Wednesday, April 01, 2009

Health Critic Brings a Past and a Wallet

WASHINGTON — Richard L. Scott is unusual in these tough economic times: a rich, conservative investor willing to spend freely on a political cause.

Mr. Scott is starring in his own rotation of advertisements against the broad outlines of President Obama’s health care plans. (“Imagine waking up one day and all your medical decisions are made by a central, national board,” he warns in a radio spot.) He has dispatched camera crews to other countries to document the perils of socialized medicine.

He visited with lawmakers on Capitol Hill this week, and his new group, Conservatives for Patients’ Rights, has hired a leading conservative public relations firm, CRC, well known for its work with Swift Boat Veterans for Truth, the group that attacked Senator John Kerry, Democrat of Massachusetts, during his presidential campaign.

Mr. Scott’s emergence this spring as the most visible conservative opponent to Mr. Obama’s not-fully-defined health care effort has former friends and foes alike doing double takes, given Mr. Scott’s history.

Once lauded for building Columbia/HCA into the largest health care company in the world, Mr. Scott was ousted by his own board of directors in 1997 amid the nation’s biggest health care fraud scandal. The company’s guilty plea and payment of $1.7 billion to settle charges including the overbilling of state and federal health programs was taken as a repudiation of Mr. Scott’s relentless bottom-line approach.

“He hopes people don’t Google his name,” said John E. Hartwig, a former deputy inspector general at the Department of Health and Human Services, one of various state and federal agencies that investigated Columbia/HCA when Mr. Scott was its chief executive.

Liberal groups planning to defend the administration’s health care plan, whatever form it takes, are seizing on Mr. Scott’s background through Web videos, fact sheets, blog postings and unflattering additions to his Wikipedia entry, which until recently did not mention his ouster from Columbia.

“He’s a great symbol from our point of view,” said Richard J. Kirsch, the national campaign manager for Health Care for America Now. “We cannot have a better first person to attack health care reform than someone who ran a company that ripped off the government of hundreds of millions of dollars.”

Conservative health care activists, while glad to have a potential ally willing to spend $5 million out of his own pocket, are not fully embracing Mr. Scott, noting that he is entering a changed landscape in which some Republicans and industry groups that opposed President Bill Clinton’s health care proposals now view some form of change as necessary and inevitable.

“At the end of the day, they may come up with something we like,” said John C. Goodman, a leading conservative health care policy expert. “We shouldn’t just assume that this is something horrible — if this is something horrible, we will be against it.”

“There is no Obama plan that’s been made public yet, so what’s the point of running ads?” Mr. Goodman added. “I don’t see that you gain anything except attention for Rick Scott.”

Some former allies are more hostile toward Mr. Scott, painting him as counterproductive to their efforts for compromise.

“I just don’t understand why he would be a messenger people would listen to,” said Charles N. Kahn III, who was a senior executive with the insurance industry group that ran the “Harry & Louise” advertisements credited with helping to kill the Clinton plan 15 years ago but who is working for a deal now. “I don’t think people are waiting to hear from him.”

Mr. Kahn, a Republican, is now the head of the Federation of American Hospitals, a private-hospitals group.

Mr. Scott is showing more support from some Republicans in Congress, though. Representative Michael C. Burgess, Republican of Texas and a member of the House health subcommittee, said in an interview that he had invited Mr. Scott to meet with him on Tuesday because he liked what Mr. Scott had been saying.

Mr. Scott declined several interview requests. His public relations firm, after initially offering to make him available for a discussion, later declined to answer questions about him, citing an exclusive arrangement with another publication.

In recent years, Mr. Scott, 56, has settled into a comfortable life in Naples, Fla., where he has built an investment portfolio that includes a chain of urgent-care clinics, some located in Wal-Mart stores, which Mr. Scott promotes as inexpensive alternatives to emergency rooms, especially for the uninsured.

Mr. Scott has said his sole policy interest is to see to it that whatever overhaul Mr. Obama and Congress consider does not move the country toward a socialized system and away from what he calls his four pillars of reform: “choice, competition, accountability and personal responsibility.”

“After spending over two decades in the health care provider industry, I’ve seen these principles work firsthand,” Mr. Scott said in a recent statement in which he also criticized Mr. Obama for seeking a $634 billion reserve fund for unspecified changes to the health care system.

Mr. Scott’s supporters say that he has been unfairly attacked over the years for challenging the longstanding orthodoxy of the nonprofit health care establishment.

“He has a much more businesslike approach to health care than anybody I’ve ever seen, and it is much more bottom-line-driven,” said Joshua Nemzoff, a hospital consultant based in New Hope, Pa., who has represented nonprofit hospitals in several deals with Mr. Scott. “He’s aggressive, and sometimes that rubs people the wrong way.”

Mr. Scott, a former Navy radar operator, built what would become Columbia/HCA from two hospitals in Texas into the largest health care chain in the world over just a few years. He seemed to relish publicly lambasting the nonprofit hospitals against which he competed and which he described as “non-taxpaying hospitals” impervious to real-world business concerns.

His approach earned him plenty of enmity, but also high praise. In 1996, Time magazine named him one of the “25 most influential Americans” for “transforming how American hospitals do business,” with an operation that “consolidates operations and imposes cost controls.”

Though Mr. Scott was not directly implicated in the fraud scandal — with whistle-blower suits filed against some hospitals before his acquisition of them — critics said his drive for profits had created incentive for fraud.

“The practices did pre-exist Rick Scott,’ said Stephen Meagher, a lawyer who represented some of the ex-employees whose complaints prompted the initial investigation. “They were aggravated by the pressure he put on HCA employees.”

In an interview this week with The Washington Independent, Mr. Scott said of the charges against his former company, “If you go back and look at the hospital industry, and the whole health care industry since the mid-1990s, it was constantly going through investigations.” He added, “Great institutions, like ours, paid fines.”

One defender of Mr. Scott, Mr. Burgess, the Texas lawmaker and a former HCA doctor, said of the investigation, “A lot of us just looked at it as somebody in Washington playing politics.”

Others say the scandal took place so long ago they can hardly remember it. “I remembered reading a newspaper article about it all,” said Merrill Matthews Jr., director of the Council for Affordable Health Insurance, a group that formed to fight the Clinton proposals and expects to fight Mr. Obama’s. Mr. Matthews said he would not shun Mr. Scott. “He’s bringing a lot of money to the table,” he said.

CSI is it real or so much bull....?

Report questions science, reliability of crime lab evidence
The National Academy of Sciences says many courtroom claims about fingerprints, bite marks and other evidence lack scientific verification. It finds forensics inconsistent and in disarray nationwide.
By Jason Felch and Maura Dolan

February 19, 2009

Sweeping claims made in courtrooms about fingerprints, ballistics, bite marks and other forensic evidence often have little or no basis in science, according to a landmark report released Wednesday by the nation's leading science body.

The National Academy of Sciences report called for a wholesale overhaul of the crime lab system, which has become increasingly crucial to American jurisprudence.

Many experts said the report could have a broad impact on crime labs and the courts, ushering in changes at least as significant as those generated by the advent of DNA evidence two decades ago. But the substantial reforms would require years of planning and major federal funding.

In the meantime, the findings are expected to unleash a flood of new legal challenges by defense attorneys.

"This is a major turning point in the history of forensic science in America," said Barry Scheck, co-founder of the Innocence Project, an organization dedicated to exonerating the wrongfully convicted. He said the findings would immediately lead to court challenges.

"If this report does not result in real change, when will it ever happen?" Scheck asked.

The Los Angeles County Public Defender's office plans to use the National Academy report to file challenges on the admissibility of fingerprint evidence and is reviewing cases in which fingerprints played a primary role in convictions, officials said.

Separately, the Los Angeles Police Department has been reviewing 1,000 fingerprint cases after discovering that two people were wrongfully accused because of faulty fingerprint analyses.

The academy, the preeminent science advisor to the federal government, found a system in disarray: labs that are underfunded and beholden to law enforcement and that lack independent oversight and consistent standards.

The report concludes that the deficiencies pose "a continuing and serious threat to the quality and credibility of forensic science practice," imperiling efforts to protect society from criminals and shield innocent people from convictions.

With the notable exception of DNA evidence, the report says that many forensic methods have never been shown to consistently and reliably connect crime scene evidence to specific people or sources.

"The simple reality is that the interpretation of forensic evidence is not always based on scientific studies to determine its validity," the report says.

For example, frequent claims that fingerprint analysis had a zero error rate are "not scientifically plausible," the report said. The scientific basis for bite mark evidence is called "insufficient to conclude that bite mark comparisons can result in a conclusive match."

Recent cases of CSI gone awry have underscored the report's urgency. In the cases of the 232 people exonerated by DNA evidence, more than half involved faulty or invalidated forensic science, according to the Innocence Project.

Margaret Berger, a professor at Brooklyn Law School and a member of the panel, explained: "We're not saying all these disciplines are useless. We're saying there is a lot of work that needs to be done."

Said U.S. Court of Appeals Judge Harry Edwards, co-chairman of the panel: "There are a lot of people who are concerned, and they should be concerned. Forensic science is the handmaiden of the legal system. . . . If you claim to be science, you ought to put yourself to the test."

Although the panel's recommendations are not binding, they are expected to be influential. Among the recommendations:

* Create a new federal agency, the National Institute of Forensic Science, to fund scientific research and disseminate basic standards.

* Make crime labs independent of law enforcement. Most crime labs are run by police agencies, which can lead to bias, a growing body of research shows.

* Require that expert witnesses and forensic analysts be certified by the new agency, and that labs be accredited.

* Fund research into the scientific basis for claims routinely made in court, as well as studies of the accuracy and reliability of forensic techniques.

Those recommendations have been cautiously embraced by leading associations of forensic scientists, which in 2005 helped convince Congress that the study was necessary.

"You can't continue to do business in 2009 the way you did in 1915," said Joseph Polski of the International Assn. for Identification, whose members include examiners of fingerprints, documents, footwear and tire tracks. "We knew there would be things in there we'd like and things we didn't like."

Many forensic scientists were hesitant to criticize the report for fear of seeming resistant to testing and scrutiny. But there were some delicate complaints.

"It's not the science of forensic science that is in need of repair, I think; it's how the results are interpreted in the courtroom," said Dean Gialamis, head of the American Society of Crime Lab Directors, who was quick to add that his group welcomed the recommendations.

The report was hailed by many defense attorneys, scientists and law professors, who for years have been raising scientific and legal challenges.

"The courts were highly skeptical of experts and resistant to hearing their arguments," said Simon A. Cole, a professor of criminology at UC Irvine who has often testified for defense teams about the limitations of fingerprint evidence. "I feel like I'm Alice coming out of the rabbit hole and back into a world of sanity and reason."

The report had harsh words for the FBI Laboratory and the National Institute of Justice, the research arm of the Justice Department, which have shown little enthusiasm for exploring the shortcomings of forensic science.

"Neither agency has recognized, let alone articulated, a need for change," the report states, adding that they could be subject to pro-prosecution biases.

Atty. Gen. Eric H. Holder Jr. signaled in comments to reporters shortly before the report was released that he would take its concerns seriously: "I think we need to devote a lot of attention and a lot of resources to that problem."

Prosectors on the front lines, however, were more skeptical. "I know the defense is probably starting bonfires, but this should not in any way shake up anyone's confidence in forensics," said Paula Wulff, manager and senior attorney of the DNA Forensic Program of the National District Attorneys Assn.

She called the recommendations a "Cadillac of aspirations," and expressed doubt that they would be followed given the poor state of the economy.

All sides, however, agreed that the report signals an aggressive reentry of scientists into issues that for decades have fallen to lawyers, judges and juries to resolve.

Iraqi Militants Show a New Boldness in Cities

BAGHDAD — As the American military prepares to withdraw from Iraqi cities, Iraqi and American security officials say that jihadi and Baath militants are rejoining the fight in areas that are largely quiet now, regrouping as a smaller but still lethal insurgency.

There is much debate as to whether any new insurgency, at a time of relative calm in most of Iraq, could ever produce the same levels of violence as existed at the height of the fighting here. A recent series of attacks, however, like bubbles that indicate fish beneath still water, suggest the potential danger, all the more perilous now because the American troops who helped to pacify Iraq are leaving.

Several well-planned bombings, one on a street recently reopened because it was thought to be safe, have killed 123 people, most of them in and around Baghdad. Three were suicide bombings, signatures of Al Qaeda in Mesopotamia, a homegrown Sunni extremist group with some foreign leadership.

Assassination attempts on members of the Awakening movement, some of them former insurgents who switched sides for pay, are rising, as are fears that some of the members are joining Islamic extremists or other insurgent groups. On Saturday an important Awakening leader was arrested on charges, among others, of being a member of the military wing of the outlawed Baath Party, formerly led by Saddam Hussein.

Detainees, some innocent, but many of them former insurgents long held in American military custody, are being set free every day, potentially increasing the insurgency’s numbers. The American-Iraqi security agreement requires the release of all detainees in American custody unless there is sufficient evidence to bring charges in an Iraqi court.

At least one former detainee has already blown himself up in a suicide attack.

Most of the latest attacks, at a time when overall violence is at its lowest level since the beginning of the war in 2003, have singled out Iraqis, but one development affects the Americans. A new weapon has appeared in Iraq: Russian-made RKG-3 grenades, which weigh just five pounds and, attached to parachutes, can be lobbed by a teenager but can penetrate the American military’s latest heavily armored vehicle, the MRAP. The grenades cost as little as $10, according to American military officials, who would not say how often they have killed soldiers.

To some experts, this amounts to ugly, but unavoidable, background noise, the deadly but no longer destabilizing face of violence in Iraq. In this view, there will be attacks, but no longer ones likely to topple Iraq’s government. Military officers, who spoke on the condition of anonymity because they were not authorized to talk to the news media, say they have reduced the number of jihadi militants to under 2,000, from about 3,800.

“In most places there isn’t an insurgency in Iraq anymore,” said an American military intelligence officer in Washington, who was not authorized to be quoted by name. “What we have now is a terrorism problem, and there is going to be a terrorism problem in Iraq for a long time.”

Other officials, Iraqi and American, are more worried. They observe jihadi and other insurgent groups activating networks of sleeper cells, which are already striking government and civilian targets. Insurgent groups linked to the rule of Mr. Hussein are also reviving.

Among the most powerful now is Nashqabandi, which is believed to have ties to a former Hussein deputy, Izzat Ibrahim al-Douri. The organization, which gets money from Iraqi exiles in Syria, formed an alliance with religious Sunni extremists, according to American and Iraqi military intelligence.

“Al Qaeda and the hard-core Saddamists are the main threats to the national security of Iraq,” said Mowaffak al-Rubaie, Iraq’s national security adviser.

“Nashqabandi is the cradle; they are providing logistical support for Al Qaeda,” he said. “What we are seeing is the resurgence of the hard-core Saddamists, but using Al Qaeda in Iraq as a front and as suicide bombers.”

American military officials believe they have checked the insurgency, but liken it to a spring. “It can come up quickly as soon as it is released, but the longer you keep it down the less it rebounds,” said Col. James Phelps, an insurgency expert attached to the multinational force in Iraq. “Some Al Qaeda in Iraq leadership did go to ground,” he said.

In interviews with 14 leaders of the Awakening movement, which has been credited with helping to reduce violence, all said they believed that the jihadi presence in their areas had increased, as American troops began to close combat outposts or hand them over to the Iraqi Army, a first step toward withdrawing entirely. The Awakening leaders reported signs of trouble: assassination attempts, homemade bombs placed near their homes or under their cars, leaflets urging them not to work with the Iraqi government.

“We notice when there is a bomb buried on a back road where there has not been one before,” said Sheik Awad al-Harbousi, whose Awakening group works in Taji, north of Baghdad, much of it empty country traversed by rugged dirt roads. One of his fighters was killed three weeks ago and two were wounded.

Undermining the stability of the last few months is rising friction between the Awakening Councils and the Iraqi Army and the police, much of it with a sectarian edge. The tensions turned violent in Baghdad on Saturday, when members of the Awakening Council in the Fadhil neighborhood of Baghdad had a shootout with a combined American and Iraqi force.

The Awakening Councils are largely Sunni, while the security forces are dominated by Shiites. Many Awakening members are angry because promises of jobs in the Shiite-dominated government have not been kept.

In Dhuluiya, in eastern Salahuddin Province, deep in the Tigris River Valley, Mullah Nadhim al-Jubori, a onetime insurgent linked to Islamic extremists who became an Awakening leader, worries that the situation is fraying.

He ticked off seven troubling events over the last month, including the abduction of four of his men. Two were executed and two were released after a ransom was paid.

“The ransom was picked up in Baghdad,” he said. “That tells me there is good coordination and organization among Al Qaeda members.”

A few of his followers have changed sides. During the last four months, 12 Awakening members were arrested as double agents, accused of killing Awakening leaders, Mr. Nadhim said.

Farther east, in Diyala Province, the situation is worse. The insurgency has never been fully eradicated there, according to the American and Iraqi military. The province’s geography favors those who know its dry high hills, empty patches of desert and thick groves of date palms.

While the province is far more secure than in 2006 and 2007, when the provincial capital, Baquba, was known locally as “the city of death,” attacks are now increasing. Forty-three people were killed in Diyala in March, up from 29 in February and 6 in January, according to the Diyala Operations Command.

Ali Al-Tamimi, the chief of the Provincial Council’s security committee, predicted an increase in violence both in Baghdad and in Baquba because the security commanders had not acted on warnings about the growing activities of armed groups within an hour of Baghdad.

“We have told them that Al Qaeda is still present in some neighborhoods and villages,” he said. “They have not done enough to stop them.”

Suadad al-Salhy and Mohamed Hussein contributed reporting from Baghdad, and an Iraqi employee of The New York Times from Diyala Province.