World Briefing | The Americas: Guatemala: Gunmen Kill Mayor

Gunmen killed the mayor of the eastern city of Jutiapa on Monday, city officials said. Mayor Carlos Castillo Medrano was shot to death at a barbershop, the officials said. The killing occurred on the same day that President Otto Pérez Molina said there had been “a historic decline” in Guatemala’s violence during the first year of his administration. In his state of the nation address, the president said that homicides had decreased about 10 percent over the past year.

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Smartphone data consumption tops tablets for the first time ever

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Today's Photos: Molly Sims Shows Off Her 'Little Bunny'

Sims's six-month-old gets an adorable earful in Los Angeles. Plus: David Arquette, Naomi & Sasha, Reese Witherspoon and more

Credit: Michael Simon/StarTraks

Published: Monday Jan 14, 2013 | 05:00 PM EST

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Hospitals crack down on workers refusing flu shots

CHICAGO (AP) — Patients can refuse a flu shot. Should doctors and nurses have that right, too? That is the thorny question surfacing as U.S. hospitals increasingly crack down on employees who won't get flu shots, with some workers losing their jobs over their refusal.

"Where does it say that I am no longer a patient if I'm a nurse," wondered Carrie Calhoun, a longtime critical care nurse in suburban Chicago who was fired last month after she refused a flu shot.

Hospitals' get-tougher measures coincide with an earlier-than-usual flu season hitting harder than in recent mild seasons. Flu is widespread in most states, and at least 20 children have died.

Most doctors and nurses do get flu shots. But in the past two months, at least 15 nurses and other hospital staffers in four states have been fired for refusing, and several others have resigned, according to affected workers, hospital authorities and published reports.

In Rhode Island, one of three states with tough penalties behind a mandatory vaccine policy for health care workers, more than 1,000 workers recently signed a petition opposing the policy, according to a labor union that has filed suit to end the regulation.

Why would people whose job is to protect sick patients refuse a flu shot? The reasons vary: allergies to flu vaccine, which are rare; religious objections; and skepticism about whether vaccinating health workers will prevent flu in patients.

Dr. Carolyn Bridges, associate director for adult immunization at the federal Centers for Disease Control and Prevention, says the strongest evidence is from studies in nursing homes, linking flu vaccination among health care workers with fewer patient deaths from all causes.

"We would all like to see stronger data," she said. But other evidence shows flu vaccination "significantly decreases" flu cases, she said. "It should work the same in a health care worker versus somebody out in the community."

Cancer nurse Joyce Gingerich is among the skeptics and says her decision to avoid the shot is mostly "a personal thing." She's among seven employees at IU Health Goshen Hospital in northern Indiana who were recently fired for refusing flu shots. Gingerich said she gets other vaccinations but thinks it should be a choice. She opposes "the injustice of being forced to put something in my body."

Medical ethicist Art Caplan says health care workers' ethical obligation to protect patients trumps their individual rights.

"If you don't want to do it, you shouldn't work in that environment," said Caplan, medical ethics chief at New York University's Langone Medical Center. "Patients should demand that their health care provider gets flu shots — and they should ask them."

For some people, flu causes only mild symptoms. But it can also lead to pneumonia, and there are thousands of hospitalizations and deaths each year. The number of deaths has varied in recent decades from about 3,000 to 49,000.

A survey by CDC researchers found that in 2011, more than 400 U.S. hospitals required flu vaccinations for their employees and 29 hospitals fired unvaccinated employees.

At Calhoun's hospital, Alexian Brothers Medical Center in Elk Grove Village, Ill., unvaccinated workers granted exemptions must wear masks and tell patients, "I'm wearing the mask for your safety," Calhoun says. She says that's discriminatory and may make patients want to avoid "the dirty nurse" with the mask.

The hospital justified its vaccination policy in an email, citing the CDC's warning that this year's flu outbreak was "expected to be among the worst in a decade" and noted that Illinois has already been hit especially hard. The mandatory vaccine policy "is consistent with our health system's mission to provide the safest environment possible."

The government recommends flu shots for nearly everyone, starting at age 6 months. Vaccination rates among the general public are generally lower than among health care workers.

According to the most recent federal data, about 63 percent of U.S. health care workers had flu shots as of November. That's up from previous years, but the government wants 90 percent coverage of health care workers by 2020.

The highest rate, about 88 percent, was among pharmacists, followed by doctors at 84 percent, and nurses, 82 percent. Fewer than half of nursing assistants and aides are vaccinated, Bridges said.

Some hospitals have achieved 90 percent but many fall short. A government health advisory panel has urged those below 90 percent to consider a mandatory program.

Also, the accreditation body over hospitals requires them to offer flu vaccines to workers, and those failing to do that and improve vaccination rates could lose accreditation.

Starting this year, the government's Centers for Medicare & Medicaid Services is requiring hospitals to report employees' flu vaccination rates as a means to boost the rates, the CDC's Bridges said. Eventually the data will be posted on the agency's "Hospital Compare" website.

Several leading doctor groups support mandatory flu shots for workers. And the American Medical Association in November endorsed mandatory shots for those with direct patient contact in nursing homes; elderly patients are particularly vulnerable to flu-related complications. The American Nurses Association supports mandates if they're adopted at the state level and affect all hospitals, but also says exceptions should be allowed for medical or religious reasons.

Mandates for vaccinating health care workers against other diseases, including measles, mumps and hepatitis, are widely accepted. But some workers have less faith that flu shots work — partly because there are several types of flu virus that often differ each season and manufacturers must reformulate vaccines to try and match the circulating strains.

While not 100 percent effective, this year's vaccine is a good match, the CDC's Bridges said.

Several states have laws or regulations requiring flu vaccination for health care workers but only three — Arkansas, Maine and Rhode Island — spell out penalties for those who refuse, according to Alexandra Stewart, a George Washington University expert in immunization policy and co-author of a study appearing this month in the journal Vaccine.

Rhode Island's regulation, enacted in December, may be the toughest and is being challenged in court by a health workers union. The rule allows exemptions for religious or medical reasons, but requires unvaccinated workers in contact with patients to wear face masks during flu season. Employees who refuse the masks can be fined $100 and may face a complaint or reprimand for unprofessional conduct that could result in losing their professional license.

Some Rhode Island hospitals post signs announcing that workers wearing masks have not received flu shots. Opponents say the masks violate their health privacy.

"We really strongly support the goal of increasing vaccination rates among health care workers and among the population as a whole," but it should be voluntary, said SEIU Healthcare Employees Union spokesman Chas Walker.

Supporters of health care worker mandates note that to protect public health, courts have endorsed forced vaccination laws affecting the general population during disease outbreaks, and have upheld vaccination requirements for schoolchildren.

Cases involving flu vaccine mandates for health workers have had less success. A 2009 New York state regulation mandating health care worker vaccinations for swine flu and seasonal flu was challenged in court but was later rescinded because of a vaccine shortage. And labor unions have challenged individual hospital mandates enacted without collective bargaining; an appeals court upheld that argument in 2007 in a widely cited case involving Virginia Mason Hospital in Seattle.

Calhoun, the Illinois nurse, says she is unsure of her options.

"Most of the hospitals in my area are all implementing these policies," she said. "This conflict could end the career I have dedicated myself to."

__

Online:

R.I. union lawsuit against mandatory vaccines: http://www.seiu1199ne.org/files/2013/01/FluLawsuitRI.pdf

CDC: http://www.cdc.gov

___

AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner

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Nordstrom hostages made to strip naked; 1 sexually assaulted, police say

Los Angeles police confirmed Sunday evening the arrests of three suspected gang members in the takeover robbery at the Nordstrom Rack in Westchester last week.

The Times first reported two arrests, one on Friday and the second Saturday in Phoenix. Sources familiar with the investigation described the man arrested in Phoenix as a principal suspect but would give no further details.

In a press release Sunday, the LAPD said that a total of three suspects had been arrested but did not give additional details.

Police would not release the suspects’ identities, nor would they detail how the suspects were taken into custody or their alleged roles in the robbery and hostage situation.

Sources said they had strong evidence linking the men to the crime, including physical evidence and security camera video. Prosecutors will decide this week whether to file charges.

The incident began about 11 p.m. Thursday at the Promenade at Howard Hughes Center, near the 405 Freeway. The LAPD called a tactical alert and closed off the area around the shopping center.
When the Police Department's SWAT officers arrived, they surrounded the store. At one point, one suspect exited, saw the police and ran back inside.

A second suspect walked out with an unidentified woman, saw police and also headed back inside. The officers entered the store at 3:30 a.m. and freed the hostages.

At least three of the hostages were injured, including one woman who was sexually assaulted. Another woman was stabbed in the neck and sustained non-life-threatening injuries, and a third employee was pistol-whipped, police said.

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News Analysis: François Hollande Moves Away From His Image

Fred Dufour/Agence France-Presse — Getty Images

Protesters in Paris on Sunday denounced the government’s plans to legalize same-sex marriage.

PARIS — President François Hollande of France has regularly been criticized as indecisive, even complacent. But the events of the last few days will go some way toward changing his image, as Mr. Hollande has moved swiftly to use the French military in Mali and Somalia after pulling off an important compromise with domestic unions over job creation.

The sudden French military intervention in Mali, which took only half a day to set in motion, together with a bold, if failed, hostage rescue mission in Somalia, have displayed Mr. Hollande in a more somber, decisive light that could represent a turning point for his presidency. The French, like the Americans, judge presidents on their ability to make tough decisions, and there are few tougher ones than to send young soldiers into battle.

While the future of the Mali intervention is unclear, it has begun well, with French forces hitting two columns of Islamist rebels with jet fighters and attack helicopters and appearing to halt a rebel march south toward the capital, Bamako. Mr. Hollande’s actions have garnered widespread political support in France and abroad, from African countries, the United States and Britain, all of which have promised to move more quickly to help Mali recover a vast piece of land lost months ago to the rebels.

Even the failure of the raid in Somalia, in which two French commandos died and the hostage is believed to have been killed by his captors, does not seem to have hurt Mr. Hollande. Many of his countrymen do not expect warfare to be risk-free, and France is seized by both worries about the rise of radical Islam and the plight of several French hostages in North Africa believed to be held by religious extremists. “This is the first occasion Hollande had or seized upon to act decisively, without the sort of the waffling that had appeared to be his trademark,” said François Heisbourg, a defense expert at the Foundation for Strategic Research in Paris. “So in that sense, it changes his image instantaneously.”

Throughout his career in the Socialist Party, Mr. Hollande has been criticized and even ridiculed for being soft and compromising, likened in the early days to a wobbly custard dessert called “Flanby.” But he has always said that his critics underestimate him, and his victory last May over the energetic incumbent, Nicolas Sarkozy, surprised many.

Now Mr. Hollande has “demonstrated that he can decide on matters of war and peace, which in the French system, as in the U.S., is very important,” Mr. Heisbourg said.

“Until you prove that, you haven’t proved much,” he said, comparing the impact of Mr. Hollande’s actions with that of President Obama’s decision to approve the raid on Osama bin Laden.

A cartoon on Saturday in the centrist newspaper Le Parisien showed Mr. Hollande as commander in chief, with a bystander saying, “Must admit that sometimes he surprises.”

On Sunday, Bruno Jeudy, an editor at the newspaper Le Journal du Dimanche, wrote: “Finally president! Finished, the hesitant and nonchalant François Hollande of the first months of his mandate.” Like many, Mr. Jeudy noted that once begun, the operation in Mali — to help dismantle a safe haven for radicals linked to terrorist groups — will be long and difficult. (In the same newspaper, Dominique de Villepin, a former foreign minister, warned that the operation in Mali was likely to fail because it had too many ambitious goals.)

“Wars are rarely popular,” Mr. Jeudy said. “But by putting on the uniform of a war leader, he rose to the rank of his predecessors.” He also lowered the domestic pressure on him to back off his proposal to legalize same-sex marriage, turning the national conversation more toward foreign policy.

A week ago, all the talk in France was of the large demonstration called for Sunday against same-sex marriage. The proposed law has created significant opposition because it would allow married gay couples to adopt children. Religious leaders and many ordinary citizens are troubled by the proposal, and opposition parties have tried to make political capital out of opposition to the bill.

Up to 340,000 demonstrators came out in Paris on Sunday to protest the bill, according to the police, while organizers gave a turnout of 800,000.

Emmanuel Bogeat, 35, a lawyer, and his wife, Laetitia, 32, a teacher, came from Nice, upset about a move they believe would add instability to the troubled institution of the family. “This is once again hurting the family’s core,” Ms. Bogeat said.

Mr. Bogeat said he knew the law would pass, “but it’s my duty, since I’m against it, to be here.”

Arthur Touchot contributed reporting from Paris.

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Facebook search leads to Iowa man, sister reunion

DAVENPORT, Iowa (AP) — An Iowa man has been reunited with his sister 65 years after the siblings were separated in foster care thanks to a 7-year-old friend who searched Facebook.

Sixty-six-year-old Clifford Boyson of Davenport met his 70-year-old sister, Betty Billadeau, in person on Saturday. Billadeau drove up from her home in Florissant, Mo., with her daughter and granddaughter for the reunion.

Boyson and Billadeau both tried to find each other for years without success.

Then 7-year-old Eddie Hanzelin, who is the son of Boyson‘s landlord, got involved.

Eddie managed to find Billadeau by searching Facebook with her maiden name. He recognized the family resemblance when he saw her picture.

Near the end of their tearful reunion Boyson and Billadeau presented Eddie with a $ 125 check in appreciation of his detective work.

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Claire Danes, Eric Stonestreet, Julia Louis-Dreyfus Keep the Red Carpet Fun at Golden Globes

By Maggie Coughlan

01/13/2013 at 07:30 PM EST

Claire Danes and Julia-Louis Dreyfus

Jason Merritt/Getty; Paul Buck/EPA/Landov

Fashion wasn't the only hot topic on the red carpet at Sunday's Golden Globe Awards.

From Claire Danes talking about being a new mom to Julia Louis-Dreyfus to accepting a 52nd birthday present, nothing was off limits.

Danes – who welcomed son Cyrus with husband Hugh Dancy in December – looked flawless in a red Versace gown, but beamed most when speaking about her new addition (upstairs at the Beverly Hilton Hotel with his grandparents). "I've been in baby world," she told Ryan Seacrest. "I'm hoping I don't leak!"

Eric Stonestreet – who's nominated for a Globe for best supporting actor – was all laughs on the red carpet, revealing that host Tina Fey was his level two teacher at Chicago's Second City improv school. "Do you need help?" he asked her co-host Amy Poehler, joking and pretending to shake her as she made her way down the stairs. Then, he told Seacrest, who's been cautioning stars as they leave his platform, "I said, 'Are you going to be okay?' Well, what if I push you, will you still be okay?"

Zooey Deschanel doesn't mess around when it comes to her nails. The New Girl kept things lighthearted with a highly-anticipated gold and white film-themed manicure.

Louis-Dreyfus celebrated her birthday little help from E! News host Giuliana Rancic. "We know that you're specifically a huge dark chocolate fan," Rancic told the Veep star. "I love dark chocolate," Louis-Dreyfus responded. "So happy birthday from E! We got you some chocolate," Rancic said, gifting her with a box of treats.

And finally, it was a battle of the (lack of) bulge between Seacrest and Liev Schreiber when they commiserated about a mutual personal trainer who created some friendly competition between the two. When it comes to push-ups, Schreiber can churn out 426, while Seacrest can manage 430. It's one fit red carpet!

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Flu more widespread in US; eases off in some areas

NEW YORK (AP) — Flu is now widespread in all but three states as the nation grapples with an earlier-than-normal season. But there was one bit of good news Friday: The number of hard-hit areas declined.

The flu season in the U.S. got under way a month early, in December, driven by a strain that tends to make people sicker. That led to worries that it might be a bad season, following one of the mildest flu seasons in recent memory.

The latest numbers do show that the flu surpassed an "epidemic" threshold last week. That is based on deaths from pneumonia and influenza in 122 U.S. cities. However, it's not unusual — the epidemic level varies at different times of the year, and it was breached earlier this flu season, in October and November.

And there's a hint that the flu season may already have peaked in some spots, like in the South. Still, officials there and elsewhere are bracing for more sickness

In Ohio, administrators at Miami University are anxious that a bug that hit employees will spread to students when they return to the Oxford campus next week.

"Everybody's been sick. It's miserable," said Ritter Hoy, a spokeswoman for the 17,000-student school.

Despite the early start, health officials say it's not too late to get a flu shot. The vaccine is considered a good — though not perfect — protection against getting really sick from the flu.

Flu was widespread in 47 states last week, up from 41 the week before, the Centers for Disease Control and Prevention said on Friday. The only states without widespread flu were California, Mississippi and Hawaii.

The number of hard-hit states fell to 24 from 29, where larger numbers of people were treated for flu-like illness. Now off that list: Florida, Arkansas and South Carolina in the South, the first region hit this flu season.

Recent flu reports included holiday weeks when some doctor's offices were closed, so it will probably take a couple more weeks to get a better picture, CDC officials said Friday. Experts say so far say the season looks moderate.

"Only time will tell how moderate or severe this flu season will be," CDC Director Dr. Thomas Frieden said Friday in a teleconference with reporters.

The government doesn't keep a running tally of adult deaths from the flu, but estimates that it kills about 24,000 people in an average year. Nationally, 20 children have died from the flu this season.

Flu vaccinations are recommended for everyone 6 months or older. Since the swine flu epidemic in 2009, vaccination rates have increased in the U.S., but more than half of Americans haven't gotten this year's vaccine.

Nearly 130 million doses of flu vaccine were distributed this year, and at least 112 million have been used. Vaccine is still available, but supplies may have run low in some locations, officials said.

To find a shot, "you may have to call a couple places," said Dr. Patricia Quinlisk, who tracks the flu in Iowa.

In midtown Manhattan, Hyrmete Sciuto got a flu shot Friday at a drugstore. She skipped it in recent years, but news reports about the flu this week worried her.

During her commute from Edgewater, N.J., by ferry and bus, "I have people coughing in my face," she said. "I didn't want to risk it this year."

The vaccine is no guarantee, though, that you won't get sick. On Friday, CDC officials said a recent study of more than 1,100 people has concluded the current flu vaccine is 62 percent effective. That means the average vaccinated person is 62 percent less likely to get a case of flu that sends them to the doctor, compared to people who don't get the vaccine. That's in line with other years.

The vaccine is reformulated annually, and this year's is a good match to the viruses going around.

The flu's early arrival coincided with spikes in flu-like illnesses caused by other bugs, including a new norovirus that causes vomiting and diarrhea, or what is commonly known as "stomach flu." Those illnesses likely are part of the heavy traffic in hospital and clinic waiting rooms, CDC officials said.

Europeans also are suffering an early flu season, though a milder strain predominates there. China, Japan, the West Bank, the Gaza Strip, Algeria and the Republic of Congo have also reported increasing flu.

Flu usually peaks in midwinter. Symptoms can include fever, cough, runny nose, head and body aches and fatigue. Some people also suffer vomiting and diarrhea, and some develop pneumonia or other severe complications.

Most people with flu have a mild illness. But people with severe symptoms should see a doctor. They may be given antiviral drugs or other medications to ease symptoms.

Some shortages have been reported for children's liquid Tamiflu, a prescription medicine used to treat flu. But health officials say adult Tamiflu pills are available, and pharmacists can convert those to doses for children.

___

Associated Press writers Dan Sewell in Cincinnati, Catherine Lucey in Des Moines, and Malcolm Ritter in New York contributed to this report.

___

Online:

CDC flu: http://www.cdc.gov/flu/index.htm

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California's debt still a heavy cloud over state's future

SACRAMENTO — Gov. Jerry Brown proclaimed last week that California, which now has enough cash to pay its day-to-day bills, can no longer be described by naysayers as a "failed state."

But even though it appears to be free of the deficit that dogged the Capitol in recent years, the state is no model of financial health.

Sacramento is legally obligated to pay many billions of dollars withheld from schools, local governments and healthcare providers as lawmakers struggled repeatedly to balance the books. It owes Wall Street more per resident than almost every other state. And it has accumulated a crushing load of debt for retiree pensions and healthcare, now totaling more than taxpayers spend each year on all state programs combined.

The budget Brown proposed Thursday addresses only a small portion of the overall debt, which stems from the same types of bills that drove cities like Vallejo, Stockton and San Bernardino into bankruptcy. The state is likely to find its debt consuming an ever larger share of money meant for the basic needs of government.

"Every year we fail to acknowledge or fix these things, it just makes the cost bigger," said Joe Nation, a former Democratic assemblyman who teaches public policy at Stanford University.

When he released his budget plan, Brown vowed to knock down the state's "wall of debt." He presented a timeline for repaying nearly $28 billion the state owes to government programs that it raided for cash or deprived of funds over the years, as well as some bonds sold to balance the budget.

Payments of $4.2 billion would be made in the budget year that begins in July. Subsequent payments, growing to as much as $7.3 billion a year, would continue into 2017.

At that point, Brown says, $4.3 billion in debt would remain, mostly for delayed payments to healthcare providers and money owed to municipalities and schools for implementing state mandates.

"By paying down the debt, we've put ourselves in a stronger position when things go bad, as they inevitably do," Brown said.

But numerous reports by state agencies, think tanks and academics have shown the wall of debt to be many stories higher than $28 billion — hundreds of billions of dollars over the next few decades. Brown's repayment plan does not significantly reduce the sizable debt to Wall Street or account for promises the state has made to its current and future retirees but is not setting enough money aside to cover.

"If we just ignore these longer-term pressures, we're going to be back in the soup soon," said Mike Genest, who was budget director for Gov. Arnold Schwarzenegger.

State officials must grapple with a major shortfall in the retirement fund for teachers. Fund officials have warned that Sacramento needs to immediately start contributing about $3 billion annually to keep the pension system solvent.

Sacramento could kick the bill to school districts, requiring them to start paying more pension costs from their own budgets. But the money needed now to stabilize the fund is enough to wipe out the $2.7-billion budget boost the governor is proposing for schools after many years of cuts.

"That is a demand that will have to be met," said David Crane, who advised Schwarzenegger on pensions and the economy. "Even if there is an increase in funding for schools, the districts may have to use that — and more — to meet that demand."

So far, lawmakers have taken no action to fill the gap. They have opted, for now, to let it grow. (The changes legislators made in public pensions last year do not apply to teachers.)

They have taken the same approach with the escalating cost of retiree healthcare.

State employees on the payroll 10 years or more are guaranteed insurance coverage for life — a benefit bestowed decades ago, before the cost of medical care exploded. Now, the state is facing a bill of $62.1 billion for those employees over the next 30 years, according to state projections. Sacramento has set no money aside to cover the payments, and the tab grows each year.

Brown proposed that lawmakers confront that cost last year. Lawmakers balked and excluded his plan to limit the number of state workers eligible for retiree healthcare.

The cost of closing the gaps in California's major public pension funds would be considerable. The State Budget Crisis Task Force, a bipartisan think tank based in New York, reported in September that every Californian would have to contribute $3,635 to cover the shortfalls. Paying for retiree healthcare might add a couple of thousand dollars to that tab.

The state's borrowing from Wall Street in recent years also comes at a cost. According to the state treasurer's office, it will cost $2,559 per Californian to pay that back. Texas, by contrast, has taken on just $588 of debt per resident.

Genest said California undeniably has made major strides since the darkest budget days of recent years. "We've finally got through the worst of it," he said.

But the mess is far from cleaned up, he cautioned: "We can't jump for joy."

evan.halper@latimes.com

chris.megerian@latimes.com

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