Fewer health care options for illegal immigrants

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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With Rice out, is Kerry a lock for secretary of state?

So, it's official: Ambassador Susan Rice will not be Secretary of State — she's withdrawn and President Obama has accepted, and John McCain is twisting his face in pleasure somewhere. Which means... John Kerry, right? Well, yes, probably — all the conservatives just love him now. But speculation also puts some other options in front of the president between now and whenever Hillary Clinton steps down — including, but not limited to, her husband.

RELATED: Susan Rice Edges One Step Closer to Getting Hillary Clinton's Job

The Long Shot

Name: Richard Berman

RELATED: John Kerry Wants Hillary Clinton's Job

Credentials: 15 terms in Congress; served on important security committees; reputation for being discreet. 

RELATED: Huntsman: The Candidate Who Couldn't

Source of Speculation: A bunch of people talking about it to reporters. But not in a "we hear that Obama's thinking..." kind of way. Berman just lost re-election after his district in California was re-zoned, and the guy who beat him said he thought he might be good for the job — and so it went from there. 

RELATED: Why You Shouldn't Trust Gadget Rumors

Likelihood of Actually Getting It: Slim. Berman doesn't even have the kind of national profile necessary for such an international job, and no White House officials are leaking his name. It's all good-will consolation prize quotes from his teammates after he just lost his job. 

RELATED: John Kerry, Organic Food, and the Hair of Dorian Gray

The Really Long Shot

Name: Bill Clinton

Credentials: Served two terms as President; former Gov. of Arkansas; is insanely popular; Obama owes him a favor for helping to save his campaign with his legendary, mostly-improvised convention speech. 

Source of Speculation: Joe Nocera thinks it's a good idea, and a New York Post report from June said Clinton might be angling for the Secretary of State job under a potential Ander Cuomo Presidency if Hillary does decide not to run in 2016. "I think everyone who knows Bill Clinton knows he'd love to be secretary of state because he's so smart and because he knows so much about the world," an 'insider' told the Post.

Likelihood of Actually Getting It: Dream on.

The Fool-Me-Twice Shot

Name: Jon Huntsman

Credentials: Former Utah Gov, former Ambassador to China and Singapore, former Republican presidential candidate. 

Source of Speculation: An Associated Press report that said "officials" were looking at him for the job. 

Likelihood of Actually Getting It: Slim, for different reasons. Namely that he'd probably never accept the appointment. Huntsman was the Republican Obama's team was most scared of in the last election, and the President named him his Ambassador to China, so it's clear Obama thinks highly of him. But Huntsman has dreams of potentially running for the Big Job again, potentially against Hillary in 2016, and this would make it pretty hard — if not impossible — to get Republican support for that. 

The Safe Bet

Name: William Burns

Credentials: Current Deputy Secretary of State.

Source of Speculation: The same report that named Huntsman as a candidate. 

Likelihood of Actually Getting It: Good, if not great. He's Hillary's current number two, and he's getting good buzz with "insiders," apparently. The report that floated his name left things a bit unspectacular, though. Burns, "is a career diplomat who has no political baggage and would be unlikely to stir significant opposition among lawmakers." So, basically, he's an unsexy pick that wouldn't garner any headlines. 

The Safest Bet

Name: John Kerry

Credentials: He's getting it. 

Source of Speculation: He's getting it.

Likelihood of Actually Getting It: Guys, it's going to be Kerry. Just stop. 

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Rights group accuses Pakistani military of abuse

ISLAMABAD (AP) — Amnesty International has accused the Pakistani military of carrying out widespread human rights abuses in the country's northwest tribal region where the army is fighting a domestic Taliban insurgency.

The London-based group said in a report Thursday that the military has regularly held people without charges and tortured or otherwise mistreated them in custody.

It says some detainees do not survive and are returned to their families dead, or their corpses are dumped in remote parts of the tribal region.

The report says the military acts with impunity with the help of laws that provide cover for abuse.

The military did not immediately respond to request for comment.

Amnesty also criticized the Taliban for a range of rights abuses, including the killings of captured soldiers and innocent civilians.

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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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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."

RECOMMENDED: A Second Amendment quiz

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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China revokes new Shanghai Catholic bishop's title

BEIJING (AP) — In a fresh challenge to Vatican authority, China has revoked the title of a new Catholic bishop in Shanghai who outraged Chinese officials by immediately dropping out of the government agency that oversees the country's officially sanctioned church, religious officials said Thursday.

Ma Daqin, who was jointly named for the post in a rare consensus between Beijing and the Vatican, has been confined to a seminary since he announced his intention to drop out of the Chinese Catholic Patriotic Association in front of a congregation during his July 7 ordination as auxiliary bishop.

The move by Ma, 44, was seen as challenging China's attempts to run the country's Catholic church independently of the Vatican.

A Shanghai church official, speaking on condition of anonymity because of the sensitivity of the matter, said the decision by Chinese officials to revoke Ma's title was announced at an internal meeting this week. He said no reason was given for the revocation.

The Rev. Jeroom Heyndrickx, of Belgium's Catholic University of Leuven, and the Rev. Bernardo Cervellera, editor-in-chief of AsiaNews, said Chinese colleagues had informed them of the development earlier this week.

The Chinese Catholic Patriotic Associated declined to comment.

The Vatican does not formally recognize the association and says the Chinese church should take its orders directly from Rome. The selection of bishops has been one of the most contentious issues between the sides, with the Chinese association saying it has the right to make independent appointments in defiance of Rome's insistence that only it has that power.

Ma's announcement in July had been greeted with applause by hundreds of worshippers in Shanghai's Cathedral of St. Ignatius, the seat of one of China's largest, wealthiest and most independent dioceses. He was taken away by officials immediately after the service and has not been seen in public since, with the Shanghai diocese saying he is in retreat at the seminary at Sheshan on the outskirts of Shanghai.

Days after Ma's announcement, the Patriotic Association issued a two-sentence statement saying it was investigating his ordination. Scores of priests and nuns were interviewed and seminary classes and other internal church activities either canceled or delayed.

Another Catholic website, ucanews, said Ma had been suspended from performing priestly duties for two years and would remain in the seminary indefinitely.

Ma's ordination, with the approval of both sides, had been seen as a hopeful sign that a China-Vatican dialogue that broke down in 2010 was back on track. The pope had issued the Vatican's approval of Beijing's selection of Ma to take over as auxiliary, giving him day-to-day control over the Shanghai diocese and placing him next in line after 97-year-old Shanghai Bishop Jin Luxian.

Cervellera said the Shanghai diocese had handed Ma's case to more hardline officials in Beijing, resulting in the harsh punishment. China's officially atheistic Communist Party wants not only the right to approve bishops, but also to fire those who get out of line, he said.

"The situation is very serious," Cervellera said.

Heyndrickx, who has traveled frequently to China over the past three decades, said the action against Ma was "not conducive to dialogue" but that the situation would remain in flux until new communist leader Xi Jinping consolidates his power. Concessions would likely be needed on both sides, such as China releasing detained underground priests, and the Vatican recognizing bishops appointed without its prior agreement, he said.

"Contact, communication, and dialogue is the only way out of the current impasse," Heyndrickx said, adding that both sides would remain firm in their public statements, but that back-channel discussions would likely continue.

China has an estimated 8 million to 12 million Catholics, around half of whom worship in underground congregations. The Communist Party ordered Catholics to cut ties with the Holy See in the 1950s, and persecuted the church for years until restoring a degree of religious freedom and freeing imprisoned priests in the late 1970s.

The current tensions come five years after Pope Benedict XVI called for reconciliation between the underground and government-affiliated congregations in China. Beijing ultimately rejected the appeal as interference in its internal affairs.

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Indian sitar virtuoso Ravi Shankar dies at 92

NEW DELHI (AP) — With an instrument perplexing to most Westerners, Ravi Shankar helped connect the world through music. The sitar virtuoso hobnobbed with the Beatles, became a hippie musical icon and spearheaded the first rock benefit concert as he introduced traditional Indian ragas to Western audiences over nearly a century.

From George Harrison to John Coltrane, from Yehudi Menuhin to David Crosby, his connections reflected music's universality, though a gap persisted between Shankar and many Western fans. Sometimes they mistook tuning for tunes, while he stood aghast at displays like Jimi Hendrix's burning guitar.

Shankar died Tuesday at age 92. A statement on his website said he died in San Diego, near his Southern California home with his wife and a daughter by his side. The musician's foundation issued a statement saying that he had suffered upper respiratory and heart problems and had undergone heart-valve replacement surgery last week.

Indian Prime Minister Manmohan Singh also confirmed Shankar's death and called him a "national treasure."

Labeled "the godfather of world music" by Harrison, Shankar helped millions of classical, jazz and rock lovers discover the centuries-old traditions of Indian music.

"He was legend of legends," Shivkumar Sharma, a noted santoor player who performed with Shankar, told Indian media. "Indian classical was not at all known in the Western world. He was the musician who had that training ... the ability to communicate with the Western audience."

He also pioneered the concept of the rock benefit with the 1971 Concert For Bangladesh. To later generations, he was known as the estranged father of popular American singer Norah Jones.

His last musical performance was with his other daughter, sitarist Anoushka Shankar Wright, on Nov. 4 in Long Beach, California; his foundation said it was to celebrate his 10th decade of creating music. The multiple Grammy winner learned that he had again been nominated for the award the night before his surgery.

"It's one of the biggest losses for the music world," said Kartic Seshadri, a Shankar protege, sitar virtuoso and music professor at the University of California, San Diego. "There's nothing more to be said."

As early as the 1950s, Shankar began collaborating with and teaching some of the greats of Western music, including violinist Menuhin and jazz saxophonist Coltrane. He played well-received shows in concert halls in Europe and the United States, but faced a constant struggle to bridge the musical gap between the West and the East.

Describing an early Shankar tour in 1957, Time magazine said. "U.S. audiences were receptive but occasionally puzzled."

His close relationship with Harrison, the Beatles lead guitarist, shot Shankar to global stardom in the 1960s.

Harrison had grown fascinated with the sitar, a long-necked string instrument that uses a bulbous gourd for its resonating chamber and resembles a giant lute. He played the instrument, with a Western tuning, on the song "Norwegian Wood," but soon sought out Shankar, already a musical icon in India, to teach him to play it properly.

The pair spent weeks together, starting the lessons at Harrison's house in England and then moving to a houseboat in Kashmir and later to California.

Gaining confidence with the complex instrument, Harrison recorded the Indian-inspired song "Within You Without You" on the Beatles' "Sgt. Pepper's Lonely Hearts Club Band," helping spark the raga-rock phase of 60s music and drawing increasing attention to Shankar and his work.

Shankar's popularity exploded, and he soon found himself playing on bills with some of the top rock musicians of the era. He played a four-hour set at the Monterey Pop Festival and the opening day of Woodstock.

Though the audience for his music had hugely expanded, Shankar, a serious, disciplined traditionalist who had played Carnegie Hall, chafed against the drug use and rebelliousness of the hippie culture.

"I was shocked to see people dressing so flamboyantly. They were all stoned. To me, it was a new world," Shankar told Rolling Stone of the Monterey festival.

While he enjoyed Otis Redding and the Mamas and the Papas at the festival, he was horrified when Hendrix lit his guitar on fire.

"That was too much for me. In our culture, we have such respect for musical instruments, they are like part of God," he said.

In 1971, moved by the plight of millions of refugees fleeing into India to escape the war in Bangladesh, Shankar reached out to Harrison to see what they could do to help.

In what Shankar later described as "one of the most moving and intense musical experiences of the century," the pair organized two benefit concerts at Madison Square Garden that included Eric Clapton, Bob Dylan and Ringo Starr.

The concert, which spawned an album and a film, raised millions of dollars for UNICEF and inspired other rock benefits, including the 1985 Live Aid concert to raise funds for famine relief in Ethiopia and the 2010 Hope For Haiti Now telethon.

Ravindra Shankar Chowdhury was born April 7, 1920, in the Indian city of Varanasi.

At the age of 10, he moved to Paris to join the world famous dance troupe of his brother Uday. Over the next eight years, Shankar traveled with the troupe across Europe, America and Asia, and later credited his early immersion in foreign cultures with making him such an effective ambassador for Indian music.

During one tour, renowned musician Baba Allaudin Khan joined the troupe, took Shankar under his wing and eventually became his teacher through 7 1/2 years of isolated, rigorous study of the sitar.

"Khan told me you have to leave everything else and do one thing properly," Shankar told The Associated Press.

In the 1950s, Shankar began gaining fame throughout India. He held the influential position of music director for All India Radio in New Delhi and wrote the scores for several popular films. He began writing compositions for orchestras, blending clarinets and other foreign instruments into traditional Indian music.

And he became a de facto tutor for Westerners fascinated by India's musical traditions.

He gave lessons to Coltrane, who named his son Ravi in Shankar's honor, and became close friends with Menuhin, recording the acclaimed "West Meets East" album with him. He also collaborated with flutist Jean Pierre Rampal, composer Philip Glass and conductors Andre Previn and Zubin Mehta.

"Any player on any instrument with any ears would be deeply moved by Ravi Shankar. If you love music, it would be impossible not to be," singer Crosby, whose band The Byrds was inspired by Shankar's music, said in the book "The Dawn of Indian Music in the West: Bhairavi."

Shankar's personal life, however, was more complex.

His 1941 marriage to Baba Allaudin Khan's daughter, Annapurna Devi, ended in divorce. Though he had a decades-long relationship with dancer Kamala Shastri that ended in 1981, he had relationships with several other women in the 1970s.

In 1979, he fathered Norah Jones with New York concert promoter Sue Jones, and in 1981, Sukanya Rajan, who played the tanpura at his concerts, gave birth to his daughter Anoushka.

He grew estranged from Sue Jones in the 80s and didn't see Norah for a decade, though they later re-established contact.

He married Rajan in 1989 and trained young Anoushka as his heir on the sitar. In recent years, father and daughter toured the world together.

The statement she and her mother released said, "Although it is a time for sorrow and sadness, it is also a time for all of us to give thanks and to be grateful that we were able to have him as part of our lives."

When Jones shot to stardom and won five Grammy awards in 2003, Anoushka Shankar was nominated for a Grammy of her own.

Shankar himself won three Grammy awards and was nominated for an Oscar for his musical score for the movie "Gandhi." His album "The Living Room Sessions, Part 1" earned him his latest Grammy nomination, for best world music album.

Despite his fame, numerous albums and decades of world tours, Shankar's music remained a riddle to many Western ears.

Shankar was amused after he and colleague Ustad Ali Akbar Khan were greeted with admiring applause when they opened the Concert for Bangladesh by twanging their sitar and sarod for a minute and a half.

"If you like our tuning so much, I hope you will enjoy the playing more," he told the confused crowd, and then launched into his set.

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Nessman reported from Bangkok. Associated Press writer Julie Watson in San Diego contributed to this report.

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DA investigating Texas' troubled $3B cancer agency

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Gunman kills 2, then self at Oregon mall

A masked gunman opened fire today at Clackamas Town Center, a mall in suburban Portland, Ore., killing two people, injuring one, and then killing himself.

"I can confirm the shooter is dead of an apparent self inflicted gunshot wound," Lt. James Rhodes of the Clackamas County, Ore., Sheriff's Department said today. "By all accounts there were no rounds fired by law enforcement today in the mall."

Police have not released the names of the deceased. Rhodes said authorities are in the process of notifying victims' families. The injured victim has been transported to a local hospital.

Rhodes described the shooter as an adult male.

Witnesses from the shooting rampage said that a young man in a white hockey mask and bulletproof vest tore through the Macy's, food court, and mall hallways firing rounds at shoppers beginning around 3:30 p.m. PT today.

Hundreds of people were evacuated from the busy mall full of holiday shoppers after the shooting began.

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The gunman entered the mall through a Macy's store, ran through the upper level of Macy's and opened fire near the mall food court, firing multiple shots, one right after another, with what is believed to be a black, semiautomatic rifle, according to witness reports.

Amber Tate said she was in the parking lot of the mall when she saw the shooter run by, wearing a mask and carrying a machine gun, headed for the Macy's.

"He looked like a teenager wearing a gun, like a bullet-proof vest and he had a machine, like an assault rifle and a white mask and he looked at me," she said.

Witnesses described the shooter as being on a mission and determined, looking straight ahead. He then seemed to walk through the mall toward the other end of the building, shooting along the way, according to witness reports.

Those interviewed said that Macy's shoppers and store employees huddled in a dressing room to avoid being found.

"I was helping a customer in the middle of the store, her and her granddaughter and while we were looking at sweatshirts we heard five to seven shots from a machine gun fire just outside my store," Jacob Rogers, a store clerk, told ABC affiliate KATU-TV in Portland.

"We moved everyone into the back room where there's no access to outside but where there's a camera so we can monitor what's going on out front," Rogers said.

Evan Walters, an employee at a store in the mall, told ABC News Radio that he was locked in a store for his safety and he saw two people shot and heard multiple gunshots.

"It was over 20, and it was kind of surreal because we hear pops and loud noises," he said. "We're next to the food court here and we hear pops and loud noises all the time, but we don't -- nothing like that. It was very definite gunshots."

Police are tracing the weapon used in the shooting.

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