Further Criticism Over Dr. Nystrom’s Comments About “Excited Delirium” 

The prior post discussed comments about “excited delirium” by Dr. Paul Nystrom, who also is a moonlighting MPD police officer, that were skeptical about AMA and other criticism over the concept of “excited delirium.”[1] Those comments have triggered vigorous dissent. [2]

On February 14, Minneapolis Mayor Jacob Frey said he was “irate” when he learned of these comments by Dr. Nystrom. According to the Mayor, “The direction we gave was very clear. We wanted this to be a substantive — not a cosmetic — change. I directed very clearly to move away from excited delirium as both a term and a concept. … The video you’re referencing was not in line.”

In addition, the Mayor directed “the department to immediately terminate their contract with Dr. Nystrom.”

Similar criticism was voiced by Hennepin Healthcare CEO Jennifer DeCubellis, Chief Medical Officer Dr. Daniel Hoody and Chief Health Equity Officer Dr. Nneka Sederstrom. They said their organization had “failed to follow through on our promise to no longer teach excited delirium and to be intentional in addressing systemic racism.  Systemic racism is deeply imbedded in law enforcement and health care systems, including ours. We failed to address it here when we had the opportunity and, in doing so, have caused further pain and mistrust. We are extremely sorry for the further harm this has caused to our community.”

Interim Minneapolis Police Chief Amelia Huffman had additional comments. She said when Nystrom gave an outline of the revised training in person to [MPD] command staff he did not include “this digression into really his thoughts about the controversy” that were included in the final training video and that “did not meet what we asked for . . . and wasn’t appropriate.”

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[1] New Evidence of “Excited Delirium” Training by MPD, dwkcommentaries.com (Feb. 13, 2022).

[2] Mannix, Mayor Frey: Hennepin Healthcare doctor failed to follow directive on ‘excited delirium’ training, StarTribune (Feb. 14, 2022).

New Evidence of “Excited Delirium” Training by MPD

So far, prosecution witnesses repeatedly have testified that the Minneapolis Police Department (MPD) has rejected the concept of “excited delirium” as a valid medical concept for use by its police officers in confronting suspects.

On February 12th, however, Andy Mannix of the StarTribune reported that its public records request has discovered a recent MPD training video that teaches officers how to respond to excited delirium and using studies with “excited delirium” in the titles.

In this training video, Dr. Paul Nystrom, an emergency physician at Hennepin Healthcare and also a moonlighting MPD police officer, says officers should no longer use the words “excited delirium” to describe the real phenomenon and instead use a name like “severe agitation with delirium.” He also stated, “We all agree the entity exists.” But, says Mannix, not everyone agrees, especially the American Medical Association.

Dr. Nystrom, however, in the video criticizes “specialists” and “experts” who have rejected the science of excited delirium. “I wouldn’t go into an operating room and tell an anesthesiologist how to practice. Most of us [policemen] don’t appreciate somebody else getting in our lane when they don’t do the things we do.”

He also uses the same acronym used in the previous training—“NOTACRIME” to help officers remember how to identify the syndrome:” “N=Nudity; O=Objects (person acting violently toward objects such as glass or shiny objects).”

This new training has been endorsed by MPD’s Deputy Chief of Professional Standards, Troy Schoenberger, who said it meets AMA policy, including having a medical professional teach the course. He added, “This training was important in the transition away from the use of the term ‘excited delirium,’ while still recognizing that there are symptoms that officers may observe, along with his [Nystrom’s] recommendations as to how to properly care for patients exhibiting those symptoms.”

A contrary opinion on the new training was voiced by Dr. Michael Freeman, an associate professor of forensic medicine at Maastricht University in the Netherlands. The new training, he said, is “window dressing” that fails to meet the AMA policy, and instead reinforces dangerous police practices based on shoddy research.

Also critical of the new training was Dr. Max Fraden of Hennepin Healthcare. “This is a change in name only. And the issue with excited delirium is not the name.” Last year Fraden and other hospital staff presented a petition to the its  leadership to stop training law enforcement on the concept, and leadership responded by saying they had stopped such training in 2018 and any new training would involve “trauma-informed care” and anti-racist framework.” Fraden, however, said the new video “seems very opposed to what Hennepin leadership says their policy is.”

Mayor Frey’s office said it “will be reviewing with external medical experts what appears to be a failure to follow a directive,” and the Mayor has directed the department to terminate its contract with Dr. Nystrom.

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1 Federal Criminal Trial for George Floyd Killing: Prosecution Witnesses (Part (I), dwkcommentaries.com (Feb. 2, 2022); Federal Criminal Trial for George Floyd Killing (Part (II), dwkcommentaries.com (Feb. 11, 2022).

2 Mannix, Minneapolis Police Department still teaching controversial ‘excited delirium’ syndrome—despite claiming it had stopped, StarTribune (Feb. 12, 2022),

 

 

 

 

 

 

 

 

Derek Chauvin Trial: Week One

March 8-12 marked the first week of the criminal trail of Derek Chauvin, the former Minneapolis police officer accused of second-degree murder and second-degree manslaughter for the death of George Floyd. This recap will open with the trial court’s reinstatement of the third-degree murder charge and then discuss the parties selection of 14 jurors, two of whom would be alternates. Then this recap will conclude with the March 12th announcement that the City of Minneapolis had reached an historic settlement agreement with the Floyd family over its civil claims for damages, which may have an impact on the Chauvin  and the other criminal cases against the other ex-police officers accused of aiding and abetting Chauvin’s alleged crimes.

Reinstatement of Third-Degree Murder Charge [1]

On March 11, Hennepin County District Court Judge Peter Cahill decided that the third-degree murder charge would be reinstated after the Minnesota Court of Appeals had rebuked his previous refusal to follow the majority opinion of a three-judge panel of that appellate court’s upholding the third-degree murder conviction of another former Minneapolis policeman, Mohammed Noor. 

Judge Cahill said he was “duty bound” to accept the appellate court’s ruling and its interpretation of the relevant statute as covering “single acts directed at a single person.” Moreover, “it would be an abuse of discretion not to grant the motion” to reinstate the charge.

Rachel Paulose, former U.S. Attorney for the District of Minnesota and now a professor at the University of St. Thomas Law School in Minneapolis, says the prosecution correctly asserted this charge since Chauvin threatened to harm witnesses who attempted to intervene to provide medical help to Floyd in addition to the harm to Floyd caused by the chokehold on the latter’s neck. Nevertheless, this additional charge carries the risk that the Minnesota Supreme Court in the pending case of the third-degree murder conviction of another former Minneapolis policeman, Mohammed Noor, might interpret this crime’s requirements more narrowly and enable Chauvin to escape criminal liability if this is the only charge on which he is held guilty at trial.

Minnesota Standards for Potential Jurors [2]

Minnesota Rule of Criminal Procedure 26.02, subd. 1 provides that a county’s jury list shall be “composed of persons randomly selected for a fair cross-section of qualified county residents.”

Rule 26.02, sub. 5(1) then provides 11 specified grounds for challenging a potential juror “for cause.” The most relevant one for the Chauvin trial appears to be “1. The juror’s state of mine—in reference to the case or to either party—satisfies the court that the juror cannot try the case impartially and without prejudice to the substantial rights of the challenging party.” Subd. 5 (3) then goes on to say, “If a party objects to the challenge for cause, the court must determinate the challenge.” 

First Week of Chauvin Jury Selection [3]

In preparation for the task of selecting jurors in such a case of wide importance and publicity, the trial court earlier had submitted to potential jurors a 14-page questionnaire with questions about race, policing, martial arts and podcasts.” That court also had determined that Chauvin would have 15 preemptory challenges (8 of which were used this week); the prosecution, only 9 (five of which were used this week).

By the end of the week, seven people had been selected for this jury, five men and two women. Four are white and three are people of color: one black man in his 30’s, one biracial woman in her 20’s, one Hispanic man in his 20’s, one white woman in her 50’s, a white man in his 20’s and two white men in their 30’s. Six of them said they held “a somewhat favorable view of the Black Lives Matter  movement” although some said that view was more for its concept, not its tactics or politics. A jury consultant said “asking about Black Lives Matter and Blue Lives Matter gave lawyers a concrete way to frame conversations about otherwise uncomfortable topics.”

According to Wall Street Journal reporters, during this first week lawyers for both sides “often focused their questioning on Black Lives Matter, Blue Lives Matter and how jurors answered . . . [the court’s] questionnaire answered a questionable item about ‘defunding the Minneapolis Police Department.” This was seen by the reporters as the lawyers attempting to discern “whether potential jurors can put aside their personal opinions while evaluating evidence presented in court—though lawyers haven’t always been swayed by such pledges.”

The founder and chief organizer of Black Lives Matter Minnesota told the Wall Street Journal that he was encouraged that some of initial seven jurors held a positive view of this group while disappointed that the only black individual chosen so far was an immigrant who came to the U.S. more than a decade ago, rather than someone whose ancestors “went through slavery, Jim Crow and the Civil Rights era and who understands the history of our relationship with the police.”

Another issue arose this week over “spark of life” testimony allowed by a Minnesota statute to humanize the deceased victim. The Judge said that he would allow such witnesses to speak about how much they loved Mr. Floyd, but that if they started talking about his character,, it would “open the door’ for the defense to introduce evidence of his criminal history, which so far has been barred by the court.

As someone who only watched a few minutes of the questioning of the prospective jurors (the process of voire dire) and who saw only the questioning by Chauvin’s attorney, Eric Nelson, this blogger was impressed by his logical and conversational tone and maintenance of a straight face and thought that the prospective jurors probably would believe he was someone who deserved to be listened too during the trial. (After retiring from the practice of law, I was summoned for jury duty and was once a potential juror in a civil case who was very annoyed with the manner of one of the attorneys posing questions to the panel; I was eliminated as a juror as I expected because very few, if any, trial lawyers would want to have a lawyer as a juror.)

Settlement Between City of Minneapolis & Floyd Family [4]

On Friday, March 12, Minneapolis city officials and lawyers for the Floyd family publicly announced that they had agreed to settle the latter’s civil lawsuit for money damages with the city’s payment of $27 million.

Mayor Jacob Frey called it a milestone for the city’s future and a reflection of “a shared commitment to advancing racial justice and a sustained push for progress.” Indeed, Frey said the city would implement major policy changes in the pursuit of racial justice. The city’s coordinator, Mark Ruff, added that with cash reserves, officials were confident that this agreement would not lead to an increase of the city’s property taxes.

Ben Crump, the lead lawyer for the family said it would set an example for other communities: “After the eyes of the world rested on Minneapolis in its darkest hour, now the city can be a beacon of hope and light and change for cities across America and across the globe.” Crump also said that this settlement “sends a powerful message that Black lives do matter and police brutality against people of color must end.” the family had pledged to donate $500,000 of the settlement to “lift up” the neighborhood around the site of the killing of Mr. Floyd. And Floyd’s brother pledged to use some of the money to help other struggling Black communities.

Some commentators thought this agreement might make it even harder to seat an impartial jury. A former city chief public defender thought the timing of this agreement “could hardly be worse” for the criminal case against Chauvin and his lawyers might even ask for a mistrial if potential or already chosen jurors saw the agreement as the city’s acknowledgment that his actions were inappropriate.

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[1] Paulose, Opinion: The third-degree murder charges against Derek Chauvin carry worthwhile risks, Wash. Post (Mar. 12, 2021); Bogel-Burroughs, Derek Chauvin will now face a third-degree murder charge, N.Y. Times (Mar. 11, 2021); Court of Appeals Reverses District Court’s Refusal To Follow Precedent on third-Degree Murder Charge Against Derek Chauvin, dwkcommentaries.com (Mar. 5, 2021).  Derek Chauvin again charged with third-degree murder, StarTribune (Mar.  11, 2021); Bailey, Derek Chauvin trial judge reinstates third-degree murder charge in the death of George Floyd, Wash. Post (Mar. 11, 2021)

[2] Minn. Rules of Criminal Procedure 26.02, subdivisions 1, 2(3), 5(1), 5(3);Court’s Questionnaire for Prospective Jurors in George Floyd Criminal Cases, dwkcommentaries.com (Dec. 23, 2020).

[3] Dewan & Arango, What Are the Question for Potential Jurors in the Derek Chauvin Trial?, N.Y. Times (Mar. 7 & 11, 2021);  Levinson, Jury selection begins in Derek Chauvin’s trial in the death of George Floyd. Here’s what to expect, CNN.com (Mar. 11, 2021); Xiong & Walsh, StarTribune (Mar. 12, 2021); Bailey, Hints of strategy and new revelations in first week of Derek Chauvin murder trial, Wash. Post (Mar. 15, 2021).

[4] Bogel-Burroughs & Eligon, George Floyd’s Family Settles Suit Against Minneapolis for $27 Million, N.Y. Times (Mar. 12, 2021); Bailey & Olorunnipa, George Floyd’s family to receive recored $27 million in settlement approved by Minneapolis city council, Wash. Post (Mar. 12, 2021); Barrett & Winter,George Floyd Family Reaches $27 Million Settlement with Minneapolis, W.S.J. (Mar. 12, 2021). Here are summaries of the federal civil complaint by the Floyd family against the City of Minneapolis from dwkcommentaries.com: George Floyd’s Family Sues City of Minneapolis and Four Ex-Officers Involved in His Death (July 16, 2020); George Floyd Family’s Complaint Against City of Minneapolis Over His Death: Count II (July 18, 2020); George Floyd Family’s Complaint Against City of Minneapolis Over His Death: Count III (July 19, 2020).

Former Minneapolis Mayor Discusses Police Reform Problems

R.T. Rybak, former Mayor of Minneapolis (2002-2013) believes that police unions and their leaders are major reasons why past efforts at reforming policing in Minneapolis and elsewhere in this country have had problems and why current reform efforts are facing difficulties.[1]

He says this as he struggles with competing police images. On the one hand, Rybak has seen “police officers perform extraordinary acts of courage at explosive crime scenes, protect women from domestic abuse, build trusted relationships with immigrants who are terrified the government will take their children, and so much more.” On the other hand, he also has seen “toxic us-versus-them police cultures—in which an officer who might individually make the right call becomes silently complicit when a fellow officer goes rogue.This culture enabled three officers in my city to stand by while [George] Floyd was killed.” [2]

The latter culture is understandable when “officers see the worst things happening in their city on any given shift. After being in danger every night, officers gradually stop seeing the humanity in the people and neighborhoods they patrol. Instead, they go back to the precinct with the only people who can really understand what they are going through. People with exceptionally tough jobs serving complex humans naturally vent when they are together.”

“But the tribalism that can build up within police departments is far more consequential. Us versus them—meaning police versus criminals—slowly curdles into police versus the people: Who would live in these crime-infested neighborhoods where we risk our lives? Waiting to stoke that resentment are police-union leaders such as [Bob] Kroll [the President of the Police Officers Federation of Minneapolis], who defend even the more aggressive acts of officers and, even in a case as extreme as [George] Floyd’s death, prevent any self-examination by blaming the victim.”

“As matters stand, the public—through its elected representatives—has also ceded far too much power to the police unions that enable bad behavior. Floyd’s death underscores that police work should be subject to oversight, and officers who violate policy and misuse their power should be subject to discipline. But the unions’ power is most notable in contracts that limit the accountability that, as the community can now see, is so desperately needed. The lack of accountability seems incongruous because the mayors and city councils that negotiate with police unions include some of the country’s most progressive elected officials and represent some of the country’s most progressive constituencies.”

“Yet when duly elected officials propose reforms, police unions do not merely oppose them; they actively work to thwart them. Last year, Minneapolis Mayor Jacob Frey banned so-called warrior-style training, which emphasizes physical threats to police officers rather than the benefits of de-escalating confrontations. . . . Kroll and the police federation defied Frey’s move by offering warrior-style training of their own.”[3]

“Some local officials have also hesitated to demand tougher reforms in contracts because police unions often spend heavily in local elections to oppose any politician who challenges them. I know what that’s like. The union supported me near the end of my first race for mayor. But after I took office, we disagreed over the police budget and my choice of police chief. When I ran for reelection, the police union went all out to defeat me: It helped pay for polling to identify the strongest candidate to run against me and pounded voters relentlessly with literature and broadcast ads that portrayed me as soft on crime. [Nevertheless,] I got more than 60 percent of the vote. The police federation also made a massive investment to defeat an incoming council member, Betsy Hodges, who still won overwhelmingly. Eight years later, again, despite massive police opposition, she was elected mayor.”

“Electing mayors and city-council members who support such reforms is not enough. Police-union leaders use back channels to go around local officials and get more conservative state legislators to block meaningful changes. That dynamic holds true in Minnesota, where a Republican state representative, who was also a Minneapolis [police] officer, helped overturn a residency requirement for police. Today more than 90 percent of Minneapolis officers live outside the city. The legislature also has stonewalled attempts by the city to get supervisory positions removed from police-federation ranks. As a result, some of the people directing and disciplining officers, and developing the union contract, are actually negotiating with the union of which they are a member.”

“In return, police unions have helped their enablers on the state and national levels. Police-federation leaders endorse Republicans in most gubernatorial races. Last fall, Kroll appeared with President Donald Trump at a rally in Minneapolis and was interviewed wearing a ‘cops for trump’ T-shirt on Fox News.”

“If progressive local officials want wholesale reform of police tactics and culture, they will have to do something that runs counter to their own culture: take on union leaders. [After all,] Minnesota’s chapter of the American Federation of Labor and Congress of Industrial Organizations—an umbrella group that does not include the police federation—recognizes that Kroll isn’t merely taking his members’ side in a labor-management dispute. In a recent statement calling for Kroll’s resignation, the Minnesota AFL-CIO president, Bill McCarthy, faulted him for trying to justify Floyd’s killing rather than participate in a dialogue about reform. McCarthy also accused Kroll of failing the labor movement. ‘Unions exist to protect workers who have been wronged,” McCarthy declared, “not to keep violent people in police ranks.’”

“I used to say that the majority of officers are good but silently let a minority set the dominant culture. But now I believe that no one can be called a ‘good officer’ if they are not working actively and openly to change the culture and unseat their toxic union leaders. The silence of the ‘good officers’ so far is deafening, but a glimmer of hope came recently when more than a dozen brave Minneapolis officers bucked their union, condemned the officer who murdered George Floyd, and vowed to regain the community’s trust.”[4]

“In general, intimidated local officials overestimate the political muscle of police unions. Their credibility with the public is even more diminished in the aftermath of [George] Floyd’s death. So now is the time to push for reforms that hold police departments more accountable to the public.”

“I am not suggesting that cities should try to bust police unions. Far from it. Working people need and deserve the protections that collective bargaining provides. In a better world, a police-union leader could help the public understand how hard the job can be—but could also set the moral and professional standards for officers, rather than defend them no matter what they do.”

“While the breakdown between the police union and the public’s elected representatives has been especially acute in Minneapolis, I know from my discussions with other mayors that many other communities experience similar tensions. These relationships must be fundamentally reshaped. When cities lack the power to provide basic oversight of their officers and cannot break down an us-versus-them culture, they cannot prevent future deaths like that of George Floyd.”

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[1] Rybak, I Was Mayor of Minneapolis. I Know Why Police Reforms Fail, Atlantic (June 10, 2020). See also Mannix, Killing of George Floyd shows that years of police reform fall far short, StarTribune (June 20, 2020).

[2]  It must not be forgotten that the Minneapolis Chief of Police immediately fired the four officers involved in the killing of George Floyd, that soon thereafter serious criminal charges were filed against all four and the City banned chokeholds and neck restraints under an agreement with the Minnesota Department of Human Rights that was incorporated in a court injunction. See List of Posts to dwkcommentaries—Topical: GEORGE FLOYD CASE.

[3] Jany, Minneapolis police union offers free ‘warrior’ training, in defiance of mayor’s ban, StarTribune (April 24, 2019).

[4] Olson, Minneapolis police officers issue open letter condemning colleague in George Floyd’s death, pledging to work toward trust, StarTribune (June 12, 2020); The Criminal Complaints Against the Other Three Policemen Involved in George Floyd’s Death, dwkcommentaries.com (June 14, 2020).

 

 

New Uses of New Spaces at Minneapolis’ Westminster Presbyterian Church   

The previous post covered the joyous celebration of the new addition at Westminster Presbyterian Church on Martin Luther King, Jr. Sunday, January 14, 2018. Now we examine how that new space will be used after looking at these photographs of the new addition (the last two show a 21st century version of stained glass windows provided by a film application from 3M).

The Westminster Counseling Center— which the church has long supported with funding, office space and administrative support — has new offices on the second floor of the new expansion to provide counseling by licensed psychotherapists, welcoming people of all faiths or none at all to seek counseling and mental health services in an open and welcoming environment. Such services are provided on a sliding-fee scale to ensure  high-quality counseling to those who could not otherwise afford it, no matter their circumstances.

The expansion will also soon house the Harman Center for Child & Family Wellbeing, a new and innovative early intervention clinic of St. David’s Center–Child & Family Development.[1] The Harman Center will occupy approximately 8,000 square feet of space on the second floor, and will primarily serve children from birth to age five who have experienced relational trauma. Services will include an infant team to assess and treat families with children in out-of-home placement, children’s mental health services and pediatric rehabilitative therapies, a clinical training site for graduate students in mental health, and a new home for the Center’s day-treatment program for young Somali children diagnosed with autism. A private space for Islamic prayer will be provided.

The new Recreation Room and adjacent Youth Room offer open, youth-friendly places for Westminster’s young people as well as youth groups from all over the country who often need a place to connect and stay.

In partnership with Hennepin County Library, Westminster will host an onsite senior community center two days per week to respond to the needs of the downtown seniors dispersed by the recent closures of two senior centers in the area. The church also will be providing a safe space for homeless people to store their belongings.

Westminster is planning two new worship services for Westminster Hall: starting February 14, a 6:30 p.m. Wednesday contemplative service called “The Clearing,” and in September, a 5:00 p.m. Sunday service.

There also are these upcoming inaugural events.

January 28 (2:00 p.m.)  Bold Hope in the North. This free and open-to-the-public event is co-sponsored by Downtown Congregations to End Homelessness  and the Super Bowl Host Committee.  100% of the free-will donations at the event will go to the highly effective Emergency Rental Assistance Program (80% of families who received this assistance have remained housed after six months). The program will be emceed by Minneapolis Mayor Jacob Frey  and  joined by senior clergy from the downtown congregations (Christian, Jewish and Muslim) and two former NFL Vikings stars: punter Greg Coleman and defensive end Mark Mullaney. Music will be provided by J.D. and Fred Steele, Amwaaj Middle Eastern Ensemble, MacPhail Community Youth Choir, Mill City Singers, Spoken- word teen artist Kaaha Kaahiye and Klezmer Cabaret Orchestra. Following the program, attendees will enjoy delicious food from Holy Land Market and assemble dignity bags for people who are homeless (consisting of hygiene products, socks, hand warmers, food, etc.).

February 25 (4:00 p.m.) Annual Youth Coffeehouse Cabaret will be presented by the church’s youth to showcase their talents through individual and group performances and a skit comedy.

March 2 (7:30 p.m.)Cantus, a male chamber a cappella ensemble that has an office and practice space at Westminster, will present the inaugural concert in Westminster Hall, a photograph of which is below. Additional details to be announced.

March 3 (10:30 a.m.—12:30 p.m.). Community Open House and Justice Choir Sing-Along. Tesfa Wondemagegnehu, Westminster’s Director, Choral Ministries, will lead all in the sing-along.

April 17. Harman Center Grand Opening with two events: over the lunch hour will be dedicated to the downtown business community and in the afternoon the broader community will be involved. More details will be forthcoming on its website: https://www.stdavidscenter.org/.

May 5 (5:00 p.m.-8:30 p.m.). Celebration of Open Doors/Open Future Campaign. Worship in the sanctuary to recognize the generosity of the congregation and leaders in the Open Doors Open Futures project. Vice President Walter Mondale, a Westminster member, will be a speaker, as well as several youth and the campaign co-chairs. Afterwards games and activities on both Nicollet and Marquette Green and a  buffet dinner and light appetizers. Watch the Westminster website for updates.

May 17-19. Windows into Palestine: Encountering the Heart of a People through Art. This collaboration among Westminster; its partner congregation, Christmas Lutheran Church of Bethlehem, Palestine; Bright Stars of Bethlehem; and Bethlehem Lutheran Foundation will include an art exhibit, Choral and Instrumental Music, featuring the Georges Lammam Ensemble; Food Tastings and Cooking Demonstrations; Chef Showcase – featuring Chef Sameh Wadi of Minneapolis’ World Street Kitchen and Chef Bassem Hazboun from Bethlehem; and  Spice and Crafts Market. Most of these programs will be at Westminster. Check the festival’s website for more details: https://www.windowsintopalestine.org.

Conclusion

Welcome all to this beautiful new space and inspiring programs!

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[1] St. David’s Center at its Minnetonka campus offers an exceptional preschool, children’s mental health clinic and pediatric therapy clinic as well as day-treatment programs for children with autism and mental health diagnoses.