Coast Guardsman is killed after suspected smugglers ram his boat









A veteran U.S. Coast Guard chief petty officer was killed Sunday after suspected smugglers rammed his vessel near Santa Cruz Island, casting him into the ocean with a fatal head wound.


Chief Petty Officer Terrell Horne III, 34, of Redondo Beach was second in command of the Halibut, an 87-foot patrol cutter based in Marina del Rey. Authorities said they could not recall a Coast Guard chief petty officer being killed in such a manner off the coast of California.


Early Sunday morning, the Halibut was dispatched to investigate a boat operating near Santa Cruz Island, the largest of California's eight Channel Islands. The island is roughly 25 miles southwest of Oxnard.





The boat, first detected by a patrol plane, had fallen under suspicion because it was operating in the middle of the night without lights and was a "panga"-style vessel, an open-hulled boat that has become "the choice of smugglers operating off the coast of California," said Coast Guard spokesman Adam Eggers.


The Coast Guard cutter contains a smaller boat — a rigid-hull inflatable used routinely for search-and-rescue operations and missions that require a nimble approach. When Horne and his team approached in the inflatable, the suspect boat gunned its engine, maneuvered directly toward the Coast Guard inflatable, rammed it and fled.


The impact knocked Horne and another Coast Guardsman into the water. Both were quickly plucked from the sea. Horne had suffered a traumatic head injury. While receiving medical care, he was raced to shore aboard the Halibut. Paramedics met the Halibut at the pier in Port Hueneme and declared Horne dead at 2:21 a.m.


"We are deeply saddened by the loss of our shipmate," said Adm. Robert J. Papp, the Coast Guard commandant. "Our fallen shipmate stood the watch on the front lines protecting our nation, and we are all indebted to him for his service and sacrifice."


The second crew member knocked into the water suffered minor injuries and was treated and released from a hospital later Sunday. He was not identified.


Using a helicopter and a 45-foot boat stationed in Los Angeles, the Coast Guard later found the panga and stopped it.


Two men were detained. The Coast Guard declined to identify them or say whether drugs were found aboard the boat. A second suspicious vessel was believed to have been traveling alongside the panga before the incident.


"We are actively working to ensure that all of the individuals involved in this illegal activity are brought to justice," said Coast Guard Capt. James Jenkins.


The Coast Guard was unable to provide a detailed account of Horne's service.


He had been heralded by the agency on several occasions.


He appears to have arrived in Southern California last summer after serving for two years as an executive petty officer in Emerald Isle, N.C. There, he received a Coast Guard Commendation Medal for his leadership in 63 search-and-rescue cases, in which 38 lives were saved.


According to an account of the medal ceremony, the most notable of those operations involved a boat that capsized in a North Carolina inlet in 2010. The account said he coached his team through "treacherous" sea conditions to rescue five people.


The Coast Guard also noted Horne's involvement in a January operation in which the Halibut found and stopped two boats operating at midnight with


no lights. The boats contained 2,000 pounds of marijuana.


In the last five years, as U.S. authorities have become increasingly successful at blocking traditional land routes, smugglers have taken increasingly to the sea — ferrying both drugs and immigrants. Authorities believe a smuggling vessel is launched toward California every three days; the number of immigrants and smugglers arrested at sea or along the coast more than doubled to 867 in 2010 from the previous year.


Drug runners and human smugglers have run ashore at a dog beach in Del Mar, at Crystal Cove in Orange County and next to the San Onofre nuclear power plant. Border Patrol agents have been diverted from land to sea, and an agency supervisor recently called the ocean "the front line."


The eruption in sea-based smuggling has created the same cat-and-mouse game in the ocean that has long existed along the U.S.-Mexico border. Smuggling boats often travel without lights and at a slow speed to limit their wakes. When U.S. agents began disrupting routes into San Diego beaches, smugglers began conducting counter-surveillance, using radios to direct boat pilots to unguarded beaches.


scott.gold@latimes.com





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Specs surface for alleged low-end $99 Nexus 7












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Vietnam Veterans, Claiming PTSD, Sue for Better Discharges





NEW HAVEN — In the summer of 1968, John Shepherd Jr. enlisted in the Army, figuring that the draft would get him anyway. By January 1969, he was in the Mekong Delta, fighting with the Ninth Infantry Division.




Within a month, his patrol was ambushed, and Mr. Shepherd responded by tossing a hand grenade into a bunker that killed several enemy soldiers. The Army awarded him a Bronze Star with a valor device, one of its highest decorations.


Yet the medal did little to assuage Mr. Shepherd’s sense of anxiousness and futility about the war. A few weeks after his act of heroism, he said, his platoon leader was killed by a sniper as he tried to help Mr. Shepherd out of a canal. It was a breaking point: his behavior became erratic, and at some point he simply refused to go on patrol.


“I never felt fear like I felt when he got shot,” Mr. Shepherd said last week.


After a court-martial, the Army discharged Mr. Shepherd under other-than-honorable conditions, then known as an undesirable discharge. At the time, he was happy just to be a civilian again. But he came to rue that discharge, particularly after his claim for veterans benefits was denied because of it.


Today, Mr. Shepherd, 65, is part of a class-action lawsuit against the armed forces arguing that he and other Vietnam veterans had post-traumatic stress disorder when they were issued other-than-honorable discharges. The suit, filed in Federal District Court, demands that their discharges be upgraded.


The suit raises two thorny issues that could affect thousands of Vietnam veterans: Can they be given a diagnosis of PTSD retroactively, to their time in service, though the disorder was not identified until 1980? And if they can, should recently instituted policies intended to protect troops with PTSD be applied retroactively to their cases?


Mr. Shepherd’s legal team, students with the Yale Law School veterans legal clinic, argues yes on both counts. In court papers, they assert that it is reasonable to assume that Mr. Shepherd and other veterans who were later given PTSD diagnoses began exhibiting troublesome symptoms while in service.


Moreover, under rules put in place during the Iraq war, troops who say they have PTSD must be given medical examinations before they are forced out of the military, to ensure that problematic behavior is not linked to the disorder. If they are given a PTSD diagnosis, service members may still receive an honorable discharge.


“Vietnam War-era veterans, in contrast, have been denied this opportunity for appropriate consideration of the PTSD,” the students said in the complaint.


But the Army says no. In a rejection of an earlier request by Mr. Shepherd to upgrade his discharge, the Army tersely rejected evidence that his misconduct 43 years ago was linked to PTSD and raised questions about whether his platoon leader was actually killed.


A spokesman for the Army said the military has a policy of not discussing pending litigation.


The details of Mr. Shepherd’s case aside, the suit could have a wide impact. The Yale team says that its review of records from 2003 to 2012 shows that 154 Vietnam-era veterans petitioned the Army to upgrade discharges because of PTSD, but that only two were successful. Yet the Army Board of Corrections for Military Records granted upgrades nearly half of the time for other cases.


The students estimate that more than a quarter million Vietnam-era veterans were discharged under other-than-honorable conditions, and that thousands of those probably had PTSD. Their suit names as defendants the secretaries for the Army, Air Force and Navy. Vietnam Veterans of America, the veterans service organization, is joining the case as a plaintiff on Monday.


Discharges that are other than honorable can make it harder for veterans to find work and also disqualify them for veterans benefits.


In Mr. Shepherd’s case, a Department of Veterans Affairs doctor in 2004 gave him a diagnosis of service-connected PTSD. As a result, the department will provide health care for his PTSD. But it will not provide him general medical care, unless he is found to have other health problems related to his service.


Veterans disability compensation is also a problem. Mr. Shepherd’s undesirable discharge was actually upgraded to a general discharge in the 1970s under a special Carter administration program. That upgrade should have made it easier for him to apply for disability compensation. But subsequent legislation enacted by Congress said that clemency upgrades like Mr. Shepherd’s did not automatically qualify veterans for benefits. Mr. Shepherd’s compensation claim was ultimately rejected.


Mr. Shepherd, who has been divorced twice and battled through alcoholism and drug abuse, lives in New Haven, getting by on Social Security and a Teamsters pension. (He drove trucks for years.) He could use the extra money from disability compensation, but what matters as much, he says, is removing the stain of his discharge.


“I want that honorable,” he said. “I did do my part, until I really felt it wasn’t worth getting killed for.”


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Chinatrust Bank to move U.S. headquarters to downtown L.A.









Chinatrust Bank has agreed to move its U.S. headquarters to downtown Los Angeles from Torrance.


The bank will rent two floors in 801 Tower, a company representative said. The high-rise is in the financial district north of Staples Center.


"We wanted to be in a major financial area," said Brian Gregson, head of U.S. retail banking at Chinatrust. "This is the early stage of getting our ducks in a row to start some expansion."





The bank's name will be affixed on top of the 25-story tower at 801 S. Figueroa St., he said.


Chinatrust, which is based in Taiwan, has 12 branches in the United States, including seven in Southern California. The bank will move about 175 employees to the new headquarters by the middle of next year, Gregson said.


Terms of the lease with landlord Mani Bros. Real Estate Group were not disclosed, but data provider CoStar said the agreement is for 10 years. At current rents, the lease for nearly 40,000 square feet would be valued at nearly $20 million.


Chinatrust's decision to move to downtown L.A. is part of a recent trend for businesses to relocate their main offices to the financial center, reversing the exodus of previous decades, real estate broker Ted Simpson of Cushman & Wakefield said.


"This speaks to the emergence of downtown L.A. as a corporate headquarters destination not seen since the 1980s," said Simpson, who represented the bank in the transaction with his partner Michael Ma.


Other companies to recently move their main offices or regional headquarters downtown include law firm Haight Brown Bonesteel and architecture firm Gensler.


"Corporations are once again choosing downtown for its attractiveness to its employees, not just low cost," Simpson said.


Average rents are cheaper downtown than on the popular Westside, in part because downtown has higher vacancy. Large corporations including Arco and First Interstate Bank left downtown in past decades or substantially reduced their offices.


Apartments going up in N. Hollywood


Apartment complexes planned before the demise of redevelopment agencies in California continue to rise in North Hollywood.


The projects in the NoHo Arts District near the northern terminus of the Red Line subway include the recently completed NoHo Senior Villas for elderly low-income tenants.


A larger, $50-million market-rate complex is under construction nearby and has reached its top height of six stories.


Phoenix developer Alliance Residential Co. is building the 308-unit market-rate complex called the Ferrara at 5031 Fair Ave. It is intended to be resort-like with outdoor dining facilities and bars, pools, cabanas and an outdoor movie venue.


"Our goal is to create a luxurious urban getaway for the residents," said Jonas Bronk of Alliance.


The Ferrara is slated for completion late next year.


NoHo Senior Villas, at 5525 Klump Ave., has 49 units and was built by Clifford Beers Housing and PATH Ventures for $16 million. Most of the units are reserved for seniors who were homeless and are living with a mental illness. The five-story complex has on-site facilities for mental health and social service personnel.


Both projects were designed by Killefer Flammang Architects of Santa Monica.


Also recently completed in North Hollywood was the $32-million NoHo Senior Arts Colony. It is intended for residents age 62 and over with interests in such pursuits as singing, acting, photography and writing.


The two senior housing projects are in the former North Hollywood Redevelopment Project Area, which offered tax breaks to developers. State officials dissolved local redevelopment agencies this year to save money.


roger.vincent@latimes.com





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After a billion, what next for Facebook?









MENLO PARK — In just eight years, Facebook signed up more than half the world's Internet population.


Now it's going after the rest.


Facebook wants to reach every single person on the Internet whether they are logging on from a laptop in Santa Monica, an iPhone in Tokyo or a low-tech phone with a tiny screen in Nairobi.





It's parachuting into market after market to take on homegrown social networks by currying favor with the locals and venturing where many people have spotty — if any — access to the Internet.


In Japan, it lets users list their blood types, which the Japanese believe — like astrological signs in the Western world — give insight into personality and temperament. In Africa, Facebook markets a stripped-down, text-only version of its service that works on low-tech mobile phones.


International growth is crucial to maintain its dominance as the world's largest social network. The company's scorching pace of growth has cooled especially in the United States. Facebook must coax users to sign up — and make sure it remains popular with the users it already has — or risk being knocked from its lofty perch.


"We're not a company that is just trying to add more people," said Chris Cox, Facebook's vice president of product. "What we are trying to do is build a service that everyone in the world can use."


But overseas growth that once seemed to come so easily is slower now. Facebook has already saturated most major markets around the globe. Eight out of 10 Facebook users are outside of the U.S.


"I don't think that Facebook has a chance of attracting another billion users," Wedbush Securities analyst Michael Pachter said.


Inside Facebook's Menlo Park, Calif., headquarters is a small army out to prove naysayers wrong. Above their desks they have hung flags from around the world that represent their nationalities. They obsessively scan screens that track user growth around the world.


They cheered and popped open champagne in September when the number of active Facebook users crossed 1 billion. But the moment of jubilation quickly passed as they redoubled their efforts to spread Facebook around the globe.


Naomi Gleit is the soft-spoken, headstrong 29-year-old product manager in charge of growth at Facebook. She says Facebook's future is on mobile devices, the medium by which most people will experience the Web in coming years. Facebook now works on more than 2,500 different phones, helping it gain a foothold in emerging markets. And it is forging relationships with mobile phone operators around the world.


Gleit's 150-member team has boots on the ground in far-flung places armed with low-tech phones and cheap data plans. Even team members here carry Nokia phones alongside their iPhones to update their status or check their News Feed.


"We originally built a product for ourselves," Gleit said. "This is different. Now we need to understand the experience of users who are not like us."


Analysts say Facebook already has established an impressive track record of uprooting entrenched competitors. In Britain, it displaced the dominant social network Bebo, forcing AOL to sell it at a huge loss. In Germany, Facebook overtook the homegrown StudiVZ. Facebook even broke Google social network Orkut's stranglehold on Brazil and India.


In 2009, it launched a clever tool to help Facebook users find their Orkut friends on Facebook and instantly send them friend requests. Two years later it swiped Google's top executive in Latin America, Alexandre Hohagen. Facebook sprinted ahead of Orkut one year ago, and now has 61 million active users in Latin America's largest country.


Facebook is treating India as a test lab for how it can spread in other emerging markets such as Indonesia. Facebook, which has offices in Hyderabad, India, has grown from 8 million users in 2010 to 65 million users today. It is aggressively targeting India's youth. A few hundred young Indian programmers recently jammed a Facebook hackathon at a Bangalore convention center to chug chai and brainstorm new apps that would appeal to their friends.


But Facebook has its eyes on a much bigger prize beyond the country's 100 million Internet users: the 900 million-plus Indians on mobile phones. Some analysts predict India will have more Facebook users than any other country including the United States by 2015.


The company also faces significant challenges in India. It must make the service captivating on low-tech mobile phones with unreliable Internet connections and it must gingerly navigate demands from the Indian government to remove objectionable content without alienating users.


Facebook is making some of its biggest moves in Russia, South Korea and Japan, the only major markets where it operates but has penetration of less than 50%, according to research firm ComScore.





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Katzenberg, Spielberg attend Governors Awards

LOS ANGELES (AP) — Stars such as Steven Spielberg and George Lucas are arriving at the Hollywood and Highland Center in Los Angeles to pay homage to four industry heavyweights.

The film academy's fourth annual Governors Awards are being presented Saturday to honorary Oscar winners Jeffrey Katzenberg, stuntman Hal Needham, documentarian D.A. Pennebaker and American Film Institute founding director George Stevens Jr.

The four men will accept their Oscar statuettes during the Academy of Motion Picture Arts and Sciences' private dinner program in the Ray Dolby Ballroom. Portions of the untelevised event may be included in the Feb. 24 Academy Awards telecast.

Other guests expected at Saturday's ceremony include Quentin Tarantino, Bradley Cooper, Kristen Stewart, Bryan Cranston and Oscar host Seth MacFarlane.

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After a billion, what next for Facebook?









MENLO PARK — In just eight years, Facebook signed up more than half the world's Internet population.


Now it's going after the rest.


Facebook wants to reach every single person on the Internet whether they are logging on from a laptop in Santa Monica, an iPhone in Tokyo or a low-tech phone with a tiny screen in Nairobi.





It's parachuting into market after market to take on homegrown social networks by currying favor with the locals and venturing where many people have spotty — if any — access to the Internet.


In Japan, it lets users list their blood types, which the Japanese believe — like astrological signs in the Western world — give insight into personality and temperament. In Africa, Facebook markets a stripped-down, text-only version of its service that works on low-tech mobile phones.


International growth is crucial to maintain its dominance as the world's largest social network. The company's scorching pace of growth has cooled especially in the United States. Facebook must coax users to sign up — and make sure it remains popular with the users it already has — or risk being knocked from its lofty perch.


"We're not a company that is just trying to add more people," said Chris Cox, Facebook's vice president of product. "What we are trying to do is build a service that everyone in the world can use."


But overseas growth that once seemed to come so easily is slower now. Facebook has already saturated most major markets around the globe. Eight out of 10 Facebook users are outside of the U.S.


"I don't think that Facebook has a chance of attracting another billion users," Wedbush Securities analyst Michael Pachter said.


Inside Facebook's Menlo Park, Calif., headquarters is a small army out to prove naysayers wrong. Above their desks they have hung flags from around the world that represent their nationalities. They obsessively scan screens that track user growth around the world.


They cheered and popped open champagne in September when the number of active Facebook users crossed 1 billion. But the moment of jubilation quickly passed as they redoubled their efforts to spread Facebook around the globe.


Naomi Gleit is the soft-spoken, headstrong 29-year-old product manager in charge of growth at Facebook. She says Facebook's future is on mobile devices, the medium by which most people will experience the Web in coming years. Facebook now works on more than 2,500 different phones, helping it gain a foothold in emerging markets. And it is forging relationships with mobile phone operators around the world.


Gleit's 150-member team has boots on the ground in far-flung places armed with low-tech phones and cheap data plans. Even team members here carry Nokia phones alongside their iPhones to update their status or check their News Feed.


"We originally built a product for ourselves," Gleit said. "This is different. Now we need to understand the experience of users who are not like us."


Analysts say Facebook already has established an impressive track record of uprooting entrenched competitors. In Britain, it displaced the dominant social network Bebo, forcing AOL to sell it at a huge loss. In Germany, Facebook overtook the homegrown StudiVZ. Facebook even broke Google social network Orkut's stranglehold on Brazil and India.


In 2009, it launched a clever tool to help Facebook users find their Orkut friends on Facebook and instantly send them friend requests. Two years later it swiped Google's top executive in Latin America, Alexandre Hohagen. Facebook sprinted ahead of Orkut one year ago, and now has 61 million active users in Latin America's largest country.


Facebook is treating India as a test lab for how it can spread in other emerging markets such as Indonesia. Facebook, which has offices in Hyderabad, India, has grown from 8 million users in 2010 to 65 million users today. It is aggressively targeting India's youth. A few hundred young Indian programmers recently jammed a Facebook hackathon at a Bangalore convention center to chug chai and brainstorm new apps that would appeal to their friends.


But Facebook has its eyes on a much bigger prize beyond the country's 100 million Internet users: the 900 million-plus Indians on mobile phones. Some analysts predict India will have more Facebook users than any other country including the United States by 2015.


The company also faces significant challenges in India. It must make the service captivating on low-tech mobile phones with unreliable Internet connections and it must gingerly navigate demands from the Indian government to remove objectionable content without alienating users.


Facebook is making some of its biggest moves in Russia, South Korea and Japan, the only major markets where it operates but has penetration of less than 50%, according to research firm ComScore.





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South L.A. frustrated by delays in building new King hospital









Earlier this year, Joane Austin rushed her elderly mother to the emergency room for fear she was having a heart attack.


Austin normally would have made the short trip to Martin Luther King Jr./Drew Medical Center, the landmark hospital in South Los Angeles. But King/Drew has been closed for five years, so Austin drove several miles to the emergency room at Centinela Hospital Medical Center in Inglewood.


"I prayed all the lights would stay green," she said. "It was scary."





Once they arrived, doctors determined that Austin's mother needed emergency surgery to remove scar tissue around her intestines.


For years, King/Drew provided emergency, trauma and inpatient care to residents from throughout South Los Angeles. After a series of medical errors resulted in patient deaths, Los Angeles County closed it in 2007. County officials promised the community a better, safer new medical center in a few years.


But the opening has been repeatedly delayed, and the community is still waiting. Originally, officials hoped to have the new facility ready by 2010. Then it was pushed to 2012. Now, officials say they plan to have construction completed next year and the hospital opening its doors in 2014.


Without a nearby hospital, patients have had to travel to such places as Bellflower, Inglewood and Long Beach for emergency room and inpatient care.


Several local hospitals — California Hospital Medical Center, L.A. County/USC Medical Center and Harbor-UCLA Medical Center — received an influx of former King patients after the closure. The closest hospital, St. Francis Medical Center in Lynwood, reported an increase of 20% to 30% in emergency room visits since King/Drew closed, though other factors also may have contributed to the rise.


Getting to other hospitals has presented a challenge for many in the low-income neighborhood, said William Hobson, president and chief executive of the Watts Healthcare Corp. "Just the fact that it is a long way away may discourage them from going," he said.


The closure of King/Drew, which was born out of the Watts riots and opened in 1972, created a healthcare gap in a community where rates of chronic disease are high and vast swaths of the population lack insurance, said David Carlisle, president of the adjacent Charles R. Drew University of Medicine and Science. South Los Angeles has a shortage of doctors, inpatient beds and outpatient services, according to both experts and research.


Despite King/Drew's many medical lapses, which earned it the nickname "Killer King," many in the community remained fiercely loyal to the hospital and the services it provided.


Studies examining the impact of King/Drew's closure found that it led to delays in care for elderly blacks and Latinos and a dramatic increase in patient admissions at other trauma centers. Physicians throughout the county also reported more overcrowding in other emergency rooms and said they saw sicker patients who didn't know where to go or couldn't afford transportation elsewhere.


"It is fearful to think about how many lives may have been saved had this thing been opened by now," said Lark Galloway-Gilliam, executive director of the advocacy group Community Health Councils. "It shouldn't take five years to build a facility."


Patrick Wooten, 49, went to St. Francis when he had a dislocated kneecap a few years ago. Wooten, who is uninsured, said he received good care at the private hospital but then got a $3,200 bill. Wooten said he is frustrated that the new King hospital still hasn't opened and won't until 2014. "What you do until then, God only knows," he said. "Hopefully we can wait it out."


Last year, Sandira Gonzalez, 29, took her 5-year-old son to the Martin Luther King urgent care center when he had a fever. But when the center closed for the night, her son had to be taken by ambulance to Harbor-UCLA near Torrance, where he was treated for an infection.


Community members and advocates said they are disappointed by the long wait, caused by a combination of bureaucratic delays and the complexity of the project. But when it does open, they said, they are hopeful that it will be a better, and safer, hospital.


The county is building the hospital and will help support it financially but will not be responsible for day-to-day operations. Instead, an independent, nonprofit organization will run the facility, to be known as Martin Luther King Jr. Community Hospital, and the University of California will help staff it and ensure the quality of patient care. Construction is progressing, but the grand opening may still be nearly two years away.


"It will be a significantly different kind of institution, with the right kind of accountability," said Robert K. Ross, president and chief executive of the California Endowment. "Now we just need the institution to open up on budget and on time."


Los Angeles County Supervisor Mark Ridley-Thomas said it takes time to create a state-of-the-art hospital — and a whole medical complex — that could become a model for others around the nation. "A lot of eyes are on this," he said. "We want to do this well and we want to do it right.... Nothing else is acceptable."


The nonprofit's board recognizes how critical the facility is to the area, said board President Manny Abascal. "Every day this hospital is not open, people are suffering," he said. At the same time, he added, the board is committed to ensuring that the new hospital is a high-quality institution. "If you open it … and there are some of the same problems you had before, then it's going to be devastating," he said.





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Glen Campbell considering more live shows in 2013

NASHVILLE, Tenn. (AP) — Glen Campbell may be wrapping up a goodbye tour but that doesn't mean he's done with the stage.

Campbell is considering scheduling more shows next year after playing more than 120 dates in 2012.

The 76-year-old singer has Alzheimer's disease and has begun to lose his memory. He put out his final studio album, "Ghost on the Canvas," in 2011 and embarked on the tour with family members and close friends serving in his band and staffing the tour.

Campbell's longtime manager Stan Schneider said in a phone interview from Napa, Calif., where the tour wrapped for the year Friday night, that recent West Coast shows have been some of the singer's strongest. Campbell will break for the holidays and if he still feels strong he'll begin scheduling more shows.

___

Online:

http://glencampbellmusic.com

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Doctors Who Work for Hospitals Face a New Bottom Line





For decades, doctors in picturesque Boise, Idaho, were part of a tight-knit community, freely referring patients to the specialists or hospitals of their choice and exchanging information about the latest medical treatments.




But that began to change a few years ago, when the city’s largest hospital, St. Luke’s Health System, began rapidly buying physician practices all over town, from general practitioners to cardiologists to orthopedic surgeons.


Today, Boise is a medical battleground.


A little over half of the 1,400 doctors in southwestern Idaho are employed by St. Luke’s or its smaller competitor, St. Alphonsus Regional Medical Center.


Many of the independent doctors complain that both hospitals, but especially St. Luke’s, have too much power over every aspect of the medical pipeline, dictating which tests and procedures to perform, how much to charge and which patients to admit.


In interviews, they said their referrals from doctors now employed by St. Luke’s had dropped sharply, while patients, in many cases, were paying more there for the same level of treatment.


Boise’s experience reflects a growing national trend toward consolidation. Across the country, doctors who sold their practices and signed on as employees have similar criticisms. In lawsuits and interviews, they describe growing pressure to meet the financial goals of their new employers — often by performing unnecessary tests and procedures or by admitting patients who do not need a hospital stay.


In Boise, just a few weeks ago, even the hospitals were at war. St. Alphonsus went to court seeking an injunction to stop St. Luke’s from buying another physician practice group, arguing that the hospital’s dominance in the market was enabling it to drive up prices and to demand exclusive or preferential agreements with insurers. The price of a colonoscopy has quadrupled in some instances, and in other cases St. Luke’s charges nearly three times as much for laboratory work as nearby facilities, according to the St. Alphonsus complaint.


Federal and state officials have also joined the fray. In one of a handful of similar cases, the Federal Trade Commission and the Idaho attorney general are investigating whether St. Luke’s has become too powerful in Boise, using its newfound leverage to stifle competition.


Dr. David C. Pate, chief executive of St. Luke’s, denied the assertions by St. Alphonsus that the hospital’s acquisitions had limited patient choice or always resulted in higher prices. In some cases, Dr. Pate said, services that had been underpriced were raised to reflect market value. St. Luke’s, he argued, is simply embracing the new model of health care, which he predicted would lead over the long term to lower overall costs as fewer unnecessary tests and procedures were performed.


Regulators expressed some skepticism about the results, for patients, of rapid consolidation, although the trend is still too new to know for sure. “We’re seeing a lot more consolidation than we did 10 years ago,” said Jeffrey Perry, an assistant director in the F.T.C.’s Bureau of Competition. “Historically, what we’ve seen with the consolidation in the health care industry is that prices go up, but quality does not improve.”


A Drive to Consolidate


An array of new economic realities, from reduced Medicare reimbursements to higher technology costs, is driving consolidation in health care and transforming the practice of medicine in Boise and other communities large and small. In one manifestation of the trend, hospitals, private equity firms and even health insurance companies are acquiring physician practices at a rapid rate.


Today, about 39 percent of doctors nationwide are independent, down from 57 percent in 2000, according to estimates by Accenture, a consulting firm.


Many policy experts praise the shift away from independent practices as a way of making health care less fragmented and expensive. Systems that employ doctors, modeled after well-known organizations like Kaiser Permanente, are better able to coordinate patient care and to find ways to deliver improved services at lower costs, these advocates say. Indeed, consolidation is encouraged by some aspects of the Obama administration’s health care law.


“If you’re going to be paid for value, for performance, you’ve got to perform together,” said Dr. Ricardo Martinez, chief medical officer for North Highland, an Atlanta-based consultant that works with hospitals.


The recent trend is reminiscent of the consolidation that swept the industry in the 1990s in response to the creation of health maintenance organizations, or H.M.O.’s — but there is one major difference. Then, hospitals had difficulty managing the practices, contending that doctors did not work as hard when they were employees as they had as private operators. Now, hospitals are writing contracts more in their own favor.


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