of Buffalo, and two more died at an apartment building in Rochester, 70 miles east of Buffalo, Staebell said. Bombs also exploded in West Valley, 30 miles south of Buffalo, and Massena, hundreds of miles away in northeastern New York, authorities said. No deaths were reported in either town.

DIARRHEA Continued from Page 1 for International Development has exported these solutions, called oral rehydration therapy or ORT. to developing countries. The United Nations credits them with saving 1 million lives a year. Now. scientists and USAID are working to get the treatment to children in the United States, too.

In the United States, dehydrated kids typically get fluids intravenously, in doctor's offices or hospitals, at a cost of $1 billion a year. ORT costs $4 to $6 for a one-liter bottle; treatment takes three or four bottles. They don't require a prescription and can prevent diarrhea, avoiding IVs. They could virtually wipe out deaths from diarrhea in this country, said Dr. Julius Goepp of Johns Hopkins University in Baltimore.

Yet few pediatricians and parents know about ORT, said Goepp, who is part of the National ORT Project that is traveling the country to educate doctors. This spring, USAID workers will join the effort, conducting seminars to explain how to use ORT solutions. But to work, the government must pay for ORT for poor parents, said Meyers, who has pushed for Insurance coverage since the death of a patient whose mother tried unsuccessfully to buy ORT with food stamps because she had no cash. "Health care reform has got to include these practical kinds of things that keep people out of the hospital," Meyers said Medicaid in 16 states doesn't cover ORT; in an additional eight states, it pays only under very restricted circumstances. ORT's special sugars let the diarrhea-wracked Intestine absorb the solution's salt and potassium, which trap water.

Parents should keep ORT on hand so they can begin giving it as soon as diarrhea starts, Goepp advised. They also should phone the pediatrician to ensure there are no symptoms of a more serious illness and avoid giving a child sugar-laden colas or gelatin that only worsen diarrhea, he said. v. son Tilas, 3, has brain damage. state reform measures have cut Trying to save a life Gary Muston isn't worried about a ventilator, but he firmly believes that only a 24-hour-a-day watch will keep his son alive.

Six days after he was born, Ransom was rushed back to Memorial Hospital in South Bend, where doctors removed virtually all of his intestinal tract because of a loss of circulation. Serious problems with the boy's stomach and liver persisted, requiring more surgeries. Now Ransom, with what's called short bowel syndrome, cannot normally digest food. He's given fluid every hour through a tube that runs from his nose to his stomach. That's where the medicines go, too.

He also has an intravenous opening, called a central line, through which he receives IV feedings at night while he sleeps. Since his last major surgery. Ransom has been hospitalized twice for pneumonia, says his father, and twice for IV infections. The boy Is also being treated for attention deficit hyperactivity disorder. During the tantrums, he usually tries to pull out the tubes.

The strain of caring for Ransom has left his mother psychologically unable to cope, and his father's full-time Job has been caring for his son. Twenty-four hours of nursing assistance, as ordered by his doctor, is still in effect because Medicaid's decision last summer to cut back still is on appeal. Even so, many eight-hour shifts aren't filled because nurses sometimes aren't available, Muston says. Ransom is on a waiting list for a transplant that would provide him with a new stomach, intestines and liver. In the meantime, the stress is showing.

Finding a way for a break Clearly, the time spent in a home by a nurse is time that family care givers have fob sleep, tt Star Staff Photo Joe Stefanchik Medicaid once paid for 56 hours that to 24 hours weekly. chores, work or simply a respite. Verdier says there's no doubt that's true, but giving parents a respite isn't part of "medically necessary" treatment. "Medicaid doesn't cover it. So if they need It, it has to come from someplace else." Where that will come from is unclear.

Friends and other family members are not always available or willing. Joyce Fields moved to Indianapolis to be closer to Riley, but that meant leaving much of her family behind. Untrained people, she says, are "terrified" that something might go wrong. It's a dilemma that needs some creative thinking, says Olson at Visiting Nurse Service. Funding for such services continues to shrink, but the demand, she predicts, will grow.

Babies will continue to go home with equipment, and more people will need care as the population ages. She proposes alternatives such as small group settings for people needing 24-hour observation and care, rather than larger nursing home facilities. A nurse with, say, four patients, might be less expensive, and more effective, than either individual care at home, or an institution. Another example may be a special program operated by Medicaid for about a year to provide extra assistance for "medically fragile" children. The program, which required special permission from the federal government, was designed to help 30 children, Verdier said; but when the initial plans of care were developed, there was going to be enough money for only seven.

Rethinking got costs down and enabled more children to be covered, though the number remained tiny compared to the total needing health care. "The families are doing more, being more creative," Verdier said. "And they're making sacri-. fices." fkf CUTTING CARE: Joyce Fields' a week of home care, but now, care paid by Medicaid in 1992. For 84 percent, the costs averaged a relatively modest $1,735.

However, a relative handful, 143 patients, cost the state about $15 million, or nearly 35 percent of all dollars spent by Medicaid on home health care. According to Verdier, about 41 percent of Indiana's 1992 Medicaid spending on home health care went for patients under 21 years old. The national average was 7.5 percent. Why Indiana spends so much more on children isn't certain, but Verdier blames what he calls excessive reimbursement rates for home health companies. Verdier contends that requests for home health services used to get little more than a cursory review and an almost automatic OK.

Now, he says, the state is taking a closer look. As a result, reductions in services have been ordered in 80 percent of the Medicaid patients seen by pediatric nursing specialists, said Mary Webber, regional manager. Harriet Olson, president of Visiting Nurse Service in Indianapolis, estimated that 40 percent to 50 percent of that firm's Medicaid patients have had their levels of service reduced. Due to an archaic computer system, Medicaid officials say, the number of patients who've had service reductions ordered isn't known. Neither is the number who have appealed, nor the number who may have been moved Into a nursing home.

Whatever the impact on patient health, cutbacks in services almost certainly raise the burden on those who must care for patients when the nurses leave. No family can provide 24-hour care without help, but many of the patients need it. Ackerman said. "Thirty seconds off the ventilator and they die." BUSINESS Allison Transmission's outgoing leader, Robert M. Clark helped keep the GM division together amid tumult.

B1 Mexican market, smaller and weaker than United States', likely will feel effect of NAFTA first. B2 Federal tax forms all 86 million of them go into the mail starting Monday, courtesy of Uncle Sam. B3 OPINION The land trust discusses the first land acquisition by the Indiana Heritage Trust, and Random shootings explains how drivers can best avoid the risk of random shootings. A8 James J. Kilpatrick, Paul Greenberg, Stephen Chapman, Richard B.

McKenzie and Benjamin R. Cole are today's featured columnists. A8 and A9 CORRECTIONS Part of the last item was inadvertently omitted in Tuesday's Helolse column. The complete Item Is includ--" ed with today's column in the Sunrise section on Page D7. Obituary corrections are on Page B6.

CALL THE STAR If you have suggestions, corrections, comments or criticism regarding the news content of The Indianapolis Star, call 633-9284, or if outside the Indianapolis area, toll-free (800) 669- 7827. Correspondence should be directed to Charles G. Griffo, reader representative, P.O. Box 145, The Indianapolis Star, In-; dianapoJis, Ind. 46206-0145..