UCLA Medical Center gets failing grade on patient safety

A national report card on patient safety gave a failing grade to Ronald Reagan UCLA Medical Center, one of the country's most prestigious hospitals and one of only 25 nationwide to receive such low marks.

In a report issued Wednesday, the Leapfrog Group, an employer-backed nonprofit group focused on healthcare quality, gave a letter grade of F to UCLA Medical Center for performing poorly on several measures tied to preventing medical errors, patient infections and deaths.

Leapfrog withheld a failing grade for UCLA in June when it released its first-ever hospital safety scores to give low-performing hospitals time to show improvement.

Officials at UCLA disputed the failing grade and they said one patient death in 2010 unfairly lowered its grade from a C to an F under Leapfrog's methodology.

"UCLA is not an F hospital in quality and safety," said Tom Rosenthal, chief medical officer at Ronald Reagan UCLA Medical Center. "It is not a fair scoring system and it does a disservice to the public."

This debate over UCLA's score comes amid a proliferation of healthcare ratings by outside organizations trying to provide more information to consumers and employers. These scores are also taking on greater importance as some insurers and employers use them as one factor in determining whether a hospital or doctor should be included in a provider network.

Given those stakes, the California Hospital Assn. has called on Leapfrog and other rating organizations to offer more details on how their scores are tabulated and to focus on reliable measures that can assess patient care. Some highly regarded hospitals across the country, such as UCLA, fare well in one ranking and then poorly in the next.

Leapfrog gave an F to one other area hospital, Western Medical Center Anaheim. The hospital said it disagreed with Leapfrog's rating methods and added that it "continuously adds new systems to enhance our patient care."

Cedars-Sinai Medical Center received an A in Leapfrog's June report, but its grade dropped to a C on this latest review, which included more recent data from last year. Thirty Kaiser Permanente hospitals received an A and one got a B from Leapfrog.

Experts urge consumers to use these score cards as one tool in evaluating a hospital and to discuss any specific concerns with their doctor and other medical providers.

Leapfrog estimates that 180,000 Americans die annually from hospital accidents, errors and infections, and it says hospitals need to do more to protect patients from harm. Its hospital safety score is derived from 26 measures of publicly reported data.

Rosenthal said UCLA scores well on healthcare quality and patient outcomes on numerous measures tracked by the federal government and other rating organizations, suggesting that Leapfrog's methods are potentially flawed.

He said a liver transplant patient died during surgery in 2010 from an air embolism, one of several preventable medical errors that Leapfrog and other groups regularly track. Rosenthal said the patient's death was a regrettable mistake, but that error hasn't occurred since then.

Leah Binder, Leapfrog's president and chief executive, said her group's scoring methods are statistically valid and devised by a panel of leading experts in patient safety. She said UCLA scored poorly in several areas of patient care, such as foreign objects left in a patient during surgery and pressure ulcers.

"It isn't just one incident that gave them a score so far below the national average," Binder said. "We see it all the time that a hospital might have a stellar reputation, but behind the scenes they aren't safe for many of their patients."

On pressure ulcers, Rosenthal said, UCLA looked worse than its actual performance because of over-reporting in the hospital billing data that was reviewed by Leapfrog.

Overall, Leapfrog gave an A or B to 1,468 hospitals, or 56% of the 2,618 reviewed nationwide. The group issued a C to 1,004 hospitals, or 38%. At the bottom, 146 hospitals, or 6%, were labeled D or F.

Leapfrog reviewed 246 hospitals in California. The ratings are available online at http://www.hospitalsafetyscore.org.

chad.terhune@latimes.com

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Program opens door to citizenship for immigrants

Ricardo Sepida gets emotional when he sees his son-in-law in a Navy uniform. Even aircraft carriers make him misty-eyed. There is no better country than the United States, says Sepida, an immigrant from the Philippines.

Yet despite possessing a green card for 40 years, Sepida has never become an American citizen. Life got in the way, as he raised two children, worked a full-time job as a biomedical technician and ran side businesses on the weekends.

"I was so busy at work, I had so many things to do and I'd forget about it," said Sepida, 61, of Sylmar. "I regret it now. I should have done it a long time ago."

Sepida is among the millions of immigrants who are eligible for citizenship but have postponed the milestone, whether because of the $680 fee, a busy schedule or fear of the English and civics exams. In 2011, about 750,000 immigrants applied for naturalization out of the 8.5 million who were eligible.

A $20-million effort is now under way to get more permanent residents to become citizens so they can vote, have access to a wider range of jobs and become fully American. The money for the New Americans Campaign comes from major foundations and is going mainly to nonprofits that have already been doing citizenship work. Two former commissioners of the Immigration and Naturalization Service have signed on as advisors.

"We're going to just grow the number of people who aren't really completely part of the American fabric, who aren't pitching their tent, unless we get them off the sideline and into the game," said Eric Cohen, executive director of the Immigrant Legal Resource Center, which is the campaign's main coordinator.

The campaign is being touted as bipartisan — Doris Meissner and James Ziglar, the two former INS leaders, served under Presidents Clinton and George W. Bush, respectively. Organizers chose to launch the effort after the November presidential election to avoid any association with partisan voter registration drives, Meissner said.

With the growing clout of Latinos and Asian Americans, who voted for Democrat Barack Obama over Republican Mitt Romney by a ratio of nearly three to one, an increase in naturalization rates could have an effect on local and national politics.

Los Angeles is among eight cities targeted by the New Americans drive, which will last three to five years. The cities, which also include Charlotte, Dallas, Detroit, Houston, Miami, New York and San Jose, are home to about 40% of those who qualify for citizenship.

The money will pay for more workshops to help immigrants fill out the 10-page application and prepare for the exams. The New Americans project will also fund outreach efforts like the CitzenshipWorks website, which provides application guidance in English, Spanish, Chinese and Vietnamese.

Separately, U.S. Citizenship and Immigration Services, which processes applications and is a successor agency to INS, has worked with Los Angeles officials to install a "citizenship corner" in each of the city's 73 public libraries.

"It's one of those things where you don't know how good it is unless you experience it," said Phyllis Coven, director of U.S. Citizenship and Immigration Services' Los Angeles office. "It's a great gift, an honor and a privilege to hold a U.S. passport and become a full member of this society."

At the Chinatown library, the most pressing issue is English fluency, said Shan Liang, the branch manager. Elderly Chinese immigrants flock to the library's free English and civics classes, but some have a long way to go before they can answer such questions as, "Why did the colonists fight the British?" The cost can also be an issue for retirees living on a fixed income, Liang said.

"It is an intimidating process. It is quite a lot of questions," said Joyce Noche, head of the citizenship and immigration project at the Asian Pacific American Legal Center, one of the groups conducting workshops under the program. "Our attorneys can't actually answer all the questions themselves. It is not a walk in the park."

Typically, the naturalization process takes about five months from submitting the initial application to reciting an oath of allegiance at a group swearing-in ceremony.

On a recent Saturday morning, Sepida attended a New Americans workshop in North Hills with his wife, Sally, who has been a citizen for decades. Among a group of procrastinators, Sepida stood out.

Tony Lu, who coordinates the CitizenshipWorks project for the Immigration Advocates Network, examined Sepida's permanent resident card. The pale blue document, dating from 1972, was so old that Lu had never seen that version of it. (Most versions are beige or pink; the agency returned to its original green hue in 2010).

Sepida sat down at a computer to work on his application. Others got one-on-one help with pen and paper, leaving with a completed application and free flashcards to practice English vocabulary and civics.

Elizabeth Lopez Perez, 45, who was brought across the Mexican border when she was 2, got her green card more than 25 years ago. As a single mother raising three children, she hardly had a spare moment.

Now, the impediment is the $680 application fee. The former nursing assistant, who has been unemployed for the last six years, hoped to qualify for a fee waiver for low-income applicants.

"Before, I didn't have the time, and I had the money," said Lopez Perez, of North Hills. "Now I have the time, and I don't have the money."

cindy.chang@latimes.com

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India: 2 policemen suspended, magistrate transferred for arrest of 2 women over Facebook post

NEW DELHI – An Indian official says two senior policemen have been suspended for arresting two women over a Facebook post criticizing the shutdown of Mumbai for the funeral of a powerful politician.

Maharashtra state Home Minister R.R. Patil said Tuesday the policemen were suspended indefinitely and the magistrate who registered the case against the women has been transferred to another district.

Police also arrested nine men who vandalized a medical clinic run by the uncle of one of the women, Patil said.

One of the women had posted a Facebook comment complaining that Mumbai had come to a standstill after the death of rightwing leader Bal Thackeray. Her friend “liked” the post.

Their arrest last week was seen as a misuse of Internet laws and an attempt to curb freedom of expression.

Social Media News Headlines – Yahoo! News

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Berry's ex says he was threatened before fight

LOS ANGELES (AP) — Halle Berry's ex-boyfriend claims the actress's fiance threatened to kill him during a Thanksgiving confrontation that left him with a broken rib, bruised face and under arrest.

Gabriel Aubry's claims are included in court filings that led a judge Monday to grant a restraining order against actor Olivier Martinez, who is engaged to the Oscar-winning actress.

Aubry, 37, was arrested on suspicion of misdemeanor battery after his confrontation with Martinez on Thursday, but he states in the civil court filings that he was not the aggressor and that he was threatened and attacked without provocation. Martinez told police that Aubry had attacked first, the filings state.

A representative for Martinez could not be immediately reached for comment.

Aubry's filing claims Martinez threatened him the day before the fight at an event at his daughter's school that he and the actors attended. Aubry, a model, has a 4-year-old daughter with Berry and the former couple have been engaged in a lengthy custody battle.

The proceedings have been confidential, but Aubry states a major aspect of the case was Berry's wish to move to Paris and take her daughter with her. The request was denied Nov. 9, Berry's court filings state, and Aubry shares joint custody of the young girl.

Aubry claims Martinez told him, "You cost us $3 million," while he was punched and kicked him in the driveway of Berry's home. Aubry had gone to the home to allow his daughter to spend Thanksgiving with her mother, the filings state. Aubry claims Martinez threatened to kill him if Aubry didn't move to Paris.

Berry was not in the driveway during the confrontation and neither was their daughter, the documents state.

Photos of Aubry's face with cuts and a black eye were included in his court filing.

A judge set a hearing for Dec. 17 to consider whether a three-year restraining order should be granted. Aubry has a Dec. 13 court date for the possible battery case, which has not yet been filed by prosecutors.

___

Anthony McCartney can be reached at http://twitter.com/mccartneyAP .

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Clearing the Fog Around Personality Disorders

For years they have lived as orphans and outliers, a colony of misfit characters on their own island: the bizarre one and the needy one, the untrusting and the crooked, the grandiose and the cowardly.

Their customs and rituals are as captivating as any tribe’s, and at least as mystifying. Every mental anthropologist who has visited their world seems to walk away with a different story, a new model to explain those strange behaviors.

This weekend the Board of Trustees of the American Psychiatric Association will vote on whether to adopt a new diagnostic system for some of the most serious, and striking, syndromes in medicine: personality disorders.

Personality disorders occupy a troublesome niche in psychiatry. The 10 recognized syndromes are fairly well represented on the self-help shelves of bookstores and include such well-known types as narcissistic personality disorder, avoidant personality disorder, as well as dependent and histrionic personalities.

But when full-blown, the disorders are difficult to characterize and treat, and doctors seldom do careful evaluations, missing or downplaying behavior patterns that underlie problems like depression and anxiety in millions of people.

The new proposal — part of the psychiatric association’s effort of many years to update its influential diagnostic manual — is intended to clarify these diagnoses and better integrate them into clinical practice, to extend and improve treatment. But the effort has run into so much opposition that it will probably be relegated to the back of the manual, if it’s allowed in at all.

Dr. David J. Kupfer, a professor of psychiatry at the University of Pittsburgh and chairman of the task force updating the manual, would not speculate on which way the vote might go: “All I can say is that personality disorders were one of the first things we tackled, but that doesn’t make it the easiest.”

The entire exercise has forced psychiatrists to confront one of the field’s most elementary, yet still unresolved, questions: What, exactly, is a personality problem?

Habits of Thought

It wasn’t supposed to be this difficult.

Personality problems aren’t exactly new or hidden. They play out in Greek mythology, from Narcissus to the sadistic Ares. They percolate through biblical stories of madmen, compulsives and charismatics. They are writ large across the 20th century, with its rogues’ gallery of vainglorious, murderous dictators.

Yet it turns out that producing precise, lasting definitions of extreme behavior patterns is exhausting work. It took more than a decade of observing patients before the German psychiatrist Emil Kraepelin could draw a clear line between psychotic disorders, like schizophrenia, and mood problems, like depression or bipolar disorder.

Likewise, Freud spent years formulating his theories on the origins of neurotic syndromes. And Freudian analysts were largely the ones who, in the early decades of the last century, described people with the sort of “confounded identities” that are now considered personality disorders.

Their problems were not periodic symptoms, like moodiness or panic attacks, but issues rooted in longstanding habits of thought and feeling — in who they were.

“These therapists saw people coming into treatment who looked well put-together on the surface but on the couch became very disorganized, very impaired,” said Mark F. Lenzenweger, a professor of psychology at the State University of New York at Binghamton. “They had problems that were neither psychotic nor neurotic. They represented something else altogether.”

Several prototypes soon began to emerge. “A pedantic sense of order is typical of the compulsive character,” wrote the Freudian analyst Wilhelm Reich in his 1933 book, “Character Analysis,” a groundbreaking text. “In both big and small things, he lives his life according to a preconceived, irrevocable pattern.”

Others coalesced too, most recognizable as extreme forms of everyday types: the narcissist, with his fragile, grandiose self-approval; the dependent, with her smothering clinginess; the histrionic, always in the thick of some drama, desperate to be the center of attention.

In the late 1970s, Ted Millon, scientific director of the Institute for Advanced Studies in Personology and Psychopathology, pulled together the bulk of the work on personality disorders, most of it descriptive, and turned it into a set of 10 standardized types for the American Psychiatric Association’s third diagnostic manual. Published in 1980, it is a best seller among mental health workers worldwide.

These diagnostic criteria held up well for years and led to improved treatments for some people, like those with borderline personality disorder. Borderline is characterized by an extreme neediness and urges to harm oneself, often including thoughts of suicide. Many who seek help for depression also turn out to have borderline patterns, making their mood problems resistant to the usual therapies, like antidepressant drugs.

Today there are several approaches that can relieve borderline symptoms and one that, in numerous studies, has reduced hospitalizations and helped aid recovery: dialectical behavior therapy.

This progress notwithstanding, many in the field began to argue that the diagnostic catalog needed a rewrite. For one thing, some of the categories overlapped, and troubled people often got two or more personality diagnoses. “Personality Disorder-Not Otherwise Specified,” a catchall label meaning little more than “this person has problems” became the most common of the diagnoses.

It’s a murky area, and in recent years many therapists didn’t have the time or training to evaluate personality on top of everything else. The assessment interviews can last hours, and treatments for most of the disorders involve longer-term, specialized talk therapy.

Psychiatry was failing the sort of patients that no other field could possibly help, many experts said.

“The diagnoses simply weren’t being used very much, and there was a real need to make the whole system much more accessible,” Dr. Lenzenweger said.

Resisting Simplification 

It was easier said than done.

The most central, memorable, and knowable element of any person — personality — still defies any consensus.

A team of experts appointed by the psychiatric association has worked for more than five years to find some unifying system of diagnosis for personality problems.

The panel proposed a system based in part on a failure to “develop a coherent sense of self or identity.” Not good enough, some psychiatric theorists said.

Later, the experts tied elements of the disorders to distortions in basic traits.

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FDA halts operations of organic peanut butter processor Sunland

The Food and Drug Administration has halted operations of the country's largest organic peanut butter processor, cracking down on salmonella poisoning for the first time with the new enforcement authority the agency gained in a 2011 food safety law.

FDA officials found salmonella all over Sunland Inc.'s New Mexico processing plant after 41 people in 20 states, most of them children, were sickened by peanut butter manufactured at the Sunland plant and sold at the Trader Joe's grocery chain. The FDA suspended Sunland's registration Monday, preventing the company from producing or distributing food.

The food safety law gives the FDA authority to suspend a company's registration when food manufactured or held there has a "reasonable probability" of causing serious health problems or death. Before the food safety law was enacted early last year, the FDA would have had to go to court to suspend a company's registration.

Sunland had planned to reopen its peanut processing facility Tuesday. A spokeswoman said before the FDA's announcement Monday that the company hoped to be selling peanut butter again by the end of the year. The spokeswoman didn't have an immediate comment on the suspension.

The company has the right to a hearing and must prove to the FDA that its facilities are clean enough to reopen.

Michael Taylor, the FDA's deputy commissioner for foods, said the ability to suspend a registration is a major step forward for the agency.

"Consumers can be assured that products will not leave this facility until we determine they have implemented preventive measures that are effective to produce safe products," Taylor said.

Sunland is the nation's largest organic peanut butter processor, though it also produces many non-organic products. The company recalled hundreds of organic and non-organic nuts and nut butters manufactured since 2010 after Trader Joe's Valencia Creamy Peanut Butter was linked to the salmonella illnesses in September.

Sunland sold hundreds of peanut products to many of the nation's large grocery chains other than Trader Joe's, including Whole Foods, Safeway, Target and others.

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States crack down on campaigning nonprofits

WASHINGTON — Tax-exempt advocacy groups that played an aggressive role in this year's election are coming under increasing scrutiny from state regulators, who are cracking down on organizations seeking to engage in campaigns without revealing their financial backers.

The pressure in states with stringent campaign finance rules contrasts sharply with the federal level, where nonprofits that spent hundreds of millions of dollars to influence races this year have not been required to disclose their donors.

This month, California's Fair Political Practices Commission forced an Arizona-based group to reveal the source of $11 million it gave for two ballot initiative campaigns. The funds were traced to a Virginia nonprofit that also does not reveal its donors. That hasn't satisfied the commission, which has begun an investigation to uncover the original source.

Shortly before election day, judges in Idaho and Montana required the disclosure of contributors to two nonprofit organizations that had drawn the attention of state regulators with their political activity.

"Frankly, if we didn't take a stand on this, we might as well just pack up our campaign disclosure law and send it away," said Idaho Secretary of State Ben Ysursa. "The fact that federal campaign laws are deficient or you've got a deadlocked Federal Election Commission — that doesn't mean the states are powerless."

Ysursa sued a group called Education Voters of Idaho, which gave more than $200,000 for ads backing three state ballot measures, accusing it of failing to comply with the state's sunshine law. After the court order, the organization revealed it had received money from New York Mayor Michael R. Bloomberg and Albertsons supermarket scion Joseph P. Scott, among others.

The clashes between state elections officials and advocacy groups are a byproduct of the U.S. Supreme Court's 2010 ruling in Citizens United vs. Federal Election Commission, which lifted the ban on direct political expenditures by corporations. That triggered a surge of election activity by groups incorporated under the tax code's section 501(c)4 as social welfare organizations, which are allowed to engage in issue advocacy.

At the federal level, political action committees are required to report their contributors, but so far the nonprofits are not.

The Federal Election Commission, which has six members split evenly between the major parties, is frozen in partisan gridlock on questions regarding nonprofit activity. The Internal Revenue Service said this summer that it had begun examining some of the groups, but had yet to take any public action. And efforts to pass new disclosure laws have so far foundered in Congress.

But the picture is different in many states, where lawmakers have toughened disclosure rules to require any organization making a political expenditure to report its financial backers.

Disclosure opponents have systematically challenged the state measures in court, arguing that the Supreme Court has said a group must have politics as its "major purpose" in order to be considered a political committee.

Advocates for more campaign finance reporting have countered — largely successfully — that the high court has repeatedly endorsed disclosure and has not limited it to political committees.

"If you look at the federal issue, you would be inclined to throw up your hands," said Derek Cressman, vice president for state operations at Common Cause, which advocates for more transparency. "The progress that some states are making proves that these disclosure issues are problems we can solve."

Take the case of Americans for Job Security, a Virginia-based nonprofit that has been a serious political player for at least a dozen years, spending millions on ads without disclosing its backers.

In 2008, the FEC's general counsel concluded the trade group met the definition of a political committee that is required to report its donors, and requested approval to pursue a formal investigation. But the commission deadlocked, and no action was taken.

Early this month, Americans for Job Security played a role in one of California's most closely watched election-year dramas — unmasked as the source of an $11-million donation to oppose Gov. Jerry Brown's tax increase measure and support another measure intended to curb the ability of unions to raise money for political activity.

The money had first been routed to an Arizona group called the Center to Protect Patient Rights, which sent it to another nonprofit also based in Arizona called Americans for Responsible Leadership, which in turn gave the money to the conservative Small Business Action Committee in California to run ads about the ballot measures.

State authorities called it "campaign money laundering."

Ann Ravel, chairwoman of the Fair Political Practices Commission, said the contribution may have violated a rule implemented in May to prevent donors from anonymously shuttling money through nonprofits with the intention of spending it on California campaigns. If found in violation, the nonprofits involved could face millions of dollars in fines.

The Small Business Action Committee could also be forced to pay $11 million to the state's general fund if authorities prove it knowingly failed to report the original source of its funds, Ravel said.

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Betfair pulls out of Greece over permits row

LONDON (Reuters) – Online gambling exchange Betfair said it would withdraw from the Greek market until there was greater clarity on gaming regulation in the country.

Betfair, which has not yet applied for a permit to operate in Greece, questioned the cost and conditions attached to permits required by gaming firms to trade in the country.

“According to legal advice received, the value of these permits is unclear and we consider the gambling legislation in the country to be inconsistent with European law,” Betfair said on Monday.

“The associated fiscal conditions attached to these permits, which may include payment of taxes on historical revenues, make the market economically unattractive.”

Earlier this month the Greek Gaming Commission said gambling firms operating in Greece without a permit would face financial penalties and criminal sanctions.

Betfair said it believes there are “significant issues with the legality of this decision” by the Greek Gaming Commission.

It added that it was disappointed the European Commission had not moved to prevent what Betfair calls “protectionist behavior.”

Earlier this month Betfair, which launched 12 years ago and operates an exchange system that allows gamblers to bet against each other rather than the bookmaker, withdrew its online sports betting exchange in Germany because of a tax levied on stakes on sports events from July 2012.

The European Commission last month said it was not proposing EU-wide legislation to regulate online gambling.

Prior to Betfair’s decision to withdraw from the market, it had been expected to generate 13 million pounds ($ 20.81 million) of revenue from the Greek market in the current financial year.

($ 1 = 0.6246 British pounds)

(Reporting by Rhys Jones; editing by James Davey)

Internet News Headlines – Yahoo! News

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Rolling Stones mark 50th year with London show

LONDON (AP) — The Rolling Stones made a triumphant return to the London stage on Sunday night in the first of five concerts to mark the 50th anniversary of their debut as an American-oriented blues band.

They showed no signs of wear and tear — except on their aging, heavily lined faces — as frontman Mick Jagger swaggered and strutted through a stellar two-and-a-half hour show. He looked remarkably trim and fit and was in top vocal form.

The Stones passed the half-century mark in style at the sometimes emotional gig that saw former bassist Bill Wyman and guitar master Mick Taylor join their old mates in front of a packed crowd at London's 02 Arena.

It was the first of five mega-shows to mark the passage of 50 years since the band first appeared in a small London pub determined to pay homage to the masters of American blues.

Jagger, in skin-tight black pants, a black shirt and a sparkly tie, took time out from singing to thank the crowd for its loyalty.

"It's amazing that we're still doing this, and it's amazing that you're still buying our records and coming to our shows," he said. "Thank you, thank you, thank you."

Lead guitarist Keith Richards, whose survival has surprised many who thought he would succumb to drugs and drink, was blunter: "We made it," he said. "I'm happy to see you. I'm happy to see anybody."

But the band's fiery music was no joke, fuelled by an incandescent guest appearance by Taylor, who played lead guitar on a stunning extended version of the ominous "Midnight Rambler," and Mary J. Blige, who shook the house in a duet with Jagger on "Gimme Shelter."

The 50th anniversary show, which will be followed by one more in London, then three in the greater New York area, lacked some of the band's customary bravado — the "world's greatest rock 'n' roll band" intro was shelved — and there were some rare nostalgic touches.

Even the famously taciturn Wyman briefly cracked a smile when trading quips with Richards and Ronnie Wood.

The concert started with a brief video tribute from luminaries like Elton John, Iggy Pop and Johnny Depp, who praised the Stones for their audacity and staying power. The Stones' show contained an extended video homage to the American trailblazers who shaped their music: Muddy Waters, John Lee Hooker, Otis Redding, Bob Dylan, Johnny Cash and others. The montage included rare footage of the young Elvis Presley.

The Stones began their professional career imitating the Americans whose music they cherished, but they quickly developed their own style, spawning hundreds — make that thousands — of imitators who have tried in vain to match their swagger and style.

The concert began with some early Stones' numbers that are rarely heard in concert, including the band's cover of the Lennon-McCartney rocker "I Wanna Be Your Man" and the Stones original "It's All Over Now."

They didn't shy away from their darker numbers, including "Paint It Black" and "Sympathy for the Devil" — Jagger started that one wearing a black, purple-lined faux fur cape that conjured up his late '60s satanic image.

He even cracked a joke about one of the band's low points, telling the audience it was in for a treat: "We're going to play the entire "Satanic Majesty's Request" album now," he said, referring to one of the band's least-loved efforts, a psychedelic travesty that has been largely, mercifully, forgotten.

He didn't make good on his threat.

He also made fun of the sky-high ticket prices, which had exposed the band to some criticism in the London press.

"How are you doing up in the cheap seats," he said, motioning to fans in the upper rows of the cavernous 02 Arena. "Except they're not cheap seats, that's the problem."

But Jagger seemed more mellow than usual, chatting a bit about the good old days and asking if there was anyone in the crowd who had seen them in 1962, when they first took to the stage.

He said 2012 had been a terrific year for Britain and that the Stones nearly missed the boat, playing no role in the celebration of the Queen's Diamond Jubilee, the London Olympics, or the new James Bond film.

"We just got in under the wire," he said. "We feel pretty good."

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Agency Investigates Deaths and Injuries Associated With Bed Rails

Thomas Patterson for The New York Times

Gloria Black’s mother died in her bed at a care facility.

In November 2006, when Clara Marshall began suffering from the effects of dementia, her family moved her into the Waterford at Fairway Village, an assisted living home in Vancouver, Wash. The facility offered round-the-clock care for Ms. Marshall, who had wandered away from home several times. Her husband Dan, 80 years old at the time, felt he could no longer care for her alone.

Thomas Patterson for The New York Times

Gloria Black, visiting her mother’s grave in Portland, Ore. She has documented hundreds of deaths associated with bed rails and said families should be informed of their possible risks.

But just five months into her stay, Ms. Marshall, 81, was found dead in her room apparently strangled after getting her neck caught in side rails used to prevent her from rolling out of bed.

After Ms. Marshall’s death, her daughter Gloria Black, who lives in Portland, Ore., began writing to the Consumer Product Safety Commission and the Food and Drug Administration. What she discovered was that both agencies had known for more than a decade about deaths from bed rails but had done little to crack down on the companies that make them. Ms. Black conducted her own research and exchanged letters with local and state officials. Finally, a letter she wrote in 2010 to the federal consumer safety commission helped prompt a review of bed rail deaths.

Ms. Black applauds the decision to study the issue. “But I wish it was done years ago,” she said. “Maybe my mother would still be alive.” Now the government is studying a problem it has known about for years.

Data compiled by the consumer agency from death certificates and hospital emergency room visits from 2003 through May 2012 shows that 150 mostly older adults died after they became trapped in bed rails. Over nearly the same time period, 36,000 mostly older adults — about 4,000 a year — were treated in emergency rooms with bed rail injuries. Officials at the F.D.A. and the commission said the data probably understated the problem since bed rails are not always listed as a cause of death by nursing homes and coroners, or as a cause of injury by emergency room doctors.

Experts who have studied the deaths say they are avoidable. While the F.D.A. issued safety warnings about the devices in 1995, it shied away from requiring manufacturers to put safety labels on them because of industry resistance and because the mood in Congress then was for less regulation. Instead only “voluntary guidelines” were adopted in 2006.

More warnings are needed, experts say, but there is a technical question over which regulator is responsible for some bed rails. Are they medical devices under the purview of the F.D.A., or are they consumer products regulated by the commission?

“This is an entirely preventable problem,” said Dr. Steven Miles, a professor at the Center for Bioethics at the University of Minnesota, who first alerted federal regulators to deaths involving bed rails in 1995. The government at the time declined to recall any bed rails and opted instead for a safety alert to nursing homes and home health care agencies.

Forcing the industry to improve designs and replace older models could have potentially cost bed rail makers and health care facilities hundreds of million of dollars, said Larry Kessler, a former F.D.A. official who headed its medical device office. “Quite frankly, none of the bed rails in use at that time would have passed the suggested design standards in the guidelines if we had made them mandatory,” he said. No analysis has been done to determine how much it would cost the manufacturers to reduce the hazards.

Bed rails are metal bars used on hospital beds and in home care to assist patients in pulling themselves up or helping them out of bed. They can also prevent people from rolling out of bed. But sometimes patients — particularly those suffering from Alzheimer’s — can get confused and trapped between a bed rail and a mattress, which can lead to serious injury or even death.

While the use of the devices by hospitals and nursing homes has declined as professional caregivers have grown aware of the dangers, experts say dozens of older adults continue to die each year as more rails are used in home care and many health care facilities continue to use older rail models.

Since those first warnings in 1995, about 550 bed rail-related deaths have occurred, a review by The New York Times of F.D.A. data, lawsuits, state nursing home inspection reports and interviews, found. Last year alone, the F.D.A. data shows, 27 people died.

As deaths continued after the F.D.A. warning, a working group put together in 1999 and made up of medical device makers, researchers, patient advocates and F.D.A. officials considered requiring bed rail makers to add warning labels.

But the F.D.A. decided against it after manufacturers resisted, citing legal issues. The agency said added cost to small manufacturers and difficulties of getting regulations through layers of government approval, were factors against tougher standards, according to a meeting log of the group in 2000 and interviews.

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