Jo Ciavaglia's portfolio : August 2014

Saturday, August 30, 2014

He/She/We: The struggle to understand gender identity

Posted: Monday, August 25, 2014

In his last Instagram post, Riley Matthew Moscatel tried to explain what it was like to live in a body that he felt belonged to someone else.

Riley Moscatel

“My mirror reflected Jessica, my heart and mind say Riley ... I am a prisoner.”

In the long, and at times poetic post, the 17-year-old, who was born a girl and given the name Jessica, expressed frustration with his female body and feelings of hopelessness for the future.

“I am not as strong or influential as everyone thinks. I’ve had enough,” the message read. “Enough of being a walking lie. Being told what gender I am from the outside.”

Not long after posting the message Aug. 18 afternoon, Riley stepped onto the train tracks that can be seen from his family’s Second Avenue home in Croydon and in front of a passing Amtrak train. Riley died instantly, the death ruled a suicide.

The final Instagram post wasn’t the first that Riley left on the social media outlet expressing his gender identity struggle.

“It kills me that I am so alone in this feeling and that my surgical options are poor ... If I could choose if I was born a girl or a guy, I would’ve chosen a guy,” Riley wrote in an earlier post. “The emotions are too much some days. Most TFMs (Transgender Female-to-Male) wouldn’t agree because they’re (sic) journey made them stronger but it really takes a toll on me.”

Riley’s suicide has shaken to the core his friends at Bucks County Technical High School, where he would have been a senior this coming school year and where other openly gay, lesbian and transgender kids attend, according to an administrator.

He came out as a male in English class last year, friends said. Riley’s mom called him “JR,” which stood for Jessica-Riley, they added.

Riley’s struggle with gender identity alone was most likely not the catalyst for his suicide, according to psychology and behavior experts. Suicide is rarely triggered by a single factor, but rather an accumulation of factors the individual perceives as insurmountable, according to Dan Romer, a psychologist at University of Pennsylvania's Annenberg Public Policy Center.

Individuals who attempt suicide frequently also have at least one diagnosable psychiatric illness, most commonly major depression, a highly treatable disease, Romer and other behavior experts added.

“That is really your smoking gun,” said Jonathan Singer, a professor of social work at Temple University, whose research has included suicide among adults and youth including gay, lesbian and transgender.

Available statistics suggest gay, lesbian and transgender teens and adults are at a higher risk for suicidal behavior and thoughts. The Youth Suicide Prevention Program estimates that more than 50 percent of them attempt suicide at least once by their 20th birthday.

A nationally representative study of adolescents in grades seven through 12 found that lesbian, gay and bisexual youth were more than twice as likely to have attempted suicide as their heterosexual peers, according the Centers of Disease Control and Prevention in Atlanta. But the CDC noted that more studies are needed to better understand the risks for suicide among transgender youth.

But Singer pointed out the lack of reliable sources for statistics on suicides or attempted suicides among transgender youth. While death certificates will list suicide, they do not list sexual orientation or gender identity, he said.

“There are so few youth suicides relative to the population, it would be almost impossible to measure,” he said.

The closest anyone has come to reliable statistics is a study released earlier this year by the American Foundation for Suicide Prevention and the UCLA Law School’s Williams Institute. It looked at suicidal behavior among adult transgender and gender non-conforming individuals, Singer said.

The study suggests that several minority stressors, such as negative experiences may contribute to elevated prevalence of suicide attempts among transgender people, such as experiences of harassment and family rejection.

Ten years ago Beverly’s son, then in his early 20s, told her that he was living in the wrong body, which was quite a shock for the Bucks County woman.

Riley

“I thought, he will grow out of it. I never even told my husband. It is very difficult. People treat it worse than being gay 30 years ago,” said Beverly, who asked that her last name not be used to protect her child. “I was hoping I’d be long dead and gone if she ever came out.”

For the next decade, her son continued to live as a male trying to fit in, until two years ago when she started the physical transition to female, Beverly said. Recently she decided to change her gender on her driver’s license from male to female.

The journey has been difficult for her new daughter. She has faced discrimination and harassment in the workplace and public when people learned she was born male.

“I talked her off a ledge many a day,” Beverly added. “But she is a wonderful person with a good heart. It is who she is that’s important.”

Riley’s parents have said that their child struggled for years with depression and gender identity, but displayed no outward signs recently of a growing sense of desperation.

“Things were just building up and building up and she just couldn’t take it anymore,” Riley’s mom Kristine Moscatel said Tuesday. “She hid behind her mask. She had a mask for me, my husband, my son, my parents ... Everyone she had a different face for, but they were all happy (faces).”

Friends say Riley — then known as Jessica — came out in ninth grade as bisexual, then a lesbian in 10th grade, but realized he was transgender his junior year.

Riley appeared happy and was popular at school, where staff and students called him Riley Matthew at his request after the transgender announcement, friends said.

Christina Gavagin said her friend was looking forward to senior year: the annual Powder Puff Football game, prom (he picked out a tuxedo) and the senior class trip.

“The only thing he wanted was to graduate and go away to California for college,” said Christina, who is going into her senior year at the tech school.

“I knew Riley when he had down times. I’d go over his house. A lot of times he’d try to make me feel better,” she added.

They are sentiments another close friend Carley Foss repeated. She, like Christina, met Riley in seventh grade. They talked every day, she said. Riley, though increasingly frustrated with his female body, seemed fine when she last saw him last Saturday.

Riley

“He was so nice. So caring. Even if he didn’t really know you or like you much, he’d try to make you happy,” Carley said. “(That’s) just the way he impacted people’s lives. He put a smile on everybody’s face.”

Riley also appeared to be taking steps toward transitioning from female to male, visiting a Philadelphia health clinic that specializes in transgender youth to inquire about hormone treatments and surgery to remove his female breasts, friends said. He wore a binder to flatten his breasts and attended Pennsbury High School’s gay-straight alliance.

Temple’s Singer pointed out that adolescence is all about coming to terms with your identity. But when biological sex isn’t consistent with gender identity — combined with depression and a brain where emotional and cognitive reasoning hasn’t fully matured — it can become overwhelming.

While he applauded the school and others who accepted Riley as a male, Singer said that unconditional social acceptance can also have the opposite effect on an individual.

“This kid was clearly suffering so much inside,” he said. “It’s not uncommon for kids who are depressed to put on a happy face, especially if they feel like they don’t have any reason to feel as bad as they do.”

Jo Ciavaglia: 215-949-4181; email: jciavaglia@calkins.com; Twitter: @jociavaglia

Vandals burn American flag grave markers in Bensalem

Posted: Tuesday, August 26, 2014

Bensalem police believe there's a connection with recent incidents of vandalism involving the burning of American flags that were plucked from the graves of veterans.

The latest incident — the third in the past few weeks — was discovered Tuesday morning by caretakers at Rosedale Memorial Park, in the 3800 block of Richlieu Road. Overnight, vandals pulled a dozen small American flags out of grave markers in the veterans section of the cemetery and burned them, Bensalem Sgt. William McVey said.

The flags were burned on top of a World War II era artillery cannon display in the cemetery, causing minor damage to the memorial, McVey said.

Caretakers at nearby Roosevelt Memorial Park in the 2700 block of Old Lincoln Highway reported Monday that a dozen small American flags were burned on a cemetery monument there, McVey said.

In both of those incidents, not only flags were removed but so were flag holders and graveside decorations, McVey said. The items were placed in a pile and burned.

The flag-burning vandalism was the second time Roosevelt cemetery was hit in the last month; the caretakers didn't report the first to police, the sergeant added. The newspaper was unsuccessful in immediately reaching a caretaker at Rosedale Memorial Park for comment Tuesday.

As part of the investigation, Bensalem police are checking with other local cemeteries seeking any similar incidents, McVey added.

“This is very unusual,” McVey said about the vandalism.

Jo Ciavaglia: 215-949-4181; email: jciavaglia@calkins.com; Twitter: @jociavaglia

Saturday, August 23, 2014

Lower Makefield cops: Alzheimer's patient assaulted by assisted living employee

Posted: Friday, August 15, 2014

A nanny camera captured a now ex-employee of a Lower Makefield assisted living center repeatedly assaulting a 90-year-old Alzheimer’s patient, police said.

The patient’s family had placed the audio/video camera in the woman’s room last year, when she relocated to the Arden Court facility in the 400 block of Stony Hill Road because of concerns about how she was treated at another care center, according to court documents.

Baindu Kromah

In the secretly recorded videos, the woman, who uses a walker and is described as “frail,” is seen and heard crying and pleading for help during several incidents at the residential assisted living unit, police said. The unit serves patients with dementia and Alzheimer’s disease.

Her adult diaper is ripped off her body in one of the incidents, police said.

The caregiver, Baindu Kromah, 36, of Philadelphia, then pointed at the woman, warned her not to kick before slapping her across the face so hard it was “clearly heard” on the video, according to police.

In another incident caught on camera, Kromah manhandled the woman, police allege.

Kromah grabbed her by her right leg and yanked her around to the side of the bed with so much force that the woman’s legs flung around hitting and knocking her walker to the ground, court documents said.

She then grabbed the elderly woman by the arm and forced her to a standing position before forcing her hands onto the walker and ripping off the woman’s diaper with such force it tore the garment, according to the affidavit of probable cause.

Again, the elderly woman is heard crying and begging for help, but Kromah appeared irritated and ignored her pleas, police said.

The elderly resident’s daughter claims that about two months ago she saw a large bruise on the top of her mother’s head, which no one could account for, court documents said. A month ago, she discovered another bruise above her mother’s left eye that no one could explain.

The patient’s granddaughter was visiting on Aug. 10 and saw bruising on her grandmother’s hands and the left side of her face, police said. The granddaughter took the nanny cam home to view the footage.

That is when police say the family’s suspicions of abuse were confirmed and their investigation began.

Kromah, who had worked the overnight shift on weekends at Arden Courts since October, was fired, police said.

Kromah allegedly told police that she was trying to dress the woman but the elderly woman started a fight. Police say that wasn’t the case.

“At no time in the videos is (the woman) observed resisting,” the affidavit shows.

Kromah was arraigned Friday before Morrisville District Judge Michael Burns on two counts of neglect of a care dependent person and four counts of simple assault. She was released on $25,000 unsecured bail.

Jo Ciavaglia: 215-949-4181; email: jciavaglia@calkins.com; Twitter: @jociavaglia

Bristol cops: Missing Megan's Law offender arrested in Richland Twp.

Posted: Thursday, August 14, 2014

Bucks County’s longest missing convicted sex offender has been apprehended in Upper Bucks nearly four years after he last checked in with Pennsylvania State Police, as required under the state’s Megan’s Law.

Brahin Johnson in 2010

Brahin Johnson, 27, was apprehended Wednesday night by Richland Township police after they responded to a report of a domestic dispute and learned he had been wanted on felony Megan’s Law registration violations since 2011, according to Bristol police Sgt. Joe Moors.

In 2006, Johnson, who is considered a high-risk sex offender, pleaded guilty in Bucks County Court to statutory sexual assault, sexual assault and indecent exposure and was sentenced to two to five years in state prison, according to online court records.

He registered as a sex offender with state police in September 2010, but allegedly never updated his information including his home and work address and social media accounts. As a high-risk offender, Johnson is required to do an in-person update with state police every three months for the rest of his life.

Bristol Borough police filed an arrest warrant charging him with failure to comply with registration of sex offender in January 2011, one month after he missed his quarterly meeting with state police. A police investigation allegedly found that Johnson was not living at the Spruce Street address that he told state police was his home.

When Bristol police spoke to the woman living at the home, she said Johnson never lived there and she had no idea why he would tell police he did, according to a probable cause affidavit. The affidavit does not say when state police notified the borough that Johnson may not have provided accurate information.

Johnson was arraigned before Northampton District Judge William Benz Thursday and sent to Bucks County prison in lieu of 10 percent of $50,000 bail. It is unclear if he will face any charges related to the domestic incident that police initially responded to Wednesday.

Further information about Johnson’s arrest was not immediately available.

Active arrest warrants have been filed for six other unaccounted for registered sex offenders last known to be living or working in Bucks County who failed to update information, according to authorities. One has been missing nearly as long as Johnson.

Former Bristol Township resident Luis Vasquez, who was convicted of carnal knowledge of a child in Virginia in 2006, last updated his information with state police in 2011. He is considered a low-risk sex offender and required to check in with state police at least once a year.

Vasquez had been convicted in Virginia in 2008 and 2011 of failing to register as a sex offender, according to court records. The second time he was missing five months before the U.S. Marshals apprehended him in Bristol Township, where Vasquez was living, according to court documents.

Between 2012 and 2013, the Pennsylvania State Police Megan’s Law unit sent two notices for an investigation after Vasquez missed required update appointments. In May 2013, a Bristol Township detective visited Vasquez’s apartment, where he learned he and his mom had moved out a year earlier, court documents said.

In April, former Bristol Township resident Samuel Lovelace, 29, a convicted moderate-risk sex offender who had not updated his registration with state police since 2010, was arrested in Norristown for allegedly raping a 15-year-old girl during the time he was listed as non-compliant with Megan’s Law.

Lovelace, who is awaiting trial in Montgomery County, had been unaccounted for nearly three years before Bristol Township filed an arrest warrant for alleged Megan’s Law violations.

Jo Ciavaglia: 215-949-4181; email: jciavaglia@calkins.com; Twitter: @jociavaglia

Pa. unveils new ER guidelines for dispensing pain medications

Posted: Wednesday, August 13, 2014

Several times a day someone walks into the emergency room at St. Mary Medical Center complaining of pain and looking for medication to stop it, according to the department's director.

But not everyone seeking prescription painkillers leaves with the drugs or a prescription for them.

Three years ago, the Middletown hospital implemented new restrictions on how it dispenses controlled substances through its ER. The effort was part of an initiative to reduce the abuse and overdose deaths associated with opioid-based pain medications while also appropriately treating patients in pain.

The result has been fewer ER patients with pain complaints looking for prescriptions, Chairman of Emergency Medicine Dr. Gary Zimmer said.

The Pennsylvania Medical Society wants more hospitals to follow the efforts hospitals like St. Mary have put in place. At a press conference in Philadelphia on Wednesday, the organization announced the state’s new — voluntary — emergency department pain prescribing guidelines.

The recommendations are designed to make sure patients who are in pain get the relief they need, while also attempting to identify individuals who may be abusing controlled substances and refer them into treatment.

“As an emergency physician, I see the devastating impact of prescription drug abuse on a regular basis. I know this epidemic does not discriminate on the basis of race, age or gender,” said Dr. Ted Christopher, a medical society board member and emergency medicine doctor in Philadelphia.

National statistics confirm that prescription drug abuse in the U.S. has reached epidemic proportions. The National Institute on Drug Abuse estimated that 8.76 million Americans misused prescription drugs in 2010. The most abused prescription categories are painkillers, tranquilizers and stimulants.

Health care providers wrote 259 million prescriptions for painkillers in 2012, enough for every American adult to have a bottle of pills, according to Centers for Disease Control and Prevention in Atlanta.

The CDC estimates that drug misuse and abuse resulted in about 2.5 million emergency department visits in 2011, with more than half related to pharmaceuticals. Opioid pain relievers were involved in about 74 percent of the 22,810 deaths related to pharmaceutical overdoses in 2011, according to the CDC.

The new guidelines were created in collaboration with the Pennsylvania College of Emergency Physicians, which presented them to Gov. Tom Corbett’s Safe and Effective Prescribing Practices and Pain Management Task Force last month.

The task force has been charged with reviewing health care prescribing practices and identifying guidelines to promote safer and more effective pain management by health care providers. It is also working to ensure prescribers and dispensers are able to identify drug abuse and addiction problems in their patients in order to refer them for drug and alcohol assessment and for the appropriate level of treatment.

“These guidelines will help doctors break the deadly cycle of the unlawful obtaining of prescription drugs,” Pennsylvania’s Physician General Dr. Carrie DeLone said.

The list of seven prescribing guidelines include recommending providers choose the lowest potency necessary to relieve pain, when an opioid medication is indicated; dispensing only the amount of medication necessary to control a patient’s pain until they can access a pharmacy; and not writing discharge prescriptions that exceed seven days.

The guidelines also recommend emergency departments not prescribe long-acting opioids such as OxyContin, extended release morphine or methadone unless they coordinate with an outpatient provider.

“These guidelines are the next steps in fighting prescription drug abuse in Pennsylvania,” Christopher added. “Let’s not stop there. More work can be done and needs to be done in our battle against misuse and abuse of prescription drugs.”

The new state recommendations are similar to what St. Mary Medical Center has in place, Zimmer said.

St. Mary patients with chronic pain complaints can no longer automatically get refills through the ER; instead they are referred back to the prescribing doctor, Zimmer said. Also the hospital limits its discharge prescriptions to not exceed three days' worth of pain pills.

ER patients who are uninsured or don't have a pain management doctor are referred to two hospital-associated specialists who accept charity cases for follow-up care, Zimmer said.

Zimmer added that the hospital and its ER doctors are careful to make sure that pain patients are getting proper care in and out of the hospital setting.

“The reality is, unless a patient with chronic pain gets their care coordinated through a qualified pain management specialist, they are at very high risk for adverse events associated with controlled substances,” he said.

Jo Ciavaglia: 215-949-4181; email: jciavaglia@calkins.com; Twitter: @jociavaglia

Did You Know?

Prescription painkiller work by binding receptors in the brain to decrease the perception of pain. The drugs can create a feeling of euphoria, cause physical dependence and, in some people, led to addiction. The drugs also cause sedation and slow a person’s breathing. It is one reason why an overdose on opioid drugs can take one to three hours after ingestion.

Suicide and celebrities: An opportunity for an open discussion

Posted: Tuesday, August 12, 2014

Happy people do kill themselves. Funny people kill themselves. Famous people kill themselves.

But when celebrities commit suicide, people pay more attention, which provides an opportunity to talk openly about an issue that many people are reluctant to discuss, mental health advocates said.

Robin Williams

“They’re just as human as everyone else, and mental illness, addiction, suicide don’t discriminate based on how famous you are or how wealthy,” said Sharon Curran, associated executive director of the Lenape Valley Foundation, a Doylestown crisis mental health organization. “No matter what kind of resources you have available to you, it’s still a serious disease.”

Authorities confirmed Tuesday that actor comedian Robin Williams, 63, committed suicide by hanging himself with a belt in his California home. He also had superficial cuts on his wrist and a pocket knife was found.

Also revealed was that Williams had been in treatment for depression and had bipolar disorder. The Oscar winner, who had long battled alcohol and drug addiction, also had reportedly checked back into rehab last month.

Behavior experts say there is no one clear answer as to why people commit suicide, but available research shows that people with poor coping skills, mental illness and drug and alcohol problems are far more susceptible to suicidal thoughts and behaviors.

More unusual are impulsive suicides committed in reaction to a single event, such as a job loss or romantic breakup, but that also doesn’t necessarily mean a lot of planning goes into most suicides, either, according to experts. While most people who commit suicide show warning signs, rarely will an individual take his or her own life in the fit of a psychotic episode.

Celebrity suicides like Williams' can be more baffling, especially when the person appears to be enjoying career and personal success.

“Most of us feel like we know them,” said John McIntosh, a psychology professor at Indiana University, South Bend, who has studied suicide trends. “They have money, power, influence, adoration, all the things that people want to have. I want to be just like that person. Why would they ever kill themselves?”

LIKE FAMILY

Celebrity suicides generate a lot of attention because people often feel an emotional connection to the person — like a family member — especially someone with a long and varied career like Robin Williams, McIntosh added.

Research suggests that when major celebrities kill themselves, calls to suicide prevention hotlines jump. Also, suicides among people who have the same demographic characteristics as the celebrity may also increase as happened in 1994 after the suicide of Nirvana front-man musician Kurt Cobain.

“(Williams’ death) alone is not going to cause a suicide, but you have people who are already vulnerable, and this could be one thing that makes them feel worse,” McIntosh said.

After more than a decade of declines, suicide rates in the United States started rising again in 2006, after the most recent economic recession hit. The numbers have continued rising every year since, according to national statistics. The increases are across all demographic groups, though white, middle-aged men still have a slightly higher rate, McIntosh said.

An average of one person committed suicide every 13.3 minutes in the United States in 2011, the most recent year that national statistics were available, and someone attempted suicide every 32 seconds.

Last year in Bucks County, 68 people killed themselves. So far this year the number stands at 47, according to the county coroner’s office. In neighboring Montgomery County, 87 suicides were reported last year, and so far this year the number is 68.

At any given time, 7 percent of the population is affected by major depressive disorder, which puts them at a high risk for suicidal thoughts and behavior, said Dr. Shivkumar Hatti, president of the Pennsylvania Psychiatric Society.

While thoughts of suicide are not unusual among people with depressive disorders, acting on those feelings is less common, Hatti added. That is why quick treatment is critical for individuals experiencing major depression. With medications and psychotherapy, more than 85 percent of people rebound.

“People need to understand this is a common disorder and there are multiple treatment options and it’s successful,” Hatti said.

CRISIS INTERVENTION

Amanda Hilzer worries Williams’ death will send the wrong message about recovery. She specializes in working with individuals with both substance abuse issues and mental illness at Livengrin, a Bensalem substance abuse treatment center.

Mental health issues and substance abuse frequently are co-occurring disorders, which makes effective treatment more complicated since the disorders are so intertwined, Hilzer said. Addicts often self-medicate with drugs or alcohol to reduce mental illness symptoms, she added. They also may avoid mental health treatment because of the lingering stigma associated with it.

National estimates are that 50 percent to 75 percent of individuals who abuse drugs or alcohol also have a mental illness, and as many as 90 percent of people who complete suicide had undertreated or untreated mental health and substance abuse issues, Hilzer said.

The linked nature of mental health and substance abuse requires integrated treatment that addresses both problems for long-term recovery success.

“If someone appears in the emergency room with a heart attack and a broken arm, we wouldn’t just treat one or the other,” Hilzer added.

Almost universally, suicide attempts or completions are the result of more than one factor, McIntosh and others said. A person could have good coping abilities most of the time, but gets to the breaking point when they are overwhelmed and unable to function normally.

While research shows most people exhibit signs of suicidal behaviors — which either aren’t taken seriously or go unnoticed — some are particularly good at concealing their feelings, especially if they live alone, McIntosh said.

Among the common misconceptions is that someone who is considering suicide doesn’t plan for the future.

That isn’t always the case, McIntosh said. Suicide is a crisis behavior, meaning a person considering killing themselves today, may not have thought about it three days earlier. It’s another reason why accessible and immediate mental health intervention is critical.

“If you can get a person through the crisis, they may never again think about suicide again.”

Jo Ciavaglia: 215-949-4181; email: jciavaglia@calkins.com; Twitter: @jociavaglia

Monday, August 11, 2014

Judge in Bensalem suicide-pact homicide case: Where is the malice?

Posted: Friday, August 8, 2014 '

Where is the malice?

That is the question Bucks County Judge Albert Cepparulo wanted answered Friday during a hearing involving a 30-year-old Bensalem man charged with killing his mother in what was believed to have been a suicide pact.

Gus Yiambilis

“You have got to be kidding, if that is your evidence of malice for homicide,” Cepparulo said in response to prosecutor Alan J. Garabedian’s assertion that even if Karen Yiambilis wanted to die, it doesn’t mean her death isn’t a homicide.

The 59-year-old Yiambilis died of carbon monoxide poisoning April 7, and police charged her son, Koustantinos “Gus” Yiambilis, in her death.

The hearing was held at the request of his attorneys, who asked the court to dismiss the charges of homicide and causing a catastrophe against their client. The defense argued that the Bucks County District Attorney’s Office has failed to show evidence supporting either charge.

The defense contends that Karen and Gus Yiambilis both intended to commit suicide, but Gus survived.

Cepparulo, who is overseeing the case, is expected to issue a written decision on the dismissal requests within 60 days. Yiambilis family members at the hearing declined comment.

The open homicide charge means Gus Yiambilis is ineligible for bail and must remain incarcerated in Bucks County prison. He is also charged with a felony aiding in suicide, risking a catastrophe and misdemeanor reckless endangerment.

At the hearing Friday, Yiambilis’ attorney, William Goldman Jr., read from seven handwritten suicide notes left in the bedroom where authorities say Karen Yiambilis was found along with a borrowed gas generator.

Four of the notes were written by Karen Yiambilis to family members. Gus wrote the others.

In court, Yiambilis and his sister Eleni each cried as portions of the letters were read.

Suicide letters from Gus and Karen Yiambilis

Goldman has argued that the notes, along with testimony from a neighbor who claims it was Karen Yiambilis — not Gus, as police allege — who asked to borrow her gas generator the day of her death, show his client was not actively involved in the planning or execution of the suicide pact nor did he intend his mother to die and he survive.

“Karen Yiambilis expressed her intent by her own hand,” Goldman added. “There was no deception, no fraud, no duress.”

Goldman said the only reason Gus lived is because police were called to the one bedroom apartment, and pounded on the door for 10 minutes before Yiambilis answered it. Police said Yiambilis appeared lethargic and confused when he opened the door. Police noticed a haze in the apartment and smelled exhaust fumes.

Goldman also presented new evidence that he said shows his client played no role in his mother’s death. A recent fingerprint analysis shows that none of the 41 prints lifted from packing tape used to seal vents, doors and windows in the bedroom match Gus Yiambilis’, he said.

“Two people lived in that apartment, and that leaves one person: Karen Yiambilis,” Goldman added.

But there are no fingerprints of Karen Yiambilis to compare because her fingerprints weren’t taken when her body was released and then was later cremated, he said.

Goldman also tried to cast doubt on what prosecutors have cited as a key piece of evidence supporting the homicide charge — a statement Gus made while at the hospital for treatment of carbon monoxide poisoning. He allegedly said, “I can’t believe I killed my mother. She’s the only thing I got.”

Goldman suggested the statement was taken out of context.

“If someone were to say, ‘I’m Hulk Hogan’... it doesn’t make it true,” he said.

But prosecutor Garabedian countered that the homicide charge is appropriate because Karen Yiambilis died as a result of a gas generator that her son ran and even refilled once after it ran out of gas.

When Judge Cepparulo asked if charging him with both homicide and aiding in suicide is contradictory, the prosecutor responded that a judge or jury could see the death as a suicide, too, so it’s appropriate to charge it as well.

“That is just wrong,” Cepparulo said. “You cannot have homicide and assisted suicide. Those two don’t fly.”

Then Cepparulo asked Garabedian what evidence showed that Yiambilis’ actions were malicious, a requirement for a homicide charge.

“From every note I read, it was clear they wanted to commit suicide,” the judge said. “Is there any evidence ... that Mr. Yiambilis took certain steps to avoid dying by carbon monoxide? Did he try to make sure that he would live and his mother would die? Is there any evidence?”

Garabedian’s answer: Yiambilis survived.

“When officers knocked on the door, he answered (it), he left the (bed)room,” he added. “By answering the door he took himself out of the zone of danger.”

Goldman also argued that Yiambilis didn’t intend to cause widespread injury, damage or destruction and none happened. He added that steps were taken to reduce the gas exposure to others.

Garabedian countered that Yiambilis put a large number of people in danger. He cited CO readings in two neighboring apartments reached potentially hazardous levels and the evacuation of four apartments for two hours while fumes dissipated.

“How many people need to die before we call this a catastrophe, judge?” Garabedian added.

Jo Ciavaglia: 215-949-4181; email: jciavaglia@calkins.com; Twitter: @jociavaglia