A delicate new balancing act in senior healthcare

When Claire Gordon arrived at Cedars-Sinai Medical Center, nurses knew she needed extra attention.

She was 96, had heart disease and a history of falls. Now she had pneumonia and the flu. A team of Cedars specialists converged on her case to ensure that a bad situation did not turn worse and that she didn't end up with a lengthy, costly hospital stay.

Frail seniors like Gordon account for a disproportionate share of healthcare expenditures because they are frequently hospitalized and often land in intensive care units or are readmitted soon after being released. Now the federal health reform law is driving sweeping changes in how hospitals treat a rapidly growing number of elderly patients.

The U.S. population is aging quickly: People older than 65 are expected to make up nearly 20% of it by 2030. Linda P. Fried, dean of the Columbia University Mailman School of Public Health, said now is the time to train professionals and test efforts to improve care and lower healthcare costs for elderly patients.

"It's incredibly important that we prepare for being in a society where there are a lot of older people," she said. "We have to do this type of experiment right now."

At Cedars-Sinai, where more than half the patients in the medical and surgical wards are 65 or older, one such effort is dubbed the "frailty project." Within 24 hours, nurses assess elderly patients for their risk of complications such as falls, bed sores and delirium. Then a nurse, social worker, pharmacist and physician assess the most vulnerable patients and make an action plan to help them.

The Cedars project stands out nationally because medical professionals are working together to identify high-risk patients at the front end of their hospitalizations to prevent problems at the back end, said Herb Schultz, regional director of the U.S. Department of Health and Human Services.

"For seniors, it is better care, it is high-quality care and it is peace of mind," he said.

The effort and others like it also have the potential to reduce healthcare costs by cutting preventable medical errors and readmissions, Schultz said. The federal law penalizes hospitals for both.

Gordon, an articulate woman with brightly painted fingernails and a sense of humor, arrived at Cedars-Sinai by ambulance on a Monday.

Soon, nurse Jacquelyn Maxton was at her bedside asking a series of questions to check for problems with sleep, diet and confusion. The answers led to Gordon's designation as a frail patient. The next day, the project team huddled down the hall and addressed her risks one by one. Medical staff would treat the flu and pneumonia while at the same time addressing underlying health issues that could extend Gordon's stay and slow her recovery, both in the hospital and after going home.

To reduce the chance of falls, nurses placed a yellow band on her wrist that read "fall risk" and ensured that she didn't get up on her own. To prevent bed sores, they got her up and moving as often as possible. To cut down on confusion, they reminded Gordon frequently where she was and made sure she got uninterrupted sleep. Medical staff also stopped a few unnecessary medications that Gordon had been prescribed before her admission, including a heavy narcotic and a sleeping pill.

"It is really a holistic approach to the patient, not just to the disease that they are in here for," said Glenn D. Braunstein, the hospital's vice president for clinical innovation.

Previously, nurse Ivy Dimalanta said, she and her colleagues provided similar care but on a much more random basis. Under the project, the care has become standardized.

The healthcare system has not been well designed to address the needs of seniors who may have had a lifetime of health problems, said Mary Naylor, gerontology professor at the University of Pennsylvania School of Nursing. As a result, patients sometimes fall through the cracks and return to hospitals again and again.

"That is not good for them and that is not good for society to be using resources in that way," Naylor said.

Using data from related projects, Cedars began a pilot program in 2011 and expanded it last summer. The research is continuing but early results suggest that the interventions are leading to fewer seniors being admitted to the intensive care unit and to shorter hospital stays, said Jeff Borenstein, researcher and lead clinician on the frailty project. "It definitely seems to be going in the right direction," he said.

The hospital is now working with Naylor and the University of Pennsylvania to design a program to help the patients once they go home.

"People who are frail are very vulnerable when they leave the hospital," said Harriet Udin Aronow, a researcher at Cedars. "We want to promote them being safe at home and continuing to recover."

In Gordon's case, she lives alone with the help of her children and a caregiver. The hospital didn't want her experiencing complications that would lengthen the stay, but they also didn't want to discharge her before she was ready. Under the health reform law, hospitals face penalties if patients come back too soon after being released.

Patients and their families often are unaware of the additional attention. Sitting in a chair in front of a vase of pink flowers, Gordon said she knew she would have to do her part to get out of the hospital quickly. "You have to move," she said. "I know you get bed sores if you stay in bed."

Gordon said she was comfortable at the hospital but she wanted to go back to her house as quickly as she could. "There's no place like home," she said.

Two days later, that's where she was.

anna.gorman@latimes.com

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Chris Brown crashes car while evading paparazzi

BEVERLY HILLS, Calif. (AP) — Police in Beverly Hills say Chris Brown escaped injury after crashing his Porsche into a wall while being chased by paparazzi.

Lt. Lincoln Hoshino said the collision occurred around noon Saturday. Brown told police that he lost control of his black Porsche during the chase.

Hoshino said police will investigate the incident. He said he didn't know whether the paparazzi in the pursuing vehicles have been identified.

A call to Brown's lawyer was not immediately returned.

The crash came a day before the Grammy Awards, where Brown is up for best urban contemporary album.

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For Families Struggling with Mental Illness, Carolyn Wolf Is a Guide in the Darkness

When a life starts to unravel, where do you turn for help?

Melissa Klump began to slip in the eighth grade. She couldn’t focus in class, and in a moment of despair she swallowed 60 ibuprofen tablets. She was smart, pretty and ill: depression, attention deficit disorder, obsessive-compulsive disorder, either bipolar disorder or borderline personality disorder.

In her 20s, after a more serious suicide attempt, her parents sent her to a residential psychiatric treatment center, and from there to another. It was the treatment of last resort. When she was discharged from the second center last August after slapping another resident, her mother, Elisa Klump, was beside herself.

“I was banging my head against the wall,” the mother said. “What do I do next?” She frantically called support groups, therapy programs, suicide prevention lines, anybody, running down a list of names in a directory of mental health resources. “Finally,” she said, “somebody told me, ‘The person you need to talk to is Carolyn Wolf.’ ”

That call, she said, changed her life and her daughter’s. “Carolyn has given me hope,” she said. “I didn’t know there were people like her out there.”

Carolyn Reinach Wolf is not a psychiatrist or a mental health professional, but a lawyer who has carved out what she says is a unique niche, working with families like the Klumps.

One in 17 American adults suffers from a severe mental illness, and the systems into which they are plunged — hospitals, insurance companies, courts, social services — can be fragmented and overwhelming for families to manage. The recent shootings in Newtown, Conn., and Aurora, Colo., have brought attention to the need for intervention to prevent such extreme acts of violence, which are rare. But for the great majority of families watching their loved ones suffer, and often suffering themselves, the struggle can be boundless, with little guidance along the way.

“If you Google ‘mental health lawyer,’ ” said Ms. Wolf, a partner with Abrams & Fensterman, “I’m kinda the only game in town.”

On a recent afternoon, she described in her Midtown office the range of her practice.

“We have been known to pull people out of crack dens,” she said. “I have chased people around hotels all over the city with the N.Y.P.D. and my team to get them to a hospital. I had a case years ago where the person was on his way back from Europe, and the family was very concerned that he was symptomatic. I had security people meet him at J.F.K.”

Many lawyers work with mentally ill people or their families, but Ron Honberg, the national director of policy and legal affairs for the National Alliance on Mental Illness, said he did not know of another lawyer who did what Ms. Wolf does: providing families with a team of psychiatrists, social workers, case managers, life coaches, security guards and others, and then coordinating their services. It can be a lifeline — for people who can afford it, Mr. Honberg said. “Otherwise, families have to do this on their own,” he said. “It’s a 24-hour, 7-day-a-week job, and for some families it never ends.”

Many of Ms. Wolf’s clients declined to be interviewed for this article, but the few who spoke offered an unusual window on the arcane twists and turns of the mental health care system, even for families with money. Their stories illustrate how fraught and sometimes blind such a journey can be.

One rainy morning last month, Lance Sheena, 29, sat with his mother in the spacious family room of her Long Island home. Mr. Sheena was puffy-eyed and sporadically inattentive; the previous night, at the group home where he has been living since late last summer, another resident had been screaming incoherently and was taken away by the police. His mother, Susan Sheena, eased delicately into the family story.

“I don’t talk to a lot of people because they don’t get it,” Ms. Sheena said. “They mean well, but they don’t get it unless they’ve been through a similar experience. And anytime something comes up, like the shooting in Newtown, right away it goes to the mentally ill. And you think, maybe we shouldn’t be so public about this, because people are going to be afraid of us and Lance. It’s a big concern.”

Her son cut her off. “Are you comparing me to the guy that shot those people?”

“No, I’m saying that anytime there’s a shooting, like in Aurora, that’s when these things come out in the news.”

“Did you really just compare me to that guy?”

“No, I didn’t compare you.”

“Then what did you say?”

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Boeing 787 Dreamliner takes test flight to assess batteries

SEATTLE — Aerospace giant Boeing Co. sent a 787 Dreamliner passenger jet on a test flight Saturday, the first since the new airliner was grounded three weeks ago because of a battery fire.

The aircraft took off from Boeing Field in Seattle and spent more than two hours flying back and forth over the inland Columbia Plateau. It landed at Boeing Field shortly before 3 p.m. Pacific Time. According to flight-tracking website FlightAware, the aircraft flew 1,131 miles, slightly more than the 919 planned.

The Federal Aviation Administration granted permission for test flights Thursday.

The 787 is the first commercial airliner to rely heavily on lithium-ion batteries, the same kind used in cellphones. Each plane has two of the 63-pound blue power bricks, one near the front to provide power to the cockpit if the engines stop and one near the back to start up the auxiliary power unit, which is essentially a backup generator.

On Jan. 7, a battery on a plane that had recently landed in Boston short-circuited and caught fire. Nine days later, a battery on an All Nippon Airways plane started smoking, leading to an emergency landing in Japan.

Boeing said Saturday's flight was to assess the in-flight performance of the batteries. Data would be used to support continuing investigations of the recent incidents.

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Big Bear locked down amid manhunt

The bustling winter resort of Big Bear took on the appearance of a ghost town Thursday as surveillance aircraft buzzed overhead and police in tactical gear and carrying rifles patrolled mountain roads in convoys of SUVs, while others stood guard along major intersections.

Even before authorities had confirmed that the torched pickup truck discovered on a quiet forest road belonged to suspected gunman Christopher Dorner, 33, officials had ordered an emergency lockdown of local businesses, homes and the town's popular ski resorts. Parents were told to pick up their children from school, as rolling yellow buses might pose a target to an unpredictable fugitive on the run.

By nightfall, many residents had barricaded their doors as they prepared for a long, anxious evening.

PHOTOS: A tense manhunt amid tragic deaths

"We're all just stressed," said Andrea Burtons as she stocked up on provisions at a convenience store. "I have to go pick up my brother and get him home where we're safe."

Police ordered the lockdown about 9:30 a.m. as authorities throughout Southern California launched an immense manhunt for the former lawman, who is accused of killing three people as part of a long-standing grudge against the LAPD. Dorner is believed to have penned a long, angry manifesto on Facebook saying that he was unfairly fired from the force and was now seeking vengeance.

Forest lands surrounding Big Bear Lake are cross-hatched with fire roads and trails leading in all directions, and the snow-capped mountains can provide both cover and extreme challenges to a fugitive on foot. It was unclear whether Dorner was prepared for such rugged terrain.

Footprints were found leading from Dorner's burned pickup truck into the snow off Forest Road 2N10 and Club View Drive in Big Bear Lake.

San Bernardino County Sheriff John McMahon said that although authorities had deployed 125 officers for tracking and door-to-door searches, officers had to be mindful that the suspect may have set a trap.

"Certainly. There's always that concern and we're extremely careful and we're worried about this individual," McMahon said. "We're taking every precaution we can."

PHOTOS: A fugitive's life on Facebook

Big Bear has roughly 400 homes, but authorities guessed that only 40% are occupied year-round.

The search will probably play out with the backdrop of a winter storm that is expected to hit the area after midnight.

Up to 6 inches of snow could blanket local mountains, the National Weather Service said.

FULL COVERAGE: Sweeping manhunt for rampaging ex-cop

Gusts up to 50 mph could hit the region, said National Weather Service meteorologist Mark Moede, creating a wind-chill factor of 15 to 20 degrees.

Extra patrols were brought in to check vehicles coming and going from Big Bear, McMahon said, but no vehicles had been reported stolen.

"He could be anywhere at this point," McMahon said. When asked if the burned truck was a possible diversion, McMahon replied: "Anything's possible."

Dorner had no known connection to the area, authorities said.

Craig and Christine Winnegar, of Murrieta, found themselves caught up in the lockdown by accident. Craig brought his wife to Big Bear as a surprise to celebrate their 28th wedding anniversary. Their prearranged dinner was canceled when restaurant owners closed their doors out of fear.

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Kiefer Sutherland honored by Harvard theater group

CAMBRIDGE, Mass. (AP) — Golden Globe-winning actor Keifer Sutherland has been awarded the pudding pot after being honored as Man of the Year by Harvard's Hasty Pudding Theatricals.

The roast for the actor took place despite a massive snowstorm hitting the Boston area. The Friday evening event, including presentation of the traditional pudding pot, was moved to the Charles Hotel in Cambridge.

The 46-year-old Sutherland has been in dozens of films. He's perhaps best known for his role as Jack Bauer in the television series "24," for which he won Golden Globe and Primetime Emmy awards. He is currently starring in the television show "Touch."

Last year's Man of the Year was Jason Segel.

The 2013 Woman of the Year, Marion Cotillard (koh-tee-YAR'), was honored last week.

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In Nigeria, Polio Vaccine Workers Are Killed by Gunmen

At least nine polio immunization workers were shot to death in northern Nigeria on Friday by gunmen who attacked two clinics, officials said.

The killings, with eerie echoes of attacks that killed nine female polio workers in Pakistan in December, represented another serious setback for the global effort to eradicate polio.

Most of the victims were women and were shot in the back of the head, local reports said.

A four-day vaccination drive had just ended in Kano State, where the killings took place, and the vaccinators were in a “mop-up” phase, looking for children who had been missed, said Sarah Crowe, a spokeswoman for the United Nations Children’s Fund, one of the agencies running the eradication campaign.

Dr. Mohammad Ali Pate, Nigeria’s minister of state for health, said in a telephone interview that it was not entirely clear whether the gunmen were specifically targeting polio workers or just attacking the health centers where vaccinators happened to be gathering early in the morning. “Health workers are soft targets,” he said.

No one immediately took responsibility, but suspicion fell on Boko Haram, a militant Islamist group that has attacked police stations, government offices and even a religious leader’s convoy.

Polio, which once paralyzed millions of children, is now down to fewer than 1,000 known cases around the world, and is endemic in only three countries: Nigeria, Pakistan and Afghanistan.

Since September — when a new polio operations center was opened in the capital and Nigeria’s president, Goodluck Jonathan, appointed a special adviser for polio — the country had been improving, said Dr. Bruce Aylward, chief of polio eradication for the World Health Organization. There have been no new cases since Dec. 3.

While vaccinators have not previously been killed in the country, there is a long history of Nigerian Muslims shunning the vaccine.

Ten years ago, immunization was suspended for 11 months as local governors waited for local scientists to investigate rumors that it caused AIDS or was a Western plot to sterilize Muslim girls. That hiatus let cases spread across Africa. The Nigerian strain of the virus even reached Saudi Arabia when a Nigerian child living in hills outside Mecca was paralyzed.

Heidi Larson, an anthropologist at the London School of Hygiene and Tropical Medicine who tracks vaccine issues, said the newest killings “are kind of mimicking what’s going on in Pakistan, and I feel it’s very much prompted by that.”

In a roundabout way, the C.I.A. has been blamed for the Pakistan killings. In its effort to track Osama bin Laden, the agency paid a Pakistani doctor to seek entry to Bin Laden’s compound on the pretext of vaccinating the children — presumably to get DNA samples as evidence that it was the right family. That enraged some Taliban factions in Pakistan, which outlawed vaccination in their areas and threatened vaccinators.

Nigerian police officials said the first shootings were of eight workers early in the morning at a clinic in the Tarauni neighborhood of Kano, the state capital; two or three died. A survivor said the two gunmen then set fire to a curtain, locked the doors and left.

“We summoned our courage and broke the door because we realized they wanted to burn us alive,” the survivor said from her bed at Aminu Kano Teaching Hospital.

About an hour later, six men on three-wheeled motorcycles stormed a clinic in the Haye neighborhood, a few miles away. They killed seven women waiting to collect vaccine.

Ten years ago, Dr. Larson said, she joined a door-to-door vaccination drive in northern Nigeria as a Unicef communications officer, “and even then we were trying to calm rumors that the C.I.A. was involved,” she said. The Iraq and Afghanistan wars had convinced poor Muslims in many countries that Americans hated them, and some believed the American-made vaccine was a plot by Western drug companies and intelligence agencies.

Since the vaccine ruse in Pakistan, she said, “Frankly, now, I can’t go to them and say, ‘The C.I.A. isn’t involved.’ ”

Dr. Pate said the attack would not stop the newly reinvigorated eradication drive, adding, “This isn’t going to deter us from getting everyone vaccinated to save the lives of our children.”

Aminu Abubakar contributed reported from Kano, Nigeria.

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Execs off the hook at S&P

You may have heard last week about a couple of big lawsuits brought by federal and state governments, alleging that the credit rating agency Standard & Poor's concocted a fraudulent scheme that contributed to trillions of dollars in investment losses and the cratering of pretty much the entire world financial system.

Those are serious charges, and the federal government's demand for $5 billion in penalties isn't peanuts. Yet there's something bloodless about the lawsuits, for the simple reason that they don't point the finger at any particular person who was responsible for these dastardly doings.

For example, you won't find the name Harold McGraw III anywhere in the court papers. Who?

McGraw was chairman, chief executive and president of McGraw-Hill, S&P's parent company, in the period at issue, 2004 to 2007. (He's still in place today.) Did he profit from S&P's wrongdoing? Let's assume so: he not only owns 10 million company shares but received $44.5 million in compensation over those years, according to corporate disclosures. Did he know or care about what was happening at S&P? One would hope so because it was by far the most profitable domain in his empire, contributing an average of more than 70% of McGraw-Hill's operating profit.

Harold McGraw's largest business unit engaged in an "egregious" fraud that "goes to the very heart" of the financial crisis, Atty. Gen. Eric H. Holder Jr. said. But prosecutors have made no effort to hold him, or anyone else, directly responsible for what was done at S&P.

These new lawsuits replay the only story uglier than the financial meltdown itself, which is the government's pathetic record at prosecuting the crimes that produced it.

For companies can't do things like manipulate numbers on spreadsheets, lie about their "independent" judgment, and fire employees who try to rectify such errors. Only people can.

In accordance with the government's standard approach to financial crisis justice, no flesh-and-blood people are on the hook in these cases. Only companies, which (more's the pity) can't be put in jail for their wrongdoing. Yet it's only people who can profit from such conniving.

The lawsuits name a few executives here and there, and identify others by initials (presumably they're the ones who cooperated with regulators). But the overall impression is that something happened at S&P, and some individuals were involved, but they were all swept up in some inchoate historical event that requires, nevertheless, that S&P fork over $5 billion. That's what makes reading these legal papers resemble getting through all of "War and Peace" without ever meeting Napoleon.

"We've had the greatest explosion of elite white collar crime in history and the weakest criminal justice response," observes William K. Black, who helped put financial wrongdoers behind bars as a thrift regulator after the savings-and-loan collapse of the 1980s. "There's reason to believe they're not unrelated."

To be fair, the S&P lawsuits — they include the federal case filed in Los Angeles and actions by more than a dozen states, including California — amount to a more aggressive regulatory attack than any mounted thus far. Their target is an indisputably major player in the meltdown.

The $5-billion penalty sought by the U.S. Justice Department would be a pittance compared with the damage done to investors and the general economy by S&P. But as the equivalent of about six years of corporate profits, it would be enough to reduce McGraw-Hill's Manhattan headquarters to a smoking hole in the ground — if you think there's any chance the government can make the claim stick. California Atty. Gen. Kamala Harris seeks redress of at least $1.4 billion in investment losses incurred by the California Public Employees' Retirement System and other state agencies on S&P-rated securities.

The essence of the governments' fraud claim is that S&P held itself out to be an independent and objective appraiser of investment securities, especially the residential mortgage-backed bonds that were hot investment vehicles during the housing bubble. But it wasn't.

To a great extent, the investors who took S&P at its word knew they were acting on faith. The firm, like the other major credit agencies, Moody's and Fitch, were paid for their ratings by the investment banks issuing the securities, a flagrant conflict of interest. S&P charged the bankers up to $750,000 to rate really oddball paper.

The lawsuits allege that as early as 2004, S&P began tailoring its ratings to keep those clients happy by exaggerating the safety of their securities. S&P allegedly allowed issuing bankers to browbeat analysts for better ratings. The firm delayed or suppressed changes in its analytical software that would reveal that huge swaths of the high-rated deals were heading south. It cheaped out on hiring enough analysts to keep up with the mounting need for accurate updates. Analysts emailed each other with complaints about the corrupting of their objectivity, while executives signaled, essentially, that they should put a sock in it.

Nevertheless, McGraw-Hill's annual reports every year from 2004 through 2007 touted S&P's stature as a "provider of independent credit ratings," even though it was then allegedly tailoring its procedures for the issuers' benefit.

When the firm could no longer delay the inevitable, it downgraded hundreds of billions of dollars worth of mortgage securities in a torrent — 9,000 in the second half of 2007, an additional 6,300 in early 2008, including some deals it had graced with AAA ratings only a few months before. Many investors were bound by law to rely on these ratings in choosing securities for their portfolios. The flood of downgrades made a bad market much, much worse.

None of this is news. The role of the rating agencies in the meltdown was documented thoroughly by the Financial Crisis Inquiry Commission, headed by former California Treasurer Phil Angelides, in January 2011 and by a Senate subcommittee under Sen. Carl Levin (D-Mich.) a few months later. Any aficionado of our financial train wreck can repeat many of the emails cited in the lawsuit from memory.

S&P's response to the lawsuits is standard: The firm wasn't cooking its numbers but was relying on "the same ... mortgage data available to the rest of the market," it said last week. Yet S&P held itself out to be experts — if all it was doing was repeating what everybody else knew, than who needed its opinion? Any investment bank could have dragged any nimrods off the street and gotten an opinion for —I'd wager —a lot less than $750,000.

No one should doubt that the federal and state prosecutors poured their souls into these cases. The California lawsuit followed nearly two years of investigation, interrogation and compiling of documents. And there are hints that investigations of Moody's may be continuing.

But the key question sidestepped by the new lawsuits is why no individuals are being brought to book for what were, in every way, the plots and designs of individual people, acting to slake their own greed and ambition. This is another example of what UC Irvine criminologist Henry Pontell calls "the trivialization of criminal fraud."

"This is essentially a criminal fraud case," Pontell told me. "The only difference between civil and criminal cases is that they [the prosecutors] can spend a lot less on civil cases because the burden of proof is lower."

That speaks to the impoverishment of our white collar prosecutorial corps since 9/11, when the best and brightest were diverted to anti-terrorism cases and not replaced. By normalizing major corporate fraud cases as merely matters for civil fines, however, this trend has destroyed the deterrent effect of the justice system.

"Persuasive anecdotal evidence exists that the prospect of criminal penalties is an effective deterrent" to wrongdoing in the corporate suite, Pontell said. "Upper-class businesspersons fear shame and fear incarceration. Paying fines? No problem — that's a cost of doing business. If anything, it's anti-deterrence."

That's true. It's a good bet that after fighting the government to a draw, McGraw-Hill will settle these lawsuits for much less than $5 billion and S&P will retain its plausible deniability in the next meltdown. The deterrent effect will be zero.

What would really deter wrongdoing? It would be an outcome that prompts a CEO of the future to instruct his underlings: "You better be on the straight and narrow, because the last thing in the world I want is to end up in jail like Harold McGraw."

That might work.

Michael Hiltzik's column appears Sundays and Wednesdays. Reach him at mhiltzik@latimes.com, read past columns at latimes.com/hiltzik, check out facebook.com/hiltzik and follow @latimeshiltzik on Twitter.

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Police say ex-cop was bent on exacting revenge

On the day Christopher Dorner was fired from the Los Angeles Police Department, officials took the unusual step of summoning armed guards to stand watch at his disciplinary hearing downtown.

Those present were nervous that Dorner might do something rash when he learned that he was being stripped of his badge. He was a hulking, muscled man and his body language left no doubt about the anger seething out of him.

"It was clear… that he was wound way too tight," said a police official who attended Dorner's termination hearing and requested anonymity because of safety concerns.

Photos: A tense manhunt amid tragic deaths

That day four years ago, authorities now allege, was the start of a free fall into despair and deadly violence for Dorner. Police say the 33-year-old ex-cop killed three people and injured others on a campaign to exact revenge against those he blamed for his downfall.

Friends and acquaintances who knew Dorner before he became a police officer struggled to reconcile the person they remembered with the image of the deeply disturbed man that emerged Thursday from a rambling manifesto that authorities said was published on what they believe is Dorner's Facebook page. The manifesto portrays Dorner as having no choice but to kill in order to reclaim his destroyed reputation.

"I am a man who has lost complete faith in the system, when the system betrayed, slandered and libeled me," the manifesto states.

Photos: A fugitive's life on Facebook

Born in New York state, Dorner grew up in Southern California with his mother and at least one sister, according to public records and claims in the manifesto.

Dorner felt isolated growing up as one of the few African American children in the neighborhoods where he lived and was the victim of racism, according to the manifesto. "My first recollection of racism was in the first grade," Dorner allegedly wrote, recalling a fellow student at Norwalk Christian School who called him a racial slur. Dorner said he responded "fast and hard," punching and kicking the student.

It was an early, telling illustration of a notion Dorner returned to repeatedly throughout his life — that he was a victim, often wronged by others, records show.

As a teenager in La Palma, Dorner joined the Police Department's youth program, and decided to pursue a career in law enforcement.

Dorner went on to enroll at Southern Utah University, where he joined the school's football team and was befriended by a teammate, Jamie Usera.

Usera, who grew up in Alaska, said he and Dorner bonded over the feelings of culture shock that came with being outsiders on the predominantly white, Mormon campus.

Usera said he introduced Dorner to hunting and other outdoor sports. "He was a typical guy," he said. "I liked him an awful lot. Nothing about him struck me as violent or irrational in any way. He was opinionated, but always seemed level-headed."

Dorner often brought up race issues and the two had heated, but respectful arguments about the extent of racism in the country, Usera said. "Of all the people I hung out with in college, he is the last guy I would have expected to be in this kind of situation."

Neil Gardner, an assistant athletic director, knew Dorner through football and echoed Usera, saying Dorner was "never a disgruntled guy."

Dorner graduated in 2001 with a degree in political science and, soon after, enlisted in the Navy. Over the next several years, military records indicate Dorner received extensive combat and counter-terrorism training and earned commendations for his marksmanship with rifles and pistols.

In 2005, while still enlisted in the military, Dorner applied to the LAPD and earned a spot in one of the department's training academy classes. An officer in Dorner's class who asked not to be identified because he is not authorized to discuss the case, recalled Dorner as "one of our problem children" who frequently pushed the bounds of authority .

A few days into training, the recruits were explicitly told to only wear white or black shoes for a conditioning run, the officer said. Dorner, however, showed up in bright neon sneakers. "He thought he knew it all, that rules just kind of didn't apply to him," the officer said. "He was not a team player."

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'Being Mandela:' Granddaughters dish on show

NEW YORK (AP) — The newest reality television show is in some ways like any other: mother and daughters, sibling rivalry, family gossip and talk of Big Grandpa, who is very strict but loves it when his great-grandchildren are around making a racket. But that's where the twist comes in: Big Grandpa is Nelson Mandela, the anti-apartheid legend.

"Being Mandela," a new series premiering Sunday on COZI TV, invites U.S. audiences into the lives of Zaziwe Dlamini-Manaway and Swati Dlamini, the fashionable, 30-something granddaughters of Mandela and Winnie Madikizela-Mandela. The 94-year-old former South African president, who recently was treated for a lung infection and had surgery to remove gallstones, does not appear in the series but his controversial ex-wife — "Big Mommy" to her grandchildren — does and seems to relish it.

If the Mandela clan seems like an odd subject for a reality show, the granddaughters make no apologies.

"We get asked this question a lot. Is this not going to tarnish the name and is this not going to be bad for the name?" Swati Dlamini said in an interview with The Associated Press in New York, where she and her sister were promoting the show. "But our grandparents have always said to us, this is our name too, and we can do what we think is best fitting with the name, as long as we treat it with respect and integrity."

The 13-episode first season follows the two women as they try to carry on the family legacy while juggling motherhood in Johannesburg.

The sisters, who spent most of their childhood in exile in the United States, make an emotional visit to the prison on Robben Island where their grandfather spent 18 of the 27 years he was imprisoned by South Africa's white-ruled government. Swati works on publishing the prison diaries that her grandmother wrote but now cannot bear to read.

The women, along with two brothers, also become the latest famous names to launch a fashion line, called "Long Walk to Freedom" in honor of their grandfather's autobiography. Their lives are special and glamorous and they know it. They hope that U.S. audiences — COZI TV is a new network launched by NBC Owned Television Stations — will see a vibrant and modern side of South Africa through their eyes.

They also bicker. The family, especially Winnie Madikizela-Mandela, loves to gossip about when Swati, the single mother of a 4-year-old daughter, is going to get married. Swati is furious when Zaziwe, despite being sworn to secrecy, blurts to their grandmother that her sister is dating someone. Zaziwe, 35, is married to an American businessman and has three children.

The sisters are the daughters of Zenani Mandela and Prince Thumbumuzi Dlamini of Swaziland. But parents everywhere will delight in seeing that being royal doesn't help them face toddler tantrums or get older children out of bed and into school uniforms.

Big Grandpa and Big Mommy are into the show, the sisters insisted.

Mandela will definitely watch it, they said. The Nobel Peace Prize winner apparently sort of likes reality TV.

"You'll be interested to know that he loves Toddlers and Tiarras," said Swati, laughing in reference to the TLC series about child beauty pageants.

"Because of the kids! He just loves children," Zaziwe added quickly.

The sisters said their grandfather is "happy and healthy."

Zaziwe showed a Feb. 2 photograph of Mandela at home, flashing his familiar smile, with his youngest great-grandchild on his lap — Zaziwe's one-year-old son. The picture is a rare public image of Mandela, whose last appearance on a major stage was during the 2010 World Cup soccer tournament in South Africa.

Mandela, who always lamented his long separation from his family during his imprisonment, is happiest these days when his offspring are running around being loud, his granddaughters said.

"We're in and out of the house. We're loud and he loves the noise," Zaziwe said.

The granddaughters say their grandfather — to the world, a symbol of integrity and magnanimity — holds the family to high standards and sets rules for when the children should be home and when dinner should start.

"He's a very strict person. Most people wouldn't think that but he really, really is," Zaziwe said.

The sisters are closer to Winnie Madikizela-Mandela, who divorced Mandela in 1997. Their adoring description of their grandmother as the doting matriarch stands in contrast with her checkered public image. Beloved by many poor urban blacks, Madikizela-Mandela also faces accusations that she and her bodyguard unit committed 18 killings in the 1980s. She denies it.

"She's fun. She never says no to us. I don't think I've ever heard my grandmother say no to us," Zaziwe said.

Still, the series shows Big Mommy clearly taking charge of the family. She marches into the hospital room where Zaziwe gave birth to Zen with a list of possible names for the baby boy.

The sisters say it was only after Mandela retired from public life that they started to get to know their grandfather.

"Our grandfather always told us that he belongs to the country and he's of service to the country and he doesn't belong to us as a family. And that's the sacrifice he's made for the country and that what he's told us as far as I can remember," Swati said.

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AP Entertainment Writer Lauri Neff contributed to this story.

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