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."

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

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

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Marijuana not a high priority, Obama says

President Obama says recreational users of marijuana in states that have legalized the substance should not be a "top priority" of federal law enforcement officials prosecuting the war on drugs.

"We've got bigger fish to fry," Obama said of pot users in Colorado and Washington during an exclusive interview with ABC News' Barbara Walters.

"It would not make sense for us to see a top priority as going after recreational users in states that have determined that it's legal," he said, invoking the same approach taken toward users of medicinal marijuana in 18 states where it's legal.

More of Barbara Walters' exclusive first joint, post-election interview with President Obama and first lady Michelle Obama airs tonight on "20/20" at 10 p.m. ET on ABC stations.

Obama's comments on marijuana are his first following Colorado and Washington voters' approval of Nov. 7 ballot measures that legalize the recreational use and sale of pot in defiance of federal law.

Marijuana, or cannabis, remains classified under the Controlled Substances Act as a Schedule I narcotic whose cultivation, distribution, possession and use are criminal acts. It's in the same category as heroin, LSD and "Ecstasy," all deemed to have high potential for abuse.

Official White House Photo by Pete Souza

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Obama told Walters he does not – "at this point" – support widespread legalization of marijuana. But he cited shifting public opinion and limited government resources as reasons to find a middle ground on punishing use of the drug.

"This is a tough problem, because Congress has not yet changed the law," Obama said. "I head up the executive branch; we're supposed to be carrying out laws. And so what we're going to need to have is a conversation about, How do you reconcile a federal law that still says marijuana is a federal offense and state laws that say that it's legal?"

The president said he has asked Attorney General Eric Holder and the Justice Department to examine the legal questions surrounding conflicting state and federal laws on drugs.

"There are a number of issues that have to be considered, among them the impact that drug usage has on young people, [and] we have treaty obligations with nations outside the United States," Holder said Wednesday of the review underway.

As a politician, Obama has always opposed legalizing marijuana and downplayed his personal history with the substance.

Obama wrote in his 1995 memoir, "Dreams from My Father," that he would smoke pot regularly with his high school buddies who formed a "club of disaffection." The group was known as the "Choom Gang," says Obama biographer David Maraniss.

"There are a bunch of things I did that I regret when I was a kid," Obama told Walters. "My attitude is, substance abuse generally is not good for our kids, not good for our society.

"I want to discourage drug use," he added.

While the administration has not prioritized prosecutions of marijuana users and small-scale distributors in states where it's legal, it has not ceased prosecutions altogether. The Justice Department has continued raids on pot providers – including in states where they are legal – in an approach that experts say is more aggressive than Obama's predecessor, George W. Bush.

"I never made a commitment that somehow we were going to give carte blanche to large-scale producers and operators of marijuana – and the reason is, because it's against federal law," Obama told "Rolling Stone" in an interview earlier this year.

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NKorea still years away from credible missiles

SEOUL, South Korea (AP) — After 14 years of painstaking labor, North Korea finally has a rocket that can put a satellite in orbit. But that doesn't mean the reclusive country is close to having an intercontinental ballistic missile.

Experts say Pyongyang is years from even having a shot at developing reliable missiles that could bombard the American mainland and other distant targets, though it did gain attention and the outrage of world leaders Wednesday with its first successful launch of a three-stage, long-range rocket.

A missile program is built on decades of systematic, intricate testing, something extremely difficult for economically struggling Pyongyang, which faces guaranteed sanctions and world disapproval each time it stages an expensive launch. North Korea will need larger and more dependable missiles, and more advanced nuclear weapons, to threaten U.S. shores, though it already poses a threat to its neighbors.

"One success indicates progress, but not victory, and there is a huge gap between being able to make a system work once and having a system that is reliable enough to be militarily useful," said Brian Weeden, a former U.S. Air Force Space Command officer and a technical adviser to the Secure World Foundation, a think tank on space policy.

North Korea's satellite launch Wednesday came only after repeated failures and hundreds of millions of dollars.

South Korea's Defense Ministry said Thursday the satellite was orbiting normally at a speed of 7.6 kilometers (4.7 miles) per second, though it's not known what mission it is performing. North Korean space officials say the satellite would be used to study crops and weather patterns.

Though Pyongyang insists the project is peaceful, it also has conducted two nuclear tests and has defied international demands that it give up its nuclear weapons program.

The U.N. Security Council said in a brief statement after closed consultations Wednesday that the launch violates council resolutions against the North's use of ballistic missile technology, and said it would urgently consider "an appropriate response."

"This launch is about a weapons program, not peaceful use of space," U.S. State Department spokeswoman Victoria Nuland said. Even the North's most important ally, China, expressed regret.

North Korea has long possessed the components needed to construct long-range rockets. Scientists in Pyongyang, however, had been trying and failing since 1998 to conduct a successful launch. Only this week — their fifth try — did they do so, prompting dancing in the streets of the capital.

North Korea's far more advanced rival, South Korea, has failed twice since 2009 to launch a satellite on a rocket from its own territory, and postponed two attempts in recent weeks because of technical problems.

Each advancement Pyongyang makes causes worry in Washington and among North Korea's neighbors. In 2010, U.S. Secretary of Defense Robert Gates warned that within five years the North could develop an intercontinental ballistic missile capable of reaching the United States.

Wednesday's launch suggests the North is on track for that, said former U.S. defense official James Schoff, now an expert on East Asia at the Carnegie Endowment for International Peace.

But he and other experts say the North must still surmount tough technical barriers to build the ultimate military threat: a sophisticated nuclear warhead small enough to mount on a long-range missile, something experts say will be the focus of future nuclear tests.

And despite Wednesday's launch, Pyongyang is also lacking the other key part of that equation: a reliable long-range missile.

"If in the future they develop a nuclear warhead small enough to put on a rocket, they are not going to want to put that on a missile that has a high probability of exploding on the launch pad," David Wright, a physicist with the Union of Concerned Scientists who has written extensively about North Korea's missile program, said in an email.

To create a credible missile program, experts say, North Korean technicians need to conduct many more tests that will allow them to iron out the wrinkles until they have a missile that works more often than it fails. Pyongyang's past tests have been somewhat scattershot, possibly because of the heavy international sanctions the rocket and nuclear tests have generated.

North Korea must build a larger missile than the one launched Wednesday if it wants to be able to send nuclear weapons to distant targets, analysts said.

The satellite North Korea mounted on the rocket weighs only 100 kilograms (220 pounds), according to the office of South Korean lawmaker Jung Chung-rae, who was briefed by a senior South Korean intelligence official. A nuclear warhead would be about five times heavier.

Other missing parts of the puzzle include an accurate long-range missile guidance system and a re-entry vehicle able to survive coming back into the atmosphere at the high speeds — 10,000 mph — traveled by intercontinental ballistic missiles, said Jonathan McDowell of the Harvard-Smithsonian Center for Astrophysics in Massachusetts.

Both are seen as being years off.

History also shows that first-generation, long-range missiles need dozens of test flights before they are accurate enough to be deployed.

The world's "ICBM club" has just four countries: the United States, Russia, China and France, according to Markus Schiller, an analyst with Schmucker Technologie in Germany and a leading expert on North Korean missiles.

If North Korea "really intended to become a player in the ICBM game, they would have to develop a different kind of missile, with higher performance," Schiller said. "And if they do that seriously, we would have to see flight tests every other month, over several years."

Wright said the Unha-3 rocket launched Wednesday has a potential range of 8,000 to 10,000 kilometers (4,970 to 6,210 miles), which could put Hawaii and the northwest coast of the mainland United States within range.

But even if North Korea builds a ballistic missile based on a liquid-fueled rocket like the 32-meter (105-foot)-tall Unha-3, it would take days to assemble and hours to fuel. That would make it vulnerable to attack in a pre-emptive airstrike. Solid-fueled missiles developed by the U.S. and Soviet Union are more mobile, more easily concealed and ready to launch within minutes.

Money is another problem for Pyongyang. A weak economy, chronic food shortages and the sanctions make it difficult to sustain a program that can build and operate reliable missiles.

"I don't think the young leader (Kim Jong Un) has any confidence that the home economy could afford a credible deterrent capability," said Zhu Feng, deputy director of the Center for International and Strategic Studies at Peking University.

Zhu said Pyongyang's recent launch was a negotiating chip, not an immediate threat. He said it was intended to stoke tensions abroad in order to improve Pyongyang's position in future international negotiations.

Weeden said North Korea may want to create the perception that it poses a threat to the United States, but is not likely to go further than that.

"I expect North Korea to milk this situation for everything they can get," he said. "But I don't think that perception will be matched by the actual hard work and testing needed to develop and field a reliable, effective weapon system like the ICBMs deployed by the US, Russia and China."

But Victor Cha, a former White House director for Asia policy, warned there has been an unspoken tendency in the United States to regard North Korea as a technologically backward and bizarre country, underestimating the strategic threat it poses.

"This is no longer acceptable," he wrote in a commentary.

North Korea already poses a major security threat to its East Asian neighbors. It has one of the world's largest standing armies and a formidable if aging arsenal of artillery that could target Seoul, the capital of South Korea. Nearly 30,000 U.S. forces are based in South Korea, a legacy of the 1950-53 Korean War that ended with an armistice, not a formal peace treaty.

The North's short-range rockets could also potentially target another core U.S. ally, Japan.

Darryl Kimball, executive director of the nongovernmental Arms Control Association, said those capabilities, rather than the North's future ability to strike the U.S., still warrant the most attention.

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Matthew Pennington reported from Washington. Associated Press writer Alexa Olesen in Beijing contributed to this report.

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'Lincoln' leads Golden Globes with 7 nominations

BEVERLY HILLS, Calif. (AP) — Steven Spielberg's Civil War epic "Lincoln" led the Golden Globes on Thursday with seven nominations, among them best drama, best director for Spielberg and acting honors for Daniel Day-Lewis, Sally Field and Tommy Lee Jones.

Tied for second-place with five nominations each, including best drama are Ben Affleck's Iran hostage-crisis thriller "Argo" and Quentin Tarantino's slave-turned-bounty-hunter tale "Django Unchained."

Other best-drama nominees put forward by The Hollywood Foreign Press Association are Ang Lee's shipwreck story "Life of Pi" and Kathryn Bigelow's Osama bin Laden manhunt thriller "Zero Dark Thirty."

Nominated for best musical or comedy were: the British retiree adventure "The Best Exotic Marigold Hotel"; the Victor Hugo musical "Les Miserables"; the first-love tale "Moonrise Kingdom"; the fishing romance "Salmon Fishing in the Yemen"; and the lost-soul romance "Silver Linings Playbook."

Globe attention can give contenders a boost for Hollywood's top honors, the Academy Awards, whose nominations come out Jan. 10, three days before the Globe ceremony.

The directing lineup came entirely from dramatic films, with Affleck, Bigelow, Lee, Spielberg and Tarantino all in the running.

"It's very gratifying to get this many nominations from the HFPA for a film I worked so hard on and am so passionate about. I look forward to having fun at the Golden Globes with my cast mates and fellow nominees," Tarantino said in a statement.

Filmmakers behind best musical or comedy nominees were shut out for director, including Tom Hooper for "Les Miserables" and David O. Russell for "Silver Linings Playbook."

Along with Day-Lewis as Abraham Lincoln in Spielberg's epic, best dramatic actor contenders are Richard Gere as a deceitful Wall Streeter in "Arbitrage"; John Hawkes as a polio victim trying to lose his virginity in "The Sessions"; Joaquin Phoenix as a Navy veteran under the sway of a cult leader in "The Master"; and Denzel Washington as a boozy airline pilot in "Flight."

Dramatic-actress nominees are Jessica Chastain as a CIA analyst hunting Osama bin Laden in "Zero Dark Thirty"; Marion Cotillard as a whale biologist beset by tragedy in "Rust and Bone"; Helen Mirren as Alfred Hitchcock's strong-minded wife in "Hitchcock"; Naomi Watts as a woman caught up in a devastating tsunami in "The Impossible"; and Rachel Weisz as a woman ruined by an affair in "The Deep Blue Sea."

For musical or comedy actress, the lineup is Emily Blunt as a consultant for a Mideast sheik in "Salmon Fishing in the Yemen"; Judi Dench as a widow who retires overseas in "The Best Exotic Marigold Hotel"; Jennifer Lawrence as a young widow in a new romance in "Silver Linings Playbook"; Maggie Smith as an aging singer in a retirement home in "Quartet"; and Meryl Streep as a wife trying to save her marriage in "Hope Springs."

Nominees for musical or comedy actor are Jack Black as a solicitous mortician in "Bernie"; Bradley Cooper as a troubled man fresh out of a mental hospital in "Silver Linings Playbook"; Hugh Jackman as Hugo's long-suffering hero Jean Valjean in "Les Miserables"; Ewan McGregor as a British fisheries expert in "Salmon Fishing in the Yemen"; and Bill Murray as Franklin Roosevelt in "Hyde Park on Hudson."

Competing for supporting actor are Alan Arkin as a Hollywood producer helping a CIA operation in "Argo"; Leonardo DiCaprio as a cruel slave owner in "Django Unchained"; Philip Seymour Hoffman as a mesmerizing cult leader in "The Master"; Tommy Lee Jones as firebrand abolitionist Thaddeus Stevens in "Lincoln"; and Christoph Waltz as a genteel bounty hunter in "Django Unchained."

The supporting-actress picks are Amy Adams as a cult leader's devoted wife in "The Master"; Sally Field as Mary Todd Lincoln in "Lincoln"; Anne Hathaway as a mother fallen into prostitution in "Les Miserables"; Helen Hunt as a sexual surrogate in "The Sessions"; and Nicole Kidman as a trashy mistress of a Death Row inmate in "The Paperboy."

Kidman was a dual nominee, also in the running as best actress in a TV movie or miniseries for "Hemingway & Gellhorn."

"As an actor you look for roles that are rich, complicated, and that stretch you and this year I was blessed to find two," Kidman said in a statement. "To have the chance to play them was a gift in itself and to then be acknowledged this way is icing on the cake."

"Quartet" star Smith also had a second nomination, for supporting actress in a TV series, miniseries or movie for "Downton Abbey."

Snubbed completely was the low-budget critical darling "Beasts of the Southern Wild," which won top honors at last January's Sundance Film Festival. Also shut out was the stripper hit "Magic Mike," which had good buzz for supporting player Matthew McConaughey, who also earned acclaim for roles in "Bernie" and "Killer Joe." Another film to not notch a single nomination was "The Hobbit," a prelude to the "The Lord of the Rings" films, which all got Globe nods.

With three nominations, "Salmon Fishing in the Yemen" was a surprise inclusion Thursday, since the film had virtually no awards buzz behind it.

There will be some friendly rivalry among the hosts at the Globe ceremony, Tina Fey and Amy Poehler. Both were nominated for best actress in a TV comedy, Fey for "30 Rock" and Poehler for "Parks and Recreation."

Fey and Poehler follow Ricky Gervais, who was host the last three years and rubbed some Hollywood egos the wrong way with sharp wisecracks about A-list stars and the foreign press association itself.

The Sarah Palin drama "Game Change" leads TV contenders with five nominations: including best movie or miniseries and acting honors for Julianne Moore, Woody Harrelson, Ed Harris and Sarah Paulson.

Best TV comedy series nominees are "The Big Bang Theory," ''Episodes," ''Girls," ''Modern Family" and "Smash." TV drama picks are "Breaking Bad," ''Boardwalk Empire," ''Downton Abbey: Season 2," ''Homeland" and "The Newsroom."

Globe acting winners often go on to receive the same prizes at the Oscars. All four Oscar winners last season — lead performers Meryl Streep of "The Iron Lady" and Jean Dujardin of "The Artist," and supporting players Octavia Spencer of "The Help" and Christopher Plummer of "Beginners" — won Globes first.

The Globes have a spotty record predicting which films might go on to earn the best-picture prize at the Academy Awards, however.

Last year's Oscar best-picture winner, "The Artist," preceded that honor with a Globe win for best musical or comedy. But in the seven years before that, only one winner in the Globes' two best-picture categories — 2008's "Slumdog Millionaire" — followed up with an Oscar best-picture win.

Along with 14 film prizes, the Globes hand out awards in 11 television categories.

Jodie Foster, a two-time Oscar and Globe winner for "The Accused" and "The Silence of the Lambs," will receive the group's Cecil B. DeMille Award for lifetime achievement.

With stars sharing drinks and dinner, the Globes have a reputation as one of Hollywood's loose and unpredictable awards gatherings. Winners occasionally have been off in the restroom when their names were announced, and there have been moments of onstage spontaneity such as Jack Nicholson mooning the crowd or Ving Rhames handing over his trophy to fellow nominee Jack Lemmon.

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Online:

http://www.goldenglobes.org

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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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Outgoing husband and wife reps at odds on fiscal cliff deal

Spinners and Winners

Husband-and-wife team Reps. Connie Mack, R-Fla., and Mary Bono Mack, R-Calif., got some bad news on November 6. Both lost their elections and are now leaving Congress at the same time. But they've got one foot out the door during one of the most controversial lame duck sessions in recent history. Neither is budging on their votes -- though they don't exactly see eye-to-eye on the ongoing fiscal cliff negotiations with the White House.

Bono Mack is more open to compromising on taxes than Mack is, joking that Spinners and Winners was trying to start a fight by bringing up the topic!

"I think if this is the best possible deal we can get, and for me I think that it is, I think we ought to go for it," Bono Mack said.

"She's for extending the tax cuts for the middle class, but we all know what that means—that means that what the bill actually is going to do is raise taxes on people who do make more than $250,000," Mack said. "A lot of us would say that that's raising taxes on small businesses, the very people that we rely on to go out and create jobs."

Bono Mack says she thinks President Obama and Speaker John Boehner, R-Ohio, will reach a deal that she will be able to support; Mack says if tax increases are part of the deal, it won't get his vote.

Bono Mack came to Congress in an unconventional way 14 years ago after her former husband, Rep. Sonny Bono, suddenly died. The brand new congresswoman found herself on the House Judiciary Committee in the midst of the Clinton impeachment hearings. She voted in favor of impeaching President Clinton at the time. Clinton is now one of the most respected political figures, but Bono Mack says she does not regret her decision, but says she thinks Republicans "overplayed their hand" at the time.

"It's not good to do it, it's not easy to do, it's not good for the American people, and if we should ever do it, it better be for very serious reasons, because it really tears us apart as a people," Mary said.

As for those incoming representatives, Mack has some advice: Build strong relationships with your fellow representatives, and don't get too attached to anything.

"If you ever question your permanency here, just look at your furniture," Connie said. "There's a bar code on the furniture in your office, and as quickly as they can move you in they can move you out."

To hear more from the Congressional couple, including their future plans, check out this week's Spinners and Winners.

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UN says 2 million Afghans at risk this winter

KABUL, Afghanistan (AP) — The United Nations and several humanitarian agencies are saying that more than 2 million Afghans are at risk from cold, disease and malnutrition this winter.

Wednesday's warning comes as an international appeal for funds to help Afghanistan — one of the world's poorest countries — has fallen drastically short of its goal.

The U.N. says that only 48 percent of $448 million requested to help 8.8 million Afghans was pledged by the end of November.

The aid agencies are preparing to help Afghans deal with harsh winter conditions, especially about 400,000 people who live in some of the most remote mountainous areas of northern and central Afghanistan.

Snow has already covered mountaintops and the first snow of the year was forecast to fall this week in the Afghan capital, Kabul.

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'Lincoln,' 'Les Mis,' 'Playbook' lead SAG awards

LOS ANGELES (AP) — Steven Spielberg's Civil War saga "Lincoln," the Victor Hugo musical adaptation "Les Miserables" and the lost-soul romance "Silver Linings Playbook" led the Screen Actors Guild Awards with four nominations each Wednesday.

All three films were nominated for overall performance by their casts. Also nominated for best ensemble cast were the Iran hostage-crisis thriller "Argo" and the British retiree adventure "The Best Exotic Marigold Hotel."

"Lincoln" also scored individual acting nominations for Daniel Day-Lewis in the title role as best actor, Sally Field for supporting actress as Mary Todd Lincoln and Tommy Lee Jones for supporting actor as abolitionist firebrand Thaddeus Stevens.

"Les Miserables" had nominations for Hugh Jackman for best actor as Hugo's long-suffering hero Jean Valjean and Anne Hathaway for supporting actress as a woman fallen into prostitution, plus a nomination for its stunt ensemble.

"Silver Linings Playbook" also had lead-acting nominations for Bradley Cooper and Jennifer Lawrence as troubled spirits who find a second chance at love and Robert De Niro for supporting actor as a football-obsessed dad.

Besides Lawrence, best-actress nominees are Jessica Chastain as a CIA analyst pursuing Osama bin Laden in "Zero Dark Thirty;" Marion Cotillard as a woman who finds romance after tragedy in "Rust and Bone;" Helen Mirren as Alfred Hitchcock's strong-willed wife in "Hitchcock;" and Naomi Watts as a woman caught in the devastation of a tsunami in "The Impossible."

Joining Cooper, Day-Lewis and Jackman in the best-actor field are John Hawkes as a polio victim aiming to lose his virginity in "The Sessions" and Denzel Washington as a boozy airline pilot in "Flight."

The SAG Awards will be presented Jan. 27. The guild nominations are one of Hollywood's first major announcements on the long road to the Feb. 24 Academy Awards, whose nominations will be released Jan. 10.

Nominations for the Golden Globes, the second-biggest film honors after the Oscars, come out Thursday.

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Online:

http://www.sagawards.org

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DA investigating Texas' troubled $3B cancer agency

AUSTIN, Texas (AP) — Turmoil surrounding an unprecedented $3 billion cancer-fighting effort in Texas worsened Tuesday when its executive director offered his resignation and the state's chief public corruption prosecutor announced an investigation into the beleaguered agency.

No specific criminal allegations are driving the latest probe into the Cancer Prevention and Research Institute of Texas, said Gregg Cox, director of the Travis County district attorney's public integrity unit. But his influential office opened a case only weeks after the embattled agency disclosed that an $11 million grant to a private company bypassed review.

That award is the latest trouble in a tumultuous year for CPRIT, which controls the nation's second-largest pot of cancer research dollars. Amid the mounting problems, the agency announced Tuesday that Executive Director Bill Gimson had submitted his letter of resignation.

"Unfortunately, I have also been placed in a situation where I feel I can no longer be effective," Gimson wrote in a letter dated Monday.

Gimson said the troubles have resulted in "wasted efforts expended in low value activities" at the agency, instead of a focused fight against cancer. Gimson offered to stay on until January, and the agency's board must still approve his request to step down.

His departure would complete a remarkable house-cleaning at CPRIT in a span of just eight months. It began in May, when Dr. Alfred Gilman resigned as chief science officer in protest over a different grant that the Nobel laureate wanted approved by a panel of scientists. He warned it would be "the bomb that destroys CPRIT."

Gilman was followed by Chief Commercialization Officer Jerry Cobbs, whose resignation in November came after an internal audit showed Cobbs included an $11 million proposal in a funding slate without a required outside review of the project's merits. The lucrative grant was given to Dallas-based Peloton Therapeutics, a biomedical startup.

Gimson chalked up Peloton's award to an honest mistake and has said that, to his knowledge, no one associated with CPRIT stood to benefit financially from the company receiving the taxpayer funds. That hasn't satisfied some members of the agency's governing board, who called last week for more assurances that no one personally profited.

Cox said he has been following the agency's problems and his office received a number of concerned phone calls. His department in Austin is charged with prosecuting crimes related to government officials; his most famous cases include winning a conviction against former U.S. House Majority Leader Tom DeLay in 2010 on money laundering charges.

"We have to gather the facts and figure what, if any, crime occurred so that (the investigation) can be focused more," Cox said.

Gimson's resignation letter was dated the same day the Texas attorney general's office also announced its investigation of the agency. Cox said his department would work cooperatively with state investigators, but he made clear the probes would be separate.

Peloton's award marks the second time this year that a lucrative taxpayer-funded grant authorized by CPRIT instigated backlash and raised questions about oversight. The first involved the $20 million grant to M.D. Anderson Cancer Center in Houston that Gilman described as a thin proposal that should have first been scrutinized by an outside panel of scientific peer-reviewers, even though none was required under the agency's rules.

Dozens of the nation's top scientists agreed. They resigned en masse from the agency's peer-review panels along with Gilman. Some accused the agency of "hucksterism" and charting a politically-driven path that was putting commercial product-development above science.

The latest shake-up at CPRIT caught Gilman's successor off-guard. Dr. Margaret Kripke, who was introduced to reporters Tuesday, acknowledged that she wasn't even sure who she would be answering to now that Gimson was stepping down. She said that although she wasn't with the agency when her predecessor announced his resignation, she was aware of the concerns and allegations.

"I don't think people would resign frivolously, so there must be some substance to those concerns," Kripke said.

Kripke also acknowledged the challenge of restocking the peer-review panels after the agency's credibility was so publicly smeared by some of the country's top scientists. She said she took the job because she felt the agency's mission and potential was too important to lose.

Only the National Institutes of Health doles out more cancer research dollars than CPRIT, which has awarded more than $700 million so far.

Gov. Rick Perry told reporters in Houston on Tuesday that he wasn't previously aware of the resignation but said Gimson's decision to step down was his own.

Joining the mounting criticism of CPRIT is the woman credited with brainstorming the idea for the agency in the first place. Cathy Bonner, who served under former Texas Gov. Ann Richards, teamed with cancer survivor Lance Armstrong in selling Texas voters in 2007 on a constitutional amendment to create an unprecedented state-run effort to finance a war on disease.

Now Bonner says politics have sullied an agency that she said was built to fund research, not subsidize private companies.

"There appears to be a cover-up going on," Bonner said.

Peloton has declined comment about its award and has referred questions to CPRIT. The agency has said the company wasn't aware that its application was never scrutinized by an outside panel, as required under agency rules.

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Follow Paul J. Weber on Twitter: www.twitter.com/pauljweber

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Defiant North Korea launches long-range rocket into orbit

United States officials confirm that North Korea appears to have carried out the successful launch of a long-range rocket.

The move comes as a surprise to the international community, which has consistently called on North Korea to abandon its efforts.

Less than 24 hours earlier, the North Koreans had indicated they were grappling with "technical uncertainties" that forced them to extend the launch window to Dec. 29.

The secretive regime insists its efforts are part of a peaceful space program intended to place a satellite into orbit. But the U.S. and key Asian allies believe it is a thinly disguised attempt to test an intercontinental ballistic missile aimed at furthering development of the technology needed to mount a nuclear warhead on a long-range rocket that could one day reach the U.S.

National Security Council spokesman Tom Vietor called the launch a "highly provocative act that threatens regional security."

In recent weeks even China, North Korean's only remaining ally, sent a high level delegation into Pyongyang to convey a message of constraint. Today, China expressed "regret" over the incident. In the past, China has supported North Korea's right to develop its space program.

"The action is yet another example of North Korea's pattern of irresponsible behavior," read the National Security Council statement. "The United States remains vigilant in the face of North Korean provocations and is fully committed to the security of allies in the region."

North American Aerospace Defense Command (NORAD) acknowledged the launch initiated at 9:49 a.m. local time and followed its intended trajectory, traveling south between Korea and Japan.

"At no time was the missile or the resultant debris a threat to North America," said NORAD.

Japan's emergency alert system – M-NET – recorded the rocket's flight path directly over Okinawa just after 10:00 a.m. Officials say they have located three points of debris: One in South Korea's Yellow Sea, a second location further down the country's west coast and the third point 180 miles north of the Philippines.

A South Korean military official confirmed that one of their three warships, equipped with the Aegis radar system, detected the launch. The first stage fell just below Byeonsanbando, southwest of the Korean peninsula, exactly where it was supposed to, according to the official.

Increased attention focused on North Korea in recent weeks as satellite images showed action at the Tongchang-ri launch site. But on Monday, a statement from the Korean Committee of Space Technology claimed that scientists and technicians "found a technical deficiency in the first-stage control engine module of the rocket carrying the satellite." Satellite images also revealed that a new third-stage booster was delivered to the launch pad on Saturday.

A key issue is how far the rocket traveled and whether it was able to successfully separate its second and third stage rockets. If so, the capacity to travel long distances would be greatly enhanced.

The type of rocket is believed to be the Taepodong 2 missile. The North Koreans refer to it as the Unha-3, which in Korean translates as "Galaxy-3." The same type of missile has been previously tested three times in 2006, 2009 and 2012. Each time, the rocket failed soon after launch. It is believed to have the capacity to travel a minimum of 3,400 miles. That puts it well within striking range of the western U.S.

The U.S. had mobilized four warships in the Asia-Pacific region to monitor the launch. The guided missile destroyers the USS John S. McCain, the USS Benfold and the USS Fitzgerald joined the guided missile cruiser the USS Shiloh to "reassure allies in the region" according to officials.

South Korea's president Lee Myung-bak called an emergency security meeting in response. The timing is particularly sensitive for this country which is still officially at war with North Korea.

In just one week, South Korea holds key elections and will choose a new president. North Korea's successful launch could potentially sway voters favoring either a harsher line or a return to the "Sunshine Policy" of past administrations.

Current ruling party candidate Park Geun-hye has indicated a willingness to hold talks with North Korea.

Her father, Park Chung-hee, served as the South Korean president for 16 years. He was the target of multiple assassination attempts by North Korea. One of those efforts killed his wife, Chung-hee's mother.

Park took over her mother's duties as first lady until her father was assassinated by the chief of security in 1979. She re-emerged in 1997 as an active politician and is the first female candidate to be seriously considered for president.

Her party, the Saenuridang, is a traditionally conservative group that adapts a somewhat stricter policy towards North Korea that her opponent, Moon Jae-in. As head of the Democratic United Party, he champions a more lenient approach to the South's belligerent neighbor.

In repeated breaking news announcements throughout the day North Korean state-run television celebrated the launch. "We are proud of the glorious success of our satellite technology," said the presenter. "This is a landmark achievement."

Dec. 17 marks the one year anniversary of the country's Dear Leader Kim Jong-il's death. Analysts believe his son and successor, Kim Jong-Un, is under pressure to show the world he is intent on continuing his father's "Military First" policy and demonstrate a show of strength.

While experts do not believe North Korea currently has the technology to mount a nuclear warhead, today's launch is a significant development for the closed country's new leader.

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