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Posts published in July 2015

Severance

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Most folks are unaware that Boise City’s urban renewal agency owns the Ada County Courthouse through a convoluted “lease” agreement which was used to deny voters the right to approve or reject the debt.

Capital City Development Corp (CCDC) financed the courthouse, but now the current Commishes are aiming to pay off the thinly disguised debt with a mid-August payment within the current 2015 budget. We applaud the move and hope the current Commishes will go to the voters for approval of future “profound projects” as required by the Idaho constitution.

Here is today’s press release on the Ada budget about the lease that was really a purchase as well as an outline of the proposed 2016 budget.

On Tuesday, July 21 at 6 p.m., Ada County will be hosting a public presentation of its fiscal year (FY) 2016 proposed budget. The public and media are encouraged to attend the presentation, which will be held in the first floor Public Hearing Room of the Ada County Courthouse at 200 W. Front St. in Boise. Parking is free after 5 p.m.

The presentation will cover the proposed budget of $231,435,852 for the year beginning October 1, 2015 through September 30, 2016.

During the current fiscal year, $37 million was budgeted to pay off the lease and purchase the county Courthouse, scheduled to occur in August. As a result of this purchase, county taxpayers will save $6 million in future lease payments. Despite continued growth within Ada County, the removal of this large one-time expenditure is what causes the FY16 budget to be down from last year.

Highlights of the proposed FY16 budget include the second year funding of public safety initiatives approved last year. These initiatives include $6.9 million for construction of a new emergency 911 Dispatch Center. Of that funding, $2.6 million will be provided by the $1.00 surcharge applied to monthly telephone bills, with the remaining $4.3 million from new county property taxes. The FY16 budget also contains $4 million to cover a 27th pay period, due to a calendar anomaly which occurs once every 11 years. Fees collected from Drug Court have been saved over time to build a new Drug Court and treatment facility at a cost of $2.8 million. A 2% merit increase for the county’s 1,780 employees is included at a cost of $2 million, and $1.2 million is included to replace aging network systems throughout the county government infrastructure.

The proposed $231,435,852 budget is funded by $109,395,305 from property taxes, $95,996,814 from other revenue, and $26,043,733 in savings. A breakdown of the proposed budget will be made available Friday, July 17 on the county website at adacounty.id.gov.

First take

Layoffs happen. I was laid off from my first job when I was in high school - the local McDonald's staffed up for summer, then eased back as summer's end approaches, reflecting customer demand. I got it then, and it's understandable now in larger contexts. When Intel last month laid off several hundred people, that was unfortunate but it wasn't too hard to understand: Parts of Intel's business has slowed, especially the large part geared around supplying chips for computers. The growth business is in chips for other things, and Intel is getting into that, but transition means some jobs will be lost.

The complaints surfacing seem to recognize all that. The complaints seem to have more to do with changes in the rules about who is ineligible to be rehired by Intel when the corporation is hiring. The Oregonian reported last week, "Previously, employees say, workers became eligible for layoffs when they received substandard ratings in the company's rigorous annual-review process. But according to documents obtained by The Oregonian, Intel selected some employees for last month's layoffs based instead on the level of performance-based stock grants they received last year."

But I think there may have been more upset about Intel executive Brian Krzanich's comment that "this is the way a meritocracy works."

Well, no, but this is the way today's megacorporations - or their CEOs at least - think. Anyone who's been through a large layoff knows that people are swept out without much regard to the quality of the work they were doing: They were in the wrong place at the wrong time. That's injurious enough, but adding the insult to the trauma of joblessness is what's most meritless here.

A letter to the Oregonian's editor commented, "Something needs to change if this is acceptable in America. We've become a nation of sheep." Have they been not only injured but insulted enough, yet, to actually start, you know, organizing, the way their forebears did a century and more ago?

What’s medically necessary

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Being neither a medical nor a legal professional, I’m wary of stepping too far into this intersection of the two arenas. But there’s a large public policy question here worth your, as well as my, consideration.

On July 7 the Idaho Supreme Court decided Sohar Chavez v. Kevin Stokes, a worker compensation case. Chavez worked as an irrigator for Stokes on a farm near Payette; one day in September 2012 his pinky finger was caught and mangled in a piece of machinery. Stokes wasn’t insured for workers compensation but paid without dispute Chavez’ various medical expenses – except one.

After the accident happened, Chavez drove himself to the home of a Payette area law officer, where paramedics tried to treat him. Someone – apparently a paramedic – made the decision to call for the Life Flight helicopter, which flew him to the St. Alphonsus hospital in Boise. A few days later Life Flight issued a bill for $21,201. Stokes paid all the other expenses, but argued that the Life Flight, or at least its cost, was not necessary or reasonable.

The dispute over this has lasted a long time. About a year after the accident a referee was called in, and sought an independent doctor’s opinion. The doctor said the injury to the finger (which was serious enough that it was amputated at St. Alphonsus) was serious but it “was not in any way, shape or form, life critical. For that reason I do not understand why Life Flight was called or addressed in the first place, and why the case was not taken to Holy Rosary. Indeed, it is extremely reasonable that the patient would be taken physically to Holy Rosary Hospital. Had there been an incident which may in some way benefited from a vascular reconstruction, then the patient could be transferred to St. Alphonsus or St. Luke’s. Indeed, this was in no way necessary.”

The Holy Rosary Medical Center at Ontario is a substantial general-purpose hospital located about four to five miles from Payette, and could have been reached in a few minutes. St. Alphonsus in Boise was about an hour away by car, less by helicopter but still a longer trip even by air than to Holy Rosary. The referee concluded that the medical work could have been done properly at Ontario.

There are specific rules and guidelines in Idaho (as elsewhere) covering when a medical procedure is “reasonable,” and in this case the court applied some of those rules and partly reversed an earlier ruling. Overall, the unanimous court said, “We recognize that the Life Flight transport may be seen as arguably unnecessary with the benefit of hindsight, but the evidence nonetheless supports the Commission’s finding that the Life Flight transport was reasonable medical treatment at the time of Chavez’s injury.”

So, the conclusion was that the $21,201 less-than-an-hour helicopter flight was deemed a legitimate medical expense, and had to be paid by Stokes.

As the court’s language suggests, hindsight is easier than real-time emergency action.

Could the same result have been obtained for $21,201 less? It would seem so.

The answers aren’t completely settled and obvious in this area. The question of what was the right thing to do in this case was answered in different ways by various professionals. But the case of Chavez v. Stokes shines a light on why getting a handle on our medical expenses has been so hard, and on some of the discussions we’re going to have to have if we ever hope to bring them under some rational control.

First take

Is murder different in Oregon too? Put aside that the rates, compared with the nation overall, are not the same - they are lower (it is 2 per 100,000 people), and murders in Portland come at half the rates of comparable-sized cities like Baltimore. But there are other things. The Oregonian crunched some numbers and found that although guns are plentiful around Oregon, Oregonians are less likely to be shot to death than are residents of the country overall. (Would be interesting to know why.) The report also says police are more likely in Oregon to identify killers.

The flag and the budget

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The federal appropriations process may at its most convoluted point ever. A case in point: The Interior Appropriations bill was pulled from consideration by the leadership of Congress on July 9. That’s the spending bill that includes funding for the Bureau of Indian Affairs and the Indian Health Service.

Why? The debate wasn’t about money — even though that is an issue — but because some Southern Representatives are keen on protecting the Confederate Flag from being banned on federal land.

Really.

At the same moment when South Carolina was debating, and then lowering the battle flag from state grounds, Democrats successfully included language to remove the flag from federal facilities including National Parks. Republican leaders (no doubt seeing their fellow legislators at work) quickly agreed and the measure passed on a voice vote.

That should have been the end of the story. There isn’t a lot of support anywhere for the Confederate Flag these days.

Except in Congress.

Roll Call reported that “a number” of Southern Republicans demanded that leadership reverse that flag measure and were more than willing to cast no votes against Interior Appropriations — and possibly all 12 spending bills.

Who would ever have thought the Confederate Flag could be the controversy that stops spending on federal Indian programs? What’s next, a resolution on the Washington NFL team interrupting agricultural programs? Seriously this is messed up but it’s a good example of how dysfunctional the Congress is right now.

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The U.S. Congress works best in a framework of two parties: Federalists challenging the Anti-federalists; Whigs against the Democrat-Republicans; and, mostly, Democrats versus Republicans. But now Congress is really three distinct parties: Democrats, Republicans and the Tea Party. This has happened before with the rise of the Radical Republicans around the Civil War. It was chaos then — and now.

A three-way split in the House means that Speaker John Boehner has essentially two choices. He can accept the Tea Party ideas as mainstream ones or he can produce legislation (and especially a budget) that’s centrist enough to win Democratic votes. The speaker’s goal is 218 votes — an impossible number when Republicans are divided.

That’s why Tea Party support for the Confederate Flag is not easy to dismiss because the rest of the budget is so radical that it cannot pass without that faction’s support.

As Norman Ornstein, a congressional scholar at the conservative American Enterprise Institute, told Talking Points Memo: “What it means is he has to accommodate people he would really rather not accommodate. And what happened in this case of course he didn’t have the votes and several southern Republicans basically said, ‘You want our votes? You’re going to have to do something on the Confederate flag.’”

Then the prospect for this year’s Appropriations bills was already risky before last week’s blow up. The Obama Administration has been pressing Congress for a broader spending package that would lift the strict spending caps that are in place because of the four-year-old Budget Control Act. And Congress has pushed back by loading up the now stalled appropriations bills with poison pills, such as prohibitions that limit federal agencies from doing their jobs. (Read this: the U.S. Environmental Protection Agency.)

But federal spending will have to wait until the flag issue is resolved on Capitol Hill. As Rep. John Lewis, D-Georgia, said last week, “When I was marching a across that bridge in Selma in 1965, I saw some of the law officers, sheriff’s deputies, waring on their helmet the Confederate flag. I don’t want to go back, and as a country, we cannot go back.”

Mark Trahant is an independent journalist and a member of The Shoshone-Bannock Tribes. For up-to-the-minute posts, download the free Trahant Reports app for your smart phone or tablet.

First take

Here's a list Idaho leads: States with the most commercial drone activity, per capita. Is it a positive list? Generally, I think so, even while having (as many people do) some uneasiness about those unmanned devices buzzing around through the air space, maybe overhead, maybe looking into windows. But then, the issue really isn't the technology but rather how it's used. A KBOI-TV (Boise) report notes that eight local companies have gotten federal approval for commercial drone use, and the uses they're citing seem legitimate enough. There's a real estate company that see aerial photography and land analysis uses. There are also commercial uses in agriculture, logging and even missing persons operations. Seems promising, but keeping a close eye on it is a good idea too. - rs (photo by Nicolas Halftermeyer)

What a web we weave

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Most can complete the saying: “when first we start to deceive.” Most get the point also - that one lie begets another lie, and the more a person or institution lies, the more likely it is to become entrappped in a spider web of its own making.

Apparently the folks running the Department of Energy (DoE) today and its Idaho National Lab (INL) subsidiary either don’t get it or don’t understand it or just don’t care. This casual disregard for truth is seriously eroding public trust both in the department itself and in INL’s management.

Admiral Grossenbacher, the INL site manager, is on the one hand a pleasant, intelligent, and charming fellow. The extent to which he presents the deliberately misleading company line, on the other hand, has one questioning everything he says.

The latest example of the long, sorry history of DoE duplicity, double-talk, distortion and misrepresentation is the proposed importation of “only two hundred pounds of commercial spent fuel rods” for research purposes. To bring two shipments in, however, requires a waiver of the 1995 Agreement between the state of Idaho, the Navy and the DoE negotiated by Governor Phil Batt, which prohibits such importation.

Both former Governor Batt and Governor Cecil D. Andrus immediately registered strrng objections. Andrus also referenced information he had that the first two shipments were just the camel’s nose and that DoE had plans to bring an additional 20 metric tons of commercial spent fuel rods to Idaho.

INL boosters pooh-poohed Andrus’ information saying it was indicative that he simply did not know what he was talking about. Guess what, folks? Andrus was correct. The Snake River Alliance produced a tape of Admiral Grossenbacher in a September of 2013 presentation to Governor Otter’s LINE Commission referencing DoE plans to follow up the initial two shipments with 20 metric tons of commercial spent fuel rods from the North Ana (Virginia) nuclear plant to be stored, monitored and studied for a number of years.

Both former governors pointed out to the media that absent DoE’s now cancelled final repository being constructed at Yucca Mountain, Nevada there is no other place to ship waste at INL to despite the Batt Agreement’s deadline of 2036 for all waste to be gone. Once here it will stay here.

DoE has since put out a Supplemental Analysis (SA) of the supposed environmental impacts of moving and storing these commercil spent fuel rods that can only be described as a joke. Using 20 year old data rehased from an earlier EIS simply will not fly and Governors Batt and Andrus are betting that if and when they go to Federal court on this issue the judge will again side with them.

What was most deceitful in the SA, however, was the misrepresentation that both Governor Otter and Attorney General Wasden have signed off on and in effect approved of the waiver request. That is simply not true.

In a letter to DoE on February 27th, AG Wasden made it clear he was not signing off on anything until the department fulfills another condition of the Batt agreement, that of cleaning up and disposing of 900,000 gallons of liquid waste stored at the site. Past efforts to solve this challenge have failed and the department is years away from finding a solution and meeting that pre-condition.

Just prior to Andrus/Batt attorney Laird Lucas¸ of the Advocates for the West, submitting on behalf of the former governors their comments dissing the incompleteness of the Supplemental Analysis, the Office of the Secretary of DoE finally provided a classic non-response to a separate Freedom of Information request filed by Andrus in January of 2015. The document contained 18 specific questions regarding the proposed handling and storage of the spent fuel rods, whether there was a supplemental budget to cover costs, and other basic, easy-to-answer if you want to questions.

Claiming privilege and national security, the letter was another complete non-response, containing page after page of redacted material. Here’s hoping the two governors, or at least Governor Andrus, file a federal lawsuit against INL and DoE on this matter also.

At the very first joint press conference held by the former governors to announce their opposition, Governor Batt referenced an important principle that should be honored.

He pointed out that the people of Idaho in essence ratified his agreement. Batt said any change whatsoever in the agreement would have to be taken back to the voter to be ratified.

Here’s a wager that DoE/INL will never do that for the simple reason even they know the public seldom rewards liars.

First take

Probably you'd need to read the whole document - including the one secret section on the backend of the process - before you could fully evaluate the Iran nuclear deal announced yesterday. Is there anything we can reasonably grasp about it at this point? Foreign Policy magazine has a useful take on it (meshed with developments on the Greek economy) today, and it includes this: "no one can reasonably argue that it is not better to have some agreement that at least makes ending Iran’s nuclear weapons program a possibility for the foreseeable future. The key is how leaders in Iran and around the world act once the deal is in place. We have seen deals in the past that have simply not been effective. (See North Korea.) But there is a path forward with this deal that will certainly be better than the uncertainty that has hung over this issue for the past 13 years. If the deal’s terms are enforced and it translates into real inspections that are regularly and even aggressively conducted, where violations are marked without hesitation — and, of course, the Iranian government has the intent to honor its terms — this deal will be seen as successful." So is it a good deal? Maybe; the potential is there; but ask again in another decade or two. In foreign relations, probably, thus is it ever. - rs

Money hardball ahead

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GoLocalpdx.com is a startup online news site. Every Friday they publish a who’s hot and who’s not column by Douglas Fasching.

In todays column Senator Richard Devlin is skewered as a “not hot” because Devlin has signaled his intent to run for Secretary of State and:

“The speculation is that he is not giving up his Senate seat while he runs for higher office. He intends to hold onto his leadership role whilst campaigning. While it is not required to give up one’s seat, it is still poor form. Lastly, the rumor has him intending to dip into his campaign war chest to finance his campaign. A war chest that now stands at about 272k. Money he raked in by being the 3rd most powerful person in the Senate chairing the most powerful committee in the legislature. Money that should be going to help get other Dem Senators elected not financing your own aspirations. Using your position and a shit-ton of money to deter others from jumping in a race really isn’t fair. Nobody likes a bully”

Bam!

Who could have “speculated”? Who could whispered to Mr. Fasching the “rumor” that Devlin’s dipping into his campaign war chest to conduct his campaign? Who would have the motive to do that?

The Devlin spot ends with “Cheer up, Val, at least you don’t have a recall to deal with.” So apparently Someone named Val who was recently facing a recall was on Mr. Faschings mind when he wrote the article. For some reason.

This story could have been suggested to Mr. Fasching by someone partly as a response the Oregonian article about Hoyle’s announcement. That article tells the story of Hoyle starting well behind potential rivals for the SoS office Devlin and current Labor Commissioner Brad Avakian in the money race (Hoyle has only $30,000 on hand versus Devlin’s $272,000 and Avakian’s $133,000)

If there’s one thing you need to have in Oregon’s no holes barred campaign finance and spending anarchy, its a boatload of money. And money attracts money. Anyone starting with a real and significant deficit of money may quickly fall behind in a race. No one wants to be on the losing team. And while one way to compete is to raise money, the other way is to see if you can keep your opponent from raising – or using – money, by for instance shaming them into limiting the use of their campaign treasury.

So, while we don’t know who planted the seed for the GoLocalPDX story, we can draw reasonable inferences.

With the real meaningful political races in Oregon now being waged in the Primaries, we can expect some real hardball between Democrats. And some players are more willing to slide hard into second with their spikes up.

First take

Good history often has resonance today, and so it is with a piece today in the Daily Beast, which concerns the Confederacy and how people - especially the British - saw it at the time, and some of the lessons we might draw from it today. The battle flag defenders do have one point, that the past isn't entirely gone ("it isn't even past," as that southerner Bill Faulkner said). But what points should be taken from it?

Writer Christopher Dickey, who notes that he's not only a southerner and a war correspondent but the father of a soldier, discusses a new book about the British secret agent situated in the South as the Civil War unfolded, who was horrified at what he saw.

"One of the most shameful aspects of the American Civil War," Dickey wrote, "is that hundreds of thousands of men and many women in the Confederacy gave their lives in a fight to defend the interests of a small slave-holding elite that had used its money, its control of politics and the press, the exploitation of racism and fear, and a shrewd if sickening appeal to status to mobilize the masses and then lead them to destruction."

What did the British really think of the South (with whom they often were said to have some sympathy)? Agent Robert Bunch wrote, among other things, "The frightful evil of the system is that it debases the whole tone of society — for the people talk calmly of horrors which would not be mentioned in civilized society."

Dickey concludes with the Civil War in mind, "Let’s remember that almost all wars are launched by ambitions, miscalculations, and grand illusions cherished by a few at the expense of the many. Perhaps the Confederate monuments will remind us we should be wiser about what wars we fight in the future." One can hope. But the chances don't improve with the still-large number of people deluded about what the Confederacy was.

Welcome, Donald

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Much is heard these days about Democrats welcoming Donald Trump to the 2016 presidential primaries, hoping he’ll really screw things up for Republicans. Much is also heard from many GOPers along the lines of “What the hell is Donald Trump doing screwing up our primaries?” My lone voice says, “Welcome, Donald Trump. What took you so long?”

I’ve been waiting for that most able representative of the worst in American politics to get beyond “threatening to run” to the real thing for a long, long time. I’m not saying he’ll actually do it - because he won’t. He’d have to eventually publish too much of his financial holdings to ever fully and officially qualify for the nomination. That he’ll never do.

No, it’s 99.44% certain Trump won’t be on your November, 2016, ballot. It’s also just as sure he’ll be center stage for many more months. If you’re surprised by his verbosity and dominance thus far, you shouldn’t be. The Republican candidate garden has been cross-pollinating this political weed for years. Trump is that weed taken to the extreme.

As the original Tea Party began devouring the Republican elephant more than 10 years ago, it regurgitated pre-Trump ancestors. Bachman, Gohmert, King, Issa, Mo Brooks, Don Young, Jeff Denham, Dana Rohrabacher, Duncan Hunter, Ted Yoho, Tim Huelskamp, Steve Scalise, Kevin Kramer, Mark Sanford, Jeff Duncan, Kristi Noem, Raul Labrador, Marsha Blackburn, Sam Johnson, Jeb Hensarling, Joe Barton and a couple dozen more. These spawn began devouring anything moderate in the national GOP about 2004. Dozens of level-headed, knowledgeable and acceptable Republicans were eaten alive at the polls by supporters of these nuts, or the good people just quit after trying to deal with the lies, the intransigence and nasty politics.

Though Trump has been playing around in the Republican gene pool for some years, before that he was a Democrat doing the same thing on a much quieter level. He’s old, very tarnished goods. He didn’t spring full-throated to his present undeserved prominence. The above list of much-lesser, politically-challenged earthworms preceded him, breaking up the anti-intellectual ground and sprinkling it with verbal B.S. so Trump’s most recent incarnation could be hardier stock.

The soil that grew a Donald Trump now covers the GOP garden. It’s from this diseased earth the crazies have sprung. The ones condemning nearly everything governmental. The insane voices in Texas, for example, frothing at the mouth about “secret tunnels and holding cells under empty Walmart stores” where “President Obama plans to confine them” after a long-planned military exercise starting this week. Obama taking absolute dictatorial control so there’ll be no 2016 presidential elections.” Martial law. Armed U.S. Army soldiers gunning down unarmed civilians.

Nourished by verbal excrement of Limbaugh, Beck, Savage, Ingraham and too many others to name - loons who’d normally be left to solitary mutterings are being fed tainted diets of lies and half-truths with which to weave conspiracies and whole worlds of ignorant fantasies. With superb monetary largesse from the Kochs, the NRA, Heritage Foundation, Birch Society, Faux Neus and self-serving political voices, they cling to any word that appears to justify and nourish their demented existence.

Donald Trump is the wall Republicans need to smash into before possibly bouncing back to more moderate positions - something acceptable to us normal folk. Like purging a contaminated water supply, Trump might be the impetus for thinking GOPers to finally act to retake control of what’s left of their party and do some thorough housecleaning. Because it’s now just the party of the old. Of white males. Of vanishing support. Of dwindling numbers at the polls.

One other thing about Trump and the current defective crop of GOP candidates. These “candidates” are not supported by a lot of people who, if their guy loses, will say “Oh, well” and get on someone else’s bandwagon. No, Sir. These are people who will either stay home come election day or will willingly subvert, by any means, the guy who beat their guy. They represent the zealotry of what passes for modern-day Republicanism. “Coming together” is unacceptable to zealots.

The Republican party may take a shellacking at the polls in 2016. Not everywhere. But enough to further diminish the already decreasing size of its share of the electoral pie. Not because of a Clinton or a Sanders. But because more and more folks, who usually frequent that part of the ballot, are coming to realize those running their party are as ignorant and impotent as trickle-down economics.

Trump’s embarrassing use of the Republican brand to further his own fortunes may sound the clarion call for smarter, more reasonable people to step up in and take control. This country NEEDS a healthy GOP! Soon! Donald’s as unfit as it comes in his “candidacy.” Were it not for his demented outlook on nearly everything, he’d be a cartoon character. But he ain’t funny.

Trump could be the wake-up call the GOP needs to be viable again. His racist, war-mongering, exhibitionist rhetoric may be his own undoing. Damn, I hope so!

First take

While working on this week's Idaho Briefing I ran across this press release from Idaho State University, sent out last week. It's presented here as a Monday morning read, as I encountered it . . .

Encountering a self-identified vampire can pose challenges for clinicians in the helping professions such as social work, counseling or medical fields.

“We live in an age of technology and live in a time when people can select new, alternate identities to fit how they understand themselves better,” said DJ Williams, Idaho State University associate professor of social work. “We really need to understand some of these new identities and new ways to identify ourselves, and some of these new identities do not fit into stereotypes. Helping professionals of all varieties need more education on these kinds of topics.”

Williams, along with co-author Emily Prior of the Center for Positive Sexuality in Los Angeles, recently published the study “Do We Always Practice What We Preach? Real Vampires’ Fears of Coming out of the Coffin to Social Workers and Helping Professionals” in the journal Critical Social Work, an interdisciplinary journal devoted to social justice.

“The gist of the article is that self-identified vampires are probably more common than most people realize,” Williams said. “A lot of people probably assume they are younger kids or young people who watch ‘Twilight’ or other pop-culture types of things. Yet, the real vampire community, which is self-defined by people who claim the need for extra energy (either blood or psychic energy), tend not to fit that demographic stereotype.”

Self-identified vampires say they have different energy needs than other people and that they may be distinguished based on the different sources of energy from which they “feed,” Williams said. Despite having an alternate lifestyle, Williams said that it is important for counselors and others in the helping professions to treat them without prejudice.

“People with alternative identities have the same set of issues that everybody has,” Williams said. “People of all kinds sometimes struggle with relationship issues or have a death in family or struggles with career and job-type issues. Some of these people with alternate identities may come to a therapist with these issues, and if clinicians are open and educated about this group they should be able to help the individual much better.”

He said that the self-identified vampires interviewed for this study “without exception” were very fearful about approaching clinicians. They did not want to be judged as being wicked or evil or viewed as being psychotic, delusional or having a psychological problem.