Child porn suspect indicted by federal grand jury

A North Hills woman whom authorities allege plied a young girl with crack cocaine and photographed her having sex with an older man was indicted Tuesday on federal charges of producing child pornography and sex trafficking.

Letha Montemayor Tucker was named Tuesday in a four-count indictment returned by a federal grand jury. If convicted of all the charges, Tucker would face a mandatory minimum federal sentence of 10 years and could get up to life in prison, authorities said.

The charges come a month after authorities sought the public's help in the investigation by releasing photographs of a man and woman depicted in a set of widely circulated child pornography photos.

Tips started pouring in immediately after the photos were released, investigators said.

Tucker, who goes by the name Butterfly, was located about 10 hours after the release of the photos and taken into custody, said Claude Arnold, special agent in charge for Homeland Security Investigations in Los Angeles, a division of U.S. Immigration and Customs Enforcement.

The alleged victim, who was about 12 when the photos were taken, was found within a week of the case going public, Arnold said. She is an adult now and is cooperating with authorities, he said.

In addition to photographing the girl having sex with the man, authorities said, Tucker also committed sex acts with the alleged victim.

The photos were part of a child pornography collection known as the "Jen Series."

The 40-plus photos were first discovered by investigators in the Chicago area in 2007. Investigators said images in the series have been reported about 300 times and have been found on computers across the country.

The victim "didn't even know these images were out there," Arnold said.

"The horror of child pornography is it's for life, the victimization," Arnold said. "Once the photos are there in cyberspace, they're there forever."

The girl, identified in court records only by the initials J.M.M., lived in the same Los Angeles County residential hotel as Tucker, who worked as a prostitute, authorities said.

Around 2000 or 2001, the girl stopped attending school regularly and spent more and more time in Tucker's room, smoking crack cocaine Tucker provided, according to the indictment.

The girl was present when Tucker engaged in prostitution with clients and was usually high when this happened, authorities allege. Tucker instructed the child to take off her clothes in front of the clients, prosecutors alleged in court papers.

The faces of Tucker and the girl are "clearly visible" in the photos, according to the indictment. Tucker had an eyebrow piercing and a tattoo of a sleeping cat behind her shoulder, which made her easier to identify, authorities said.

The face of the man, however, is blacked out in the photographs. Authorities are still trying to identify the man, Arnold said.

"Obviously, we want him also to answer for his crimes," Arnold said.

Arnold said the alleged victim is "going to be dealing with this for a long time."

Now that she has been identified, she will receive a victim notification every time one of the images turns up in an investigation, he said.

Tucker is being held without bond and is scheduled to be arraigned in federal court on Feb. 13. Her attorney could not be reached for comment.

hailey.branson@latimes.com

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Fox cuts ties to commentator Dick Morris

NEW YORK (AP) — Political commentator Dick Morris' prediction of a huge landslide for Mitt Romney didn't pan out. And now he's lost his job at Fox News Channel.

Network spokeswoman Dana Klinghoffer said Tuesday that Fox wasn't renewing its contract with Morris, who was steadfast throughout the campaign in his prediction of a big Romney win over President Barack Obama. He has made few appearances on Fox since the election.

Morris had also been criticized for accepting paid advertisements on his website from candidates that he discussed on the air at Fox.

On his website, Morris said he'll be appearing on CNN's Piers Morgan show Wednesday to talk politics.

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Well: Warning Too Late for Some Babies

Six weeks after Jack Mahoney was born prematurely on Feb. 3, 2011, the neonatal staff at WakeMed Hospital in Raleigh, N.C., noticed that his heart rate slowed slightly when he ate. They figured he was having difficulty feeding, and they added a thickener to help.

When Jack was discharged, his parents were given the thickener, SimplyThick, to mix into his formula. Two weeks later, Jack was back in the hospital, with a swollen belly and in inconsolable pain. By then, most of his small intestine had stopped working. He died soon after, at 66 days old.

A month later, the Food and Drug Administration issued a caution that SimplyThick should not be fed to premature infants because it may cause necrotizing enterocolitis, or NEC, a life-threatening condition that damages intestinal tissue.

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Catherine Saint Louis speaks about using SimplyThick in premature infants.

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Experts do not know how the product may be linked to the condition, but Jack is not the only child to die after receiving SimplyThick. An F.D.A. investigation of 84 cases, published in The Journal of Pediatrics in 2012, found a “distinct illness pattern” in 22 instances that suggested a possible link between SimplyThick and NEC. Seven deaths were cited; 14 infants required surgery.

Last September, after more adverse events were reported, the F.D.A. warned that the thickener should not be given to any infants. But the fact that SimplyThick was widely used at all in neonatal intensive care units has spawned a spate of lawsuits and raised questions about regulatory oversight of food additives for infants.

SimplyThick is made from xanthan gum, a widely-used food additive on the F.D.A.’s list of substances “generally recognized as safe.” SimplyThick is classified as a food and the F.D.A. did not assess it for safety.

John Holahan, president of SimplyThick, which is based in St. Louis, acknowledged that the company marketed the product to speech language pathologists who in turn recommended it to infants. The patent touted its effectiveness in breast milk.

However, Mr. Holahan said, “There was no need to conduct studies, as the use of thickeners overall was already well established. In addition, the safety of xanthan gum was already well established.”

Since 2001, SimplyThick has been widely used by adults with swallowing difficulties. A liquid thickened to about the consistency of honey allows the drinker more time to close his airway and prevent aspiration.

Doctors in newborn intensive care units often ask non-physician colleagues like speech pathologists to determine whether an infant has a swallowing problem. And those auxiliary feeding specialists often recommended SimplyThick for neonates with swallowing troubles or acid reflux.

The thickener became popular because it was easy to mix, could be used with breast milk, and maintained its consistency, unlike alternatives like rice cereal.

“It was word of mouth, then neonatologists got used to using it. It became adopted,” said Dr. Steven Abrams, a neonatologist at Texas Children’s Hospital in Houston. “At any given time, several babies in our nursery — and in any neonatal unit — would be on it.”

But in early 2011, Dr. Benson Silverman, the director of the F.D.A.’s infant formula section, was alerted to an online forum where doctors had reported 15 cases of NEC among infants given SimplyThick. The agency issued its first warning about its use in babies that May. “We can only do something with the information we are provided with,” he said. “If information is not provided, how would we know?”

Most infants who took SimplyThick did not fall ill, and NEC is not uncommon in premature infants. But most who develop NEC do so while still in the hospital. Some premature infants given SimplyThick developed NEC later than usual, a few after they went home, a pattern the F.D.A. found unusually worrisome.

Even now it is not known how the thickener might have contributed to the infant deaths. One possibility is that xanthan gum itself is not suitable for the fragile digestive systems of newborns. The intestines of premature babies are “much more likely to have bacterial overgrowth” than adults’, said Dr. Jeffrey Pietz, the chief of newborn medicine at Children’s Hospital Central California in Madera.

“You try not to put anything in a baby’s intestine that’s not natural.” If you do, he added, “you’ve got to have a good reason.”

A second possibility is that batches of the thickener were contaminated with harmful bacteria. In late May 2011, the F.D.A. inspected the plants that make SimplyThick and found violations at one in Stone Mountain, Ga., including a failure to “thermally process” the product to destroy bacteria of a “public health significance.”

The company, Thermo Pac, voluntarily withdrew certain batches. But it appears some children may have ingested potentially contaminated batches.

The parents of Jaden Santos, a preemie who died of NEC while on SimplyThick, still have unused packets of recalled lots, according to their lawyer, Joe Taraska.

The authors of the F.D.A. report theorized that the infants’ intestinal membranes could have been damaged by bacteria breaking down the xanthan gum into too many toxic byproducts.

Dr. Qing Yang, a neonatologist at Wake Forest University, is a co-author of a case series in the Journal of Perinatology about three premature infants who took SimplyThick, developed NEC and were treated. The paper speculates that NEC was “most likely caused by the stimulation of the immature gut by xanthan gum.”

Dr. Yang said she only belatedly realized “there’s a lack of data” on xanthan gum’s use in preemies. “The lesson I learned is not to be totally dependent on the speech pathologist.”

Julie Mueller’s daughter Addison was born full-term and given SimplyThick after a swallow test showed she was at risk of choking. It was recommended by a speech pathologist at the hospital.

Less than a month later, Addison was dead with multiple holes in her small intestine. “It was a nightmare,” said Ms. Mueller, who has filed a lawsuit against SimplyThick. “I was astounded how a hospital and manufacturer was gearing this toward newborns when they never had to prove it would be safe for them. Basically we just did a research trial for the manufacturer.”

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Nasdaq reportedly in settlement talks over flubbed Facebook IPO

Facebook founder Mark Zuckerberg, center, rings the Nasdaq opening bell May 18 from Facebook headquarters in Menlo Park, Calif. (Zef Nikolla / Associated Press / February 5, 2013)

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Scientists identify remains as those of King Richard III

LONDON -- More than 500 years after his death in battle, scientists announced Monday that they had definitively identified a skeleton unearthed in central England last summer as that of Richard III, the medieval king portrayed by William Shakespeare as a homicidal tyrant who killed his two young nephews in order to ascend the throne.

DNA from the bones, found beneath the ruins of an old church, matches that of a living descendant of the monarch's sister, researchers said.

"Rarely have the conclusions of academic research been so eagerly awaited," Richard Buckley, the lead archaeologist on the excavation, told a phalanx of reporters Monday morning. "Beyond reasonable doubt, the individual exhumed ... is indeed Richard III, the last Plantagenet king of England."

PHOTOS: Remains of King Richard III

The dramatic announcement capped a brief hunt for Richard's remains, the progress of which has been closely charted by international media and whose success has been barely short of miraculous.

Working from old maps of Leicester, about 100 miles northwest of London, archaeologists from the local university had less than a month to dig in a small municipal parking lot -- one of the few spaces not built over in the crowded city center. The team stumbled on the ruins of the medieval priory where records say Richard was buried, then found the bones a few days later last September.

"It was an extraordinary discovery that stunned all of us," Buckley said.

The nearly intact skeleton bore obvious traces of trauma to the skull and of scoliosis, a curvature of the spine that matched contemporary descriptions of Richard's appearance. The feet were missing, almost certainly the result of later disturbance, and the hands were crossed at the wrist, which suggests that they may have been tied.

Scientists at the University of Leicester, which pioneered the practice of DNA fingerprinting, were able to extract samples from the bones and compare them to a man descended from Richard III's sister Anne. The match through the maternal line was virtually perfect.

"The DNA evidence points to these being the remains of Richard III," said Turi King, the project’s geneticist.

Richard reigned from 1483 to 1485, and occupies a unique place in England's long line of colorful rulers. He was the last English king to be killed in combat, at the Battle of Bosworth Field, by his successor, Henry VII. His death ended the Plantagenet dynasty and ushered in the long era of the Tudors, including Henry VIII and Elizabeth I.

Jo Appleby, an osteologist at the university, said the skeleton belonged to an adult male in his late 20s to late 30s; Richard III was 32 when he died. The man would have stood 5-foot-8 at full height, but the curved spine would have made him appear shorter.

The skull was riddled with wounds strongly indicative of death in battle, including two blows from bladed weapons, either of which would have been fatal, Appleby said.

Richard III is one of England's most controversial monarchs, reviled by some as a bloodthirsty despot who stopped at nothing to gain power, but revered by others who insist that he has been unfairly maligned. His supporters note that the repugnant portrait of Richard in today's popular imagination is based almost entirely on accounts from the time of the usurping Tudors, especially Shakespeare's indelible characterization of him as a "deform'd, unfinish'd" man without scruples.

Fans say Richard III was an enlightened, capable ruler whose important social reforms included the presumption of innocence for defendants and the granting of bail, which remain pillars of the legal system in Britain and the U.S.

However, what happened to Richard's two nephews, who were his rivals for the throne and who were locked up in the Tower of London as young boys, never to be seen again, remains a mystery.

ALSO:

Race to unearth a royal mystery

Bones found in hunt for King Richard III's remains

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Facebook After Death: Who Owns Your Pages When You Die?

Most people can’t live without Facebook — but what happens to your Facebook page when you are no longer living? New Hampshire and other states are trying to figure that out.

State Rep. Peter Sullivan has introduced legislation to allow the executor of an estate control over the social networking pages of the dead. Last week, the New Hampshire House of Representatives voted 222-128 to give Sullivan more time to write an amendment that begins a study of the issue.

The bill proposed by Sullivan, a Democrat from Manchester, would allow control of someone’s Facebook, Twitter, and other accounts such as Gmail to be passed to the executor of their estate after death.

According to Sullivan, passage of his bill would bridge a gap in policies of social media sites regarding posthumous users. He said his bill would protect residents who have suffered loss.

“This would give the families a sense of closure, a sense of peace. It would help prevent this form of bullying that continues even after someone dies and nobody is really harmed by it.”

In an interview with WMUR, Sullivan tells the story of a young Canadian girl who committed suicide because of bullying. After she died the taunting continued on her Facebook page.

Read More About Teens Bullied On Facebook

“The family wasn’t able to do anything; they didn’t have access to her account.” Sullivan said. “They couldn’t go in and delete those comments, and they couldn’t take the page down completely.”

Five other states, including Oklahoma, Idaho, Rhode Island, Indiana and Connecticut, have established legislation regulating one’s digital presence after death. Rhode Island and Connecticut were first, but their bills were limited in scope to email accounts, excluding social networking sites.

According to opponents of Sullivan’s bill, contracts and provisions between the social media user and the site already lay out what happens to the page once the user passes. Opponents say Sullivan’s bill is unenforceable and incomplete. Some also say the issue would be better suited for federal law.

Ryan Kiesel, then a state legislator from Oklahoma, sponsored a similar bill in 2010 called the Digital Property Management After Death law. Though he supports states’ efforts to bring light to this issue, saying that it is a good way to get the conversation started, he also believes that this is a case that should eventually taken up by the federal government.

“Facebook and other online providers have changed their privacy policies to keep up with the times, but we still see a lot of flux within different sites like Facebook , Flickr, or Google, for example.” Keisel told ABC News. “The federal government should pass uniform laws to govern all digital assets because it is quite difficult for an estate to have to navigate endless numbers of digital policies postmortem.”

Kiesel, who now works as a civil rights activist, compared one’s digital legacy to the distribution of someone’s tangible assets after death.

Get more pure politics at ABCNews.com/Politics

“In Oklahoma, if you are administrator of the estate of a deceased person’s house and you find a box under their bed, you are well within your right to see what’s inside that box and if property is worth distributing, you should distribute it accordingly.” Kiesel told ABC News that the same idea goes for digital legacy.

Today marks the ninth Anniversary of the launch of Facebook, which currently has over 1 billion active users. That number, which has grown from just a million users in 2004, suggests there must be an enormous number of Facebook pages that must currently be occupied by deceased people.

Facebook has not completely ignored the growing number of deceased users. The site has created a function allowing Facebook pages to become memorials after they have died.

“Please use this form to request the memorialization of a deceased person’s account,” the site reads. “We extend our condolences and appreciate your patience and understanding throughout this process.”

Memorialization of a Facebook page, however, can only be done via online request. And the terms of service for Facebook’s say that it will not issue login and password information to family members of the deceased. The requestor must contact Facebook and request that the profile is taken down or memorialized.

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NJ Gov. Christie, Letterman laugh about fat jokes

TRENTON, N.J. (AP) — New Jersey Gov. Chris Christie and David Letterman have shared some laughs about the many fat jokes the comedian has made about the lawmaker's ample girth.

Christie has termed his plumpness "fair game" for comedians. And during his first appearance on "Late Show with David Letterman" on Monday, the outspoken Republican and potential 2016 presidential contender read two of Letterman's jokes that he said were "some of my personal favorites."

The governor also drew loud laughs when he pulled out a doughnut and started eating it while Letterman asked him if he was bothered by the digs that have been made about his weight. Christie said he wasn't, noting that he laughs at the jokes if he finds them funny.

"Late Show" airs on CBS at 11:35 p.m. Eastern time.

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Well: Expressing the Inexpressible

When Kyle Potvin learned she had breast cancer at the age of 41, she tracked the details of her illness and treatment in a journal. But when it came to grappling with issues of mortality, fear and hope, she found that her best outlet was poetry.

How I feared chemo, afraid
It would change me.
It did.
Something dissolved inside me.
Tears began a slow drip;
I cried at the news story
Of a lost boy found in the woods …
At the surprising beauty
Of a bright leaf falling
Like the last strand of hair from my head

Ms. Potvin, now 47 and living in Derry, N.H., recently published “Sound Travels on Water” (Finishing Line Press), a collection of poems about her experience with cancer. And she has organized the Prickly Pear Poetry Project, a series of workshops for cancer patients.

“The creative process can be really healing,” Ms. Potvin said in an interview. “Loss, mortality and even hopefulness were on my mind, and I found that through writing poetry I was able to express some of those concepts in a way that helped me process what I was thinking.”

In April, the National Association for Poetry Therapy, whose members include both medical doctors and therapists, is to hold a conference in Chicago with sessions on using poetry to manage pain and to help adolescents cope with bullying. And this spring, Tasora Books will publish “The Cancer Poetry Project 2,” an anthology of poems written by patients and their loved ones.

Dr. Rafael Campo, an associate professor of medicine at Harvard, says he uses poetry in his practice, offering therapy groups and including poems with the medical forms and educational materials he gives his patients.

“It’s always striking to me how they want to talk about the poems the next time we meet and not the other stuff I give them,” he said. “It’s such a visceral mode of expression. When our bodies betray us in such a profound way, it can be all the more powerful for patients to really use the rhythms of poetry to make sense of what is happening in their bodies.”

On return visits, Dr. Campo’s patients often begin by discussing a poem he gave them — for example, “At the Cancer Clinic,” by Ted Kooser, from his collection “Delights & Shadows” (Copper Canyon Press, 2004), about a nurse holding the door for a slow-moving patient.

How patient she is in the crisp white sails
of her clothes. The sick woman
peers from under her funny knit cap
to watch each foot swing scuffing forward
and take its turn under her weight.
There is no restlessness or impatience
or anger anywhere in sight. Grace
fills the clean mold of this moment
and all the shuffling magazines grow still.

In Ms. Potvin’s case, poems related to her illness were often spurred by mundane moments, like seeing a neighbor out for a nightly walk. Here is “Tumor”:

My neighbor walks
For miles each night.
A mantra drives her, I imagine
As my boys’ chant did
The summer of my own illness:
“Push, Mommy, push.”
Urging me to wind my sore feet
Winch-like on a rented bike
To inch us home.
I couldn’t stop;
Couldn’t leave us
Miles from the end.

Karin Miller, 48, of Minneapolis, turned to poetry 15 years ago when her husband developed testicular cancer at the same time she was pregnant with their first child.

Her husband has since recovered, and Ms. Miller has reviewed thousands of poems by cancer patients and their loved ones to create the “Cancer Poetry Project” anthologies. One poem is “Hymn to a Lost Breast,” by Bonnie Maurer.

Oh let it fly
let it fling
let it flip like a pancake in the air
let it sing: what is the song
of one breast flapping?

Another is “Barn Wish” by Kim Knedler Hewett.

I sit where you can’t see me
Listening to the rustle of papers and pills in the other room,
Wondering if you can hear them.
Let’s go back to the barn, I whisper.
Let’s turn on the TV and watch the Bengals lose.
Let’s eat Bill’s Doughnuts and drink Pepsi.
Anything but this.

Ms. Miller has asked many of her poets to explain why they find poetry healing. “They say it’s the thing that lets them get to the core of how they are feeling,” she said. “It’s the simplicity of poetry, the bare bones of it, that helps them deal with their fears.”

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Have you written a poem about cancer? Please share them with us in the comments section below.

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Air Lease places $9-billion order for Airbus jetliners

Air Lease Corp., the Century City aircraft-leasing firm, has placed a $9-billion order for Airbus jetliners.

The deal, based on aircraft list price, includes an order for 25 A350 XWB wide-body passenger jets, which compete with Boeing Co.'s grounded 787 Dreamliner. Air Lease also ordered 14 smaller A321neos.

Airbus announced the deal Monday.

"The A350 XWB family is becoming the industry benchmark for efficiency in the long haul segment, and the A320neo family is ideal for airlines operating short-to-medium-haul missions," Air Lease Corp. Chief Executive Steven F. Udvar-Hazy said in a statement. "These aircraft will help airlines grow their businesses while simultaneously reducing their operating costs and emissions."

The A350 XWB, set to enter service in 2014, seats 270 to 350 passengers in typical three-class layouts. The European plane-maker listed the jet as costing $254.3 million to $332.1 million, depending on the version ordered. Customers are known to get rebates.

Udvar-Hazy, 66, known as the godfather of aircraft leasing, in 2008 publicly criticized the A350 as having a shoddy design. After he voiced his disapproval, others joined the chorus. Several months later, Airbus began a redesign.

Airbus designed the plane to use 25% less fuel and provide an equivalent reduction in carbon emissions. There are 617 firm orders for the A350 from 35 customers worldwide, including Air Lease.

Udvar-Hazy pioneered the business of buying planes and leasing them to airlines when he co-founded International Lease Finance Corp. nearly four decades ago. He became one of the richest men in Los Angeles when he sold ILFC for $1.3 billion to American International Group Inc. in 1990.

After a rift with AIG, Udvar-Hazy left to start Air Lease in February 2010. He took the company public in April 2011.

william.hennigan@latimes.com

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Medical clinic workers struggle with burnout

Every day after work, Sandeep Lehil changes out of her lab coat and blue scrubs and sits cross-legged on a large, black pillow in her airy, quiet Los Feliz apartment. She takes two deep breaths and tries not to think about the patients she so desperately wants to help.

She pushes out thoughts of the man with heart problems who left her exam room in an ambulance. And the patient who walked out when she told him his tests indicated he could have HIV. And the woman who Lehil fears is addicted to pain pills.

"Meditation is the only thing that keeps me sane," said Lehil, a nurse practitioner in South Los Angeles. "It's like clearing your head of the anxieties and troubles you've had that day."

Lehil, 28, and others like her at community clinics throughout the U.S. are key players in the push to lower the nation's healthcare spending. They conduct physicals, refill medications and manage chronic diseases for low-income patients, providing the care necessary to keep them from requiring more costly medical treatment.

The jobs are demanding — providers spend long hours treating patients who have multiple chronic illnesses and often have gone years without care. Administrators have trouble finding enough doctors, nurse practitioners and physician assistants to staff their clinics.

That is expected to cause a major roadblock next year, when the bulk of the national healthcare reform law takes effect, aiming to help 30 million uninsured Americans gain coverage. In preparation, clinics — expected to get an influx of new patients — are stepping up recruitment and trying to hold on to the care providers they have. But burnout is common, and staff members often leave for less-stressful, higher-paying positions elsewhere.

"The workforce shortage is certainly one of the top challenges we are facing currently, and the expansion hasn't even occurred yet," said Carmela Castellano-Garcia, president of the California Primary Care Assn., which represents community clinics.

Lehil graduated in May from Johns Hopkins University with a master's degree in nursing and an idealistic goal: to make a difference in a medically underserved community. In July she started as a nurse practitioner at T.H.E. Clinic, a community health center in South Los Angeles.

Lehil said the work is fulfilling but draining, and busier than she ever could have anticipated. By the end of the week, she said, "it's almost like running on empty."

T.H.E. Clinic has eight full-time providers but needs 11. There are ongoing advertisements, and the clinic is "constantly fighting" for family practice providers, often competing with nearby centers, said human resources director Lilia Marin-Alvarez. To find new clinicians, T.H.E. Clinic and others rely heavily on the National Health Service Corps, which offers scholarships and loan repayment for those willing to work in underserved areas.

While still in school, Lehil saw an ad for T.H.E. Clinic. The name — To Help Everyone — immediately appealed to her. Lehil interviewed and, soon after, accepted a job offer. Now, Marin-Alvarez said she just has to make sure Lehil stays.

Lehil speaks quickly and walks with purpose. She wears Crocs, red-rimmed glasses and a loose ponytail, and she has several tattoos, including the infinity sign on her wrist and a flock of birds on her back. A stethoscope rests on her neck and two silver bangles on her wrist.

Raised in a tight-knit, professional Indian family in San Jose, Lehil attended UC Berkeley as an undergraduate and majored in public health. Her parents wanted her to be a doctor, but she decided to become a nurse practitioner, in part because medical school would have taken too long.

When Lehil started working at T.H.E. Clinic, she wondered how she could possibly see two dozen or more patients in a day. "It's not like they have one thing wrong with them," she said.

She took the time she needed, but it resulted in longer waits. When her patients became frustrated, Lehil just apologized and smiled.

During the first few weeks, she left each Friday with a dull headache, which she tried to shake off before Monday morning. To better manage the stress, Lehil started meditating an hour a day, at home and at the Zen Center of Los Angeles. She also moved to Los Feliz so she could take walks in Griffith Park in her free time.

On a Tuesday in the fall, Lehil arrives at work before 8 a.m. so she can get a head start on reviewing lab results and medications for the patients she expects to see that day. Hand sanitizer, a bottle of water and a clipboard filled with papers sit on her desk. She picks up a thermos and takes a sip. She wants to switch to green tea, but not today. She has 15 patients scheduled for this morning and 12 others this afternoon. "Today's a black tea day," she said.

For 10 hours, she moves quickly from one patient to the next, starting every visit the same way: "Hi, I'm Sandeep. I'm here to help you."

To save time each day, Lehil starts triaging, addressing her patients' most urgent health issues and saving the others for future visits. This morning, Mitchell Chambers, an expressive and friendly man, has come to see her. He has high blood pressure, is at risk for diabetes and has undergone open heart and gastric bypass surgeries. She notes all of it in his chart but focuses on one thing: his high cholesterol, which hasn't been treated.

She hands him a flier about nutrition and urges him to stop smoking and start exercising. She also writes him a prescription. Chambers, 50, makes a thumbs-up sign and promises to try to follow her instructions. "I'm in your hands," he says.

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