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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Benedict Pledges 'Obedience' to New Pope












In his farewell remarks to colleagues in the Roman Catholic Church, Pope Benedict XVI, the first pontiff to resign in nearly 600 years, promised "unconditional reverence and obedience" to his eventual successor.


Benedict, in a morning meeting at the Vatican, urged the cardinals to act "like an orchestra" to find "harmony" moving forward.


Benedict, 85, is spending a quiet final day as pope, bidding farewell to his colleagues and moving on to a secluded life of prayer, far from the grueling demands of the papacy and the scandals that have recently plagued the church.


His first order of business was a morning meeting with the cardinals in the Clementine Hall, a room in the Apostolic Palace. Despite the historical nature of Benedict's resignation, not all cardinals attended the event.


With their first working meeting not until Monday, only around 100 cardinals were set to attend, the Vatican press office said Wednesday. Those who are there for Benedict's departure will be greeted by seniority.


Angelo Sodano, the dean of the College of Cardinals, thanked Benedict for his service to the church during the eight years he has spent as pontiff.


Pope Benedict XVI Delivers Farewell Address










In the evening, at 5:00 p.m. local time, Benedict will leave the Vatican palace for the last time to head to Castel Gandolfo, the papal summer residence outside Rome. Before his departure, the German-born theologian will say some goodbyes in the Courtyard of San Damaso, inside the Vatican, first to his Secretary of State Cardinal Tarcisio Bertone and then to the Swiss Guards who have protected him as pontiff.


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From there it is a short drive to a heliport for the 15-minute flight via helicopter to Castel Gandolfo, just south of the city. Benedict will not be alone on his journey, accompanied by members of the Pontifical Household such as two private secretaries, the head of protocol, his personal physician and his butler.


Once Benedict lands in the gardens at Castel Gandolfo, he will be greeted a group of dignitaries, such as the governor of the Vatican City state Giovanni Bertello, two bishops, the director of the pontifical villas, and the mayor and parish priest. Off the helicopter and into a car, Benedict will head to the palace that he will call home for the coming months. From a window of the palace, Benedict will make one final wave to the crowd at the papal retreat.


It is there, at 8:00 p.m., that Benedict's resignation will take effect once and for all. Once the gates to the residence close, the Swiss Guards will leave Benedict's side for the last time, their time protecting the pontiff completed.


Pope Benedict's Last Sunday Prayer Service


For some U.S. Catholics in Rome for the historic occasion, Benedict's departure is bittersweet. Christopher Kerzich, a Chicago resident studying at the Pontifical North American College of Rome, said Wednesday he is sad to see Benedict leave, but excited to see what comes next.


"Many Catholics have come to love this pontiff, this very humble man," Kerzich said. "He is a man who's really fought this and prayed this through and has peace in his heart. I take comfort in that and I think a lot of Catholics should take comfort in that."






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Rehabilitative care innovation can alleviate manpower crunch: govt






SINGAPORE: The government said the use of technology not only accelerates the rehabilitation process of patients, but also helps ease manpower shortages in healthcare.

The latest in "rehab innovations" for those with disabilities are on display at the inaugural Rehab Tech Asia exhibition in Singapore.

The showcase includes a robot arm which allows users who are paralysed in their upper bodies to do daily functions, such as drinking a glass of water.

Laurie Piquet, director of rehabilitation development at KINOVA, said: "When we demonstrate this to users, often the first comments that we have are, 'that's the first time I'm drinking a glass of water by myself'."

The innovation from Canada is compatible with any powered wheelchair and can be controlled by a joystick or through neck movements.

A special wheelchair also improves mobility by making it easier for users to climb stairs and cross pavements.

Other than technology for patients to use, there are also devices for caregivers.

"The Body Up", distributed by Lifeline, is a transfer assist device for bed-ridden patients. The contraption can be used to lift a patient who weighs less than 120kg.

With a growing demand for special needs care, those in the field of rehabilitation said such technology can alleviate problems of manpower shortage.

Dr Kong Keng He, senior consultant at department of rehabilitation medicine at Tan Tock Seng Hospital, said: "It is still very hospital-centric. The patient goes to the hospital to get treatment. I think it will be better off to make it more patient-centric. Deploy this treatment, whether it is rehabilitation, back to the community. And it's always possible for community centres, day rehabilitation centres to acquire these equipment and to have patients to receive their therapy there."

Minister of State for Health Dr Amy Khor agreed, saying the high cost of some technology may be offset by productivity gains in the long run.

She said: "Where it is viable and applicable, I think we should adopt them because it's helpful in terms of improving, accelerating the rehabilitation experience as well as in terms of better use of manpower, improving productivity, and this is something we need to look at. Where it is still costly, I think technology will develop and we will have to continue to monitor this."

With the recent enhancements made to the Senior's Mobility and Enabling Fund, Dr Khor said the subsides should encourage the elderly to go for rehabilitation services within the community.

On how the fund will be disbursed to help home care patients, especially those who are not in touch with intermediate- and long-term care providers, Dr Khor said the Agency for Integrated Care will work with the operators to help spread awareness of the fund. The agency will also work with the grassroots organisations and Community Development Councils to publicise the fund among needy residents.

- CNA/xq



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Helicopter scam: I feel ashamed, taxpayers' money can't be wasted, Antony says

NEW DELHI: Defence minister AK Antony has said that the culprits in the VVIP helicopter scam will be punished and any company found guilty in the deal will be blacklisted.

Responding to the debate on the chopper deal in the Rajya Sabha on Wednesday, Antony said, "I feel ashamed of this scam.

"It's a matter of shame for us every time a scam is reported," Antony said, adding that I want to find the truth and punish the guilty.

The defence minister said that taxpayers' money can't be wasted and claimed that procedures were followed at all levels in the deal.

He stressed the need to get to the root of the scam.

Earlier, initiating a debate in the upper House, the BJP accused the government of delaying the probe into the VVIP helicopter deal and demanded that the money trail be traced so that those who received kickbacks could be punished.

BJP member Prakash Javadekar alleged that Rs 400 crore had been paid in kickbacks for the deal.

He said the country wants to know who "the family", referred to in documents of Italian investigators, was.

Javadekar said alleged middlemen including Guido Ralph Haschke, Karlo Valentino Ferdinando Gerosa and Christian Michel had received money in the deal; part of the money was sent to India through circuitous channels.

He said Italy had started a probe on how "corruption took place", though it was a country which benefited from the Rs 3,600-crore deal for the purchase of 12 VVIP helicopters from AgustaWestland.

Attacking the United Progressive Alliance government, Javadekar accused it of not acting on the voluminous documents on the deal prepared by Italian investigators.

He said the documents of the investigators twice mentioned "the family".

The CBI had on Monday registered a preliminary enquiry against 11 people, including former Indian Air Force chief SP Tyagi, and four companies, in the purchase of VVIP helicopters from AgustaWestland.

Besides Tyagi, the inquiry names his cousins Sanjeev alias 'Julie' Tyagi, Docsa Tyagi, Sandeep Tyagi, advocate Gautam Khaitan, formerly associated with Aeromatrix, and the company's CEO, Praveen Bakshi.

Others named in the inquiry include Orsi, Bruno Spagnolini, CEO of AgustaWestland -- a Britain-based subsidiary of Finmeccanica -- and alleged middlemen Guido Ralph Haschke, Karlo Valentino, Ferdinando Gerosa, and Christian Michel.

The firms named are Finmeccanica, AgustaWestland, IDS Infotech Ltd. (India) and Aeromatrix India.

A Central Bureau of Investigation (CBI) and defence ministry team last week went to Italy to collect documents concerning alleged kickbacks paid to clinch the deal.

The government had on February 15 initiated action for cancellation of the contract for procurement and issued a formal show cause notice to AgustaWestland seeking cancellation of contract.

Two days earlier, it put on hold further payments to the company.

The contract for purchase of 12 AW101 helicopters for the use of VVIPs was signed in 2010.
(Inputs from IANS)

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Advanced breast cancer edges up in younger women


CHICAGO (AP) — Advanced breast cancer has increased slightly among young women, a 34-year analysis suggests. The disease is still uncommon among women younger than 40, and the small change has experts scratching their heads about possible reasons.


The results are potentially worrisome because young women's tumors tend to be more aggressive than older women's, and they're much less likely to get routine screening for the disease.


Still, that doesn't explain why there'd be an increase in advanced cases and the researchers and other experts say more work is needed to find answers.


It's likely that the increase has more than one cause, said Dr. Rebecca Johnson, the study's lead author and medical director of a teen and young adult cancer program at Seattle Children's Hospital.


"The change might be due to some sort of modifiable risk factor, like a lifestyle change" or exposure to some sort of cancer-linked substance, she said.


Johnson said the results translate to about 250 advanced cases diagnosed in women younger than 40 in the mid-1970s versus more than 800 in 2009. During those years, the number of women nationwide in that age range went from about 22 million to closer to 30 million — an increase that explains part of the study trend "but definitely not all of it," Johnson said.


Other experts said women delaying pregnancy might be a factor, partly because getting pregnant at an older age might cause an already growing tumor to spread more quickly in response to pregnancy hormones.


Obesity and having at least a drink or two daily have both been linked with breast cancer but research is inconclusive on other possible risk factors, including tobacco and chemicals in the environment. Whether any of these explains the slight increase in advanced disease in young women is unknown.


There was no increase in cancer at other stages in young women. There also was no increase in advanced disease among women older than 40.


Overall U.S. breast cancer rates have mostly fallen in more recent years, although there are signs they may have plateaued.


Some 17 years ago, Johnson was diagnosed with early-stage breast cancer at age 27, and that influenced her career choice to focus on the disease in younger women.


"Young women and their doctors need to understand that it can happen in young women," and get checked if symptoms appear, said Johnson, now 44. "People shouldn't just watch and wait."


The authors reviewed a U.S. government database of cancer cases from 1976 to 2009. They found that among women aged 25 to 39, breast cancer that has spread to distant parts of the body — advanced disease — increased from between 1 and 2 cases per 100,000 women to about 3 cases per 100,000 during that time span.


The study was published Tuesday in the Journal of the American Medical Association.


About one in 8 women will develop breast cancer in their lifetime, but only 1 in 173 will develop it by age 40. Risks increase with age and certain gene variations can raise the odds.


Routine screening with mammograms is recommended for older women but not those younger than 40.


Dr. Len Lichtenfeld, the American Cancer Society's deputy chief medical officer, said the results support anecdotal reports but that there's no reason to start screening all younger women since breast cancer is still so uncommon for them.


He said the study "is solid and interesting and certainly does raise questions as to why this is being observed." One of the most likely reasons is probably related to changes in childbearing practices, he said, adding that the trend "is clearly something to be followed."


Dr. Ann Partridge, chair of the federal Centers for Disease Control and Prevention's advisory committee on breast cancer in young women, agreed but said it's also possible that doctors look harder for advanced disease in younger women than in older patients. More research is needed to make sure the phenomenon is real, said Partridge, director of a program for young women with breast cancer at the Harvard-affiliated Dana-Farber Cancer Institute.


The study shouldn't cause alarm, she said. Still, Partridge said young women should be familiar with their breasts and see the doctor if they notice any lumps or other changes.


Software engineer Stephanie Carson discovered a large breast tumor that had already spread to her lungs; that diagnosis in 2003 was a huge shock.


"I was so clueless," she said. "I was just 29 and that was the last thing on my mind."


Carson, who lives near St. Louis, had a mastectomy, chemotherapy, radiation and other treatments and she frequently has to try new drugs to keep the cancer at bay.


Because most breast cancer is diagnosed in early stages, there's a misconception that women are treated, and then get on with their lives, Carson said. She and her husband had to abandon hopes of having children, and she's on medical leave from her job.


"It changed the complete course of my life," she said. "But it's still a good life."


____


Online:


JAMA: http://jama.ama-assn.org


CDC: http://www.cdc.gov/cancer/breast/index.htm


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Pope Thanks Crowd in Final Public Appearance












On his final full day as the leader of the Roman Catholic Church, Pope Benedict XVI thanked a huge crowd for respecting his historic decision to step down and told them that God will continue to guide the church.


"The decision I have made, after much prayer, is the fruit of a serene trust in God's will and a deep love of Christ's Church," Benedict said to cheers in his last public words as pope.


Benedict, 85, is the first pope to resign in 600 years. He told the crowd today that he was "deeply grateful for the understanding, support and prayers of so many of you, not only here in Rome, but also throughout the world."


Pope Benedict's Last Sunday Prayer Service


Under sunny skies on this late February day, hundreds of thousands of people, some waving flags, some banners, flocked to Vatican City to see Benedict make a final lap around St. Peter's Square. Throughout his eight-year papacy, Benedict has conducted a weekly audience from St. Peter's. Before delivering his last papal address today, Benedict waved to the festive group of supporters as he toured the square in his glass-encased popemobile.


The city of Rome planned for more than 200,000 people to head to the Vatican for today's event. Streets around St. Peter's were blocked off to cars as pedestrians from around the world headed to the square.








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The conclave to elect Benedict's replacement will start next month at a date yet to be determined. Benedict issued a decree known as a "motu poprio" that will allow cardinals to convene the conclave sooner than the March 15 date that would have been mandated under the old rules.


Benedict today asked the faithful to pray for him and for the new pope.


"My heart is filled with thanksgiving to God who ever watches over his church," Benedict said.


The German-born Benedict, who had appeared frail at times in recent months, seemed more energized in his remarks today. He has said he will devote more time to prayer and meditation after he leaves the papacy.


Benedict will meet Thursday with his cardinals in the morning and then flies by helicopter at 5 p.m. to Castel Gandolfo, the papal residence south of Rome. Benedict will greet parishioners there from the palazzo's balcony, his final public act as pope.


Then, at 8 p.m., the exact time at which his retirement becomes official, the Swiss Guards standing outside the doors of the palazzo at Castel Gandolfo will go off duty, their service protecting the head of the Catholic Church finished.


In retirement, Benedict will continue to wear white and will be called "Pope Emeritus," or the "Supreme Roman Pontiff Emeritus" or "Your Holiness," the Vatican announced Tuesday. Benedict will ditch his trademark red shoes, opting for a pair of brown shoes given to him on a trip to Mexico. But he will still reside on Vatican grounds in a former nunnery.


Benedict's final days as pope have been marked by controversy. For nearly a week now Italian newspapers speculated that Benedict really resigned because of a dossier he was given detailing a sex and blackmail scandal in the Catholic Church. The Italian media news reports do not state any attribution.


It turns out a dossier does exist. The Vatican spokesman Monday underscored that the contents of the dossier are known only to the pope and his investigators, three elderly prelates whom the Italian papers have nicknamed "the 007 cardinals."


But the dossier itself will remain "For the Pope's Eyes Only."






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Italy faces post-vote stalemate, spooking investors


ROME (Reuters) - The Italian stock market fell and state borrowing costs rose on Tuesday as investors took fright at political deadlock after a stunning election that saw a comedian's protest party lead the poll and no group secure a clear majority in parliament.


"The winner is: Ingovernability" ran 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.


In a sign of where that might lead, former prime minister Silvio Berlusconi indicated his center-right might be open to a grand coalition with the center-left bloc of Pier Luigi Bersani, which will have a majority in the lower house thanks to a premium of seats given to the largest bloc in the chamber.


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


Any coalition administration that may be formed must have a working majority in both houses in order to pass legislation.


Comedian Beppe Grillo's anti-establishment 5-Star Movement won the most votes of any single party, taking 25 percent. He shows no immediate inclination to cooperate with other groups.


Despite talk of a new election, the main established parties seem likely to try to avoid that, fearing even more humiliation.


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


In a clear sign of worry at the top over what effect the elections could have on the economy, Prime Minister Mario Monti, whose austerity policies were repudiated by voters, called a meeting with the governor of the central bank, the economy minister and the European affairs minister for later on Tuesday.


Other governments in the euro zone sounded uneasy. Allies of German Chancellor Angela Merkel made no secret of disappointment at Monti's debacle and urged Rome to continue with economic reforms Berlin sees as vital to stabilizing the common currency.


France's Socialist finance minister also expressed "worry" at the prospect of legislative deadlock in Italy but said that Italians had rejected austerity and hoped Bersani's center-left could form a stable government to help foster growth in Europe.


INSTABILITY


Fabio Fois, an economist at Barclays bank, said: "Political instability is likely to prevail in the near term and slow the implementation of much needed structural reforms unless a grand coalition among center-left, center-right and center is formed."


Berlusconi, a media magnate whose campaigning all but wiped out Bersani's once commanding opinion poll lead, hinted in a telephone call to a morning television show that he would be open to a deal with the center-left - but not with Monti, the technocrat summoned to replace him in a crisis 15 months ago.


"Italy must be governed," Berlusconi said, adding that he "must reflect" on a possible deal with the center-left. "Everyone must be prepared to make sacrifices," he said of the groups which now have a share of the legislature.


The Milan bourse was down more than four percent and the premium Italy pays over Germany to borrow on 10-year widened to a yield spread of 338.7 basis points, the highest since December 10.


At an auction of six-month Treasury bills, the government's borrowing costs shot up by more than two thirds. Investors demanded a yield of 1.237 percent, the highest since October and compared to just 0.730 percent in a similar sale a month ago.


Berlusconi, who was forced from office in November 2011 as borrowing costs approached levels investors feared would become unsustainable, said he was "not worried" about market reaction to the election and played down the significance of the spread.


The poor showing by Monti's centrist bloc reflected a weariness with austerity that was exploited by both Berlusconi and Grillo; only with the help of center-left allies did Bersani beat 5-Star, by just 125,000 votes, to control the lower house.


The worries immediately went beyond Italy's borders.


"What is crucial now is that a stable functioning government can be built as swiftly as possible," said German Foreign Minister Guido Westerwelle. "This is not only in the interests of Italy but in the interests of all Europe."


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.


"NON-PARTY" SURGES TO THE TOP


Commentators said all Grillo's adversaries 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.


"The 'non-party' has become the largest party in the country," said Massimo Giannini, commentator for Rome newspaper La Repubblica, of Grillo, who mixes fierce attacks on corruption with policies ranging from clean energy to free Internet.


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.


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."


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.


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 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 people were let down by 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.


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, who is currently on trial for having sex with an under-age prostitute.


But Monti 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.


(Additional reporting by Barry Moody, Gavin Jones, Catherine Hornby, Lisa Jucca, Steven Jewkes, Steve Scherer and Naomi O'Leary; Writing by Philip Pullella; Editing by Alastair Macdonald)



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Keppel secures contracts worth S$200m from repeat customers






SINGAPORE : Keppel Offshore & Marine (Keppel O&M), a unit of Keppel Corp, said its subsidiaries have secured two contracts worth a combined value of S$200 million from repeat customers.

In a filing with the Singapore Exchange on Tuesday, Keppel Corp said its Brazil subsidiary, Keppel FELS Brasil, secured a contract with MODEC and Toyo Offshore Production Systems to integrate the topside modules of a Floating Production Storage and Offloading (FPSO) unit.

Integration works for the FPSO will take place from the third quarter of 2014 to the third quarter of 2015.

The project will be carried out at BrasFELS, Keppel FELS Brasil's yard in Rio de Janeiro, Brazil.

In Singapore, Keppel Shipyard won a contract from SBM Offshore to build an internal turret for a newbuild FPSO. Work on the project is scheduled to complete by the third quarter of 2014.

Keppel did not provide a breakdown of individual contract values.

- CNA/ms



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Suryanelli rape: Govt defends Kurien in Rajya Sabha

NEW DELHI: Government on Tuesday defended Rajya Sabha Deputy Chairman P J Kurien, who has been under attack in connection with the Suryanelli rape issue, with parliamentary affairs minister Kamal Nath saying that police inquiries and courts have cleared him of all charges.

"A section of media and some political members have sought to drag Rajya Sabha Deputy Chairman Kurien in a rape case. It has emphatically been stated that he has never been accused in the Suryanelli rape case," Nath said making a statement the Rajya Sabha.

When the minister rose to defend Kurien, CPI(M) members staged a walkout, with its senior leader Sitaram Yechury saying Kurien should defend himself. "Let him (Kurien) come and defend. We cannot accept the executive defend the officer of legislature and undermine the sanctity of the Constitution," Yechury said.

Nath insisted that he was making statement upon direction by the Chair. He narrated the sequence of events related to the 17-year- old Suryanelli rape case since the time FIR was filed and how several police enquiries and judicial processes "acquitted" Kurien of all charges.

Kurien, a senior Congress leader from Kerala, has been under attack, particularly from Left parties after the victim demanded recently that he be made an accused in the case.

Kurien recently met Rajya Sabha Chairman Hamid Ansari as also Congress president Sonia Gandhi to explain his position. He also wrote a letter to all Rajya Sabha members on the eve of the start of the Budget Session on February 21, insisting that there was no case against him and allegations against him were false.

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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."


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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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