Thursday, March 15, 2012

Counselor at children's home convicted of molestation - California

A Santa Ana man who worked with children without parents living in the United States was convicted Wednesday of molestation and could face more than seven years in jail.

Victor Salazar, 30, a counselor at the Florence Crittenden Home in Fullerton, was found guilty of four felony counts of lewd acts on a child between the ages of 14 and 15 and two misdemeanor counts of sexual battery, according to the Orange County district attorney’s office.

Children whose parents live outside the country, either because they were deported or because they came to the United States alone, live in the home. The children are generally taken into protective custody until they are placed in foster care, reunited with their families or reach maturity, officials said.

Salazar was found to have molested three boys he was assigned to counsel at the home between May 25, 2007, and Feb. 5, 2008.

Officials said the acts occurred when the children went into Salazar’s office to call their families in South or Central America. While on the telephone, officials said, they were sexually assaulted and fondled by Salazar.

A sentencing date will be set Thursday. Officials said Salazar also faces a lifetime sex offender registration.


State must pay $432,000 after infant dies in foster care, Clackamas County jury rules

By Steve Mayes

A Clackamas County jury concluded Wednesday that the Oregon Department of Human Services was negligent and partially responsible for the death of Astrid Ash, an infant who died while in foster care four years ago.

The jury also found the child's father partly at fault, but awarded him $432,300 in damages.

The father, Sam Driessen, filed a wrongful death lawsuit seeking more than $1.5 million.

The testimony highlighted two contrasting and troubling versions of the events preceding the death of 10 1/2-month-old Astrid.

Driessen had twice been convicted of drug crimes before he met Emily C. Ashby through a Craigslist ad where she offered to trade sex for methamphetamine, said Dirk Pierson, a state attorney representing DHS.

Ashby became pregnant and gave birth to twins -- born almost two months prematurely -- in late June 2007. Several weeks later she was found passed out in a car at a fast-food restaurant. After she tested positive for alcohol and drugs, DHS took custody of the twins and placed them in a West Linn foster home.

Astrid failed to thrive and had difficulty gaining weight. She suffered from reflux and sometimes vomited her meals. The foster mother compared the child to "a stopped-up sink."

Driessen's attorney, David Paul, said the foster parents were overwhelmed with their own children and financial responsibilities and did not have the skills to deal with medically fragile babies. DHS workers and others praised the foster parents as well trained, diligent and capable of caring for the twins.

On May 11, 2008 -- Mother's Day -- the foster mother discovered Astrid unconscious in bed. No one had checked on the baby for several hours. The foster parents unsuccessfully tried to revive her. A hospital doctor who examined Astrid after death reported her body temperature was 103 degrees, a sign of serious infection.

"This baby did not have to die," Paul said. Had DHS done its job and involved Driessen, "he would have pushed the right button" and immediately hospitalized the baby, Paul said.

DHS took a blood sample from Driessen in mid-March 2008 and knew he was the father almost two weeks before Astrid died. The agency, however, did not tell him until after Astrid was buried. The death certificate listed the cause of death -- and the name of the father -- as "unknown."

Pierson, the DHS attorney, said Driessen showed no interest in the twins or their welfare during Astrid's short life "and now he wants a million and a half bucks."

Although Ashby told Driessen he was probably the twin's father, he took no action to protect or support the children even though he knew Ashby used illegal drugs while nursing the infants, Pierson said.

The jury agreed up to a point. It found DHS was 56 percent responsible for the death.

DHS bears more blame because it was responsible for Astrid's care but failed to adequately address her on-going medical problems, said a juror, who spoke on condition he not be identified. The jury found other DHS actions troubling, said the juror: the delay in telling Driessen that he was the father, the lack of an autopsy that could determine the cause of death and burying the body the day after the death.

Driessen said he has changed since Astrid's death. He quit drugs, is employed and engaged to be married. He was given custody of the surviving twin, Axel, who reportedly is doing well.


County to pay $500K to settle foster care sexual abuse case - California

From wire service reports

LOS ANGELES - The Los Angeles County Board of Supervisors agreed Tuesday to pay $500,000 to settle a lawsuit involving the sexual assault of a 9- year-old girl by a 17-year-old boy in foster care.

"The certified foster parents allowed children to have unsupervised, unmonitored play behind closed doors resulting in the assault of a 9-year-old girl by a 17-year-old boy," according to the case summary provided by county attorneys.

The girl -- listed as Jane Doe in the suit filed in Los Angeles Superior Court on Oct. 28, 2009 -- is the biological child of the boy's foster parents.

Other details of the case, including the parents' names, were not disclosed.

The county has already spent more than $287,000 -- more than half the settlement amount -- on attorneys' fees and costs related to the claim, according to the attorneys' summary.

The supervisors met behind closed doors with their lawyers to discuss the case before voting 3-1 in open session to approve the settlement, with Supervisor Michael Antonovich casting the dissenting vote and Supervisor Gloria Molina absent due to illness.


County agency reviewing practices on taking children - California


Kern County is reviewing how its Child Protective Services agency removes children from their parents, according to Deputy County Counsel Mark Nations.

Until now, CPS has routinely taken children without warrants if the agency feels there is a credible allegation of "general neglect."

Law enforcement typically handles removal of children when severe physical or sexual abuse is alleged. General neglect is handled by CPS and runs the gamut from drugs being used in the home to no food available for the children.

On Wednesday, sources close to CPS said social workers this week had stopped taking children without warrants and were instead filing petitions asking the court to detain the children.

Nations confirmed that a review was under way but said he had no knowledge that any procedures had been changed thus far.

"Non-custody petitions (to the court) are not something new and whether they will receive increased use in the future remains to be seen," he said in an email.

The review of CPS procedures comes on the heels of a settlement offer in a federal lawsuit that was considered by the Board of Supervisors in closed session on Tuesday.

In that case, Darlene and Lawrence McCue allege CPS and the Kern County Sheriff's Department illegally took their son, then 7, from his school on March 6, 2008 without a warrant and with no evidence that he was being harmed.

The McCues were thought to be endangering their son by having him undergo unnecessary medical procedures for imagined or exaggerated conditions.

Kern County kept the child for four months before a juvenile dependency court found no evidence that supported his removal.

The McCues' attorney, Shawn McMillan, said the law is very clear that authorities must have a warrant to take a child unless they believe the child is in "imminent danger," which means they have reason to believe the child will suffer serious physical harm or death in the few hours it would take to get a warrant.

"There are no nuances," to the law, McMillan has said previously.

McMillan wouldn't say what the McCues' settlement offer involved, but did say there was no demand that CPS alter its procedures. However, he said he assumed that would happen as a result of the lawsuit.

Nations said Supervisors did consider the settlement offer Tuesday evening.

"It was more of an informational thing," he said. "Now, I need to move forward with what they instructed me to do, which I'm not at liberty to disclose."

Another portion of the McCues' lawsuit targets South Fork Union School District. McMillan expects that that part of the case will go to trial.

The McCues allege the school district gave their son a peanut butter cookie even though he's allergic to peanuts. They reported the district to the State Board of Education and believe the district then retaliated against them by filing false accusations with CPS, which resulted in the boy being taken by the county.

An attorney for the South Fork School District has said previously that school employees were simply answering questions from doctors and law enforcement.


Wednesday, March 14, 2012

Off-Label Use Of Risky Antipsychotic Drugs Raises Concerns

By Sandra G. Boodman

Adriane Fugh-Berman was stunned by the question: Two graduate students who had no symptoms of mental illness wondered if she thought they should take a powerful schizophrenia drug each had been prescribed to treat insomnia.

"It's a total outrage," said Fugh-Berman, a physician who is an associate professor of pharmacology at Georgetown University. "These kids needed some basic sleep [advice], like reducing their intake of caffeine and alcohol, not a highly sedating drug."

Those Georgetown students exemplify a trend that alarms medical experts, policymakers and patient advocates: the skyrocketing increase in the off-label use of an expensive class of drugs called atypical antipsychotics. Until the past decade these 11 drugs, most approved in the 1990s, had been reserved for the approximately 3 percent of Americans with the most disabling mental illnesses, chiefly schizophrenia and bipolar disorder; more recently a few have been approved to treat severe depression.

But these days atypical antipsychotics -- the most popular are Seroquel, Zyprexa and Abilify -- are being prescribed by psychiatrists and primary-care doctors to treat a panoply of conditions for which they have not been approved, including anxiety, attention-deficit disorder, sleep difficulties, behavioral problems in toddlers and dementia. These new drugs account for more than 90 percent of the market and have eclipsed an older generation of antipsychotics. Two recent reports found that children and adolescents in foster care, some less than a year old, are taking more psychotropic drugs than other children, including those with the severest forms of mental illness.

In 2010 antipsychotic drugs racked up more than $16 billion in sales, according to IMS Health, a firm that tracks drug trends for the health-care industry. For the past three years they have ranked near or at the top of the best-selling classes of drugs, outstripping antidepressants and sometimes cholesterol medicines. A study published last year found that off-label antipsychotic prescriptions doubled between 1995 and 2008, from 4.4 million to 9 million. And a recent report by pharmacy benefits manager Medco estimated that the prevalence of the drugs' use among adults ballooned more than 169 percent between 2001 and 2010.

Critics say the popularity of atypical antipsychotics reflects a combination of hype that the expensive medicines, which can cost $500 per month, are safer than the earlier generation of drugs; hope that they will work for a variety of ailments when other treatments have not; and aggressive marketing by drug companies to doctors and patients.

"Antipsychotics are overused, overpriced and oversold," said Allen Frances, former chair of psychiatry at Duke University School of Medicine, who headed the task force that wrote the DSM-IV, psychiatry's diagnostic bible. While judicious off-label use may be appropriate for those who have not responded to other treatments for, say, severe obsessive-compulsive disorder, Frances said the drugs, which are designed to calm patients and to moderate the hallucinations and delusions of psychosis, are being used "promiscuously, recklessly," often to control behavior and with little regard for their serious side effects. These include major, rapid weight gain -- 40 pounds is not uncommon -- Type 2 diabetes, breast development in boys, irreversible facial tics and, among the elderly, an increased risk of death.

The Latest Fad?

Doctors are allowed to prescribe drugs for unapproved uses, but companies are forbidden to promote them for such purposes. In the past few years major drugmakers have paid more than $2 billion to settle lawsuits brought by states and the federal government alleging illegal marketing; some cases are still being litigated, as are thousands of claims by patients. In 2009 Eli Lilly and Co. paid the federal government a record $1.4 billion to settle charges that it illegally marketed Zyprexa through, among other things, a "5 at 5 campaign" that urged nursing homes to administer 5 milligrams of the drug at 5 p.m. to induce sleep.

Wayne Blackmon, a psychiatrist and lawyer who teaches at George Washington University Law School, said he commonly sees patients taking more than one antipsychotic, which raises the risk of side effects. Blackmon regards them as the "drugs du jour," too often prescribed for "problems of living. Somehow doctors have gotten it into their heads that this is an acceptable use." Physicians, he said, have a financial incentive to prescribe drugs, widely regarded as a much quicker fix than a time-intensive
evaluation and nondrug treatments such as behavior therapy, which might not be covered by insurance.

In a series in the New York Review of Books last year, Marcia Angell, former editor in chief of the New England Journal of Medicine, argued that the apparent "raging epidemic of mental illness" partly reflects diagnosis creep: the expansion of the elastic boundaries that define mental illnesses to include more people, which enlarges the market for psychiatric drugs.

"You can't push a drug if people don't think they have a disease," said Fugh-Berman, who directs PharmedOut, a Georgetown program that educates doctors about drug marketing and promotion. "How do you normalize the use of antipsychotics? By using key opinion leaders to emphasize their use and through CMEs (continuing medical education) and ghost-written articles in medical journals," which, she said "affect the whole information stream."

James H. Scully Jr., medical director of the American Psychiatric Association, sees the situation differently. He agrees that misuse of the drugs is a problem and says that off-label prescribing should be based on some evidence of effectiveness. But Scully suggests that a key factor driving use of the drugs, in addition to "intense marketing and some effectiveness," is the growing number of non-psychiatrists prescribing them. Many lack the expertise and experience necessary to properly diagnose and treat mental health problems, he said.

Among psychiatrists, use of antipsychotics is rooted in a desire to heal, according to Scully. "All of the meds we use have their limits. If you're trying to help somebody, you think, 'What else might I be able to do for them?' "

Since 2005, antipsychotics have carried a black-box warning, the strongest possible, cautioning against their use in elderly patients with dementia, because the drugs increase the risk of death. In 2008 the Food and Drug Administration reiterated its earlier warning, noting that "antipsychotics are not indicated for the treatment of dementia-related psychosis." But experts say such use remains widespread.

In one Northern California nursing home in 2006 and 2007, 22 residents, many suffering from dementia, were given antipsychotics for the convenience of the staff or because the residents refused to go to the dining room. In some cases the drugs were forcibly injected, state officials said. Three residents died.

A 2011 report by the inspector general of the Department of Health and Human Services found that in a six-month period in 2007, 14 percent of nursing home residents were given antipsychotics. In one case a patient with an undetected urinary-tract infection was given the drugs to control agitation.

"The primary reason is that there's not enough staff," said Toby S. Edelman, senior policy attorney for the Center for Medicare Advocacy, a Washington-based nonprofit group, who recently testified about the problem before the Senate Special Committee on Aging. "If you can't tie people up, you give 'em a drug" she said, referring to restrictions on the use of physical restraints in nursing homes.

Drugs At 18 Months

Nursing home residents aren't the only ones gobbling antipsychotics.

Mark E. Helm, a Little Rock pediatrician who was a medical director of Arkansas's Medicaid evidence-based prescription drug program from 2004 to 2010, said he had seen 18-month-olds being given potent antipsychotic drugs for bipolar disorder, an illness he said rarely develops before adolescence. Antipsychotics, which he characterized as the fastest-growing and most expensive class of drugs covered by the state's Medicaid program, were typically prescribed to children to control disruptive
behavior, which often stemmed from their impoverished, chaotic or dysfunctional families, Helm said. "Sedation is the key reason these meds get used," he observed.

More than any other factor, experts agree, the explosive growth in the diagnosis of pediatric bipolar disorder has fueled antipsychotic use among children. Between 1994 and 2003, reported diagnoses increased 40-fold, from about 20,000 to approximately 800,000, according to Columbia University researchers.

That diagnosis, popularized by several prominent child psychiatrists in Boston who claimed that extreme irritability, inattention and mood swings were actually pediatric bipolar disorder that can occur before age 2, has undergone a reevaluation in recent years. The reasons include the highly publicized death of a 4-year-old girl in Massachusetts, who along with her two young siblings had been taking a cocktail of powerful drugs for several years to treat bipolar disorder; the revelation of more than $1 million in unreported drug company payments to the leading proponent of the diagnosis; and growing doubts about its validity.

Helm said that antipsychotics, which he believes have become more socially acceptable, serve another purpose: as a gateway to mental health services. "To get a child qualified for SSI disability, it is helpful to have a child on a medicine," he said, referring to the federal program that assists families of children who are disabled by illness.

Ask Your Doctor

Psychiatrist David J. Muzina, a national practice leader at pharmacy benefits manager Medco, said he believes direct-to-consumer advertising has helped fuel rising use of the drugs. As former director of the mood disorders center at the Cleveland Clinic, he encountered patients who asked for antipsychotics by name, citing a TV commercial or print ad.

Some states are attempting to rein in their use and cut escalating costs. Texas has announced it will not allow a child younger than 3 to receive antipsychotics without authorization from the state. Arkansas now requires parents to give informed consent before a child receives an anti-psychotic drug. The federal Centers for Medicare and Medicaid Services announced it is summoning state officials to a meeting this summer to address the use of antipsychotics in foster care. And Sens. Herb Kohl (D-Wis.) and Charles E. Grassley (R-Iowa) introduced legislation that would require doctors who prescribe antipsychotics off-label to nursing home patients to complete forms certifying that they are appropriate.

Medco is asking doctors to document that they have performed diabetes tests in patients taking the drugs. "Our intention here is to get doctors to reexamine prescriptions," Muzina said.

"In the short term, I don't see a change in this trend unless external forces intervene."


Report: Anonymous Ind. hotline caller pleaded 20 minutes for abuse check before boy’s death

SOUTH BEND, Ind. — An anonymous caller to Indiana’s child abuse hotline pleaded for 20 minutes for someone to check on conditions in a South Bend home six months before a boy living there was tortured to death, a newspaper reports.

The South Bend Tribune posted the story online ( ) Monday, after the Court of Appeals dismissed an attempt by the Department of Child Services to block the story’s publication. The caller last May told the person answering the phone at the hotline about another child’s injuries that day. The caller said the injuries left the boy limping and bleeding in his abdomen.

“Please go tonight. Please go,” the caller says. “I’m not saying this just to be saying this. Please go. Something got to be done. ... If they go there right now, they’ll see how them kids is beat, if they go there right now, because I don’t want it to get on the news and the boy died and then everybody come forward and they gonna say, ‘Well, why did nobody come forward from before?’”

Ten-year-old Tramelle Sturgis was found beaten to death in the house on Nov. 4, months after the May 27 hotline call.

His father, Terry Sturgis, is charged with murder, eight felony counts of battery and one misdemeanor count of battery, two counts of neglect, and two counts of confinement. He contends he was insane.

The Tribune reported a DCS spokeswoman did not respond to the newspaper’s requests to clarify policies on when the agency decides to investigate a call immediately and how urgent hotline calls are communicated to local offices. John Ryan, the agency’s chief of staff, declined comment to The Associated Press on Monday, saying he didn’t know enough about the policies or the case.

The Tribune reported that DCS documents it obtained under the state’s public records law indicate the call center contacted a family case manager the night of the call. The records do not indicate whether any action was taken then.

According to South Bend Police spokesman Capt. Phil Trent, police took a report from an anonymous caller just after midnight. Police records show two officers went to the house, having been told only that 10 children were possibly being abused. Trent said officers went to the home and everything appeared fine. He said unless police have more details to provide probable cause, they cannot enter a house after midnight, pull children aside and ask to look under their shirts for injuries. If an officer saw an injury or blood on a shirt, he would have probable cause.

“If you suspect that (abuse), you can seize the child, but you’d better be able to articulate why you did that,” he said.

The caller to the DCS hotline told the DCS worker the children would likely have marks.

“All you got to do is just raise them shirts up,” the caller replies with concern. “And I think them kids would tell it because them kids so scared.”

The caller said that the week before, some of the children were beaten so badly that their visible injuries kept them from being sent to school.

Indiana Attorney General Greg Zoeller said he asked the state Court of Appeals to dismiss DCS’ attempt to block the South Bend Tribune from publishing a story because prior restraint of the news media is inconsistent with the First Amendment. Ryan, who is with the DCS, said the agency was concerned the media would publish information that would identify the caller.


National child welfare advocate says Nebraska overhaul proposals won't solve problem

GRANT SCHULTE Associated Press

LINCOLN, Neb. — Nebraska's attempt to reform its child welfare system this year fails to address the fact that too many children are yanked from their homes and kept in foster care, a national child advocacy group said Monday.

The National Coalition for Child Protection Reform criticized Nebraska's reform proposals in a biting new report, which blamed most of the state's problems on a "take the child and run" mentality that needlessly splits families apart.

Lawmakers are on the verge of passing child welfare measures this session that would scale back caseloads for social workers, create a child welfare watchdog that reports to the Legislature and end the state's experiment with privatized services in all but two Omaha-area counties.

But family advocates said most of the measures fail to address the core problems: Nebraska removes children from their homes at a rate twice the national average, and keeps a higher proportion of its children in foster care than any other state.

Nebraska state officials say they use an evidence-based tool to decide which children are safe and unsafe in their homes, and will work with families and community services when possible to keep them together.

Richard Wexler, the coalition's executive director, said Nebraska child welfare workers too often see poverty in homes and assume the children are suffering from neglect.

Wexler said the glut of children becoming state wards led to high caseloads, which contributed to caseworker burnout and turnover that has destabilized the system. Costs have soared as well, and some children have had more than four caseworkers.

"Not only does Nebraska's obscene rate of removal do enormous harm to the children needlessly taken, it also overloads caseworkers so they have even less time to find children in real danger," Wexler said. "As a result, the take-the-child-and-run mentality which dominates Nebraska child welfare leaves all children less safe."

Richard Wexler, the group's executive director, says Nebraska social workers too often see poverty in homes and assume the children are suffering from neglect.
Melanie Williams-Smotherman, executive director of the Nebraska's Family Advocacy Movement, said the state's child welfare services are comprised of "career child savers" who use confidentiality and safety laws to pry children away from families.

"Their spirit is broken, their children have been harmed and alienated, and they have lost all necessary resources to remain stable and functioning," Williams-Smotherman said.

State child welfare officials said they are "on the same page" as the family advocates, and want to see fewer children taken from their homes. Lawmakers and child advocates have repeatedly criticized the state Department of Health and Human Services for failing to reduce caseloads and control costs.

Vicki Maca, who oversees the Division of Children and Family Services, said the state's Families Matter effort "is built on the goal of having fewer children in the state's care and serving them at home when it's safe to do so.

"We want a system that allows parents the opportunity to have access to services in their own community without state involvement," she said. "That is what our reform is all about."

Maca said the Department of Health and Human Services plans to apply for a federal waiver that would give the state more flexibility in how it uses child welfare dollars.

States are required to use most of the federal money for out-of-home services, which, according to some critics, creates a financial incentive to keep children in the system. Lawmakers and child advocates have pushed a measure that would require the department to apply for the waiver, which would free state officials to use the money for in-home services, such as parental counseling and substance abuse programs.

Child advocates have said Nebraska should seek the waiver right away, because states must compete for the waiver. Maca said the state needs to maximize the amount of waiver money the state can receive.

Nearly 8 out of 1,000 children were taken from their homes in Nebraska in 2010, compared with 3.4 nationally, the report found. The report also found a "racial bias" in foster care placements, with African-American children entering the system at a rate 3.4 times higher than the general population, and Native American children at 6.8 times greater.


Sunday, March 11, 2012

Oklahoma's broken DHS system spurred local advocates to ask Children's Rights for help

Here's a very informative link that contains info that others might be able to use.

Story on DCS hotline call is blocked - Indiana

Newspaper had posted information based on report that children were abused

The Indiana Court of Appeals approved an emergency request Friday from the Department of Child Services that prevents the South Bend Tribune from publishing a story based on the recording of a call made last year to the state's child abuse hotline.

On Tuesday, a St. Joseph County judge ordered DCS to release a copy of the May call to the hotline alleging 10 children were being abused in a South Bend home.

The Tribune briefly posted a story on its website based on the tape, along with audio clips from the 20-minute call. Both were removed after the appeals court ordered a stay of the local court order late Friday afternoon.

The Court of Appeals also set a hearing on the matter for Monday.

"We were very, very disappointed," said Tribune Executive Editor Tim Harmon. "The material that we received after the juvenile court judge's order is clearly something the public needs to know about. It is something we have reported about in the past and will continue to report about."

Harmon said the newspaper planned to use material from the call "very responsibly," and the story that was briefly posted did not include the caller's name or gender. It also did not use the names of the children involved.

One of those children was 10-year-old Tramelle Sturgis, who was fatally beaten about six months later. His father, Terry Sturgis, is charged with murder in the boy's death.

DCS already has released paper copies of the Sturgis family's files. Those records included information detailing allegations made in the May call to the hotline. They also reveal that a DCS worker did not make contact with the family until four days after that call.

A few weeks later, the worker ruled the allegation of abuse was unfounded.

However, the circumstances of Tramelle's killing -- he was beaten to death with a wooden club -- closely matched details of the abuse allegation in the hotline call.

Ann Houseworth, DCS spokeswoman, said she was unable to discuss details of pending litigation but did issue a brief written statement.

"The child protection process by statute begins with the call to the hotline -- 1-800-800-5556," Houseworth said.

"The statute requires and callers expect confidentiality when those calls are made. Disclosure of the identification of a caller will have a chilling effect on the willingness of people to call in and report abuse and neglect. Children will be in harm's way if the identity of the caller is disclosed. We will aggressively defend the statute and the confidentiality of those who care about children by calling in to report abuse and neglect."

The fight comes just one day after lawmakers gave final approval to Senate Bill 286. Included in the legislation addressing a number of DCS policy issues is a provision making recordings of calls to the hotline confidential unless a judge orders the information to be released.

Gov. Mitch Daniels could sign or veto the bill. The governor's spokeswoman, Jane Jankowski, said Daniels had no comment on the legal dispute.

DCS Director James Payne repeatedly has pledged that the agency would be open and transparent.

But one critic of the agency, Dawn Robertson of the family-rights group, says that has not been her experience.

"I've heard Director Payne say over and over how DCS would be open and transparent," she said. "In the years since, families we have worked with have repeatedly run into hurdles just getting their own records.

"So why would you think DCS was going to allow more access to information that would help the public determine whether or not the agency's actions are correct or appropriate?"