Change in Managed Care

Firm Won't Second-Guess Doctors

A managed-care company that serves more than 200,000 people in Virginia, Maryland and the District has decided to leave the diagnoses to the doctors.

UnitedHealthcare, one of the nation's largest managed-care companies, will no longer second-guess patients' doctors. Company officials said that requiring doctors to get approval for costly tests or procedures actually cost more money than it saved.

"We were creating a hoop that somebody had to jump through, [and] we didn't make it a satisfying experience for anybody," said Jeannine Rivet, United's chief executive.

Industry analysts said other managed-care companies could follow in the steps of United, which covers 14.5 million people across the country. "I think this is a real sea change for the industry," said Jamie Court of Consumers for Quality Care, a patient advocacy group in California.

Thanking Union Workers

District Gives $1,700 Bonuses

About 6,500 unionized city employees--from trash collectors to secretaries and other clerical and professional workers--are about to get a heartfelt thank you from the city.

Oh, and a check for $1,700, if the thanks aren't quite enough.

The one-time bonus is the city's way of rewarding workers who gave up pay hikes and suffered furloughs when the city was scraping bottom financially. And it's an effort by Mayor Anthony A. Williams (D) to improve relations with unions, which were testy at best after he fired 165 city workers when he was chief financial officer.

"It's a new beginning," said George Johnson, the unions' chief negotiator. "This will set the stage for how labor and managers work in D.C. for years to come."

It may be a new beginning, but the ending--and middle--could be messy. Williams hopes the lump sums will help persuade unions to move into an era in which people are paid on the basis of performance, and city agencies compete with private firms for city contracts. But unions say they're not ready to toss all the old rules.

Across the Region

Avoiding the Flu; Moving Home

* If advisers to Gov. Parris N. Glendening have their way, all handguns sold in Maryland will have built-in locks within two years. And the 21-member task force endorsed technology that would keep anyone but a gun's owner from firing it. The problem with that: Such "smart guns" are years away from actually existing. The task force is set to vote on the preliminary recommendation in the next couple of weeks, and Glendening will use it to frame proposed legislation.

* Blocks away from where shoppers while away the hours at White Flint Mall in Rockville, government scientists have conducted research on an exotic strain of flu virus. And that has some lawmakers worried. The House Commerce Committee has asked the federal workers to take their studies of avian flu farther afield. But federal officials say that the small amount of flu virus used isn't in a form that could infect humans.

* The District government is going back home. The General Services Administration has dropped plans to move federal workers into part of the District government's historical headquarters in the John A. Wilson Building at 14th Street and Pennsylvania Avenue NW. That means the D.C. Council and the mayor's office won't have to share the Beaux-Arts beauty, which just got a $52 million make-over. It may take a year for city honchos to move from One Judiciary Square, though.

* In a development that a Democrat says is "potentially tragic for Northern Virginia," a Fairfax County Republican dropped out of the race for speaker of Virginia's House. Some colleagues thought John H. "Jack" Rust Jr. had too little experience, after five years as a delegate, to unite the GOP caucus. But all's not lost for Rust: He's now in prime position to become majority leader.

* Sure, your car and your nerves may be jangled by the trenches dug in dozens of District streets in recent weeks, but it's all for a reasonably good cause. Crews are laying pipe and fiber-optic cable for telephone, cable TV and Internet services. Mayor Anthony A. Williams has given the companies 120 days, starting when they get a permit, to finish a job. And he says all the work downtown must be done by Thanksgiving.

* The effort by Sen. John McCain (R-Ariz.) to add flights at Reagan National Airport is going nowhere fast. Both the House and the Senate have agreed to add more flights, though they differ on the number. But the aviation bill that included McCain's initiative seemed headed for defeat, which would delight many people who live near the airport.

* Police in Capitol Hill are looking for a man who broke into the apartments of two women, crawled into bed with them--and fled when the women awoke and started to scream. Police say the man does not appear to know the women. "People write volumes in books on psychiatric problems," said D.C. police Sgt. Jeff Christy. "We don't know why he's doing it."

* They came. They saw. They turned around and headed back into the woods. The three black bears that poked around in the Great Falls area last week probably were looking for a snack, driven from their Blue Ridge Mountains home by last summer's drought, experts say. The bears didn't do any damage. But nearby residents were told to bring in their pumpkins and trash bins.

-- Erica Johnston

Fire Destroys Swath of Historic Ellicott City

Lawmakers Propose Retrofitting Buildings With Sprinklers

For most of the shopkeepers in Ellicott City's historic downtown, it's business--but not quite as usual--after a six-alarm fire ravaged several stores.

As demolition crews began work on portions of the hardest-hit buildings, shopkeepers at the undamaged buildings swung open their doors two days after the blaze, hopeful that shoppers will return for the Christmas season.

It was the second major fire in the historic district in 15 years, and experts warned that it will happen again unless the buildings are retrofitted with modern safety features. Only one of the Main Street buildings--except those rebuilt after the 1984 fire--has sprinklers, because they were built long before Maryland's modern fire code was enacted.

State lawmakers are talking about offering loans so shopkeepers can make their buildings safer. "Clearly, there's some sort of state responsibility here," said state Del. Robert L. Flanagan (R), whose district includes Ellicott City. "We'll have to do a lot of work, a lot of head-knocking, to see if we can put something together."

Switched Baby to Stay With Grandparents

Judge Allows Biological Mother Visitation With Girl

Rebecca Grace Chittum, one of two little girls switched at birth four years ago, will remain in the small town where she has been raised, a Virginia juvenile judge ruled Friday.

Paula Johnson, Rebecca's biological mother, had sought custody of the child after relations broke down earlier this year between her and the grandparents raising Rebecca. After Friday's decision, which awarded Johnson once-a-month weekend visits and a longer summertime stretch with Rebecca, the adults in the case vowed to work together in the little girl's best interests.

In a still-mysterious mix-up at the University of Virginia Medical Center in the summer of 1995, the newborn Rebecca was mistakenly sent home with Kevin Chittum and Whitney Rogers, while their baby went home with Johnson. The baby switch came to light in 1998. Chittum and Rogers had been killed in a car crash shortly before the mixup was revealed, and Rebecca has been raised by their parents.

Judge John B. Curry II based his decision largely on the comments of a child psychologist who testified that taking Rebecca away from her grandparents could be a devastating blow to the child.

CAPTION: Investigators have ruled out arson but do not know what caused a fire that did at least $2 million in damage to Ellicott City.

CAPTION: Lisa Thompson gives her father, Bill Sachs, a hug as the family surveys the damage done to their Main Street gallery.

CAPTION: A judge denied Paula Johnson's request for custody of her biological daughter.