27 indicted in Mexican Mafia drug case in Ventura County

From a prison cell outside California, an inmate known as "Evil" was making himself known on Ventura County's streets.

Martin Madrigal, 39, was squeezing drug profits from street gangs for the prison-based Mexican Mafia, according to a grand jury indictment released Tuesday. He was so feared that rival gangs cooperated on extortion schemes, drug deals and violent crimes, according to law enforcement officials.

The 35-count indictment portrays Madrigal as a powerful figure representing an efficient and merciless organization that law enforcement officials believe has been operating for decades, largely from behind bars, calling shots among street gangs. He was one of 27 people named in the indictment, 24 of whom have been arrested. Officials declined to disclose where or why Madrigal is serving time.

The forced cooperation among rival gangs alleged in the indictment may be a sign that Mexican drug cartels are attempting to extend their authority over California drug trafficking, according to Ventura County Assistant Sheriff Gary Pentis.

Madrigal operated as a kind of regional manager, with a Ventura County gang member named Edwin "Sporty" Mora enforcing his decisions on the street with a written hit list from Madrigal and "permission to conduct extortion on behalf of the Mexican Mafia," according to the indictment. In one of the document's counts, Mora is said to have indicated that a gang member named Little Rudy "was going to kick in money by Wednesday and if he can't make that happen, Mora wanted the fool in the dirt."

Dozens of weapons, including an AK47, were confiscated during a series of arrests starting in May and ending earlier this month.

The Ventura County probe, dubbed Operation Wicked Hand, started with two shootings in Moorpark in April and a heroin bust about the same time.

"We soon came to realize the incidents weren't happenstance," Ventura County Sheriff Geoff Dean said.

Sheriff's officials said investigators thwarted several crimes, including two planned killings and a drugstore robbery.

Officials would not reveal details of how the investigation was conducted. The indictment, returned Nov. 14, makes it clear authorities had access to text messages and phone calls that gang members made among themselves.

More than 70 officers from the Sheriff's Department participated in the investigation, as well as officers from the Oxnard Police Department and other agencies.

"This case has dealt a crushing blow to organized crime in Ventura County," Pentis said. "We have incapacitated the organization from the top through its geographic managers."

Bail for those arrested, including two juveniles, ranges from $1 million to $5 million. Dist. Atty. Greg Totten said a number of suspects are facing multiple charges, and three are facing possible life sentences under the state's three-strikes law.

Totten said his office submitted the case to a criminal grand jury rather than opting for a preliminary hearing because of its complexity and the ongoing investigation's need for secrecy.

The indictment names more individuals than any other in Ventura County's history, he said.

steve.chawkins@latimes.com

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In elf ears and wizard hats, 'Hobbit' fans rejoice

WELLINGTON, New Zealand (AP) — Wearing elf ears and wizard hats, sitting atop their dad's shoulders or peering from balconies, tens of thousands of New Zealanders watched their favorite "Hobbit" actors walk the red carpet Wednesday at the film trilogy's hometown premiere.

An Air New Zealand plane freshly painted with "Hobbit" characters flew low over Wellington's Embassy Theatre, eliciting roars of approval from the crowd.

Sam Rashidmardani, 12, said he came to see Gollum actor Andy Serkis walk the red carpet — and he wasn't disappointed.

"It was amazing," Rashidmardani said of the evening, adding his Gollum impression: "My precious."

British actor Martin Freeman, who brings comedic timing to the lead role of Bilbo Baggins, said he thought director Peter Jackson had done a fantastic job on "The Hobbit: An Unexpected Journey."

"He's done it again," Freeman said in an interview on the red carpet. "If it's possible, it's probably even better than 'The Lord of the Rings.' I think he's surpassed it."

While it is unusual for a city so far from Hollywood to host the premiere of a hoped-for blockbuster, Jackson's filming of his lauded 'LOTR' trilogy and now "The Hobbit" in New Zealand has helped create a film industry here. The film will open in theaters around the world next month.

One of the talking points of the film is the choice by Jackson to shoot it using 48 frames per second instead of the traditional 24 in hopes of improving the picture quality.

Some say the images come out too clear and look so realistic that they take away from the magic of the film medium. Jackson likens it to advancing from vinyl records to CDs.

"I really think 48 frames is pretty terrific and I'm looking forward to seeing the reaction," Jackson said on the red carpet. "It's been talked about for so long, but finally the film is being released and people can decide for themselves."

Jackson said it was strange working on the project so intimately for two years and then having it suddenly taken away as the world got to see the movie.

"It spins your head a little bit," he said.

Aidan Turner, who plays the dwarf Kili in the movie, said his character is reckless and thinks he's charming.

"I don't get to play real people it seems, I only get to play supernatural ones," he said. "So playing a dwarf didn't seem that weird, actually.

Perhaps the most well-known celebrities to walk the carpet were Cate Blanchett and Elijah Wood, who reprise their roles in the LOTR in the "Hobbit."

"Mostly I came here to see everyone. I like them all," said fan Aysu Shahin, 16, adding that Wood was her favorite. She said she wanted to see the movie "as soon as possible. I'm excited for it."

At a news conference earlier in the day, Jackson said many younger people are happy to watch movies on their iPads.

"We just have to make the cinema-going experience more magical and more spectacular to get people coming back to the movies again," he said.

Jackson said only about 1,000 of the 25,000 theaters that will show the film worldwide are equipped to show 48 frames, so most people will see it in the more traditional format. The movie has also been shot in 3D.

A handful of animal rights protesters held signs at the premiere.

The protest by the group People for the Ethical Treatment of Animals comes after several animal wranglers said three horses and up to two dozen other animals had died during the making of the movies because they were housed at an unsafe farm.

Jackson's spokesman earlier acknowledged two horses had died preventable deaths at the farms but said the production company worked quickly to improve stables and other facilities and that claims of mistreatment were unfounded.

"No mistreatment, no abuse. Absolutely none," Jackson said at the news conference.

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Recipes for Health: Spinach and Turkey Salad — Recipes for Health

Andrew Scrivani for The New York Times

Turkey or chicken transforms this classic spinach salad (minus the bacon) into a light main dish, welcome after Thanksgiving and before the rest of the holiday season feasting begins.

2 cups (12 ounces) shredded cooked turkey, chicken breast or chicken breast tenders

1 6-ounce bag baby spinach

6 white or cremini mushrooms, thinly sliced

1 cup cooked wild rice

2 tablespoons chopped walnuts

1 to 2 hard boiled eggs (to taste), finely chopped (optional)

2 tablespoons chopped chives

1 to 2 tablespoons chopped fresh herbs such as parsley, tarragon or marjoram

For the dressing:

2 tablespoons fresh lemon juice

1 tablespoon red wine vinegar, tarragon vinegar or sherry vinegar

1 teaspoon Dijon mustard

Salt and freshly ground pepper

1 small garlic clove, pureed

1/3 cup extra virgin olive oil

2 tablespoons plain low-fat yogurt

1. Combine all of the salad ingredients in a large salad bowl. Whisk together the lemon juice, vinegar, Dijon mustard, salt, pepper, garlic, olive oil and yogurt. Toss with the salad just before serving.

Yield: Serves 4 as a main dish

Advance preparation: The salad can be assembled and the dressing mixed several hours before serving. Refrigerate and toss together when ready to serve.

Variation: Add 1 ripe but firm persimmon, peeled, cored and sliced, to the mixture.

Nutritional information per serving: 375 calories; 25 grams fat; 4 grams saturated fat; 5 grams polyunsaturated fat; 15 grams monounsaturated fat; 53 milligrams cholesterol; 14 grams carbohydrates; 2 grams dietary fiber; 119 milligrams sodium (does not include salt to taste); 26 grams protein

Martha Rose Shulman is the author of “The Very Best of Recipes for Health.”

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UCLA Medical Center gets failing grade on patient safety

A national report card on patient safety gave a failing grade to Ronald Reagan UCLA Medical Center, one of the country's most prestigious hospitals and one of only 25 nationwide to receive such low marks.

In a report issued Wednesday, the Leapfrog Group, an employer-backed nonprofit group focused on healthcare quality, gave a letter grade of F to UCLA Medical Center for performing poorly on several measures tied to preventing medical errors, patient infections and deaths.

Leapfrog withheld a failing grade for UCLA in June when it released its first-ever hospital safety scores to give low-performing hospitals time to show improvement.

Officials at UCLA disputed the failing grade and they said one patient death in 2010 unfairly lowered its grade from a C to an F under Leapfrog's methodology.

"UCLA is not an F hospital in quality and safety," said Tom Rosenthal, chief medical officer at Ronald Reagan UCLA Medical Center. "It is not a fair scoring system and it does a disservice to the public."

This debate over UCLA's score comes amid a proliferation of healthcare ratings by outside organizations trying to provide more information to consumers and employers. These scores are also taking on greater importance as some insurers and employers use them as one factor in determining whether a hospital or doctor should be included in a provider network.

Given those stakes, the California Hospital Assn. has called on Leapfrog and other rating organizations to offer more details on how their scores are tabulated and to focus on reliable measures that can assess patient care. Some highly regarded hospitals across the country, such as UCLA, fare well in one ranking and then poorly in the next.

Leapfrog gave an F to one other area hospital, Western Medical Center Anaheim. The hospital said it disagreed with Leapfrog's rating methods and added that it "continuously adds new systems to enhance our patient care."

Cedars-Sinai Medical Center received an A in Leapfrog's June report, but its grade dropped to a C on this latest review, which included more recent data from last year. Thirty Kaiser Permanente hospitals received an A and one got a B from Leapfrog.

Experts urge consumers to use these score cards as one tool in evaluating a hospital and to discuss any specific concerns with their doctor and other medical providers.

Leapfrog estimates that 180,000 Americans die annually from hospital accidents, errors and infections, and it says hospitals need to do more to protect patients from harm. Its hospital safety score is derived from 26 measures of publicly reported data.

Rosenthal said UCLA scores well on healthcare quality and patient outcomes on numerous measures tracked by the federal government and other rating organizations, suggesting that Leapfrog's methods are potentially flawed.

He said a liver transplant patient died during surgery in 2010 from an air embolism, one of several preventable medical errors that Leapfrog and other groups regularly track. Rosenthal said the patient's death was a regrettable mistake, but that error hasn't occurred since then.

Leah Binder, Leapfrog's president and chief executive, said her group's scoring methods are statistically valid and devised by a panel of leading experts in patient safety. She said UCLA scored poorly in several areas of patient care, such as foreign objects left in a patient during surgery and pressure ulcers.

"It isn't just one incident that gave them a score so far below the national average," Binder said. "We see it all the time that a hospital might have a stellar reputation, but behind the scenes they aren't safe for many of their patients."

On pressure ulcers, Rosenthal said, UCLA looked worse than its actual performance because of over-reporting in the hospital billing data that was reviewed by Leapfrog.

Overall, Leapfrog gave an A or B to 1,468 hospitals, or 56% of the 2,618 reviewed nationwide. The group issued a C to 1,004 hospitals, or 38%. At the bottom, 146 hospitals, or 6%, were labeled D or F.

Leapfrog reviewed 246 hospitals in California. The ratings are available online at http://www.hospitalsafetyscore.org.

chad.terhune@latimes.com

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Man suspected of plotting to join Al Qaeda is held without bail

A Riverside man arrested on suspicion of plotting to join Al Qaeda with three other suspects was ordered Monday to be held without bail until trial.

Magistrate Judge Sheri Pym found that Arifeen Gojali, 21, was too much of a flight risk and danger to the community, based on the allegations by federal investigators.

Gojali was led by federal marshals into U.S. District Court in Riverside on Monday, bound by handcuffs and leg irons and wearing a bright orange, jail-issued uniform. He showed little emotion during the hearing, chatting briefly with his attorney, John Aquilina.

Aquilina told the judge that neither his client nor his family had the financial means to post bail.

"If we can't get over that hurdle, what's the point?" Aquilina told reporters outside the courtroom after the brief hearing.

Gojali and three other men from the Inland Empire have been accused of plotting to join Al Qaeda or the Taliban in Afghanistan to attack American troops or coalition forces.

Gojali and two other suspects, Bart Deleon of Ontario, 24, and Miguel Santana of Upland, were arrested during a vehicle stop in Chino on Nov. 16, a day after they booked airline tickets from Mexico to Afghanistan.

Deleon and Santana are being held without bail. The alleged ringleader, Sohiel Omar Kabir, 34, was taken into custody the next day. Kabir has lived in Pomona and served a year in the U.S. Air Force.

The native Afghan and naturalized U.S. citizen converted Deleon and Santana to Islam in 2010, then left for Afghanistan, intent on joining the Taliban or Al Qaeda and paving the way for Santana and Deleon to join him, according to authorities.

Santana and Deleon allegedly recruited Gojali in September. Deleon's attorney, Randolph K. Driggs, last week criticized the federal government's case for hinging on evidence gathered by a paid confidential informant who had been convicted of drug-related charges.

The informant, who received $250,000 from the FBI and "immigration benefits" for his work over a four-year period, infiltrated the group in March and wore recording devices that provided evidence crucial to the case.

phil.willon@latimes.com

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Berry's ex says he was threatened before fight

LOS ANGELES (AP) — Halle Berry's ex-boyfriend claims the actress's fiance threatened to kill him during a Thanksgiving confrontation that left him with a broken rib, bruised face and under arrest.

Gabriel Aubry's claims are included in court filings that led a judge Monday to grant a restraining order against actor Olivier Martinez, who is engaged to the Oscar-winning actress.

Aubry, 37, was arrested on suspicion of misdemeanor battery after his confrontation with Martinez on Thursday, but he states in the civil court filings that he was not the aggressor and that he was threatened and attacked without provocation. Martinez told police that Aubry had attacked first, the filings state.

A representative for Martinez could not be immediately reached for comment.

Aubry's filing claims Martinez threatened him the day before the fight at an event at his daughter's school that he and the actors attended. Aubry, a model, has a 4-year-old daughter with Berry and the former couple have been engaged in a lengthy custody battle.

The proceedings have been confidential, but Aubry states a major aspect of the case was Berry's wish to move to Paris and take her daughter with her. The request was denied Nov. 9, Berry's court filings state, and Aubry shares joint custody of the young girl.

Aubry claims Martinez told him, "You cost us $3 million," while he was punched and kicked him in the driveway of Berry's home. Aubry had gone to the home to allow his daughter to spend Thanksgiving with her mother, the filings state. Aubry claims Martinez threatened to kill him if Aubry didn't move to Paris.

Berry was not in the driveway during the confrontation and neither was their daughter, the documents state.

Photos of Aubry's face with cuts and a black eye were included in his court filing.

A judge set a hearing for Dec. 17 to consider whether a three-year restraining order should be granted. Aubry has a Dec. 13 court date for the possible battery case, which has not yet been filed by prosecutors.

___

Anthony McCartney can be reached at http://twitter.com/mccartneyAP .

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Recipes for Health: Quinoa Salad With Avocado and Kalamata Olives — Recipes for Health

Andrew Scrivani for The New York Times

This is inspired by a salad I recently enjoyed in a small vegetarian restaurant called Siggy’s on Henry Street in Brooklyn Heights. They called it a quinoa Greek salad, but really the only thing that was Greek about it was the kalamata olives. No matter, it was still delicious.

3/4 cup quinoa

1 1/4 cups water

Salt to taste

1 small cucumber, cut in half lengthwise, seeded and sliced, or 1 Persian cucumber, sliced; or 1/2 cup sliced or diced celery (from the inner heart)

1/4 cup kalamata olives, pitted and halved (about 12__ olives)

1 ripe avocado, diced

1 tablespoon slivered fresh mint leaves

2 tablespoons chopped fresh parsley

1 1/2 ounces feta cheese, crumbled (1/3 cup, optional)

1 6-ounce bag mixed spring salad greens, baby spinach, arugula, or a combination

For the dressing:

1 tablespoon freshly squeezed lemon juice

1 tablespoon sherry vinegar

1 teaspoon Dijon mustard

1 small garlic clove, pureed

Salt to taste

2 tablespoons extra virgin olive oil

1/3 cup buttermilk or plain low-fat yogurt

Freshly ground pepper

1. Place the quinoa in a strainer and rinse several times with cold water. Place in a medium saucepan with 1 1/4 cups water and salt to taste. Bring to a boil, cover and simmer 15 minutes, until the grains display a thread-like spiral and the water is absorbed. Remove from the heat, remove the lid and place a dish towel over the pan, then return the lid to the pan and let sit for 10 minutes or longer undisturbed. Transfer to a salad bowl and fluff with forks. Allow to cool.

2. Add the remaining salad ingredients except the salad greens to the bowl. Whisk together the dressing ingredients. If using yogurt, thin out if desired with a tablespoon of water.

3. Just before serving toss the lettuces with 3 tablespoons of the dressing. Toss the quinoa mixture with the rest of the dressing. Line a salad bowl or platter with the greens, top with the quinoa, and serve. Or if preferred, toss together the greens and quinoa mixture before serving.

Yield: Serves 4 to 6

Advance preparation: You can assemble the salad up to a day ahead but do not toss with the dressing until shortly before serving.

Nutritional information per serving (4 servings): 340 calories; 21 grams fat; 4 grams saturated fat; 3 grams polyunsaturated fat; 13 grams monounsaturated fat; 10 milligrams cholesterol; 30 grams carbohydrates; 7 grams dietary fiber; 347 milligrams sodium (does not include salt to taste); 9 grams protein

Nutritional information per serving (6 servings): 226 calories; 14 grams fat; 3 grams saturated fat; 2 grams polyunsaturated fat; 9 grams monounsaturated fat; 7 milligrams cholesterol; 20 grams carbohydrates; 5 grams dietary fiber; 231 milligrams sodium (does not include salt to taste); 6 grams protein

Martha Rose Shulman is the author of “The Very Best of Recipes for Health.”

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FDA halts operations of organic peanut butter processor Sunland

The Food and Drug Administration has halted operations of the country's largest organic peanut butter processor, cracking down on salmonella poisoning for the first time with the new enforcement authority the agency gained in a 2011 food safety law.

FDA officials found salmonella all over Sunland Inc.'s New Mexico processing plant after 41 people in 20 states, most of them children, were sickened by peanut butter manufactured at the Sunland plant and sold at the Trader Joe's grocery chain. The FDA suspended Sunland's registration Monday, preventing the company from producing or distributing food.

The food safety law gives the FDA authority to suspend a company's registration when food manufactured or held there has a "reasonable probability" of causing serious health problems or death. Before the food safety law was enacted early last year, the FDA would have had to go to court to suspend a company's registration.

Sunland had planned to reopen its peanut processing facility Tuesday. A spokeswoman said before the FDA's announcement Monday that the company hoped to be selling peanut butter again by the end of the year. The spokeswoman didn't have an immediate comment on the suspension.

The company has the right to a hearing and must prove to the FDA that its facilities are clean enough to reopen.

Michael Taylor, the FDA's deputy commissioner for foods, said the ability to suspend a registration is a major step forward for the agency.

"Consumers can be assured that products will not leave this facility until we determine they have implemented preventive measures that are effective to produce safe products," Taylor said.

Sunland is the nation's largest organic peanut butter processor, though it also produces many non-organic products. The company recalled hundreds of organic and non-organic nuts and nut butters manufactured since 2010 after Trader Joe's Valencia Creamy Peanut Butter was linked to the salmonella illnesses in September.

Sunland sold hundreds of peanut products to many of the nation's large grocery chains other than Trader Joe's, including Whole Foods, Safeway, Target and others.

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Survey finds lots of unused vacation time

As an information technology supervisor at Pitzer College in Claremont, Dennis Crowley had so much work to do last year that he finished 2011 without using nearly five days of paid vacation.

"And to be frank, I was too busy to even realize I was losing time," he said.

Crowley's situation is not unusual. A survey by Harris Interactive Inc. found that by the end of 2012, Americans will leave an average of 9.2 days of vacation unused, up from the average of 6.2 days in 2011.

Nearly 90% of those questioned said they would take more leisure trips on their vacation if they had the time and money to do so, according to the survey of more than 2,000 U.S. adults that was commissioned by travel website Hotwire.

Hotwire has a selfish reason for pointing out the survey results: The travel website says vacationers can save lots of money by traveling between Thanksgiving and Christmas. During the holiday gap, hotel rates drop 33% in Boston, 28% in San Francisco and 26% in Seattle, compared with the peak summer travel season, according to the website.

Crowley has learned his lesson. He said he is keeping closer tabs on his vacation time this year. But instead of using his accrued vacation time to travel, he said is spending more time with his children.

Airline food getting more healthful

On the nation's airlines, the days of free lunch are long over. That also goes for breakfast, dinner and snacks. Once complimentary, most airline food now comes with a price tag.

But there is some good news about what you get to eat on commercial airlines: It is getting more healthful.

That's the assessment of Charles Platkin, a professor of nutrition at the City University of New York's Hunter College who has tested and ranked airline foods off and on since 2000. With few exceptions, Platkin said most airlines now offer at least one healthful meal alternative on their menu.

"It's actually moving in a good direction," he said. "It's been an ebb and flow, but the overall trend is positive."

Platkin gave the top ranking this year to Virgin America, noting that the airline based in California offers low-calorie options such as roasted pear and arugula salad, a "protein plate" with hummus and whole wheat pita bread, plus oatmeal for breakfast. He gave the airline 41/4 stars out of a maximum of five stars.

At the bottom of the list was Allegiant Air, with a rating of only one and a half stars. Platkin said the Las Vegas airline "made it clear that their foods were not healthy. It shows."

The airline's snacks include M&Ms, Oreo Brownies and Pringles chips.

Air Canada and Alaska Airlines came in second and third, respectively, in Platkin's ranking. The other big airlines — including United, American, Delta and US Airways — ranked in the middle of the list.

Platkin does not eat the food on every airline. "I don't have that kind of time," he said. "I have classes to teach."

Instead, he collects and reviews lists of food items, including the ingredients and calorie numbers, from the airlines.

TSA defends stopping traveler over watch

A traveler was stopped by federal security officers at the Oakland International Airport this month because of an unusual wristwatch he was wearing.

When word got out about the incident, critics of the Transportation Security Administration blasted the agency, saying it was another example of the TSA overreacting.

In hopes of stifling the uproar, the TSA released a photo of the watch last week. This is no ordinary timepiece. It includes a toggle switch, wires and what look like tiny fuses attached to the wristband.

A TSA explosives detection team determined that the watch was not an explosive device. Still, the Alameda County sheriff's deputies, who were called by the TSA to investigate, arrested the watch owner, Geoffrey McGann, a teacher and artist from Rancho Palos Verdes. He was jailed on suspicion of possession of components to make a destructive device, according to news reports.

The Alameda County district attorney's office declined last week to file charges against McGann.

McGann's attorney accused the TSA of being "hyper-vigilant."

The TSA responded in its blog last week, saying, "Terrorists take everyday items and attempt to manipulate them to make improvised explosive devices. Our officers are trained to look for anomalies such as this one."

hugo.martin@latimes.com

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Agency Investigates Deaths and Injuries Associated With Bed Rails

Thomas Patterson for The New York Times

Gloria Black’s mother died in her bed at a care facility.

In November 2006, when Clara Marshall began suffering from the effects of dementia, her family moved her into the Waterford at Fairway Village, an assisted living home in Vancouver, Wash. The facility offered round-the-clock care for Ms. Marshall, who had wandered away from home several times. Her husband Dan, 80 years old at the time, felt he could no longer care for her alone.

Thomas Patterson for The New York Times

Gloria Black, visiting her mother’s grave in Portland, Ore. She has documented hundreds of deaths associated with bed rails and said families should be informed of their possible risks.

But just five months into her stay, Ms. Marshall, 81, was found dead in her room apparently strangled after getting her neck caught in side rails used to prevent her from rolling out of bed.

After Ms. Marshall’s death, her daughter Gloria Black, who lives in Portland, Ore., began writing to the Consumer Product Safety Commission and the Food and Drug Administration. What she discovered was that both agencies had known for more than a decade about deaths from bed rails but had done little to crack down on the companies that make them. Ms. Black conducted her own research and exchanged letters with local and state officials. Finally, a letter she wrote in 2010 to the federal consumer safety commission helped prompt a review of bed rail deaths.

Ms. Black applauds the decision to study the issue. “But I wish it was done years ago,” she said. “Maybe my mother would still be alive.” Now the government is studying a problem it has known about for years.

Data compiled by the consumer agency from death certificates and hospital emergency room visits from 2003 through May 2012 shows that 150 mostly older adults died after they became trapped in bed rails. Over nearly the same time period, 36,000 mostly older adults — about 4,000 a year — were treated in emergency rooms with bed rail injuries. Officials at the F.D.A. and the commission said the data probably understated the problem since bed rails are not always listed as a cause of death by nursing homes and coroners, or as a cause of injury by emergency room doctors.

Experts who have studied the deaths say they are avoidable. While the F.D.A. issued safety warnings about the devices in 1995, it shied away from requiring manufacturers to put safety labels on them because of industry resistance and because the mood in Congress then was for less regulation. Instead only “voluntary guidelines” were adopted in 2006.

More warnings are needed, experts say, but there is a technical question over which regulator is responsible for some bed rails. Are they medical devices under the purview of the F.D.A., or are they consumer products regulated by the commission?

“This is an entirely preventable problem,” said Dr. Steven Miles, a professor at the Center for Bioethics at the University of Minnesota, who first alerted federal regulators to deaths involving bed rails in 1995. The government at the time declined to recall any bed rails and opted instead for a safety alert to nursing homes and home health care agencies.

Forcing the industry to improve designs and replace older models could have potentially cost bed rail makers and health care facilities hundreds of million of dollars, said Larry Kessler, a former F.D.A. official who headed its medical device office. “Quite frankly, none of the bed rails in use at that time would have passed the suggested design standards in the guidelines if we had made them mandatory,” he said. No analysis has been done to determine how much it would cost the manufacturers to reduce the hazards.

Bed rails are metal bars used on hospital beds and in home care to assist patients in pulling themselves up or helping them out of bed. They can also prevent people from rolling out of bed. But sometimes patients — particularly those suffering from Alzheimer’s — can get confused and trapped between a bed rail and a mattress, which can lead to serious injury or even death.

While the use of the devices by hospitals and nursing homes has declined as professional caregivers have grown aware of the dangers, experts say dozens of older adults continue to die each year as more rails are used in home care and many health care facilities continue to use older rail models.

Since those first warnings in 1995, about 550 bed rail-related deaths have occurred, a review by The New York Times of F.D.A. data, lawsuits, state nursing home inspection reports and interviews, found. Last year alone, the F.D.A. data shows, 27 people died.

As deaths continued after the F.D.A. warning, a working group put together in 1999 and made up of medical device makers, researchers, patient advocates and F.D.A. officials considered requiring bed rail makers to add warning labels.

But the F.D.A. decided against it after manufacturers resisted, citing legal issues. The agency said added cost to small manufacturers and difficulties of getting regulations through layers of government approval, were factors against tougher standards, according to a meeting log of the group in 2000 and interviews.

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