The Texas Tribune: Advocates Seek Mental Health Changes, Including Power to Detain

Matt Rainwaters for Texas Monthly

The Sherman grave of Andre Thomas’s victims.

SHERMAN — A worried call from his daughter’s boyfriend sent Paul Boren rushing to her apartment on the morning of March 27, 2004. He drove the eight blocks to her apartment, peering into his neighbors’ yards, searching for Andre Thomas, Laura Boren’s estranged husband.

Expanded coverage of Texas is produced by The Texas Tribune, a nonprofit news organization. To join the conversation about this article, go to texastribune.org.

For more articles on mental health and criminal justice in Texas, as well as a timeline of the Andre Thomas case: texastribune.org

Matt Rainwaters for Texas Monthly

Laura Boren

He drove past the brightly colored slides, swings and bouncy plastic animals in Fairview Park across the street from the apartment where Ms. Boren, 20, and her two children lived. He pulled into a parking spot below and immediately saw that her door was broken. As his heart raced, Mr. Boren, a white-haired giant of a man, bounded up the stairwell, calling out for his daughter.

He found her on the white carpet, smeared with blood, a gaping hole in her chest. Beside her left leg, a one-dollar bill was folded lengthwise, the radiating eye of the pyramid facing up. Mr. Boren knew she was gone.

In a panic, he rushed past the stuffed animals, dolls and plastic toys strewn along the hallway to the bedroom shared by his two grandchildren. The body of 13-month-old Leyha Hughes lay on the floor next to a blood-spattered doll nearly as big as she was.

Andre Boren, 4, lay on his back in his white children’s bed just above Leyha. He looked as if he could have been sleeping — a moment away from revealing the toothy grin that typically spread from one of his round cheeks to the other — except for the massive chest wound that matched the ones his father, Andre Thomas (the boy was also known as Andre Jr.), had inflicted on his mother and his half-sister as he tried to remove their hearts.

“You just can’t believe that it’s real,” said Sherry Boren, Laura Boren’s mother. “You’re hoping that it’s not, that it’s a dream or something, that you’re going to wake up at any minute.”

Mr. Thomas, who confessed to the murders of his wife, their son and her daughter by another man, was convicted in 2005 and sentenced to death at age 21. While awaiting trial in 2004, he gouged out one of his eyes, and in 2008 on death row, he removed the other and ate it.

At least twice in the three weeks before the crime, Mr. Thomas had sought mental health treatment, babbling illogically and threatening to commit suicide. On two occasions, staff members at the medical facilities were so worried that his psychosis made him a threat to himself or others that they sought emergency detention warrants for him.

Despite talk of suicide and bizarre biblical delusions, he was not detained for treatment. Mr. Thomas later told the police that he was convinced that Ms. Boren was the wicked Jezebel from the Bible, that his own son was the Antichrist and that Leyha was involved in an evil conspiracy with them.

He was on a mission from God, he said, to free their hearts of demons.

Hospitals do not have legal authority to detain people who voluntarily enter their facilities in search of mental health care but then decide to leave. It is one of many holes in the state’s nearly 30-year-old mental health code that advocates, police officers and judges say lawmakers need to fix. In a report last year, Texas Appleseed, a nonprofit advocacy organization, called on lawmakers to replace the existing code with one that reflects contemporary mental health needs.

“It was last fully revised in 1985, and clearly the mental health system has changed drastically since then,” said Susan Stone, a lawyer and psychiatrist who led the two-year Texas Appleseed project to study and recommend reforms to the code. Lawmakers have said that although the code may need to be revamped, it will not happen in this year’s legislative session. Such an undertaking requires legislative studies that have not been conducted. But advocates are urging legislators to make a few critical changes that they say could prevent tragedies, including giving hospitals the right to detain someone who is having a mental health crisis.

From the time Mr. Thomas was 10, he had told friends he heard demons in his head instructing him to do bad things. The cacophony drove him to attempt suicide repeatedly as an adolescent, according to court records. He drank and abused drugs to try to quiet the noise.

bgrissom@texastribune.org

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Jail officers accused of ordering an inmate beaten

Two Cook County Jail officers overseeing a psychiatric ward ordered two inmates to beat up another inmate who had angered them and then tried to cover it up by claiming the battered victim attempted suicide, prosecutors said Friday.

"This is what happens to you (expletive) when you step out of line. You disrespect us, we disrespect you," prosecutors said the officers announced to the entire tier after the beating last February.

Delphia Sawyer, 31, and Pamela Bruce, 30, both six-year veterans with the sheriff's office, were charged with official misconduct, obstructing justice, perjury and mob action. Judge Edward Harmening set bail at $50,000 each and ordered them to turn over any firearms.

A photograph taken of the victim, Kyle Pillischafske, on the day after shows he sustained two black eyes and severe swelling on his face. Prosecutors said the damage took place despite the officers yelling for the two inmates to hit Pillischafske with "body shots" so his injuries would be less visible.

The inmate's mother, Morgan Pillischafske, of Mount Prospect, told the Tribune that she was shocked when she learned about the beating and later heard from her son that he thought he was going to die. He had been doing well there, receiving treatment for his bipolar disorder while awaiting trial on an aggravated battery charge, she said.

"Not only did these guards mistreat Kyle, they took advantage of two other inmates as well, all because they were supposedly called a name," she said Friday in a telephone interview. "You have to have thicker skin than that."

Sawyer and Bruce were working the 3 to 11 p.m. shift in the psychiatric tier in maximum-security Division 10 when inmates tried to light a makeshift cigarette in an electrical outlet, sparking a small fire and cutting power to part of the tier, Assistant State's Attorney Nicholas Trutenko said.

The officers, believing Pillischafske was partly to blame, confronted him, prompting a heated exchange, the prosecutor said.

The officers instructed "two of the larger inmates" to go into his cell and beat him, Trutenko said.

Sawyer and Bruce are alleged to have stood watch while the two inmates struck Pillischafske in the face and head. They then joined in, hitting him with their radios and kicking him in the side, the prosecutor said.

To cover up their misconduct, the officers misled a supervisor to believe that Pillischafske hurt himself by banging his head against a shower wall during a suicide attempt, the charges alleged.

The two later lied repeatedly to a grand jury investigating the beating, Trutenko said.

After their arrest Thursday, both officers were stripped of police powers and suspended with pay pending an internal disciplinary hearing next week, said Frank Bilecki, the sheriff's spokesman.

A lawsuit filed by Pillischafske against the officers, the county and Sheriff Tom Dart is pending in federal court.

Bruce, of Chicago, and Sawyer, of Justice, are both married mothers of two and have no criminal records or disciplinary history with the Sheriff's Department, according to their attorneys.

Peter Hickey, Sawyer's attorney, noted she was in charge of a very volatile tier of "psychiatrically disturbed patients."

"These aren't choir boys from St. Patrick's parish," Hickey told the judge.

Pillischafske, now 19, was jailed at the time of the beating on a charge he intentionally caused a car crash in a botched suicide attempt, injuring a woman in the other car. He pleaded guilty a few weeks later to aggravated battery and was sentenced to probation, court records show.

Pillischafske's mother said despite her son's mental health issues, he is a "pretty likable kid" who loves music, plays bass guitar and is hoping to go to college.

"Kyle needs to move on from this," she said. "The whole thing was very unfortunate."

jmeisner@tribune.com

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Drone Pilots Found to Get Stress Disorders Much as Those in Combat Do

U.S. Air Force/Master Sgt. Steve Horton

Capt. Richard Koll, left, and Airman First Class Mike Eulo monitored a drone aircraft after launching it in Iraq.

The study affirms a growing body of research finding health hazards even for those piloting machines from bases far from actual combat zones.

“Though it might be thousands of miles from the battlefield, this work still involves tough stressors and has tough consequences for those crews,” said Peter W. Singer, a scholar at the Brookings Institution who has written extensively about drones. He was not involved in the new research.

That study, by the Armed Forces Health Surveillance Center, which analyzes health trends among military personnel, did not try to explain the sources of mental health problems among drone pilots.

But Air Force officials and independent experts have suggested several potential causes, among them witnessing combat violence on live video feeds, working in isolation or under inflexible shift hours, juggling the simultaneous demands of home life with combat operations and dealing with intense stress because of crew shortages.

“Remotely piloted aircraft pilots may stare at the same piece of ground for days,” said Jean Lin Otto, an epidemiologist who was a co-author of the study. “They witness the carnage. Manned aircraft pilots don’t do that. They get out of there as soon as possible.”

Dr. Otto said she had begun the study expecting that drone pilots would actually have a higher rate of mental health problems because of the unique pressures of their job.

Since 2008, the number of pilots of remotely piloted aircraft — the Air Force’s preferred term for drones — has grown fourfold, to nearly 1,300. The Air Force is now training more pilots for its drones than for its fighter jets and bombers combined. And by 2015, it expects to have more drone pilots than bomber pilots, although fighter pilots will remain a larger group.

Those figures do not include drones operated by the C.I.A. in counterterrorism operations over Pakistan, Yemen and other countries.

The Pentagon has begun taking steps to keep pace with the rapid expansion of drone operations. It recently created a new medal to honor troops involved in both drone warfare and cyberwarfare. And the Air Force has expanded access to chaplains and therapists for drone operators, said Col. William M. Tart, who commanded remotely piloted aircraft crews at Creech Air Force Base in Nevada.

The Air Force has also conducted research into the health issues of drone crew members. In a 2011 survey of nearly 840 drone operators, it found that 46 percent of Reaper and Predator pilots, and 48 percent of Global Hawk sensor operators, reported “high operational stress.” Those crews cited long hours and frequent shift changes as major causes.

That study found the stress among drone operators to be much higher than that reported by Air Force members in logistics or support jobs. But it did not compare the stress levels of the drone operators with those of traditional pilots.

The new study looked at the electronic health records of 709 drone pilots and 5,256 manned aircraft pilots between October 2003 and December 2011. Those records included information about clinical diagnoses by medical professionals and not just self-reported symptoms.

After analyzing diagnosis and treatment records, the researchers initially found that the drone pilots had higher incidence rates for 12 conditions, including anxiety disorder, depressive disorder, post-traumatic stress disorder, substance abuse and suicidal ideation.

But after the data were adjusted for age, number of deployments, time in service and history of previous mental health problems, the rates were similar, said Dr. Otto, who was scheduled to present her findings in Arizona on Saturday at a conference of the American College of Preventive Medicine.

The study also found that the incidence rates of mental heath problems among drone pilots spiked in 2009. Dr. Otto speculated that the increase might have been the result of intense pressure on pilots during the Iraq surge in the preceding years.

The study found that pilots of both manned and unmanned aircraft had lower rates of mental health problems than other Air Force personnel. But Dr. Otto conceded that her study might underestimate problems among both manned and unmanned aircraft pilots, who may feel pressure not to report mental health symptoms to doctors out of fears that they will be grounded.

She said she planned to conduct two follow-up studies: one that tries to compensate for possible underreporting of mental health problems by pilots and another that analyzes mental health issues among sensor operators, who control drone cameras while sitting next to the pilots.

“The increasing use of remotely piloted aircraft for war fighting as well as humanitarian relief should prompt increased surveillance,” she said.

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16 airport investors show interest in Midway

An international array of airport investors and operators have shown interest in developing bids to privatize Midway Airport, the city announced Friday evening.

Sixteen parties responded to the city's "request for qualifications" by a 4 p.m. deadline, indicating they had interest in leasing, operating and improving the Southwest Side airport, the nation's 26th busiest, with about 9 million passengers passing through annually.

"The response generated from the  ... process is encouraging and provides the city with a sense of the strong level of interest in a potential lease," said Lois Scott, the city's chief financial officer. "We must evaluate fully if this could be a win for Chicagoans."

The city and its advisers will review the responses to identify qualified potential bidders.

Of the 16, seven had both the operational and financial capabilities sought in the RFQ. The city identified them as:

-- ACO Investment Group, an investor and operator with global airport experience.

-- AMP Capital Investors Limited, a manager and investor in airports, including Melbourne Airport in Australia and Newcastle Airport, in Britain.

--  Corporacion America Group, an Argentina-based airport operator with 49 airports in seven countries.

-- Global Infrastructure Partners (GIP), which is the controlling investor and active manager of London City Airport, London Gatwick Airport and Edinburgh Airport.

--Great Lakes Airport Alliance, which is a partnership of Macquarie Infrastructure and Real Assets and Ferrovial. Its airport operations include London's Heathrow, Brussels Airport and Copenhagen Airport.

-- Incheon International Airport and Hastings Funds Management, which is the sole owner and operator of Incheon International Airport in South Korea and an investor with 16 airport-related investments.

--  Industry Funds Management and Manchester Airport Group, an investor with interests in 13 airports, including Melbourne Airport and Brisbane Airport, both in Australia, and operator of Manchester Airport and East Midlands Airport, in Britain.

If the city moves forward and seeks proposals, a privatization plan could be submitted to the City Council this summer.

This is the second time Chicago has looked at privatizing Midway. A 99-year lease that would have brought in $2.5 billion died in 2009 when the financial markets froze. That deal had drawn six serious bidders.

Mayor Rahm Emanuel has said any second attempt would have to provide city taxpayers with a better deal than the widely criticized 75-year agreement to privatize parking meter operations, carried out during former Mayor Richard Daley's administration. Proceeds from the earlier deal were used to plug operating deficits, and meter rates rose sharply.

This time, proposed leases must be less than 40 years, which locks in the city for a shorter period.

Rather than making only an upfront payment, the private operator also must share revenue with the city on an ongoing basis. Initial proceeds would be used to pay down debt issued since 1996 to rebuild the airport, the mayor's office said. There is about $1.4 billion in outstanding debt.

Longer term, cash flow would be directed to city infrastructure needs. The mayor has pledged proceeds would not be used to pay for city operations.

kbergen@tribune.com

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Governors Fall Away in G.O.P. Fight Against More Medicaid

Under pressure from the health care industry and consumer advocates, seven Republican governors are cautiously moving to expand Medicaid, giving an unexpected boost to President Obama’s plan to insure some 30 million more Americans.

The Supreme Court ruled last year that expanding Medicaid to include many more low-income people was an option under the new federal health care law, not a requirement, tossing the decision to the states and touching off battles in many capitols.

The federal government will pay the entire cost of covering newly eligible beneficiaries from 2014 to 2016, and 90 percent or more later. But many Republican governors and lawmakers immediately questioned whether that commitment would last, and whether increased spending on Medicaid makes sense, given the size of the federal budget deficit. Some flatly declared they would not consider it.

In Florida, where Gov. Rick Scott reversed his position and on Wednesday announced his support for expanding Medicaid, proponents say that doing so will not only save lives, but also create jobs and stimulate the economy. Similar arguments have swayed the Republican governors of Arizona, Michigan, Nevada, New Mexico, North Dakota and Ohio, who in recent months have announced their intention to expand Medicaid.

The shift has delighted supporters of the law.

“I think this means the dominoes are falling,” said Ronald F. Pollack, the executive director of Families USA, a consumer group. “The message is, ‘Even though I may not have supported and even strongly opposed the Affordable Care Act, it would be harmful to the citizens of my state if I didn’t opt into taking these very substantial federal dollars to help people who truly need it.’ ”

 Nationwide, Medicaid covers 60 million people, most of them low-income or disabled. The Congressional Budget Office has estimated that 17 million more people could be enrolled if all states took the expansion option. So far, 22 states have said they will expand the program, 17 have opted against it, and 11 have not yet decided, according to Avalere Health, a consulting firm.

Some Republican governors remain firmly opposed to the expansion of Medicaid. In her State of the State address, Gov. Nikki R. Haley said, “As long as I am governor, South Carolina will not implement the public policy disaster that is Obamacare’s Medicaid expansion.”

Gov. Rick Perry affirmed that “Texas will not expand Medicaid” and said he was proud that Texas did not follow other states “scrambling to grab every tax dollar they can.”

The change of heart for some Republican governors has come after vigorous lobbying by health industry players, particularly hospitals. Hospital associations around the country signed off on Medicaid cuts under the health care law on the assumption that their losses would be more than offset by new paying customers, including many insured by Medicaid.

Politics could also be a factor in states where Republican governors have decided to expand Medicaid. Mr. Obama won all of those states except Arizona and North Dakota in last year’s election, a fact that may have influenced several of the governors’ decisions. Some of the seven are also up for re-election next year.

Religious leaders have added a moral dimension to the campaign in some states. The Roman Catholic bishops of Salt Lake City and Little Rock, Ark., for example, have urged state officials to expand Medicaid.

The Obama administration has tried to win over skeptical state officials by offering new flexibility to manage Medicaid as they like. On the same day that he agreed to expand Medicaid in Florida, Mr. Scott got federal permission to move more Medicaid beneficiaries into private managed care plans.

Mr. Scott’s support for expanding Medicaid is particularly significant — Florida is the fourth most populous state — and surprising. A onetime hospital executive, he has been among the most strident critics of the health care law, and his opposition to it was a cornerstone of his 2010 campaign for governor.

The battle is not over, however. In Florida, as in many other states, expansion is subject to approval by the Legislature, whose Republican leaders have expressed misgivings. The legislative session begins next month, and advocates say they plan to press ahead with a lobbying campaign.

Leah Barber-Heinz, a spokeswoman for Florida Chain, a health advocacy group, said it was trying to inform lawmakers and the public about who would benefit from an expansion of Medicaid. More than one-fifth of Florida residents, roughly 4 million of 19 million people, lack health insurance.

“There are so many misperceptions about the uninsured,” Ms. Barber-Heinz said. “So we’re trying to show faces of who would be impacted: people who have been hit by the recession, people who have been laid off, educated people, people who own homes.”

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United takes Dreamliner off schedule until June

The All Nippon Airways Dreamliner 787 arrives at Mineta San Jose International Airport. (Gary Reyes/San Jose Mercury News/MCT / January 22, 2013)

Staff and wire report

1:35 p.m. CST, February 21, 2013

The parent company of United Airlines says it is taking the Boeing 787 off its schedule through June 5 for all but one of its routes.

United Continental Holdings Inc. said it still plans to use the 787 on its flights between Denver and Tokyo's Narita airport starting May 12. It had aimed to start that route on March 31.

United, currently world's largest airline and the only U.S. customer for the 787, said the timing of that reinstatement will depend on resolution of the Dreamliner's current issues.

The 50 Dreamliners in commercial service were grounded worldwide last month after a series of battery-related incidents including a fire on board a parked plane in the United States and an in-flight problem on another jet in Japan. United had only been flying the plance since November.

Sources told Reuters earlier this week that Boeing Co. has found a way to fix the battery problems that involves increasing the space between the lithium ion battery cells.

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Tribune exclusive: 'We were just regular parents who were slapped in the face'

The parents of slain teen Hadiya Pendleton talk about her life and death and the issues raised after she died. (Chris Walker/Chicago Tribune)

11:57 p.m. CST, February 20, 2013

Hadiya Pendleton’s parents haven’t had much time to reminisce about their daughter’s life and death before Wednesday, when they sat down for an exclusive interview with the Tribune.

Cleopatra Cowley-Pendleton recalled getting the phone call on Jan. 29 that her 15-year-old daughter had been shot, and rushing to the hospital only to find out it was too late, her daughter was dead.

A whirlwind of activity followed as Hadiya became a national symbol of gun violence and her parents traveled to Washington for President Barack Obama’s State of the Union speech.

“I’m not going to be extremely political, but if I can help someone else not go through what we’ve gone through, then I have to do what I can,” Cowley-Pendleton said. “These are the cards we have been dealt. If these are the shoes I need to walk in, I don’t mind walking in them.”

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Michael Moore on “5 Broken Cameras” director’s LAX ordeal: It doesn’t compare to Palestinians’ “daily humiliation”

LOSD ANGELES (TheWrap.com) – Michael Moore said that Oscar-nominated Palestinian filmmaker Emad Burnat‘s ordeal with immigration officials on Tuesday demonstrates that the United States is overly strict when it comes to greeting foreign visitors, particularly people of color.

“If he’d been a white guy he wouldn’t have to go through that in our ‘post-racial’ America,” Moore, the Oscar-winning director of “Bowling for Columbine,” told TheWrap via email.

Burnat, whose film “5 Broken Cameras” is up for a Best Documentary Academy Award, was held for questioning by immigration officials at Los Angeles International Airport and was asked to produce evidence that he was, indeed, invited to attend Sunday’s ceremony. The director and his family were grilled for an more than an hour, he said, while authorities repeatedly suggested he might be sent back to his native country.

Moore, who is a governor in the Academy’s documentary branch and an outspoken supporter of Burnat’s film, intervened after receiving a text message from the director.

On his blog, Moore wrote that he contacted officials at the Academy of Motion Picture Arts & Sciences, which produces the Oscars, who in turn enlisted the organization’s attorney. Moore called the State Department in Washington and told Burnat to have the officials call him so he could verify that he was an Oscar nominee and shouldn’t be deported.

“5 Broken Cameras” centers on a Palestinian farmer who lives on the border of an Israeli settlement, and both Burnat and Moore likened the questioning by officials to the daily experience of living under an often oppressive regime.

“Although this was an unpleasant experience, this is a daily occurrence for Palestinians, every single day, throughout the West Bank,” Burnat said in a statement to TheWrap. “There are more than 500 Israeli checkpoints, roadblocks, and other barriers to movement across our land, and not a single one of us has been spared the experience that my family and I experienced yesterday. Ours was a very minor example of what my people face every day.”

Moore echoed those statements in an interview with TheWrap and also spoke about “5 Broken Cameras” chances of victory at the Oscars where it will go up against such acclaimed documentaries as “How to Survive a Plague” and “Searching for Sugar Man.”

What does Burnat’s detention say about the way we our country treats foreign visitors?

We have reacted with unnecessary paranoia and as a result foreign visitors first encounter with an American – the immigration officer – is not that pleasant.

Are there parallels between his treatment and that of Palestinians in the West Bank?

He has spoken to this point in his statement today. What happened at LAX last night is actually pretty minor compared to the daily humiliation he and others suffer in the Palestinian territories.

Do you think Burnat is owed an apology by Immigration officials?

Yes.

Assuming he won’t get one, I’ve already apologized on behalf of the rest of us.

You said on Twitter that part of the problem was that immigration officials could not believe a Palestinian was nominated for an Oscar – why do you believe that?

I was being slightly sarcastic. But I’m sure if he’d been a white guy he wouldn’t have to go through that in our “post-racial” America.

Do you think “5 Broken Cameras” Oscar chances are?

Thanks to the changes the Doc branch made this year where everyone in the branch got to vote to select the five nominees, the five nominated films are some of the best work we’ve seen in years. And now that we convinced the Academy to let all 6,000 members vote, I’d say the race is too close to call.

What is your critical assessment of the film?

This is not only one of the best docs of the year, it’s one of the best movies. It’s a powerful film, co-directed by a Palestinian and an Israeli. It’s the first Palestinian film to be nominated for Best Documentary. That makes it an historic moment for the Academy and for movie lovers everywhere. For that alone, he should have receives roses and an official welcome at LAX, not the detention room.

Movies News Headlines – Yahoo! News

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In Reversal, Florida to Take Health Law’s Medicaid Expansion

MIAMI — Gov. Rick Scott of Florida reversed himself on Wednesday and announced that he would expand his state’s Medicaid program to cover the poor, becoming the latest — and, perhaps, most prominent — Republican critic of President Obama’s health care law to decide to put it into effect.

It was an about-face for Mr. Scott, a former businessman who entered politics as a critic of Mr. Obama’s health care proposals. Florida was one of the states that sued to try to block the law. After the Supreme Court ruled last year that though the law was constitutional, states could choose not to expand their Medicaid programs to cover the poor, Mr. Scott said that Florida would not expand its programs.

Mr. Scott said Wednesday that he now supported a three-year expansion of Medicaid, through the period that the federal government has agreed to pay the full cost of the expansion, and before some of the costs are shifted to the states.

“While the federal government is committed to paying 100 percent of the cost, I cannot in good conscience deny Floridians that needed access to health care,” Mr. Scott said at a news conference. “We will support a three-year expansion of the Medicaid program under the new health care law as long as the federal government meets their commitment to pay 100 percent of the cost during that time.”

He said there were “no perfect options” when it came to the Medicaid expansion. “To be clear: our options are either having Floridians pay to fund this program in other states while denying health care to our citizens,” he said, “or using federal funding to help some of the poorest in our state with the Medicaid program as we explore other health care reforms.”

Mr. Scott said the state would not create its own insurance exchange to comply with another provision of the law.

His reversal sent ripples through the nation, especially given the change in tone and substance since the summer, when he said he would not create an exchange or expand Medicaid.

“Floridians are interested in jobs and economic growth, a quality education for their children, and keeping the cost of living low,” Mr. Scott said in a statement at the time. “Neither of these major provisions in Obamacare will achieve those goals, and since Florida is legally allowed to opt out, that’s the right decision for our citizens.”

Mr. Scott now joins the Republican governors of Arizona, Michigan, Nevada, New Mexico, North Dakota and Ohio, who have decided to join the Medicaid expansion. Some, like Gov. Jan Brewer of Arizona, were also staunch opponents of Mr. Obama’s overall health care law.

Shortly before his announcement, the governor received word from the federal government that it planned to grant Florida the final waiver needed to privatize Medicaid, a process the state initially undertook as a pilot project. Mr. Scott, who is running for re-election next year, has heavily lobbied for the waiver, arguing that Florida could not expand Medicaid without it.

Mr. Scott’s support of Medicaid expansion is significant, but is far from the last word. The program requires approval from Florida’s Republican-dominated Legislature, which has been averse to expanding Medicaid under the health care law. The Legislature’s two top Republican leaders said that before making a decision they would consider recommendations from a select committee, which has been asked to review the state’s options.

“The Florida Legislature will make the ultimate decision,” Will Weatherford, the state House speaker, said. “I am personally skeptical that this inflexible law will improve the quality of health care in our state and ensure our long-term financial stability.”

Medicaid, which covers three million people in Florida, costs the state $21 billion a year. The expansion would extend coverage to one million more people.

Mr. Scott’s reversal is sure to anger his original conservative supporters.

The governor “was elected because of his principled conservative leadership against Obamacare’s overreach,” said Slade O’Brien, state director for Americans for Prosperity, an influential conservative advocacy organization. “Hopefully our legislative leaders will not follow in Governor Scott’s footsteps, and will reject expansion.”

During his announcement on Wednesday, Mr. Scott said his mother’s recent death and her lifetime struggle to raise five children “with very little money” played a role in his decision.

“Losing someone so close to you puts everything in a new perspective, especially the big decisions,” he said.

Michael Cooper contributed reporting from New York.

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OfficeMax, Office Depot agree to merger

Office Depot to buy Office Max as an attempt to compete with Staples.

Office Depot Inc. and Naperville-based OfficeMax Inc. confirmed Wednesday that they're planning to merge but left some key questions about the deal unanswered.

The all-stock deal calls for Office Depot to issue 2.69 new shares of common stock for each outstanding common share of OfficeMax. But officials declined to say where the newly merged company would be headquartered, who would sit in the CEO seat or even what it would be called.

OfficeMax CEO Ravi Saligram and Office Depot CEO Neil Austrian presented a united front during a Wednesday conference call with analysts, taking turns to explain the specifics of the deal.

"It takes two to tango," Saligram said. "Lo and behold, Neil and I have decided to tango."

The announcement of a merger, which Saligram said would "create a stronger, more global, more efficient competitor," put to rest years of speculation about a deal. The merger would unite the No. 2 company in the stationery and office supplies industry, Boca Raton, Fla.-based Office Depot, with the No. 3 company, OfficeMax, headquartered off Interstate 88.

A merger between the two chains "has made sense for years," Credit Suisse analyst Gary Balter wrote in a note this week.

Market leader Staples also would benefit from a merger, BB&T Capital Markets analyst Anthony Chukumba said.

"Clearly, you can't make this deal work unless you close a bunch of stores," he said. "Store rationalization is long overdue, and Staples will clearly benefit from just having fewer stores to compete with."

OfficeMax, with about 29,000 employees, operates 978 stores, including 10 in the Chicago area. Office Depot has about 39,000 employees and operates 1,675 stores, including seven in the Chicago area.

The two CEOs wouldn't say how many stores would be closed, but Balter has predicted about 600.

If the merger is completed, the company's board would have an equal number of directors chosen by Office Depot and OfficeMax. Based on Wednesday's stock closing price, the deal's value is about $976 million.

The combined company would have $18 billion in sales and achieve $400 million to $600 million in savings over three years, according to company officials.

Office Depot shareholders would own about 54 percent of the company and OfficeMax shareholders 46 percent.

It was not clear, though, whether those stockholders would be satisfied with the deal. One of OfficeMax's largest shareholders, Neuberger Berman, said this week that it would support a deal, depending on the terms.

The deal also is subject to approval by regulatory agencies, including the Federal Trade Commission.

Officials declined to say who would lead the combined business or where it would be located once the "merger of equals" is completed, likely by the end of the year.

"During the appropriate times ... our board will make the right decision," OfficeMax's Saligram said. "Now, we're independent companies, and we've got to go through lots of processes."

Saligram and Austrian will be considered to lead the company, but until a leader is chosen, they will remain in their positions.

"From the time we started talking, Ravi and I have grown very fond of each other. It's very clear we can work well together," Austrian said.

Their proposed partnership didn't begin well. The announcement of the planned merger was buried in an earnings release posted prematurely on the Office Depot website early in the morning, then quickly removed. The companies recovered, and about 8:30 a.m., they issued a joint statement announcing the proposed merger.

The mishap will likely be investigated by stock exchanges and regulatory organizations, according to a Chicago financial attorney.

"I am highly confident that the New York Stock Exchange, the Nasdaq and the Securities and Exchange Commission will be looking very closely at who pulled the trigger, who knew about this, and was this in good faith?" James McGurk said.

McGurk said he was not suggesting wrongdoing.

"When you think about it, you have two boards, lots of investment advisers, lawyers, and deals break down at the last minute. Are there lots of ways it could happen? Sure," he said.

OfficeMax shares closed Wednesday down 91 cents, or 7 percent, at $12.09. Shares of Office Depot closed down 84 cents, or nearly 17 percent, at $4.18.

Reuters contributed.

crshropshire@tribune.com

Twitter @corilyns

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