Fewer health care options for illegal immigrants

ALAMO, Texas (AP) — For years, Sonia Limas would drag her daughters to the emergency room whenever they fell sick. As an illegal immigrant, she had no health insurance, and the only place she knew to seek treatment was the hospital — the most expensive setting for those covering the cost.

The family's options improved somewhat a decade ago with the expansion of community health clinics, which offered free or low-cost care with help from the federal government. But President Barack Obama's health care overhaul threatens to roll back some of those services if clinics and hospitals are overwhelmed with newly insured patients and can't afford to care for as many poor families.

To be clear, Obama's law was never intended to help Limas and an estimated 11 million illegal immigrants like her. Instead, it envisions that 32 million uninsured Americans will get access to coverage by 2019. Because that should mean fewer uninsured patients showing up at hospitals, the Obama program slashed the federal reimbursement for uncompensated care.

But in states with large illegal immigrant populations, the math may not work, especially if lawmakers don't expand Medicaid, the joint state-federal health program for the poor and disabled.

When the reform has been fully implemented, illegal immigrants will make up the nation's second-largest population of uninsured, or about 25 percent. The only larger group will be people who qualify for insurance but fail to enroll, according to a 2012 study by the Washington-based Urban Institute.

And since about two-thirds of illegal immigrants live in just eight states, those areas will have a disproportionate share of the uninsured to care for.

In communities "where the number of undocumented immigrants is greatest, the strain has reached the breaking point," Rich Umbdenstock, president of the American Hospital Association, wrote last year in a letter to Obama, asking him to keep in mind the uncompensated care hospitals gave to that group. "In response, many hospitals have had to curtail services, delay implementing services, or close beds."

The federal government has offered to expand Medicaid, but states must decide whether to take the deal. And in some of those eight states — including Texas, Florida and New Jersey — hospitals are scrambling to determine whether they will still have enough money to treat the remaining uninsured.

Without a Medicaid expansion, the influx of new patients and the looming cuts in federal funding could inflict "a double whammy" in Texas, said David Lopez, CEO of the Harris Health System in Houston, which spends 10 to 15 percent of its $1.2 billion annual budget to care for illegal immigrants.

Realistically, taxpayers are already paying for some of the treatment provided to illegal immigrants because hospitals are required by law to stabilize and treat any patients that arrive in an emergency room, regardless of their ability to pay. The money to cover the costs typically comes from federal, state and local taxes.

A solid accounting of money spent treating illegal immigrants is elusive because most hospitals do not ask for immigration status. But some states have tried.

California, which is home to the nation's largest population of illegal immigrants, spent an estimated $1.2 billion last year through Medicaid to care for 822,500 illegal immigrants.

The New Jersey Hospital Association in 2010 estimated that it cost between $600 million and $650 million annually to treat 550,000 illegal immigrants.

And in Texas, a 2010 analysis by the Health and Human Services Commission found that the agency had provided $96 million in benefits to illegal immigrants, up from $81 million two years earlier. The state's public hospital districts spent an additional $717 million in uncompensated care to treat that population.

If large states such as Florida and Texas make good on their intention to forgo federal money to expand Medicaid, the decision "basically eviscerates" the effects of the health care overhaul in those areas because of "who lives there and what they're eligible for," said Lisa Clemans-Cope, a senior researcher at the Urban Institute.

Seeking to curb expenses, hospitals might change what qualifies as an emergency or cap the number of uninsured patients they treat. And although it's believed states with the most illegal immigrants will face a smaller cut, they will still lose money.

The potential impacts of reform are a hot topic at MD Anderson Cancer Center in Houston. In addition to offering its own charity care, some MD Anderson oncologists volunteer at a county-funded clinic at Lyndon B. Johnson General Hospital that largely treats the uninsured.

"In a sense we've been in the worst-case scenario in Texas for a long time," said Lewis Foxhall, MD Anderson's vice president of health policy in Houston. "The large number of uninsured and the large low-income population creates a very difficult problem for us."

Community clinics are a key part of the reform plan and were supposed to take up some of the slack for hospitals. Clinics received $11 billion in new funding over five years so they could expand to help care for a swell of newly insured who might otherwise overwhelm doctors' offices. But in the first year, $600 million was cut from the centers' usual allocation, leaving many to use the money to fill gaps rather than expand.

There is concern that clinics could themselves be inundated with newly insured patients, forcing many illegal immigrants back to emergency rooms.

Limas, 44, moved to the border town of Alamo 13 years ago with her husband and three daughters. Now single, she supports the family by teaching a citizenship class in Spanish at the local community center and selling cookies and cakes she whips up in her trailer. Soon, she hopes to seek a work permit of her own.

For now, the clinic helps with basic health care needs. If necessary, Limas will return to the emergency room, where the attendants help her fill out paperwork to ensure the government covers the bills she cannot afford.

"They always attended to me," she said, "even though it's slow."

___

Sherman can be followed on Twitter at https://twitter.com/chrisshermanAP .

Plushnick-Masti can be followed on Twitter at https://twitter.com/RamitMastiAP .

Read More..

School Shooting: Officials Seek Details on Gunman

The FBI is in at least three states interviewing relatives and friends of the elementary school gunman who killed 20 children, seven adults and himself, trying to put together a better picture of the shooter and uncover any possible explanation for the massacre, ABC News has learned.

The authorities have fanned out to New Jersey, Connecticut and Massachusetts to interview relatives of Adam Lanza, 20, and his mother, who was one of Lanza's shooting victims.

The victims died Friday when Lanza invaded Sandy Hook Elementary School in Newtown, Conn., and sprayed staff and students with bullets, officials said. Lanza also was found dead in the school.

Lt. Paul Vance said 18 children died in the school and two more died later in a hospital.

Six adults also were slain, bringing the total to 26. Among them was the school's principal, Dawn Hochsprung, multiple sources told ABC News. Another adult victim was teacher Vicki Soto, his cousin confirmed.

In addition to the casualties at the school, Lanza's mother, Nancy Lanza, was killed in her home, federal and state sources told ABC News.

According to sources, Lanza shot his mother in the face, then left his house armed with at least two semi-automatic handguns, a Glock and a Sig Sauer, and a semi-automatic rifle. He was also wearing a bulletproof vest.

READ: Connecticut Shooter Adam Lanza: 'Obviously Not Well'

Lanza then drove to the elementary school and continued his rampage, authorities said.

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It appeared that Lanza died from what was believed to be a self-inflicted gunshot wound. The rifle was found in his car.

"Evil visited this community today," Gov. Dan Malloy said at a news conference Friday evening.

CLICK HERE for more photos from the scene.

In the early confusion surrounding the investigation, federal sources initially identified the suspect as Adam's older brother Ryan Lanza, 24. Identification belonging to Ryan Lanza was found at the shooting scene, federal sources told ABC News.

Ryan Lanza soon took to Facebook to say he was alive and not responsible for the shooting. He later was questioned by police.

During the rampage, first-grade teacher Kaitlin Roig, 29, locked her 14 students in a class bathroom and listened to "tons of shooting" until police came to help.

"It was horrific," Roig said. "I thought we were going to die."

She said that the terrified kids were saying, "I just want Christmas. ... I don't want to die. I just want to have Christmas."

A tearful President Obama said Friday that there was "not a parent in America who doesn't feel the overwhelming grief that I do."

The president had to pause to compose himself after saying these were "beautiful little kids between the ages of 5 and 10."

As he continued with his statement, Obama wiped away tears from each eye. He has ordered flags flown as half staff.

It is the second worst mass shooting in U.S. history, exceeded only by the Virginia Tech shooting in 2007 when 32 were killed before the shooter turned the gun on himself. The carnage in Connecticut exceeded the 1999 Columbine High School shooting in which 13 died and 24 were injured.

Friday's shooting came three days after masked gunman Jacob Roberts opened fire in a busy Oregon mall, killing two before turning the gun on himself.

The Connecticut shooting occurred at the Sandy Hook Elementary School, which includes 450 students in grades K-4. The town is located about 12 miles east of Danbury, Conn.

The massacre prompted the town of Newtown to lock down all its schools and draw SWAT teams to the school, authorities said.

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Last-minute polls tip victory for Japan hawks

TOKYO: Japan's conservative opposition and its junior coalition partner appear headed for easy victory in this weekend's election, an opinion poll said on Friday, heralding a possible hardening of foreign policy.

In one of the last gauges of the public mood before Sunday's vote, the Liberal Democratic Party (LDP) and its ally looked set to achieve a possible two-thirds majority in the lower house ballot.

That would hand hawkish party leader Shinzo Abe a premiership with enough power to try to fulfil his campaign pledge - bolstering Japan's military and coastal defences at a time of heightened tensions with China.

On Thursday Japan scrambled fighter jets after a Chinese plane entered airspace over Japanese-held disputed islands. Tokyo said it was the first time a Chinese state-owned plane had breached its airspace.

The two nations have been at loggerheads for months over the uninhabited but strategically important islands in the East China Sea. Thursday's episode was seen as a racheting-up of those tensions.

Unveiling his party's manifesto last month, Abe said his putative government would consider establishing a permanent presence on the Senkaku islands, which Beijing calls the Diaoyus.

Although he stayed away during a brief stint as prime minister in 2006-7, as opposition leader earlier this year Abe visited the Yasukuni Shrine in Tokyo, the repository of millions of war dead including Class A war criminals.

Visits to the shrine by senior politicians rankle China and other victims of Japan's aggressive military expansionism last century.

Friday's poll by the liberal Asahi Shimbun newspaper showed the LDP on course for up to 297 of the 480 seats available, with junior partner New Komeito set to gain more than 30 seats.

If both parties achieve at the top of their forecast ranges they would have a more than two-thirds majority in the powerful lower house -- enough to override the upper house, which they do not control.

The Democratic Party of Japan (DPJ) of Prime Minister Yoshihiko Noda will see its 230-strong presence diminished to somewhere between 63 and 88, the daily said, reflecting public displeasure at the ill-disciplined party.

The paper noted, however, that a significant portion of voters - about half for single-seat constituencies and 40 percent for proportional representation seats - have not yet decided which candidate or party to support.

Around 1,500 candidates, fielded by 12 parties or standing as independents, are vying for the 480 seats - 300 in single-seat constituencies and 180 allocated by proportional representation in 11 blocs.

- AFP/de

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Hardline separatists must change outlook: Mirwaiz

NEW DELHI: Hardline separatist groups should change their outlook in the efforts to find a solution to the Kashmir issue rather than professing politics of status quo which will not benefit anyone except them, moderate Hurriyat Conference chairman Mirwaiz Umer Farooq said today.

"Well, I think they (hardline separatists) need to change their outlook," said the Mirwaiz, who is leading a seven-member delegation of moderate Hurriyat Conference group to Pakistan tomorrow for meetings with the Pakistani leadership.

He was replying to a question on hardline separatists including Syed Ali Shah Geelani being not in favour of any visit by Kashmiri leaders to Pakistan.

Without naming Geelani, the Mirwaiz said "it's unfortunate that there was such voices. When we entered into a dialogue with New Delhi, they dubbed us as traitors and now when we are going to Pakistan we are being labelled as sellers.

"This is their (hardliners) politics of status quo which benefits only them and no one other. What should we do? If they have a solution, let them come forward and give us," he told PTI.

The Mirwaiz said a solution to Kashmir issue was not possible overnight and their visit to Pakistan was only a beginning. "A small step in the right direction," he said.

During their meetings, the Hurriyat delegation is due to meet Pakistan President Asif Ali Zardari, Prime Minister Raja Pervez Ashraf, Foreign Minister Heena Rabbani Khar, Chief of PML-N Nawaz Sharief, Pakistan Tehreek-e-Insaf leader Imran Khan besides political leadership of Pakistan-occupied-Kashmir (PoK).

The Mirwaiz said during his meetings with Khar and PoK leadership, he would press for opening of Sharda temple at village Shardi in Attamukam area in PoK.

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Fewer health care options for illegal immigrants

ALAMO, Texas (AP) — For years, Sonia Limas would drag her daughters to the emergency room whenever they fell sick. As an illegal immigrant, she had no health insurance, and the only place she knew to seek treatment was the hospital — the most expensive setting for those covering the cost.

The family's options improved somewhat a decade ago with the expansion of community health clinics, which offered free or low-cost care with help from the federal government. But President Barack Obama's health care overhaul threatens to roll back some of those services if clinics and hospitals are overwhelmed with newly insured patients and can't afford to care for as many poor families.

To be clear, Obama's law was never intended to help Limas and an estimated 11 million illegal immigrants like her. Instead, it envisions that 32 million uninsured Americans will get access to coverage by 2019. Because that should mean fewer uninsured patients showing up at hospitals, the Obama program slashed the federal reimbursement for uncompensated care.

But in states with large illegal immigrant populations, the math may not work, especially if lawmakers don't expand Medicaid, the joint state-federal health program for the poor and disabled.

When the reform has been fully implemented, illegal immigrants will make up the nation's second-largest population of uninsured, or about 25 percent. The only larger group will be people who qualify for insurance but fail to enroll, according to a 2012 study by the Washington-based Urban Institute.

And since about two-thirds of illegal immigrants live in just eight states, those areas will have a disproportionate share of the uninsured to care for.

In communities "where the number of undocumented immigrants is greatest, the strain has reached the breaking point," Rich Umbdenstock, president of the American Hospital Association, wrote last year in a letter to Obama, asking him to keep in mind the uncompensated care hospitals gave to that group. "In response, many hospitals have had to curtail services, delay implementing services, or close beds."

The federal government has offered to expand Medicaid, but states must decide whether to take the deal. And in some of those eight states — including Texas, Florida and New Jersey — hospitals are scrambling to determine whether they will still have enough money to treat the remaining uninsured.

Without a Medicaid expansion, the influx of new patients and the looming cuts in federal funding could inflict "a double whammy" in Texas, said David Lopez, CEO of the Harris Health System in Houston, which spends 10 to 15 percent of its $1.2 billion annual budget to care for illegal immigrants.

Realistically, taxpayers are already paying for some of the treatment provided to illegal immigrants because hospitals are required by law to stabilize and treat any patients that arrive in an emergency room, regardless of their ability to pay. The money to cover the costs typically comes from federal, state and local taxes.

A solid accounting of money spent treating illegal immigrants is elusive because most hospitals do not ask for immigration status. But some states have tried.

California, which is home to the nation's largest population of illegal immigrants, spent an estimated $1.2 billion last year through Medicaid to care for 822,500 illegal immigrants.

The New Jersey Hospital Association in 2010 estimated that it cost between $600 million and $650 million annually to treat 550,000 illegal immigrants.

And in Texas, a 2010 analysis by the Health and Human Services Commission found that the agency had provided $96 million in benefits to illegal immigrants, up from $81 million two years earlier. The state's public hospital districts spent an additional $717 million in uncompensated care to treat that population.

If large states such as Florida and Texas make good on their intention to forgo federal money to expand Medicaid, the decision "basically eviscerates" the effects of the health care overhaul in those areas because of "who lives there and what they're eligible for," said Lisa Clemans-Cope, a senior researcher at the Urban Institute.

Seeking to curb expenses, hospitals might change what qualifies as an emergency or cap the number of uninsured patients they treat. And although it's believed states with the most illegal immigrants will face a smaller cut, they will still lose money.

The potential impacts of reform are a hot topic at MD Anderson Cancer Center in Houston. In addition to offering its own charity care, some MD Anderson oncologists volunteer at a county-funded clinic at Lyndon B. Johnson General Hospital that largely treats the uninsured.

"In a sense we've been in the worst-case scenario in Texas for a long time," said Lewis Foxhall, MD Anderson's vice president of health policy in Houston. "The large number of uninsured and the large low-income population creates a very difficult problem for us."

Community clinics are a key part of the reform plan and were supposed to take up some of the slack for hospitals. Clinics received $11 billion in new funding over five years so they could expand to help care for a swell of newly insured who might otherwise overwhelm doctors' offices. But in the first year, $600 million was cut from the centers' usual allocation, leaving many to use the money to fill gaps rather than expand.

There is concern that clinics could themselves be inundated with newly insured patients, forcing many illegal immigrants back to emergency rooms.

Limas, 44, moved to the border town of Alamo 13 years ago with her husband and three daughters. Now single, she supports the family by teaching a citizenship class in Spanish at the local community center and selling cookies and cakes she whips up in her trailer. Soon, she hopes to seek a work permit of her own.

For now, the clinic helps with basic health care needs. If necessary, Limas will return to the emergency room, where the attendants help her fill out paperwork to ensure the government covers the bills she cannot afford.

"They always attended to me," she said, "even though it's slow."

___

Sherman can be followed on Twitter at https://twitter.com/chrisshermanAP .

Plushnick-Masti can be followed on Twitter at https://twitter.com/RamitMastiAP .

Read More..

What Is a Right-to-Work Law?

This week Michigan became the 24th state in the country to adopt a right-to-work law. The passage of the bill by the state legislature, and eventual signing by Rick Snyder, the state's Republican governor, brought a huge wave of protests in a state with deep union roots.

Right-to-work laws have garnered a lot of national attention in recent years as more states have implemented this legislation that prohibits unions from requiring workers to pay dues as a condition of their employment. The laws are meant to regulate agreements between employers and labor unions that would prohibit the employer from hiring non-union workers.

The laws are particularly divisive--proponents argue that businesses will be more likely to set up shop in the state, while opponents argue that weakening union power will lead to lower wages. Because each state has a variety of factors that must be considered individually when assessing its overall economic standing, it's difficult to fully assess the validity of each side's argument, since you can't isolate the direct effect of these laws on the state's economy.

However, a study conducted in 2007 by Lonnie Stevans of Hofstra University suggested that both sides of the argument are, to some degree, accurate.

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"Findings are that the number of businesses and self-employed are greater on average in right-to-work states, but employment, wages, and per-capita personal income are all lower on average in right-to-work states," Stevans wrote.

But he noted that there was little "trickle down" from the business owners to the workers--the laws benefitted the business owners who did not have to contend with union contracts, but business employees didn't get those same positive effects--as evidenced by the lower salaries on average.

An analysis by ABC News of the most recent seasonally adjusted unemployment rates in states with right-to-work laws vs. those without such laws found that on average, the unemployment rate in states with right to work laws was slightly lower than those without. The average unemployment rate in the 24 states with right-to-work laws was 7 percent, while the average rate in the 26 states plus D.C. that do not have right-to-work laws was just under 7.6 percent--a difference of just under .6 percent.

The state with the lowest unemployment rate in the country--Nebraska at just 3.8 percent unemployment--has such a law in place, as does the state with the highest unemployment rate, Nevada at 11.5 percent.

Support for the laws has often tended to fall along party lines, with Democrats opposing and Republicans supporting. The vast majority of states with right-to-work laws are Republican led, the majority of states without are led by Democrats.

Below is the list of the 24 states with right-to-work laws.

Alabama

Arizona

Arkansas

Florida

Georgia

Idaho

Indiana

Iowa

Kansas

Louisiana

Michigan

Mississippi

Nebraska

Nevada

North Carolina

North Dakota

Oklahoma

South Carolina

South Dakota

Tennessee

Texas

Utah

Virginia

Wyoming

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For North Korea, next step is a nuclear test

SEOUL (Reuters) - North Korea's next step after rattling the world by putting a satellite into orbit for the first time will likely be a nuclear test, the third conducted by the reclusive and unpredictable state.

A nuclear test would be the logical follow-up to Wednesday's successful rocket launch, analysts said. The North's 2009 test came on May 25, a month after a rocket launch.

For the North and its absolute ruler Kim Jong-un, the costs of the rocket program and its allied nuclear weapons efforts - estimated by South Korea's government at $2.8-$3.2 billion since 1998 - and the risk of additional U.N. or unilateral sanctions are simply not part of the calculation.

"North Korea will insist any sanctions are unjust, and if sanctions get toughened, the likelihood of North Korea carrying out a nuclear test is high," said Baek Seung-joo of the Korea Institute of Defense Analyses.

The United Nations Security Council is to discuss how to respond to the launch, which it says is a breach of sanctions imposed in 2006 and 2009 that banned the isolated and impoverished state from missile and nuclear developments in the wake of its two nuclear weapons tests.

The only surprise is that the Security Council appears to believe it can dissuade Pyongyang, now on its third hereditary ruler since its foundation in 1948, from further nuclear or rocket tests.

Even China, the North's only major diplomatic backer, has limited clout on a state whose policy of self reliance is backed up by an ideology that states: "No matter how precious peace is, we will never beg for peace. Peace lies at the end of the barrel of our gun."

As recently as August, North Korea showed it was well aware of how a second rocket launch this year, after a failed attempt in April, would be received in Washington.

"It is true that both satellite carrier rocket and (a) missile with warhead use similar technology," its Foreign Ministry said in an eight-page statement carried by state news agency KCNA on August 31.

"The U.S. saw our satellite carrier rocket as a long-range missile that would one day reach the U.S. because it regards the DPRK (Democratic Peoples Republic of Korea) as an enemy."

CASH IN EXCHANGED FOR COLDER WAR

The end-game for the North is a formal peace treaty with Washington, diplomatic recognition and bundles of cash to help bolster its moribund economy.

"They might hope that the U.S. will finally face the unpleasant reality and will start negotiations aimed at slowing down or freezing, but not reversing, their nuclear and missile programs," said Andrei Lankov, a North Korea expert at Kookmin University in Seoul.

"If such a deal is possible, mere cognition is not enough. The U.S. will have to pay, will have to provide generous 'aid' as a reward for North Koreans' willingness to slow down or stop for a while."

Recent commercially available satellite imagery shows that North Korea has rebuilt an old road leading to its nuclear test site in the mountainous northeast of the country. It has also shoveled away snow and dirt from one of the entrances to the test tunnel as recently as November.

At the same time as developing its nuclear weapons test site, the North has pushed ahead with what it says is a civil nuclear program.

At the end of November, the International Atomic Energy Agency (IAEA) said the construction of a light water reactor was moving ahead and that North Korea had largely completed work on the exterior of the main buildings.

North Korea says it needs nuclear power to provide electricity, but has also boasted of its nuclear deterrence capability and has traded nuclear technology with Syria, Libya and probably Pakistan, according to U.S. intelligence reports.

It terms its nuclear weapons program a "treasured sword".

The missile and the nuclear tests both serve as a "shop window" for Pyongyang's technology and Kookmin's Lankov adds that the attractions for other states could rise if North Korea carries out a test using highly enriched uranium (HEU).

In its two nuclear tests so far, the North has used plutonium, of which it has limited stocks. However it sits on vast reserves of uranium minerals, which could give it a second path to a nuclear weapon.

"An HEU-based device will have a great political impact, since it will demonstrate that North Korean engineers know how to enrich uranium, and this knowledge is in high demand among aspiring nuclear states," Lankov said.

(Editing by Raju Gopalakrishnan)

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Nurse in royal hoax call case was found hanged: inquest

LONDON: A nurse duped by a prank call to the London hospital treating Prince William's pregnant wife Catherine was found hanging in her room, an inquest heard Thursday.

Jacintha Saldanha, 46, who was found in nurses' accommodation near King Edward VII's Hospital in central London on Friday, also left three notes before she died, a police officer told the hearing.

The mother-of-two also had injuries on one of her wrists.

Detective Chief Inspector James Harman told the inquest: "Jacintha Saldanha was found by a colleague and a member of security staff. Sadly she was found hanging. There was also injuries to her wrist.

"The London Ambulance Service was called to the scene.

"At this time there are no suspicious circumstances."

Two notes were found in her room and another was among her possessions, Harman told the inquest at Westminster Coroner's Court, without revealing their contents.

In England, inquests are held to examine sudden or unexplained deaths. They set out to determine the place and time of death as well as how the deceased came by their death. They do not apportion blame.

Australia's media watchdog on Thursday opened an investigation into the prank call.

The Australian Communications and Media Authority (ACMA) said its probe was into the broadcaster, 2Day FM, and not presenters Mel Greig and Michael Christian who have borne the brunt of worldwide anger.

Saldanha, a nurse originally from near Mangalore on the southwest Indian coast and a mother of two children, was found dead Friday.

Three days earlier she answered a prank call to the hospital made by two Australian radio presenters impersonating Queen Elizabeth II and her heir Prince Charles, William's father.

Saldanha put the call through to a nurse who divulged details of Kate's condition as she recovered from acute morning sickness.

- AFP/lp

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Venkaiah Naidu for privilege motion against Moily

NEW DELHI: Senior BJP leader M Venkaiah Naidu demanded bringing privilege motion against petroleum minister M Veerappa Moily for "misusing" his office by announcing government's intent to increase cap on subsidised LPG outside Parliament when the session was on.

Raising the issue in Rajya Sabha during Zero Hour on Thursday, Naidu said the policy decision was announced by Moily outside the House when Parliament was in session.

This is also violation of "code of conduct" as elections were going on in some parts of the country and the announcement could "influence" the voters, he said.

"This is misuse of the office," he said terming it as a matter of breach of privilege.

Naidu had raised the issue on Wednesday also. Moily had on Tuesday stated that the decision to raise the cap will be taken by the Cabinet "very shortly" and that he had two rounds of discussion with finance minister P Chidambaram on the impact of the decision.

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Dozens sue pharmacy, but compensation uncertain

NASHVILLE, Tenn. (AP) — Dennis O'Brien rubs his head as he details ailments triggered by the fungal meningitis he developed after a series of steroid shots in his neck: nausea, vomiting, dizziness, drowsiness, blurred vision, exhaustion and trouble with his speech and attention.

He estimates the disease has cost him and his wife thousands of dollars in out-of-pocket expenses and her lost wages, including time spent on 6-hour round trip weekly visits to the hospital. They've filed a lawsuit seeking $4 million in damages from the Massachusetts pharmacy that supplied the steroid injections, but it could take years for them to get any money back and they may never get enough to cover their expenses. The same is true for dozens of others who have sued the New England Compounding Center.

"I don't have a life anymore. My life is a meningitis life," the 59-year-old former school teacher said, adding that he's grateful he survived.

His is one of at least 50 federal lawsuits in nine states that have been filed against NECC, and more are being filed in state courts every day. More than 500 people have gotten sick after receiving injections prepared by the pharmacy.

The lawsuits allege that NECC negligently produced a defective and dangerous product and seek millions to repay families for the death of spouses, physically painful recoveries, lost wages and mental and emotional suffering. Thirty-seven people have died in the outbreak.

"The truth is the chance of recovering damages from NECC is extremely low," said John Day, a Nashville attorney who represents several patients who have been sickened by fungal meningitis.

To streamline the process, attorneys on both sides are asking to have a single judge preside over the pretrial and discovery phases for all of the federal lawsuits.

This approach, called multidistrict litigation, would prevent inconsistent pretrial rulings and conserve resources of all parties. But unlike a class-action case, those lawsuits would eventually be returned to judges in their original district for trial, according to Brian Fitzpatrick, a law professor at Vanderbilt University Law School in Nashville.

Even with this approach, Fitzpatrick noted that federal litigation is very slow, and gathering all the evidence, records and depositions during the discovery phase could take months or years.

"Most of the time what happens is once they are consolidated for pretrial proceedings, there is a settlement, a global settlement between all the lawyers and the defendants before anything is shipped back for trial," he said.

A lawyer representing NECC, Frederick H. Fern, described the consolidation process as an important step.

"A Boston venue is probably the best scenario," Fern said in an email. "That's where the parties, witnesses and documents are located, and where the acts subject to these complaints occurred."

Complicating efforts to recover damages, attorneys for the patients said, NECC is a small private company that has now recalled all its products and laid off its workers. The company's pharmacy licenses have been surrendered, and it's unclear whether NECC had adequate liability insurance.

Fern said NECC has insurance, but they were still determining what the policy covers.

But Day says, "It's clear to me that at the end of the day, NECC is not going to have sufficient assets to compensate any of these people, not even 1 percent."

As a result, many attorneys are seeking compensation from other parties. Among the additional defendants named in lawsuits are NECC pharmacist and co-founder Barry Cadden; co-founder Greg Conigliaro; sister company Ameridose and its marketing and support arm, Medical Sales Management.

Founded in 2006 by Cadden and Conigliaro, Ameridose would eventually report annual revenue of $100 million. An NECC spokesman didn't respond to a request for the pharmacy's revenue.

While Federal Drug Administration regulators have also found contamination issues at Westborough, Mass.-based Ameridose, the FDA has said it has not connected Ameridose drugs to infection or illness.

Under tort law, a lawsuit has to prove a defendant has a potential liability, which in this case could be anyone involved in the medical procedure. However, any such suit could take years and ultimately may not be successful.

"I would not be surprised if doctors, hospitals, people that actually injected the drugs, the people that bought the drugs from the compounding company, many of those people will also be sued," said Fitzpatrick.

Plaintiffs' attorneys said they're considering that option but want more information on the relationships between the compounding pharmacy and the hundreds of hospitals and clinics that received its products.

Day, the attorney in Tennessee, said the clinics and doctors that purchase their drugs from compounding pharmacies or manufacturers could be held liable for negligence because they are in a better position to determine the safety of the medicine than the patients.

"Did they use due care in determining from whom to buy these drugs?" Day said.

Terry Dawes, a Michigan attorney who has filed at least 10 federal lawsuits in the case, said in traditional product liability cases, a pharmaceutical distributor could be liable.

"We are looking at any conceivable sources of recovery for our clients including pharmaceutical supply places that may have dealt with this company in the past," he said.

Ten years ago, seven fungal meningitis illnesses and deaths were linked to injectable steroid from a South Carolina compounding pharmacy. That resulted in fewer than a dozen lawsuits, a scale much smaller than the litigations mounting up against NECC.

Two companies that insured the South Carolina pharmacy and its operators tried unsuccessfully to deny payouts. An appellate court ruled against their argument that the pharmacy willfully violated state regulations by making multiple vials of the drug without specific prescriptions, but the opinion was unpublished and doesn't set a precedent for the current litigation.

The lawsuits represent a way for patients and their families recover expenses, but also to hold the pharmacy and others accountable for the incalculable emotional and physical toll of the disease.

A binder of snapshots shows what life is like in the O'Briens' rural Fentress County, Tenn., home: Dennis hooked up to an IV, Dennis in an antibiotics stupor, bruises on his body from injections and blood tests. He's had three spinal taps. His 11-day stay in the hospital cost over $100,000, which was covered by health insurance.

His wife said she sometimes quietly checks at night to see whether her husband of 35 years is still breathing.

"In my mind, I thought we were going to fight this and get over it. But we are not ever going to get over it," said Kaye O'Brien.

Marjorie Norwood, a 59-year-old grandmother of three who lives in Ethridge, Tenn., has spent just shy of two months total in the hospital in Nashville battling fungal meningitis after receiving a steroid injection in her back. She was allowed to come home for almost a week around Thanksgiving, but was readmitted after her symptoms worsened.

Family members are still dealing with much uncertainty about her recovery, but they have not filed a lawsuit, said their attorney Mark Chalos. He said Norwood will likely be sent to a rehabilitation facility after her second stay in the hospital rather than return home again.

Marjorie Norwood's husband, an autoworker, has taken time off work to care for her and they depend on his income and insurance.

"It doesn't just change her life, it changes everyone else's life around her because we care about her and want her to be happy and well and have everything that she needs," said her daughter, Melanie Norwood.

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