Medicare paid $5.1B for poor nursing home care


SAN FRANCISCO (AP) — Medicare paid billions in taxpayer dollars to nursing homes nationwide that were not meeting basic requirements to look after their residents, government investigators have found.


The report, released Thursday by the Department of Health and Human Services' inspector general, said Medicare paid about $5.1 billion for patients to stay in skilled nursing facilities that failed to meet federal quality of care rules in 2009, in some cases resulting in dangerous and neglectful conditions.


One out of every three times patients wound up in nursing homes that year, they landed in facilities that failed to follow basic care requirements laid out by the federal agency that administers Medicare, investigators estimated.


By law, nursing homes need to write up care plans specially tailored for each resident, so doctors, nurses, therapists and all other caregivers are on the same page about how to help residents reach the highest possible levels of physical, mental and psychological well-being.


Not only are residents often going without the crucial help they need, but the government could be spending taxpayer money on facilities that could endanger people's health, the report concluded. The findings come as concerns about health care quality and cost are garnering heightened attention as the Obama administration implements the nation's sweeping health care overhaul.


"These findings raise concerns about what Medicare is paying for," the report said.


Investigators estimate that in one out of five stays, patients' health problems weren't addressed in the care plans, falling far short of government directives. For example, one home made no plans to monitor a patient's use of two anti-psychotic drugs and one depression medication, even though the drugs could have serious side effects.


In other cases, residents got therapy they didn't need, which the report said was in the nursing homes' financial interest because they would be reimbursed at a higher rate by Medicare.


In one example, a patient kept getting physical and occupational therapy even though the care plan said all the health goals had been met, the report said.


The Office of Inspector General's report was based on medical records from 190 patient visits to nursing homes in 42 states that lasted at least three weeks, which investigators said gave them a statistically valid sample of Medicare beneficiaries' experiences in skilled nursing facilities.


That sample represents about 1.1 million patient visits to nursing homes nationwide in 2009, the most recent year for which data was available, according to the review.


Overall, the review raises questions about whether the system is allowing homes to get paid for poor quality services that may be harming residents, investigators said, and recommended that the Centers for Medicare & Medicaid Services tie payments to homes' abilities to meet basic care requirements. The report also recommended that the agency strengthen its regulations and ramp up its oversight. The review did not name individual homes, nor did it estimate the number of patients who had been mistreated, but instead looked at the overall number of stays in which problems arose.


In response, the agency agreed that it should consider tying Medicare reimbursements to homes' provision of good care. CMS also said in written comments that it is reviewing its own regulations to improve enforcement at the homes.


"Medicare has made significant changes to the way we pay providers thanks to the health care law, to reward better quality care," Medicare spokesman Brian Cook said in a statement to AP. "We are taking steps to make sure these facilities have the resources to improve the quality of their care, and make sure Medicare is paying for the quality of care that beneficiaries are entitled to."


CMS hires state-level agencies to survey the homes and make sure they are complying with federal law, and can require correction plans, deny payment or end a contract with a home if major deficiencies come to light. The agency also said it would follow up on potential enforcement at the homes featured in the report.


Greg Crist, a Washington-based spokeswoman for the American Health Care Association, which represents the largest share of skilled nursing facilities nationwide, said overall nursing home operators are well regulated and follow federal guidelines but added that he could not fully comment on the report's conclusions without having had the chance to read it.


"Our members begin every treatment with the individual's personal health needs at the forefront. This is a hands-on process, involving doctors and even family members in an effort to enhance the health outcome of the patient," Crist said.


Virginia Fichera, who has relatives in two nursing homes in New York, said she would welcome a greater push for accountability at skilled nursing facilities.


"Once you're in a nursing home, if things don't go right, you're really a prisoner," said Fichera, a retired professor in Sterling, NY. "As a concerned relative, you just want to know the care is good, and if there are problems, why they are happening and when they'll be fixed."


Once residents are ready to go back home or transfer to another facility, federal law also requires that the homes write special plans to make sure patients are safely discharged.


Investigators found the homes didn't always do what was needed to ensure a smooth transition.


In nearly one-third of cases, facilities also did not provide enough information when the patient moved to another setting, the report found.


___


On the Web:


The OIG report: http://1.usa.gov/VaztQm


The Medicare nursing home database: http://www.medicare.gov/NursingHomeCompare/search.aspx?bhcp=1&AspxAutoDetectCookieSupport=1


___


Follow Garance Burke on Twitter at —http://twitter.com/garanceburke.


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Arias Prosecutor Too Combative, Experts Say












He has barked, yelled, been sarcastic and demanded answers from accused murderer Jodi Arias this week.


And in doing so, prosecutor Juan Martinez and his aggressive antics may be turning off the jury he is hoping to convince that Arias killed her ex-boyfriend Travis Alexander in June 2008, experts told ABCNews.com today.


"Martinez is his own worst enemy," Mel McDonald, a prominent Phoenix defense attorney and former judge, told ABC News. "He takes it to the point where it's ad nauseam. You have difficulty recognizing when he's driving the point home because he's always angry and pushy and pacing around the courtroom. He loses the effectiveness, rather than build it up."


"He's like a rabid dog and believes you've got to go to everybody's throat," he said.


"If they convict her and give her death, they do it in spite of Juan, not because of him," McDonald added.


Martinez's needling style was on display again today as he pestered Arias to admit that she willingly participated in kinky sex with Alexander, though she previously testified that she only succumbed to his erotic fantasies to please him.


Arias, now 32, and Alexander, who was 27 at the time of his death, dated for a year and continued to sleep together for another year following their break-up.


Arias drove to his house in Mesa, Ariz., in June 2008, had sex with him, they took nude photos together and she killed him in his shower. She claims it was in self-defense. If convicted, Arias could face the death penalty.








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Martinez also attempted to point out inconsistencies in her story of the killing, bickering with her over details about her journey from Yreka, Calif., to Mesa, Ariz., including why she borrowed gas cans from an ex-boyfriend, when she allegedly took naps and got lost while driving, and why she spontaneously decided to visit Alexander at his home in Mesa for a sexual liaison.


"I want to know what you're talking about," Arias said to Martinez at one point.


"No, I'm asking you," he yelled.


Later, he bellowed, "Am I asking you if you're telling the truth?"


"I don't know," Arias said, firing back at him. "Are you?"


During three days of cross examining Arias this week, Martinez has spent hours going back and forth with the defendant over word choice, her memory, and her answers to his questions.


"Everyone who takes witness stand for defense is an enemy," McDonald said. "He prides himself on being able to work by rarely referring to his notes, but what he's giving up in that is that there's so much time he wastes on stupid comments. A lot of what I've heard is utterly objectionable."


Martinez's behavior has spurred frequent objections of "witness badgering" from Arias' attorney Kirk Nurmi, who at one point Tuesday stood up in court and appealed to the judge to have a conference with all of the attorneys before questioning continued. Judge Sherry Stephens at one point admonished Martinez and Arias for speaking over one another.


Andy Hill, a former spokesperson for the Phoenix police department, and Steven Pitt, a forensic psychiatrist who has testified as an expert witness at many trials in the Phoenix area, both said that despite his aggressive style, Martinez would likely succeed in obtaining a guilty verdict.


"When it comes to cross examination, one size does not fit all," said Pitt. "But if you set aside the incessant sparring, what the prosecutor I believe is effectively doing is pointing out the various inconsistencies in the defendant's version of events."






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Australian cyclone crossing Western Australian coast






SYDNEY: A tropical cyclone hit Australia's resource-rich northwest coast Wednesday, bringing winds of up to 165 kilometres (102 miles) an hour as it crossed the shore near the tiny community of Pardoo.

Severe tropical cyclone Rusty had been sitting offshore for several days, slowly intensifying as it edged towards the Pilbara coast and bringing heavy rain and gale-force winds to the iron ore region.

"It is in the process of crossing," Neil Bennett from Australia's Bureau of Meteorology told AFP just after 0700 GMT, adding it was too soon to say whether it had caused any damage.

"Wind gusts in excess of 165 kilometres an hour are in that area."

Bennett said the storm had been downgraded from a category 4 storm, just one notch short of the top category, to a category 3.

The bureau had expected Rusty to make landfall close to Port Hedland, 1,300 kilometres (800 miles) north of Perth, but Bennett said the major iron ore port appeared to have escaped the full brunt of the storm.

"It looks as if Hedland has dodged the bullet, so to speak, because the worst of the winds are away from Hedland," he said.

"Hedland though has been experiencing a constant period of gale-force winds for over 36 hours now. And that's unprecedented (for that area)."

While the storm has been downgraded, its eye has also contracted from being about 80 kilometres wide on Tuesday to about 50 kilometres by the time it crossed land.

Authorities had warned residents to move out of the storm's path or seek shelter. Resident Ian Badger said he was seeking refuge at the Pardoo Roadhouse, about 120 kilometres from Port Hedland.

"It's just a matter of hanging on," he told the Australian Broadcasting Corporation.

"The amount of water that's around is a bit worrying. The ground is very sodden, very soft. As soon as you get a get a bit of strong wind, trees start going over."

The weather bureau expects the cyclone to move slowly in a south-southeasterly direction, gradually downgrading to a category 1 storm by Thursday afternoon and a tropical low the following day.

Australia's major iron ore export ports have been shut for several days anticipating Rusty's approach. Hundreds of people have been forced to evacuate their homes in the sparsely populated but cyclone-prone area.

Global iron ore giants including BHP Billiton, Rio Tinto and Fortescue Metals Group have all shut down or scaled back operations due to the storm.

-AFP/fl



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Ruckus in Rajya Sabha over alleged tapping of Arun Jaitley's phone

NEW DELHI: The issue of the alleged tapping of the phone of Rajya Sabha leader of opposition Arun Jaitley created a ruckus in the upper House on Wednesday morning.

Rajya Sabha chairman M Hamid Ansari was forced to adjourn the House briefly.

As soon as the House met for the day, Samajwadi Party leader Naresh Agarwal stood up and raised the issue.

"It is a matter of concern that the leader of opposition's phone is being tapped, we need an answer from the home minister," Agarwal said.

He was joined by members of the Bharatiya Janata Party (BJP), Bahujan Samaj Party (BSP), Janata Dal (United) and AIADMK.

Ravishankar Prasad of BJP, Satish Chandra Misra of BSP, AIADMK's V Maitreyan, and Shivanand Tiwari of JD(U) were among those who stood up demanding a clarification from the government on the issue.

Minister of state for parliamentary affairs Rajiv Shukla then assured them that the home minister would inform the house on the issue. The agitated members, however, were not pacified by this and sought a timeframe for the government's response.

Members sought to know if the government was involved in the phone tapping, to which Shukla responded: "The government does not do such things."

This led to uproar from the opposition benches which forced the chairman to order a brief adjournment.

When the House reassembled after the five-minute adjournment, home minister Sushilkumar Shinde said he would collect information on the matter and place it before the House soon.

"Government is bound to make a statement on this," Shinde said.

With that, the proceedings of the House continued smoothly and question hour was taken up.

The Delhi Police has arrested Anurag Singh, a doctor-turned-private detective, who runs V-Detect Private Detective Agency in New Delhi. He is believed to be the brain behind the move to acquire Jaitley's phone call details.

Anurag Singh is also one of the main accused in the tapping of the phone of former Samajwadi Party leader Amar Singh.

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Inside Organized Retail Crime Raids












We used to call it shoplifting, but these days the foot soldiers of retail crime rings are known as boosters. Police even have an acronym for these operations: ORC, which stands for Organized Retail Crime.


"It's just like a Fortune 500 company," said Sergeant Eric Lee of the Gardena Police Department in Gardena, Calif. "All of this is just organized."


Watch the full story on "Nightline" TONIGHT at 12:35 a.m. ET


Police say big retail stores, from Walgreens to J.C. Penny, are getting hit by highly sophisticated shoplifting networks that steal and resell everything from underwear to razors to milk. According to the National Retail Federation, theft can amount to annual losses as high as a $37 billion for retail businesses.


"Every store in every city has to go through this," Lee said. "They wait until no one's paying attention and they walk out."


Tide detergent is currently a hot target because it is compact, expensive and easy to sell on the streets for profit, police said. The Street name: "liquid gold."


"Sometimes we get rings that just do alcohol," Lee said. "And then we get some that do just meat and seafood."


Investigators say boosters move the loot for cents on the dollar to fencing operations -- the black market resellers of the stolen goods -- which sell the stolen merchandise in plain sight in stores. Boosters, fencers, Mr. Bigs, all of those involved in these shoplifting operations can potentially make millions a year from boosting and re-selling stolen goods.








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And Mike Swett is on the case. A former Riverside County sheriff's deputy in Los Angeles, Swett was badly injured in a car wreck and now works as a full-time private investigator on the ORC beat who has worked with Target, Marshalls, T.J. Maxx. Stores hire him to do his own undercover police work, catching thieves before involving local law enforcement.


"Kind of like working a narcotics case, it's like you've got low-level, mid-level and then top dog," Swett said. "We like to go after the top dog and the only way to get to the top dog is mid-level first."


At his command center -- his apartment -- Swett showed off the boxes upon boxes of tapes and photographs he has collected, the fruits of countless silent stake-out hours.


Swett said he has been casing two joints in L.A. for months, both alleged to be mid-level fencing operations. "Nightline" was invited to ride along with him when he sent undercover agents in for a final reconnaissance mission.


At some stores and shopping malls, clerks do little to stop shoplifters and often let them run, which has contributed to the growing fencing operations.


"[The stores] don't want their employees to get injured," Swett said. "So oftentimes they will call the police, but by the time we get there they are already in their car and they are gone."


This leaves professional investigators like Swett to put the pieces together and bust open the gangs to lead over-stretched police departments to the prey.


When raid day arrived, a motorcade of squad cars departed from the Gardena, Calif., police department and pulled up to one fencing operation. Swett said the merchandise being sold was boosted goods.


"There is Victoria's Secret, expensive Victoria's Secret, the gift sets," he said, pointing down a line of tables. "J.C. Penny, Miramax, its real stuff not counterfeit."


He spotted a bottle of Katy Perry brand perfume, which usually retails for around $90 but one seller had it priced at $59.






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Italy faces stalemate after election shock


ROME (Reuters) - Italy faced political deadlock on Tuesday after a stunning election that saw the anti-establishment 5-Star Movement of comic Beppe Grillo become the strongest party in the country but left no group with a clear majority in parliament.


"The winner is: Ingovernability" was the headline in Rome newspaper Il Messaggero, reflecting the stalemate the country would have to confront in the next few weeks as sworn enemies would be forced to work together to form a government.


The center-left coalition led by Pier Luigi Bersani won the lower house by around 125,000 votes, where it will have a majority because of a premium given to the largest party or coalition.


Results in the upper house Senate indicated the center-left would end up with about 119 seats, compared with 117 for the center-right. Seats are awarded on a region-by-region basis in the Senate, where a majority of 158 is needed to govern.


Any coalition must have a working majority in both houses in order to pass legislation.


Bersani claimed victory but said it was obvious that Italy was in "a very delicate situation".


Neither Grillo, a comedian-turned-politician who previously ruled out any alliance with another party, nor Silvio Berlusconi's center-right bloc, which threatened to challenge the close tally, showed any immediate willingness to negotiate.


Commentators said all of Grillo's adversaries had underestimated the appeal of a grassroots movement that called itself a "non-party", particularly its allure among young Italians who find themselves without jobs and the prospect of a decent future.


The 5-star Movement's score of 25.5 percent in the lower house was just ahead of the 25.4 percent for Bersani's Democratic Party, which ran in a coalition with the leftist SEL party, and it won almost 8.7 million votes overall - more than any other single party.


FRUSTRATED GENERATION


"The 'non-party' has become the largest party in the country," said Massimo Giannini, commentator for the Rome newspaper La Repubblica.


World financial markets reacted nervously to the prospect of a government stalemate in the euro zone's third-largest economy with memories still fresh of the financial crisis that took the 17-member currency bloc to the brink of collapse in 2011.


The euro skidded to an almost seven-week low against the dollar in Asia on fears about the euro zone's debt crisis. It fell as far as $1.3042, its lowest since January 10.


A first indication of investors' reaction to the results will come later on Tuesday when the Treasury auctions 8.75 billion euros in 6-month bonds.


Italy's borrowing costs have come down in recent months, helped by the promise of European Central Bank support but the election result confirmed fears of many European countries that it would not produce a government strong enough to implement effective reforms.


Grillo's surge in the final weeks of the campaign threw the race open, with hundreds of thousands turning up at his rallies to hear him lay into targets ranging from corrupt politicians and bankers to German Chancellor Angela Merkel.


In just three years, his 5-Star Movement, heavily backed by a frustrated generation of young Italians increasingly shut out from permanent full-time jobs, has grown from a marginal group to one of the most talked about political forces in Europe.


"The 5-Star Movement is the real winner of the election," said SEL leader Nichi Vendola, who said that his coalition would have to deal with Grillo, who mixes fierce attacks on corruption with policies ranging from clean energy to free Internet.


RECESSION


"It's a classic result. Typically Italian," said Roberta Federica, a 36-year-old office worker in Rome. "It means the country is not united. It is an expression of a country that does not work. I knew this would happen."


A long recession and growing disillusionment with mainstream parties fed a bitter public mood that saw more than half of Italian voters back parties that rejected the austerity policies pursued by Prime Minister Mario Monti with the backing of Italy's European partners.


Monti suffered a major setback. His centrist grouping won only 10.6 percent and two of his key centrist allies, Pier Ferdinando Casini and lower house speaker Gianfranco Fini, both of parliamentarians for decades, were booted out.


"It's not that surprising if you consider how much delusion there was with politics in its traditional forms," Monti said.


Berlusconi's campaign, mixing sweeping tax cut pledges with relentless attacks on Monti and Merkel, echoed many of the themes pushed by Grillo and underlined the increasingly angry mood of the Italian electorate.


Stefano Zamagni, an economics professor at Bologna University said the result showed that a significant share of Italians "are fed up with following the austerity line of Germany and its northern allies".


"These people voted to stick one up to Merkel and austerity," he said.


Even if the next government turns away from the tax hikes and spending cuts brought in by Monti, it will struggle to revive an economy that has scarcely grown in two decades.


Monti was widely credited with tightening Italy's public finances and restoring its international credibility after the scandal-plagued Berlusconi, whom he replaced as the 2011 financial crisis threatened to spin out of control.


But he struggled to pass the kind of structural reforms needed to improve competitiveness and lay the foundations for a return to economic growth, and a weak center-left government may not find it any easier.


(Writing by Philip Pullella; Additional reporting by Barry Moody, Gavin Jones, Catherine Hornby and Naomi O'Leary; Editing by Pravin Char)



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Asian markets mostly slip on Italy uncertainty






HONG KONG: Asian markets mostly fell on Tuesday, with dealers spooked by an election in Italy that left no clear winner, leading to political uncertainty and fresh fears about eurozone stability.

The dollar and euro extended the losses suffered in US trade as investors absorbed the Italian results, while there was also concern about the lack of progress in Washington to avoid spending cuts due to take effect on Friday.

Tokyo tumbled 2.26 percent, or 263.71 points, to 11,398.81, with profit-takers also moving in after the index enjoyed a big surge on Monday.

Sydney shed 1.03 percent, or 52.2 points, to 5,003.6, and Seoul lost 0.47 percent, or 9.51 points, to close at 2,000.01.

Shanghai tumbled 1.40 percent, or 32.48 points, to 2,293.34, while Hong Kong fell 1.32 percent, or 300.39 points, to 22,519.69.

Italy Tuesday looked headed for political deadlock as results from Sunday's election indicated there would be no clear winner, while the biggest gainer was a protest party run by a popular comedian.

The polls show that while the leftists won the lower house, the party run by former prime minister Silvio Berlusconi had more seats in the upper house.

Investors fear the outcome will lead to political stalemate in the country and a possible return to the dark days of the region's financial crisis if austerity measures introduced to cut Rome's huge debt pile are reversed.

The developments in Italy sent a shiver through forex markets in New York, with the euro tumbling to $1.3065 and 120.12 yen.

In Asia, the single currency sat at $1.3045 and 119.70 yen, well down from the $1.3197 and 124.24 yen in Tokyo on Monday.

The dollar fetched 91.76 yen against 91.92 yen in New York, far off the 94.77 yen high seen Monday in Asia.

The split vote in Italy wiped out the yen's Monday losses that were fuelled by reports Japan's government is likely to nominate a man to run the central bank who is in favour of more aggressive monetary easing.

On Wall Street, the Dow tumbled 1.55 percent in its biggest single-day drop since November, while the S&P 500 dived 1.83 percent and the Nasdaq sank 1.44 percent.

Traders are also keeping an eye on US lawmakers to see if they can muster an agreement to avoid the imposition of $85 billion in budget cuts -- known as the sequester -- that will come in on Friday.

Analysts have warned that if less drastic cuts are not agreed, the still-fragile economy could slip back into recession.

Oil prices fell, with New York's main contract, light sweet crude for delivery in April, dropping 85 cents to $92.26 a barrel in the afternoon and Brent North Sea crude for delivery in April shedding 85 cents to $113.59.

Gold was at $1,593.60 at 0805 GMT compared with $1,593.30 late Monday.

In other markets:

-- Taipei fell 0.84 percent, or 66.78 points, to 7,880.9.

Taiwan Semiconductor Manufacturing Co shed 1.43 percent to NT$103.5 while leading smartphone maker HTC was 0.36 percent higher at NT$276.5.

-- Manila closed 1.35 percent lower, giving up 90.66 points to 6,630.67.

SM Investments shed 1.37 percent to 1,010 pesos and Ayala Corp. fell 1.02 percent to 584 pesos, while SM Prime Holdings slid 1.60 percent to 18.50 pesos.

-- Wellington closed 0.30 percent, or 12.47 points, higher at 4,238.92.

Telecom rose 1.1 percent to NZ$2.32, Sky City added 0.5 percent to NZ$4.10 and Air New Zealand was up 4.7 percent at NZ$1.33.

- AFP/xq



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Koop, who transformed surgeon general post, dies


With his striking beard and starched uniform, former Surgeon General Dr. C. Everett Koop became one of the most recognizable figures of the Reagan era — and one of the most unexpectedly enduring.


His nomination in 1981 met a wall of opposition from women's groups and liberal politicians, who complained President Ronald Reagan selected Koop, a pediatric surgeon and evangelical Christian from Philadelphia, only because of his conservative views, especially his staunch opposition to abortion.


Soon, though, he was a hero to AIDS activists, who chanted "Koop, Koop" at his appearances but booed other officials. And when he left his post in 1989, he left behind a landscape where AIDS was a top research and educational priority, smoking was considered a public health hazard, and access to abortion remained largely intact.


Koop, who turned his once-obscure post into a bully pulpit for seven years during the Reagan and George H.W. Bush administrations and who surprised both ends of the political spectrum by setting aside his conservative personal views on issues such as homosexuality and abortion to keep his focus sharply medical, died Monday at his home in Hanover, N.H. He was 96.


An assistant at Koop's Dartmouth College institute, Susan Wills, confirmed his death but didn't disclose its cause.


Dr. Richard Carmona, who served as surgeon general a decade ago under President George W. Bush, said Koop was a mentor to him and preached the importance of staying true to the science even if it made politicians uncomfortable.


"He set the bar high for all who followed in his footsteps," Carmona said.


Although the surgeon general has no real authority to set government policy, Koop described himself as "the health conscience of the country" and said modestly just before leaving his post that "my only influence was through moral suasion."


A former pipe smoker, Koop carried out a crusade to end smoking in the United States; his goal had been to do so by 2000. He said cigarettes were as addictive as heroin and cocaine. And he shocked his conservative supporters when he endorsed condoms and sex education to stop the spread of AIDS.


Chris Collins, a vice president of amFAR, the Foundation for AIDS Research, said many people don't realize what an important role Koop played in the beginning of the AIDS epidemic.


"At the time, he really changed the national conversation, and he showed real courage in pursuing the duties of his job," Collins said.


Even after leaving office, Koop continued to promote public health causes, from preventing childhood accidents to better training for doctors.


"I will use the written word, the spoken word and whatever I can in the electronic media to deliver health messages to this country as long as people will listen," he promised.


In 1996, he rapped Republican presidential hopeful Bob Dole for suggesting that tobacco was not invariably addictive, saying Dole's comments "either exposed his abysmal lack of knowledge of nicotine addiction or his blind support of the tobacco industry."


Although Koop eventually won wide respect with his blend of old-fashioned values, pragmatism and empathy, his nomination met staunch opposition.


Foes noted that Koop traveled the country in 1979 and 1980 giving speeches that predicted a progression "from liberalized abortion to infanticide to passive euthanasia to active euthanasia, indeed to the very beginnings of the political climate that led to Auschwitz, Dachau and Belsen."


But Koop, a devout Presbyterian, was confirmed after he told a Senate panel he would not use the surgeon general's post to promote his religious ideology. He kept his word.


In 1986, he issued a frank report on AIDS, urging the use of condoms for "safe sex" and advocating sex education as early as third grade.


He also maneuvered around uncooperative Reagan administration officials in 1988 to send an educational AIDS pamphlet to more than 100 million U.S. households, the largest public health mailing ever.


Koop personally opposed homosexuality and believed sex should be saved for marriage. But he insisted that Americans, especially young people, must not die because they were deprived of explicit information about how HIV was transmitted.


Koop further angered conservatives by refusing to issue a report requested by the Reagan White House, saying he could not find enough scientific evidence to determine whether abortion has harmful psychological effects on women.


Koop maintained his personal opposition to abortion, however. After he left office, he told medical students it violated their Hippocratic oath. In 2009, he wrote to Senate Majority Leader Harry Reid, urging that health care legislation include a provision to ensure doctors and medical students would not be forced to perform abortions. The letter briefly set off a security scare because it was hand delivered.


Koop served as chairman of the National Safe Kids Campaign and as an adviser to President Bill Clinton's health care reform plan.


At a congressional hearing in 2007, Koop spoke about political pressure on the surgeon general post. He said Reagan was pressed to fire him every day, but Reagan would not interfere.


Koop, worried that medicine had lost old-fashioned caring and personal relationships between doctors and patients, opened his institute at Dartmouth to teach medical students basic values and ethics. He also was a part-owner of a short-lived venture, drkoop.com, to provide consumer health care information via the Internet.


Koop was born in the New York City borough of Brooklyn, the only son of a Manhattan banker and the nephew of a doctor. He said by age 5 he knew he wanted to be a surgeon and at age 13 he practiced his skills on neighborhood cats.


He attended Dartmouth, where he received the nickname Chick, short for "chicken Koop." It stuck for life.


Koop received his medical degree at Cornell Medical College, choosing pediatric surgery because so few surgeons practiced it.


In 1938, he married Elizabeth Flanagan, the daughter of a Connecticut doctor. They had four children, one of whom died in a mountain climbing accident when he was 20.


Koop was appointed surgeon-in-chief at Children's Hospital in Philadelphia and served as a professor at the University of Pennsylvania School of Medicine.


He pioneered surgery on newborns and successfully separated three sets of conjoined twins. He won national acclaim by reconstructing the chest of a baby born with the heart outside the body.


Although raised as a Baptist, he was drawn to a Presbyterian church near the hospital, where he developed an abiding faith. He began praying at the bedside of his young patients — ignoring the snickers of some of his colleagues.


Koop's wife died in 2007, and he married Cora Hogue in 2010.


He was by far the best-known surgeon general and for decades afterward was still a recognized personality.


"I was walking down the street with him one time" about five years ago, recalled Dr. George Wohlreich, director of the College of Physicians of Philadelphia, a medical society with which Koop had longstanding ties. "People were yelling out, 'There goes Dr. Koop!' You'd have thought he was a rock star."


___


Ring reported from Montpelier, Vt. Cass reported from Washington. AP Medical Writers Lauran Neergaard in Washington and Mike Stobbe in New York contributed to this report.


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Americans Targeted for Allegedly Running Underage Prostitution in Philippines












Arthur Benjamin is sitting at the edge of a small stage, wearing a lavender Hawaiian shirt and nursing a bottle of San Miguel Light beer. The 6-foot-6 mustachioed Texan lazily watches the half dozen or so girls dancing rather unenergetically around the stage's pole.


"I forgot your gift again, it's in the car," Benjamin says to one of the girls on stage, shouting above the pop music blaring from the speaker system.


The small, dingy bar, which Benjamin says he owns, is called Crow Bar. It's in a rundown part of the picturesque Subic Bay in the western Philippines, about a three hour drive from the capital, Manila. Home for 50 years to a United States naval base, Subic Bay has become synonymous with foreigners looking for sex in the long string of bars that line the main road along the coast.


Watch the full story on "Nightline" TONIGHT at 12:35 a.m. ET


The bars in this area are often packed with older foreign men ogling the young Filipina women available for the night for a "bar fine" of around 1,500 Filipino pesos, or just over $35. Many of the bars are owned and operated by Americans, often former military servicemen who either served on the base or whose ships docked here until the base was shuttered under political pressure in 1992.








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Most of the prostitutes working in the bars are indeed 18 or older. But in the Philippines, just a small scratch to the surface can reveal a layer of young, underage girls who have mostly come from impoverished rural provinces to sell their bodies to help support their families.


Benjamin, 49, is, according to his own statements, one of the countless foreigners who has moved beyond just having sex with underage girls to owning and operating a bar where girls in scantily-clad outfits flaunt their bodies for patrons.


"My wife recently found out that I have this place," he tells an ABC News "Nightline" team, unaware they are journalists and recording the conversation on tiny hidden cameras disguised as shirt buttons.


Benjamin said that a "disgruntled waitress" had written his wife on Facebook, detailing his activities in Subic Bay.


"She sent her this thing saying that I have underage girls who stayed with me, that I [have anal sex with them], I own a bar, I've got other girls that I'm putting through high school, all this other crap," he said.


"All of which is true," he laughed. "However, I have to deny."


He sends a text message summoning his current girlfriend, a petite dark-skinned girl called Jade, who he said is just 16 years old. Benjamin says he bought the bar for her about a year ago and while most still call it Crow Bar, he officially re-named it with her last name.


"She needed a place to stay, I needed a place to do her. I bought a bar for her," he says, explaining that she lives in a house out back by the beach.


"You're not going to find anything like this in the States, not as a guy my age," he said as he looked down at Jade. "Ain't going to happen."


Benjamin is the latest target of Father Shay Cullen, a Catholic priest with a thick Irish brogue and fluency in the local language, Tagalog. Through his non-profit center called Preda, he's been crusading against underage sex trafficking in the Philippines for 40 years.




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Cuban leader Raul Castro says he will retire in 2018


HAVANA (Reuters) - Cuban President Raul Castro announced on Sunday he will step down from power after his second term ends in 2018, and the new parliament named a 52-year-old rising star to become his first vice president and most visible successor.


"This will be my last term," Castro, 81, said shortly after the National Assembly elected him to a second five-year tenure.


In a surprise move, the new parliament also named Miguel Diaz-Canel as first vice president, meaning he would take over if Castro cannot serve his full term.


Diaz-Canel is a member of the political bureau who rose through the Communist Party ranks in the provinces to become the most visible possible successor to Castro.


Raul Castro starts his second term immediately, leaving him free to retire in 2018, aged 86.


Former President Fidel Castro joined the National Assembly meeting on Sunday, in a rare public appearance. Since falling ill in 2006 and ceding the presidency to his brother, the elder Castro, 86, has given up official positions except as a deputy in the National Assembly.


The new government will almost certainly be the last headed up by the Castro brothers and their generation of leaders who have ruled Cuba since they swept down from the mountains in the 1959 revolution.


Cubans and foreign governments were keenly watching whether any new, younger faces appeared among the Council of State members, in particular its first vice president and five vice presidents.


Their hopes were partially fulfilled with Diaz-Canel's ascension. He replaces former first vice president, Jose Machado Ventura, 82, who will continue as one of five vice presidents.


Commander of the Revolution Ramiro Valdes, 80, and Gladys Bejerano, 66, the comptroller general, were also re-elected as vice presidents.


Two other newcomers, Mercedes Lopez Acea, 48, first secretary of the Havana communist party, and Salvador Valdes Mesa, 64, head of the official labor federation, also earned vice presidential slots.


Esteban Lazo, a 68-year-old former vice president and member of the political bureau of the Communist Party, left his post upon being named president of the National Assembly on Sunday. He replaced Ricardo Alarcon, who served in the job for 20 years.


Six of the Council's top seven members sit on the party's political bureau which is also lead by Castro.


Castro's announcement came as little surprise to Cuban exiles in Miami.


"It's no big news. It would have been big news if he resigned today and called for democratic elections," said Alfredo Duran, a Cuban-American lawyer and moderate exile leader in Miami who supports lifting the U.S. trade embargo against Cuba. "I wasn't worried about him being around after 2018," he added.


The National Assembly meets for just a few weeks each year and delegates its legislative powers between sessions to the 31-member Council of State, which also functions as the executive through the Council of Ministers it appoints.


Eighty percent of the 612 deputies, who were elected in an uncontested vote February 3, were born after the revolution.


EFFORT TO PROMOTE YOUNGER GENERATION


Raul Castro, who officially replaced his ailing brother as president in 2008, has repeatedly said senior leaders should hold office for no more than two five-year terms.


"Although we kept on trying to promote young people to senior positions, life proved that we did not always make the best choice," Castro said at a Communist Party Congress in 2011.


"Today, we are faced with the consequences of not having a reserve of well-trained replacements ... It's really embarrassing that we have not solved this problem in more than half a century."


Speaking on Sunday, Castro hailed the composition of the new Council of State as an example of what he had said needed to be accomplished.


"Of the 31 members, 41.9 percent are women and 38.6 percent are black or of mixed race. The average age is 57 years and 61.3 percent were born after the triumph of the revolution," he said.


The 2011 party summit adopted a more than 300-point plan aimed at updating Cuba's Soviet-style economic system, designed to transform it from one based on collective production and consumption to one where individual effort and reward play a far more important role.


Across-the-board subsidies are being replaced by a comprehensive tax code and targeted welfare.


Raul Castro has encouraged small businesses and cooperatives in retail services, farming, minor manufacturing and retail, and given more autonomy to state companies which still dominate the economy.


The party plan also includes an opening to more foreign investment.


At the same time, Cuba continues to face a U.S. administration bent on restoring democracy and capitalism to the island and questions about the future largess of oil rich Venezuela with strategic ally Hugo Chavez battling cancer.


(Editing by Kieran Murray and Vicki Allen)



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