Emissions Standards in MarylandThe people of Maryland...

THE BALTIMORE SUN

Emissions Standards in Maryland

The people of Maryland continue to be misled.

They've been promised dramatic environmental benefits if they endorse the adoption of California's Low Emission Vehicle (LEV) regulations for new cars and trucks in Maryland.

At the same time, they've been threatened with economic chaos if they don't. In reality, the facts don't support either contention.

LEV proponents have obscured the fact that, starting next year, new cars and trucks are subject to much stricter pollution controls under the Federal Clean Air Act of 1990. Under existing law, they will become about 98 percent cleaner than pre-control vehicles.

When the LEV standards take effect in California, tailpipe emissions there will drop to about 99 percent below uncontrolled vehicles. That's a variance of only about 1 percent from the cars and trucks available in the rest of the nation ' so insignificant that it would be virtually imperceptible to the environment in Maryland.

Dealing with those few remaining traces of pollutant as required by the LEV program is an enormous task requiring sophisticated control systems and special fuels.

Meeting the LEV standards will come at a dear price to consumers. When Virginia rejected the LEV proposal, the cost of needed controls was estimated to be $645. Other independent consultants, widely respected for their competence, estimated the increased cost from $911 to $1,342 per vehicle.

And controls are only half the California regulation. Their law also mandates a cleaner, specially reformulated "California" gasoline. Consumers in California ' and, by federal law, in any state that adopts the LEV program ' expect to pay perhaps 20 cents or more per gallon for the fuel needed to make the LEV controls function properly.

The Maryland Department of the Environment (DOE) says it won't mandate the California fuels, but New York tried that approach and the federal court ruled they must adopt the complete LEV package, including "California" fuels.

No one really knows what the cost might be, because nobody has yet developed a vehicle that successfully meets all the LEV requirements, in spite of what LEV advocates have told the citizens of Maryland.

A recent study prepared with the help of Maryland's DOE concluded that the LEV program won't have a significant impact the environment of the region.

The new federal standard coupled with other measures already proposed for Maryland could reduce total motor vehicle pollution by about 62 percent.

If the LEV program were adopted, the incremental reduction would be a little more than 2 percent, not the 50-to-75 percent improvement LEV proponents want people to believe.

If the state wants measurable air quality improvement, it can take a significant step right now and beef up its inspection and maintenance program to address the greatest source of motor vehicle pollution: the older, high-emitting vehicles still on the road today. That action alone could deliver significant and immediate environmental gains.

The threat of an economic disaster in Maryland without LEV is also flawed. Motor vehicles account for only about 25 percent of the man-made pollutants that can develop into the culprit ozone. The other 75 percent comes from a variety of sources including businesses, homes and utilities.

To comply with the Clean Air Act, the state must consider stricter controls on other pollution sources as well, no matter what it does with the LEV standards. If the people of Maryland elect to adopt the California LEV program, they stand to pay a great deal and gain very little if anything.

The continuing depiction of LEV as a "must" for cleaner air in Maryland is both misleading and a disservice to the consumer.

Alan R. Weverstad

Detroit

The writer is manager of emissions compliance for General Motors Corporation.

Dying and Citizens' Rights

The eloquent article by Lillibeth Navarro (Opinion Commentary, March 10) regarding health care decision-making legislation now pending in Annapolis is an important contribution to the discussion.

Ms. Navarro brings to public attention the importance of not only facilitating individual health care choices by and for the dying, but also maintaining our respect for the living and for the purposes and integrity of the health care professions.

Sara Engram of The Sun has well presented in her columns the common objectives of the several proposals before the General Assembly.

The sponsors of those bills and the various organizations and individuals involved in their drafting have been working in a cooperative way to respect the values of everyone who has an interest in how this state responds to these important questions.

Those questions center on the values to which Ms. Navarro's commentary gives eloquent witness.

How should the legislature give assurance of dignity in every citizen's final moments but also avoid dehumanizing vulnerable and disabled persons?

How should the General Assembly assure personal health care decision-making by every citizen (and also strengthen the role of families in those decisions when that is necessary and appropriate) without giving carte blanche authority to persons who may have legal power (as health care agents or guardians or surrogate family members), but who may not have full respect for the true interests and wishes of the ill person whose life they control?

Family involvement is a very valuable component of health care today, but as we have learned through the testimony of nurses who work in the hospitals and nursing homes of this state on a daily basis:

There is a wide range among individual and emotional capabilities in any situation, much less one with the degree of stress inherent in life-ending situations. Family relationships are psychologically very complex and motives unclear even under the best of circumstances.

Differentiating between the best interests and wishes of the patient as opposed to those of the decision-maker is extremely difficult whether the motivation is altruism, guilt, greed or some combination.

Medical judgment communicated to surrogates may be poorly received (beheading the messenger) and may result in anger-influenced decisions which could be contrary to sound professional judgments. . .

Dying is certainly the most intimate of human experiences, and therefore it is important to strengthen the right of citizens to speak for themselves and exercise maximum possible control while they are competent to do so.

There is some difference of opinion, however, regarding the extent to which others may speak for persons who have not, or are not able to, express a health care decision at the moment a decision is needed.

It does not advance anyone's personal autonomy to give someone else unrestrained authority to make decisions that may border on, if not in fact be, decisions which in Ms. Navarro's words:

"... Endanger the lives of people with mental disabilities or mental retardation, whose struggles with pain or death can be confused by even well-meaning relatives and friends who don't really understand disability.

"Such people may be extremely depressed or simply unable to (( reasonably process medical information. Accident and crime victims who are unconscious or in a coma may be similarly at risk."

Legislators, lawyers, scholars, judges, health care professionals and interested citizens are working in good faith to answer the question:

When does a "protection" of vulnerable incompetent patients become an "obstacle" to individual health care decision-making?

All of the bills now under consideration search for the fine line that fairly separates protection of vulnerable patients and affirmance of an individual's right to unmolested personal control of their health care. That line is elusive and there is little doubt the search will continue in this and future sessions of the General Assembly ...

John Carroll Byrnes

Baltimore

The writer chairs the Health Care Decision Act Drafting

Committee of the Conference of Circuit Judges.

The Need for Primary Care Physicians

Much is written concerning activities at the federal level to address changes in the medical care delivery system. States including Maryland are wrestling with this problem as well, since the costs threaten to wreck their budgets.

There is also the realization that federal changes probably will take longer than is being projected, while the clamor is for more immediate relief.

The emphasis is rightly on improving access while making the services affordable without sacrificing quality of care. Most agree that more expenditure is not the answer, since this country already utilizes 14 percent of gross national product for health care, while other Western nations consume only 6 to 9 percent.

At the same time, critical indicators of a nation's health reveal that, despite expenditures, we rank nowhere near the top.

Those concerned with this problem are beginning to recognize that the tendency toward over-specialization is one of the major causes. It has resulted in over-use of expensive testing, higher fees for services, lessened emphasis on less-costly preventive measures and often over-medication (especially when the patient is being seen by more than one specialist).

Because of failure to train the proper kind of physician, we are seeing a dearth of medical practitioners in rural areas.

Inner city patients are often allowing illnesses to become more advanced prior to seeking attention. They then use hospital emergency rooms where they receive impersonal, episodic, stopgap care at comparatively exorbitant costs.

It is becoming increasingly evident that no change in our malfunctioning medical care delivery system can have more than limited effect unless we insist that medical schools train more primary care physicians.

While it is true that many factors contribute to this inadequate supply, the medical schools are a major and initial factor.

In this country, family physicians, internists and pediatricians are considered primary care physicians, yet 65 percent of internists continue their training to become cardiologists, pulmonologists, gastroenterologists, etc., and are not properly available as primary care physicians. And 35 percent of those who train as pediatricians do likewise.

In Canada, only family physicians are considered to be primary ++ care physicians, and they constitute over 50 percent of the total supply of physicians. In this country, less than 15 percent are family physicians, and their numbers are diminishing.

Maryland has three training programs for family physicians, capable of providing at most 25 per year. Last year, only 23 were graduated. This does not even replace the number lost each year through death and retirement.

Only two medical schools provide physicians for Maryland. In only one is there even a department of family medicine, or residency training program, and in that one the number being produced is grossly inadequate.

The admissions committees of the medical schools need to be sensitive to the types of students they enroll. Their curriculums need to be changed to emphasize ambulatory patients, who represent the overwhelming numbers of patients seen in practice.

The students need to be exposed to physicians' offices, urban and rural. They need exposure to the ancillary medical and social support services available in these settings, including home care.

The faculties of these institutions must be encouraged to regard the family physician as the "captain of the ship" for each patient, and not as a provider who is inferior and to be looked down upon.

The medical schools in this state have essentially told us, "Don't tell us how to run our schools." I contend that as institutions in Maryland, they have a responsibility to make available to citizens an adequate number of the proper types of providers.

There are many other medical schools in this country doing a much superior job in this respect. Jefferson Medical School in Philadelphia is one proximal example.

Our legislators need to do what counterparts in some other states are beginning to do: tie the money provided to these institutions to the number of family physicians they graduate.

It is positively shameful that the Maryland Health Resources Planning Commission should have reported that three of Maryland's counties are considered completely under-served and that portions of nine other counties and of Baltimore City are felt to be likewise lacking in adequate medical services.

Marion Friedman, M.D.

Baltimore

The writer chairs the manpower advisory committee of the Maryland Academy of Family Physicians.

Indictment of Dr. Mudd

As a retired FBI agent, I was one of nine witnesses who testified at the Pentagon hearing regarding Dr. Samuel A. Mudd in January 1992.

I was also in attendance at the University of Richmond moot court proceeding on Feb. 12 of this year, wherein three prestigious judges (including one from the South Carolina State Supreme Court) reviewed Dr. Mudd's 1865 trial by a military commission and stated that he had been wrongfully convicted.

Because of this, I am totally unable to understand why you gave such prominence in your March 10 edition to an article by Jeffrey St. John, whose analysis was filled with errors of fact and showed an appalling lack of historical objectivity.

In belittling the moot court findings, Mr. St. John complained that lawyers should never be allowed to judge history. In response, I would say that if his observations are typical, historians should never be allowed to judge the law.

To begin with, he refers to testimony given "at his trial" by Mudd, whereas neither Mudd nor any of the other defendants was allowed to testify before the commission. This issue was addressed in considerable detail at the Pentagon hearing last year.

Mr. St. John also states that David Herold, Booth's companion on his flight to Virginia, "testified" that Mudd had offered Booth a razor and suggested that he shave off his mustache as a means of disguise.

Where this so-called testimony took place I have no idea. Like Mudd, Herold was not allowed to defend himself during the trial, and an affidavit he provided the authorities on April 27, 1865 makes no mention of Mudd by name or of the alleged incident involving the razor. As far as I can determine, he gave no other "testimony."

Mr. St. John also charges that Mudd provided Booth and Herold with a slave to guide them in their escape. This sentence contains two serious errors: (1) Mudd provided no one to guide the assassin, and (2) the man who was ultimately hired by Booth to serve as his guide was not a slave but was Oswald Swann, a free farmer of mixed black and Piscataway Indian lineage.

Another statement of dubious ancestry attributes to Sam Cox Jr. an admission from Mudd in 1877 that he had been part of Booth's original plot to kidnap President Lincoln, and that Mudd had later repented and threatened to expose him until Booth pleaded "in the name of his mother not to do so."

Why Mudd would have given a political opponent such damning material raises considerable doubts about the alleged quote. Even so, the details of the story which I have found in two sources - both in Cox's handwriting - vary substantially from the ones related by Mr. St. John and have nothing whatsoever to do with the aborted kidnap conspiracy.

Cox, in these two separate sources, said that Mudd treated Booth's broken leg, rode into Bryantown on some errands and was shocked to find out that Lincoln had been killed and that Booth was the suspected assassin. According to Cox, Mudd then returned home and ordered Booth out of the house, saying he would contact the authorities until Booth pleaded with him "in the name of his mother not to do so."

Granted, this story would be bad enough, if true - and it goes against everything Mudd ever told anyone else - but it certainly doesn't say much for the research done by Mr. St. John, unless he has found still a third document, which would further undermine Cox's reliability.

Ironically, it should be noted that while Mudd had innocently taken in the crippled assassin and splinted his leg, Cox, his foster-father and his foster-uncle had all hidden Booth and Herold for approximately a week, knowing full well who they were and what they had done, and then helped them cross the Potomac River into Virginia.

Mr. St. John also quotes from the autobiography of one Louis J. Weichmann (nee Wiechmann), who claimed that his testimony at the 1865 trial had been "very important" because it had linked Booth and Mudd in some sort of evil conspiracy.

bTC On the other hand, it should be noted that when Mudd's attorney asked Weichmann on cross-examination if he had ever seen or heard Mudd do anything to suggest his participation in such a conspiracy, he said that he had not.

Also, Mr. St. John would do well to note in the 1865 trial transcript that Booth did not buy any horses at all from Mudd but had purchased one from his neighbor, Squire George Gardiner.

Likewise, testimony at the trial did not establish "intimate" ties between Booth and Mudd. Instead they showed that the two men had met only twice prior to the assassination, and as a member of the military commission reportedly said at the time, the only reason anyone had ever heard of Mudd was because Booth had broken his leg and needed medical attention.

Despite all these errors of fact and faulty research, Mr. St. John feels qualified to state that the evidence presented against Mudd "was sufficiently substantial to warrant the sentence he received."

Three highly respected judges, however, did not think so this past February, when one observed from the bench, "I have serious doubts whether an impartial military panel distanced from the moment ... would have found the evidence presented was sufficient beyond a reasonable doubt." Another added, "There is nothing to suggest that he [Mudd] agreed with or participated in the assassination."

In January 1992, I testified at the Pentagon as a professional law enforcement officer, with 27 years in the FBI and four as chief of police in Prince George's County.

After analyzing all the testimony presented against Mudd over a century ago, I stated that the investigation had been seriously flawed and that today it wouldn't even have resulted in a grand jury indictment, let alone a conviction in open court.

As the most highly regarded newspaper in Maryland, The Sun has an obligation to its readers before presenting an article of this magnitude as factual and worthy of consideration.

I hope you will take appropriate steps to correct the record ...

John E. McHale Jr.

Suitland

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