Fewer health care options for illegal immigrants

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

___

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

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

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Police, world wonder about Conn. shooting motive

NEWTOWN, Conn. (AP) — The massacre of 26 children and adults at a Connecticut elementary school elicited horror and soul-searching around the world even as it raised more basic questions about why the gunman, a 20-year-old described as brilliant but remote, would have been driven to such a crime and how he chose his victims.

Investigators were trying to learn more about the gunman, Adam Lanza, and questioned his older brother, who is not believed to have been involved in the rampage at Sandy Hook Elementary. Police shed no light on the motive for the nation's second-deadliest school shooting.

In tight-knit Newtown on Friday night, hundreds of people packed St. Rose of Lima church and stood outside in a vigil for the 28 dead — 20 children and six adults at the school, the gunman's mother at home, and the gunman himself, who committed suicide. People held hands, lit candles and sang "Silent Night."

"These 20 children were just beautiful, beautiful children," Monsignor Robert Weiss said. "These 20 children lit up this community better than all these Christmas lights we have. ... There are a lot brighter stars up there tonight because of these kids."

Lanza is believed to have suffered from a personality disorder and lived with his mother, said a law enforcement official who was briefed on the investigation.

Lanza shot his mother, Nancy Lanza, drove to the school in her car with at least three guns, including a high-powered rifle that he apparently left in the back of the vehicle, and shot up two classrooms around 9:30 a.m. Friday, law enforcement officials said, speaking on condition of anonymity.

A custodian ran through the halls, warning of a gunman, and someone switched on the intercom, perhaps saving many lives by letting them hear the chaos in the school office, a teacher said. Teachers locked their doors and ordered children to huddle in a corner or hide in closets as shots echoed through the building.

The well-liked principal, Dawn Hochsprung, was believed to be among the dead. A woman who worked at the school was wounded. An update on victims' identities was possible Saturday morning, state police Lt. Paul Vance said Friday evening.

A law enforcement official speaking on condition of anonymity said investigators believe Lanza attended the school several years ago but appeared to have no recent connection to it.

At least one parent said Lanza's mother was a substitute teacher there. But her name did not appear on a staff list. And the official said investigators were unable to establish any connection so far between her and the school.

Lanza's older brother, 24-year-old Ryan Lanza, of Hoboken, N.J., was questioned, but a law enforcement official said he was not believed to have had a role in the rampage. Investigators were searching his computers and phone records, but he told law enforcement he had not been in touch with his brother since about 2010.

The officials spoke on the condition of anonymity because they were not authorized to discuss the unfolding investigation.

At one point, a law enforcement official mistakenly identified the gunman as Ryan Lanza. Brett Wilshe, a friend of Ryan Lanza's, said Lanza told him the gunman may have had his identification. Ryan Lanza apparently posted Facebook page updates Friday afternoon that read, "It wasn't me" and "I was at work."

For about two hours late Friday and early Saturday, clergy members and emergency vehicles moved steadily to and from the school. The state medical examiner's office said bodies of the victims would be taken there eventually for autopsies.

At least three guns were found — a Glock and a Sig Sauer, both pistols, inside the school, and a .223-caliber rifle in the back of a car, authorities said. A law enforcement official speaking on condition of anonymity said some of the guns used in the attack may have belonged to Lanza's family. His mother had legally registered four weapons, his father two.

Authorities also recovered three other guns — a Henry repeating rifle, an Enfield rifle and a shotgun. It was not clear exactly where those weapons were found.

Adam Lanza and his mother lived in a well-to-do part of prosperous Newtown, about 60 miles northeast of New York City, where neighbors are doctors or hold white-collar positions at companies such as General Electric, Pepsi and IBM.

Lanza's parents filed for divorce in 2008, according to court records. His father, Peter Lanza, lives in Stamford, Conn., and works as a tax director for General Electric.

The gunman's aunt Marsha Lanza, of Crystal Lake, Ill., said her nephew was raised by kind, nurturing parents who would not have hesitated to seek mental help for him if he needed it.

"Nancy wasn't one to deny reality," Marsha Lanza said, adding her husband had seen Adam as recently as June and recalled nothing out of the ordinary.

Catherine Urso, of Newtown, said her college-age son knew the killer and remembered him for his alternative style. "He just said he was very thin, very remote and was one of the goths," she said.

Adam Lanza attended Newtown High School, and several news clippings from recent years mention his name among the honor roll students.

Joshua Milas, who graduated from Newtown High in 2009 and belonged to the school technology club with him, said Adam Lanza was generally a happy person but that he hadn't seen him in a few years.

"We would hang out, and he was a good kid. He was smart," Joshua Milas said. "He was probably one of the smartest kids I know. He was probably a genius."

An official who spoke on condition of anonymity said it was not clear that Adam Lanza had a job, and there was no indication of law enforcement interviews or search warrants at a place of business.

The mass shooting is one of the deadliest in U.S. history, and among school attacks is second in victims only to the 2007 Virginia Tech massacre, which left 33 people dead, including the gunman. Reaction was swift and emotional in Newtown, a picturesque New England community of 27,000 people, as well as across the country and around the world.

"It has to stop, these senseless deaths," said Frank DeAngelis, principal of Colorado's Columbine High School, where a massacre in 1999 killed 15 people.

In Washington, the Coalition to Stop Gun Violence organized a vigil at the White House, with some protesters chanting, "Today IS the day" to take steps to curb gun violence. In New York's Times Square, a few dozen people held tea lights in plastic cups, with one woman holding a sign that read: "Take a moment and candle to remember the victims of the Newtown shooting."

President Barack Obama's comments on the tragedy amounted to one of the most outwardly emotional moments of his presidency.

"The majority of those who died were children — beautiful little kids between the ages of 5 and 10 years old," Obama said at a White House news briefing. He paused for several seconds to keep his composure as he teared up and wiped an eye. Nearby, two aides cried and held hands.

Australian Prime Minister Julia Gillard described the attack as a "senseless and incomprehensible act of evil."

"Like President Obama and his fellow Americans, our hearts too are broken," Gillard said in a statement.

In Japan, where guns are severely restricted and there are extremely few gun-related crimes, the attack led the news two days before nationwide parliamentary elections. In China, which has seen several knife rampages at schools in recent years, the attack quickly consumed public discussion.

At the Newtown vigil, Anthony Bloss, whose three daughters survived, said they are doing better than he. "I'm numb. I'm completely numb," he said.

Panicked parents looking for their children had raced earlier in the day to Sandy Hook, a kindergarten-through-fourth-grade school where police told youngsters to close their eyes as they were led from the building so that they wouldn't see the blood and broken glass.

Schoolchildren — some crying, many looking frightened — were escorted through a parking lot in a line, hands on one another's shoulders.

Robert Licata said his 6-year-old son was in class when the gunman burst in and shot the teacher. "That's when my son grabbed a bunch of his friends and ran out the door," he said. "He was very brave. He waited for his friends."

He said the shooter didn't utter a word.

Kaitlin Roig, a teacher at the school, said she implored her students to be quiet.

"I told them we had to be absolutely quiet. Because I was just so afraid if he did come in, then he would hear us and just start shooting the door. I said we have to be absolutely quiet. And I said there are bad guys out there now and we need to wait for the good guys to come get us out," Roig told ABC News.

"If they started crying, I would take their face and say it's going to be OK. Show me your smile," she said. "They said, we want to go home for Christmas. Yes, yeah. I just want to hug my mom, things like that, that were just heartbreaking."

___

Contributing to this report were Associated Press writers Pat Eaton-Robb and Matt Apuzzo and videographer Robert Ray in Newtown; Bridget Murphy in Boston; Samantha Henry in Newark, N.J.; Pete Yost in Washington; Michael Melia in Hartford; and the AP News Research Center in New York.

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Kazakhstan to introduce mayoral elections in 2013

ALMATY, Kazakhstan (AP) — The president of Kazakhstan said Friday he plans to introduce direct elections for town and village mayors in an effort to foster democratic standards in the authoritarian Central Asian nation.

In a wide-ranging address, President Nursultan Nazarbayev said more than 2,500 municipal heads — about 90 percent of local governor posts — would be elected starting from next year. No local governors are currently elected.

Nazarbayev said Kazakhstan would seek to pursue further democratization and strengthen the power of the parliament. He gave no indication that he plans to step aside.

Kazakhstan, a vast oil-rich nation of 17 million bordering China and Russia, has come under sustained criticism for limiting media freedoms and making slow progress in political reforms. The president insisted, however, that his country would not be rushed into reforms before the economic conditions were right.

"Every step of our political reforms is closely tied to our level of economic development," he said.

The bulk of Friday's speech was aimed at cataloging achievements in the ex-Soviet nation over the 72-year old leader's two decades in power and setting out the nation's strategy until 2050.

Nazarbayev said Kazakhstan has to date attracted $160 billion in foreign investment. Much of that has gone toward developing the country's abundant energy and mineral resources.

In what may prove a controversial announcement, Nazarbayev said the Latin alphabet would be adopted by 2025 in place of the Russian-style Cyrillic alphabet currently in use. By the same year, 95 percent of Kazakhstan's citizens should have learned to speak in Kazakh, he said.

Although Kazakh is the official state language, many people speak Russian instead.

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Tolkien class at Wis. university proves popular

MILWAUKEE (AP) — The vast collection of J.R.R. Tolkien manuscripts initially sold senior Joe Kirchoff on Marquette University, so when the school offered its first course devoted exclusively to the English author, Kirchoff wanted in. The only problem: It was full and he wasn't on the literature track.

Undaunted, the 22-year-old political science and history major lobbied the English department and others starting last spring and through the summer and "kind of just made myself a problem," he said. His persistence paid off.

"It's a fantastic course," said Kirchoff, a Chicago native. "It's a great way to look at something that's such a creative work of genius in such a way you really come to understand the man behind it."

He and the 31 other students can now boast of their authority about the author who influenced much of today's high fantasy writing. The course was taught for the first time this fall as part of the university's celebration of the 75th anniversary of "The Hobbit" being published. And class wrapped up just before the film, "The Hobbit: An Unexpected Journey," was released Friday.

The class, which filled up fast with mostly seniors who had first dibs, looked at Tolkien as a whole, not just the popular "Lord of the Rings" and "The Hobbit." Students took their final exam this week, and the course was so well received, Marquette is considering more in the future.

"It's the best class I've had in 27 years here ... for student preparation, interest and enthusiasm," said English professor Tim Machan. "And I can throw out any topic and they will have read the material and they want to talk about the material."

Marquette is one of the main repositories of Tolkien's drafts, drawings and other writings — more than 11,000 pages. It has the manuscripts for "The Lord of the Rings" and "The Hobbit," as well as his lesser-known "Farmer Giles of Ham" and his children's book "Mr. Bliss." Marquette was the first institution to ask Tolkien for the manuscripts in 1956 and paid him about $5,000. He died in 1973.

Other significant collections are at the Bodleian Library at Oxford University in England and Wheaton College in Illinois.

Though Tolkien classes aren't unusual nationwide, Marquette students had the added bonus of being able to visit Tolkien's revisions, notes, detailed calendars, maps and watercolors on site at the school's archive. And they got a lesson from the school's archivist Bill Fliss.

"One of the things we wanted to impress upon the students was the fact that Tolkien was a fanatical reviser," said Fliss said. "He never really did anything once and was finished with it."

Chrissy Wabiszewski, a senior English major, described Tolkien's manuscripts as art.

"When you get down and look at just his script and his artwork in general, it all kind of flows together in this really beautiful, like, cumulative form," Wabiszewski said. "It's cool. It is just really cool to have it here."

The class also looked at Tolkien's poetry, academic articles and translations of medieval poems; talked about the importance of his writers' group, the Inklings; and explored what it meant to be a writer at that time.

"We've ... tried to think about continuities that ran through everything he did," Machan said. His students were also required to go to three lectures that were part of Marquette's commemoration.

"The Hobbit," a tale of homebody Bilbo Baggins' journey, is set in Tolkien's fictional realm of Middle-earth and takes place 60 years before "The Lord of the Rings." The movie released Friday is the first of the trilogy, with "The Hobbit: There and Back Again" set for release on Dec. 13, 2013, and a third film to come out in the summer of 2014.

Most of the students were just finishing elementary school when the first "Lord of the Rings" film was released 11 years ago.

Kirchoff said he started reading "The Hobbit" and the "Lord of the Rings" when he was in fourth grade, before the movies came out. He said the movies have introduced others to Tolkien's ideas, making his love for Tolkien's fantasy worlds more socially acceptable.

"The movies were fantastic enough and engaging enough to coexist in my mind with the literature I really do love," he said.

Wabiszewski said it's clear her classmates weren't just taking the class as a filler.

"I definitely expected the enthusiasm from everybody but just the knowledge that everybody brought into the class, it's cool," she said. "We really have a smart group of people in that class who have a lot to offer."

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Fewer health care options for illegal immigrants

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

___

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

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

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U.S. to send missiles, troops to Turkey

INCIRLIK AIR BASE, Turkey (Reuters) - U.S. Defense Secretary Leon Panetta signed an order on Friday to send two Patriot missile batteries to Turkey with 400 American personnel to operate them, in a move by NATO members to bolster Turkey's defenses against the threat of Syrian missiles.

The order was signed shortly before Panetta arrived on an unannounced visit to Turkey to meet American troops stationed at the Incirlik Air Base, the last stop on a week-long trip that took him to Afghanistan and Kuwait.

"The purpose of this deployment is to signal very strongly that the United States, working closely with our NATO allies, is going to support the defense of Turkey, especially with potential threats emanating from Syria," spokesman George Little said.

NATO-member Turkey has repeatedly scrambled jets along the countries' joint frontier and responded in kind when shells from the Syrian conflict came down inside its borders, fanning fears that the civil war could spread to destabilize the region.

The widely expected U.S. move follows similar steps by Germany and the Netherlands, which also said they will send two Patriot batteries. The three countries are the only NATO nations with the most modern type of Patriots.

Little declined to say where the U.S. batteries would be located and said the systems would be deployed to Turkey for an unspecified amount of time.

"We expect them to be deployed in the coming weeks," Little said.

NATO approved Turkey's request for air defense batteries on December 4, in a move meant to calm its fears of coming under missile attack, possibly with chemical weapons, from Syria.

The Patriot system is designed to intercept aircraft or missiles. NATO says the measure is purely defensive, but Russia, Syria and Iran have criticized the decision, saying it increases regional instability.

(Reporting by Phil Stewart; Editing by Nick Tattersall; Editing by Janet Lawrence)

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Pakistan extends refugee status for Afghans

ISLAMABAD (AP) — Pakistan has extended refugee status for over a million Afghans in the country by an additional six months, the government announced — a move likely to ease fears of Afghans living in Pakistan that they would soon have to return home.

Pakistan has been hosting hundreds of thousands of Afghan refugees dating back to the Soviet invasion of Afghanistan three decades ago. But many Pakistanis have become increasingly frustrated with the length of time the Afghans have stayed and would like them to leave.

The Pakistani government said in a statement released late Wednesday that refugee status had been set to expire on Dec. 30 and that they would extend it for another six months. The statement said there are 1.6 million registered and 1 million unregistered Afghans in Pakistan.

The extension would not affect unregistered Afghans, who are considered illegal residents.

The Afghan population in Pakistan is a legacy of Afghanistan's repeated conflicts, starting with the Soviet Union's invasion in 1979.

Many refugees can't fathom returning to Afghanistan any time soon, saying their homeland is still too violent and desperately poor.

Ehsanullah Elaj, an Afghan refugee who is a dentist in the city of Rawalpindi next to Islamabad, questioned what would happen to the refugees after the six-month extension expires.

"It would be very difficult for us to return to Afghanistan," Elaj said. "The majority of people want to stay here."

The Islamabad government has said it will not forcibly evict Afghans, many of whom have children born and raised in Pakistan. However, revoking their refugee status would encourage people to return.

Refugee status allows Afghans to get a government ID card that they use for everyday activities like banking or registering for school.

In a statement, the U.N. High Commissioner for Refugees welcomed the extension but pointed out the uncertainty for Afghan refugees.

"While the six month extension is important, Afghan refugees will be left wondering what the future has in store in July 2013 and beyond. UNHCR will therefore continue to encourage the government to maintain asylum space in the challenging transitional period ahead," said Neill Wright, the U.N. agency's Pakistan representative.

The U.N. agency has said that 83,000 Afghans have gone back this year, a 40 percent increase in those returning to their homeland compared to 2011. The U.N. has been spearheading a program this year designed to help Afghan refugees return to their homeland.

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Online:

http://www.unhcr.org/pages/49e487016.html

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Google Maps finally comes to iOS. Again [updated]

Apple has had quite a bumpy car ride so far with it’s mapping product. That all ends in just a couple hours, however, because late Wednesday evening Google is planning on bringing Maps back to iOS with the release of the company’s own software. AllThingsD is reporting that Google’s app will be available for download in the App Store shortly, and we’ll provide some initial thoughts on it soon after.

UPDATE: Google Maps is now available on Apple’s App Store for the iPhone, iPad and iPod touch.

Get more from BGR.com: Follow us on Twitter, Facebook

Gadgets News Headlines – Yahoo! News

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Familiar names line up for Golden Globe noms

BEVERLY HILLS, Calif. (AP) — A familiar lineup of Hollywood awards contenders are expected among Golden Globe nominations, whose prospects include past Oscar winners Daniel Day-Lewis, Helen Mirren, Robert De Niro and Sally Field.

Nominations come out Thursday morning for the 70th Globes ceremony, Hollywood's second-biggest film honors after the Academy Awards.

Among potential contenders are two-time Oscar winners Day-Lewis and Field for Steven Spielberg's Civil War saga "Lincoln," whose Globe possibilities also include past Oscar recipient Tommy Lee Jones.

Two-time Oscar winner De Niro is in the running for the lost-soul romance "Silver Linings Playbook," along with the film's lead performers, Bradley Cooper and Jennifer Lawrence.

The field of contenders is loaded with other Oscar recipients such as Mirren and Anthony Hopkins for "Hitchcock," Philip Seymour Hoffman for "The Master," Helen Hunt for "The Sessions," Marion Cotillard for "Rust and Bone," Russell Crowe for "Les Miserables" and Alan Arkin for "Argo."

One of the year's big action hits, the James Bond adventure "Skyfall," could bring the latest Globe nomination for past Oscar winner Javier Bardem, who elevates his super-villain role into one of the year's most entertaining performances.

Presented by the Hollywood Foreign Press Association, a relatively small group of about 90 reporters covering Hollywood for overseas outlets, the Globes sometimes single out newcomers to Hollywood's awards scene. Hilary Swank's Globe win for 1999's "Boys Don't Cry" helped put her on the map on the way to winning her first Oscar.

The possibilities this time include veteran French performers Emmanuelle Riva and Jean-Louis Trintignant, who star as an elderly couple in "Amour," and first-time actors Quvenzhane Wallis and Dwight Henry for the low-budget critical darling "Beasts of the Southern Wild."

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.

The Globes feature two best-film categories, one for drama and one for musical or comedy. 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 Globe 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 at the Jan. 13 ceremony.

Tina Fey, a two-time Globe TV winner for "30 Rock," and Amy Poehler, a past nominee for "Parks and Recreation," will host the show, which airs live on NBC.

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.

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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