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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Aides: Chavez in tough fight, may miss swearing-in

CARACAS, Venezuela (AP) — Somber confidants of President Hugo Chavez say he is going through a difficult recovery after cancer surgery in Cuba, and one close ally is warning Venezuelans that their leader may not make it back for his swearing-in next month.

Information Minister Ernesto Villegas said Wednesday night that Chavez was in “stable condition” and was with close relatives in Havana. Reading a statement, he said the government invites people to “accompany President Chavez in this new test with their prayers.”

Villegas expressed hope about the president returning home for his Jan. 10 swearing-in for a new six-year term, but said in a written message on a government website that if Chavez doesn’t make it, “our people should be prepared to understand it.”

Villegas said it would be irresponsible to hide news about the “delicateness of the current moment and the days to come.” He asked Venezuelans to see Chavez’s condition as “when we have a sick father, in a delicate situation after four surgeries in a year and a half.”

Moving to prepare the public for the possibility of more bad news, Vice President Nicolas Maduro looked grim when he acknowledged that Chavez faced a “complex and hard” process after his latest surgery.

At the same time, officials sought to show a united front amid the growing worries about Chavez’s health and Venezuela’s future. Key leaders of Chavez’s party and military officers appeared together on television as Maduro gave updates on Chavez’s condition.

“We’re more united than ever,” said Maduro, who was flanked by National Assembly President Diosdado Cabello and Oil Minister Rafael Ramirez, both key members of Chavez’s inner circle. “We’re united in loyalty to Chavez.”

Analysts say Maduro could eventually face challenges in trying to hold together the president’s diverse “Chavismo” movement, which includes groups from radical leftists to moderates, as well as military factions.

Tapped by the 58-year-old president over the weekend as his chosen political heir, Maduro is considered to be a member of radical left wing of Chavez’s movement that is closely aligned with Cuba’s communist government.

Cabello, a former military officer who also wields power within Chavez’s movement, shared the spotlight with Maduro by speaking at a Mass for Chavez’s health at a military base.

Just returned from being with Chavez for the operation, Cabello called the president “invincible” but said “that man who is in Havana … is fighting a battle for his life.”

After Chavez’s six-hour operation Tuesday, Venezuelan television broadcast religious services where people prayed for Chavez, interspersed with campaign rallies for upcoming gubernatorial elections.

On the streets of Caracas, people on both sides of the country’s deep political divide voiced concerns about Chavez’s condition and what might happen if he died.

At campaign rallies ahead of Sunday’s gubernatorial elections, Chavez’s candidates urged Venezuelans to vote for pro-government candidates while they also called for the president to get well.

“Onward, Commander!” gubernatorial candidate Elias Jaua shouted to a crowd of supporters at a rally Wednesday. Many observers said it was likely Chavez’s candidates could get a boost from their supporters’ outpouring of sympathy for Chavez.

Opposition leader Henrique Capriles, who lost to Chavez in the October presidential election and is running against Jaua, complained Wednesday that Chavez’s allies are taking advantage of the president’s health problems to try to rally support. He took issue with Jaua’s statement to supporters that “we have to vote so that the president recovers.”

Maduro looked sad as he spoke on television, his voice hoarse and cracked at times after meeting in the pre-dawn hours with Cabello and Ramirez. The pair returned to Venezuela about 3 a.m. after accompanying Chavez to Cuba for his surgery.

“It was a complex, difficult, delicate operation,” Maduro said. “The post-operative process is also going to be a complex and hard process.”

Without giving details, Maduro reiterated Chavez’s recent remarks that the surgery presented risks and that people should be prepared for any “difficult scenarios.”

The constitution says presidents should be sworn in before the National Assembly, and if that’s not possible then before the Supreme Court.

Former Supreme Court magistrate Roman Duque Corredor said a president cannot delegate the swearing-in to anyone else and cannot take the oath of office outside Venezuela. A president could still be sworn in even if temporarily incapacitated, but would need to be conscious and in Venezuela, Duque told The Associated Press.

If a president-elect is declared incapacitated by lawmakers and is unable to be sworn in, the National Assembly president would temporarily take charge of the government and a new presidential vote must be held within 30 days, Duque said.

Chavez said Saturday that if an election had to be held, Maduro should be elected president.

The dramatic events of this week, with Chavez suddenly taking a turn for the worse, had some Venezuelans wondering whether they were being told the truth because just a few months ago the president was running for his fourth presidential term and had said he was free of cancer.

Lawyer Maria Alicia Altuve, who was out in bustling crowds in a shopping district of downtown Caracas, said it seemed odd how Maduro wept at a political rally while talking about Chavez.

“He cries on television to set up a drama, so that people go vote for poor Chavez,” Altuve said. “So we don’t know if this illness is for that, or if it’s that this man is truly sick.”

Some Chavez supporters said they found it hard to think about losing the president and worried about the future. His admirers held prayer vigils in Caracas and other cities this week, holding pictures and singing hymns.

Chavez has undergone four cancer-related surgeries since June 2011. He has also undergone months of chemotherapy and radiation treatments. Throughout his treatments, Chavez has kept secret some details of his illness, including the exact location and type of the tumors.

Ecuadorean President Rafael Correa wished his close ally the best, while also acknowledging the possibility that cancer might end his presidency. “Chavez is very important for Latin America, but if he can’t continue at the head of Venezuela, the processes of change have to continue,” Correa said at a news conference in Quito.

___

Associated Press writer Christopher Toothaker contributed to this report.

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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.

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“The Voice” finale taps Rihanna, Kelly Clarkson, Bruno Mars and the Killers

LOS ANGELES (TheWrap.com) – The season finale of “The Voice” has enlisted some high-profile talent to help send the show’s third cycle off with a bang.

Rihanna, Kelly Clarkson, Bruno Mars and The Killers have been tapped to perform on the two-hour extravaganza, which will culminate with the crowning of a new champion, NBC said Wednesday.

An additional special guest will be named at a later date, the network added.

Rihanna will perform her song “Diamonds,” while “American Idol” alum Clarkson – who has served as a guest mentor on the show, as well as hosting the rival singing competition “Duets” – is set to sing “Catch My Breath.”

The Killers, meanwhile, will play their single “Runaways,” and Mars will debut the song “When I Was Your Man” from his sophomore album “Unorthodox Jukebox,” which was released Tuesday.

The season finale of “The Voice” will air live on December 18 at 8 p.m.

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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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Why more didn't die in Ore. mall shooting

Citizens' coolheadedness and individual preparation for coping with gunfire in public settings may have curtailed the casualty count from Tuesday's shooting at a Portland, Ore., shopping mall, law officers suggested on the day after the tragedy.

Two people died and one was critically wounded before the shooter, 22-year-old Jacob Tyler Roberts of Portland, killed himself a few minutes after running into the food court at the Clackamas Town Center mall. Officials say Mr. Roberts, wearing camouflage and a white hockey mask, had methodically fired "multiple" rounds from an assault-style rifle at random shoppers.

Most of the 10,000 Christmas shoppers at the mall appeared nearly as ready and able as police to deal with a gunman appearing suddenly in their midst, Clackamas County Sheriff Craig Roberts said on Wednesday.

"Many people have asked me why there were so few victims during this incident," said Sheriff Roberts. He listed the fact that Mr. Roberts's AR-15 semiautomatic rifle intermittently jammed and noted a well-practiced mall lockdown procedure. But he also credited "10,000 people in the mall who at one time kept a level head, got themselves out of the mall, helped others get out, secured themselves in stores.… It was really about a whole group of people coming together to make a difference."

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Law officers said during a Wednesday press conference that they did not know whether any member of the public carrying a concealed weapon had counterattacked Roberts. But they said they are certain that Roberts died by his own hand after fleeing down a stairwell from the mall's upper level.

The death rate from mass shootings has ticked up slightly in recent years, even as deaths in single-victim incidents have decreased, according to a recent analysis of FBI crime data by the Huffington Post. The worst recent mass shooting came in July in Aurora, Colo., where a gunman killed 12 people and injured 58 during a midnight screening of a new "Batman" movie.

Gun-control advocates seized on the mall shooting as a possible result of the expiration in 2004 of a national ban on assault weapons.

"Santa Claus could have been shot in the mall," said Penny Okamoto, executive director of Ceasefire Oregon, in an interview with the Portland Tribune. "If you're sick of this, you should call your legislators to tell them to fix the laws so that assault weapons don't end up in the hands of felons."

Many versions of the AR-15 were banned under the assault weapons law, but it's not known if the gun used in the Clackamas mall shooting was one of them.

Police said Roberts had no criminal record and had stolen the AR-15 from "someone he knew."

Does the collected response by shoppers at the Clackamas Town Center indicate that Americans are becoming less daunted by senseless violence and, perhaps, better ready to react? Those who back broad gun rights under the Constitution's Second Amendment suggest a shift may be under way in people's readiness to respond.

In blocking Illinois's ban on concealed weapons, the last such law in the nation, Seventh US Circuit Court of Appeals Judge Richard Posner on Tuesday implied that self-defense readiness in public is not only protected by the US Constitution, but may be good social policy. An awareness "that many law-abiding citizens are walking the streets armed may make criminals timid," he wrote in his ruling.

"As far as a social shift, I think people are getting more intelligent and appropriate in their reactions to shooters," says Dave Kopel, research director at the Independence Institute, a libertarian-leaning think tank in Golden, Colo. "Police training has changed in significant ways since the Columbine [High School] shooting [in 1999], where they no longer wait for the SWAT team to arrive but go in immediately with … the army they have. There's also an awareness [among police and the public] that if you're trying to stop a gangster from robbing a liquor store, you may have a [heck] of a fight on your hands, but that these publicity-seeking guys with mental illness, they basically crumble at first opposition."

The upshot, says Mr. Kopel: "Lying down and cowering doesn't seem to work very well, so law enforcement has gotten smarter and civilians have gotten smarter."

In Clackamas County, Sheriff Roberts said local law-enforcement personnel had trained earlier this year for a shooting scenario at Clackamas Town Center, an exercise that involved both police and retailers. On Tuesday, arriving police, in keeping with evolving police tactics nationwide, formed small teams and quickly entered the mall to pursue the shooter. Police could not say Wednesday whether any officers saw the shooter before he killed himself.

Dennis Curtis, the mall's general manager, noted that police officers told him that they were amazed "how many stores were secured and people were locked in place" upon entering the mall to look for the shooter.

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North Korea’s new leader burnishes credentials with rocket

SEOUL/TOKYO (Reuters) – North Korea successfully launched a rocket on Wednesday, boosting the credentials of its new leader and stepping up the threat the isolated and impoverished state poses to its opponents.

The rocket, which North Korea says put a weather satellite into orbit, has been labeled by the United States, South Korea and Japan as a test of technology that could one day deliver a nuclear warhead capable of hitting targets as far as the continental United States.

“The satellite has entered the planned orbit,” a North Korean television news-reader clad in traditional Korean garb triumphantly announced, after which the station played patriotic songs with the lyrics “Chosun (Korea) does what it says”.

The rocket was launched just before 10 a.m. Korea time (9 p.m. ET on Tuesday), according to defense officials in South Korea and Japan, and easily surpassed a failed April launch that flew for less than two minutes.

The North American Aerospace Defense Command (NORAD) said that it “deployed an object that appeared to achieve orbit”, the first time an independent body has verified North Korean claims.

North Korea followed what it said was a similar successful launch in 2009 with a nuclear test that prompted the United Nations Security Council to stiffen sanctions that it originally imposed in 2006 after the North’s first nuclear test.

The state is banned from developing nuclear and missile-related technology under U.N. resolutions, although Kim Jong-un, the youthful head of state who took power a year ago, is believed to have continued the state’s “military first” programs put into place by his deceased father Kim Jong-il.

North Korea lauded Wednesday’s launch as celebrating the prowess of all three Kims to rule since it was founded in 1948.

“At a time when great yearnings and reverence for Kim Jong-il pervade the whole country, its scientists and technicians brilliantly carried out his behests to launch a scientific and technological satellite in 2012, the year marking the 100th birth anniversary of President Kim Il Sung,” its KCNA news agency said.

Washington condemned Wednesday’s launch as a “provocative action” and breach of U.N. rules, while Japan’s U.N. envoy called for a Security Council meeting. However, diplomats say further tough sanctions are unlikely to be agreed at the body as China, the North’s only major ally, will oppose them.

“The international community must work in a concerted fashion to send North Korea a clear message that its violations of United Nations Security Council resolutions have consequences,” the White House said in a statement.

Japan’s likely next prime minister, Shinzo Abe, who is leading in opinion polls ahead of an election on December 16 and who is known as a North Korea hawk, called on the United Nations to adopt a resolution “strongly criticizing” Pyongyang.

BEIJING BLOCK

China had expressed “deep concern” prior to the launch which was announced a day after a top politburo member, representing new Chinese leader Xi Xinping, met Kim Jong-un in Pyongyang.

On Wednesday its tone was measured, regretting the launch but calling for restraint on possible counter-measures, in line with previous policy when it has effectively vetoed tougher sanctions.

“China believes the Security Council’s response should be cautious and moderate, protect the overall peaceful and stable situation on the Korean peninsula, and avoid an escalation of the situation,” Chinese Foreign Ministry spokesman Hong Lei told journalists.

Bruce Klingner, a Korea expert at the Heritage Foundation, told a conference call: “China has been the stumbling block to firmer U.N. action and we’ll have to see if the new leadership is any different than its predecessors.”

A senior adviser to South Korea’s president said last week it was unlikely there would be action from the U.N. and that Seoul would expect its allies to tighten sanctions unilaterally.

Kim Jong-un, believed to be 29 years old, took power when his father died on December 17 last year and experts believe the launch was intended to commemorate the first anniversary of the death.

The April launch was timed for the centennial of the birth of Kim Il Sung, the grandfather of its current ruler.

Wednesday’s success puts the North ahead of the South which has not managed to get a rocket off the ground.

“This is a considerable boost in establishing the rule of Kim Jong-un,” said Cho Min, an expert at the Korea Institute of National Unification.

There have been few indications the secretive and impoverished state, where the United Nations estimates a third of the population is malnourished, has made any advances in opening up economically over the past year.

North Korea remains reliant on minerals exports to China and remittances from tens of thousands of its people working on labor projects overseas.

The 22 million population often needs handouts from defectors who have escaped to South Korea in order to afford basic medicines.

Given the puny size of its economy – per capita income is less than $ 2,000 a year – one of the few ways the North can attract world attention is by emphasizing its military threat.

Pyongyang wants the United States to resume aid and to recognize it diplomatically, although the April launch scuppered a planned food deal.

It is believed to be some years away from developing a functioning nuclear warhead although it may have enough plutonium for around half a dozen nuclear bombs, according to nuclear experts.

The North has also been enriching uranium, which would give it a second path to nuclear weapons as it sits on vast natural uranium reserves.

“A successful launch puts North Korea closer to the capability to deploy a weaponized missile,” said Denny Roy, a senior fellow at the East-West Center in Hawaii.

“But this would still require fitting a weapon to the missile and ensuring a reasonable degree of accuracy. The North Koreans probably do not yet have a nuclear weapon small enough for a missile to carry.”

Pyongyang says that its development is part of a civil nuclear program, but has also boasted of it being a “nuclear weapons power”.

(Additional reporting by Jumin Park and Yoo Choonsik in SEOUL; David Alexander, Matt Spetalnick and Paul Eckert in WASHINGTON; Linda Sieg in TOKYO; Sui-Lee Wee in BEIJING; Rosmarie Francisco in MANILA; Writing by David Chance; Editing by Raju Gopalakrishnan)

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Pope Benedict offers blessings with his first tweet

VATICAN CITY (Reuters) – After weeks of anticipation, Pope Benedict sent his first tweet on Wednesday.

“Dear friends, I am pleased to get in touch with you through Twitter. Thank you for your generous response. I bless all of you from my heart.”

The tweet was sent when the 85-year-old pope tapped on a touch screen at the end of his weekly general audience in the Vatican before thousands of people.

(Reporting By Philip Pullella, editing by Paul Casciato)

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Cardiome to pay $20 million, settle debt deal with Merck

(Reuters) – Cardiome Pharma Corp said it will pay former partner Merck & Co $ 20 million by March 31 to settle debt obligations related to a licensing deal for a heart drug.

Shares of Cardiome jumped as much as 51 percent to 37 Canadian cents on the Toronto Stock Exchange on Tuesday. Its U.S.-listed shares also rose 52 percent on the Nasdaq.

The company said in September that Merck returned the global marketing and development rights for intravenous and oral versions of their heart drug, six months after dropping the development of the oral version.

The drug vernakalant is an experimental treatment for chronic atrial fibrillation, a heart rhythm disorder that can lead to stroke and heart failure.

Cardiome, which had a cash balance of $ 53.6 million at the end of September, owed Merck $ 50 million. Merck had granted Cardiome an interest-bearing credit facility of up to $ 100 million.

The companies signed the collaboration and licensing agreement for vernakalant in April 2009.

“Complete resolution of our $ 50 million debt obligation to Merck removes a significant financial and operational overhang for Cardiome,” said William Hunter, interim CEO of Cardiome, which develops drugs for diseases of the heart and circulatory system.

The settlement will terminate the credit facility and will release and discharge the collateral security taken in respect of the advances under the line of credit, Cardiome said in a statement.

Brokerage firm Canaccord Genuity raised its price target on the stock to 40 cents from 35 cents.

(Reporting by Bhaswati Mukhopadhyay in Bangalore; Editing by Roshni Menon)

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