Obama administration tackles colonoscopy confusion

WASHINGTON (AP) — It's one part of the new health care law that seemed clear: free coverage for preventive care under most insurance plans.

Only it didn't turn out that way.

So on Wednesday, the Obama administration had to straighten out the confusion.

Have you gone for a colonoscopy thinking it was free, only to get a hefty bill because the doctor removed a polyp?

No more.

Taking out such precancerous growths as part of a routine colon cancer screening procedure will now be considered preventive care.

"Polyp removal is an integral part of a colonoscopy," the Department of Health and Human Services said in guidance posted on its website. That conclusion has the backing of several leading medical societies, the department noted.

Also addressed in the notice was genetic testing for breast cancer, coverage of over-the-counter products such as aspirin for heart care and nicotine patches for smoking, and birth control for women. Unlike formal regulations, the guidance does not have the force of law, but advocates for patients say insurers would be ill-advised to ignore it.

President Barack Obama's health care law required most private health plans to cover preventive care at no additional charge to patients. It also expanded preventive coverage without copayments for Medicare recipients. For workers and their families, the expense is borne by the company health plan, which passes on some of those costs in the form of higher premiums. Advocates say preventive care saves the health care system money over time.

Colonoscopy is an expensive test that can cost more than $1,000. It's recommended for adults 50 and over, and has become a rite of passage for aging baby boomers.

News that it would be covered free under the health care law got attention, but that was followed quickly by a letdown when many insurers started charging if a polyp or two was discovered and removed during the procedure.

"Insurers were reclassifying it from a preventive test to a diagnostic procedure," said Stephen Finan, policy director for the American Cancer Society Cancer Action Network. "In some cases the cost-sharing was a significant amount of money."

His group was among several that complained to the administration.

Other free preventive services addressed in Wednesday's guidance:

—Insurers must cover testing, if ordered by a doctor, for rare BRCA genes that dramatically increase the risk of breast cancer. Such tests can cost as much as $3,000.

—Over-the-counter products such as aspirin for heart care and nicotine patches for smoking cessation are covered with a doctor's prescription.

—Insurers won't be able to fulfill the law's requirement to cover contraception as preventive care for women if they only pay for birth control pills. A full range of FDA-approved methods must be covered, including long-acting implant and intrauterine devices. Birth control methods for men are not covered as preventive care.

If a health plan does not have a network doctor who performs a particular preventive service, a patient can see a doctor out-of-network without facing copays or additional charges.

Also Wednesday, the government came out with final rules on the benefits that health plans catering to individuals and small businesses will have to offer starting next year, when new insurance markets called exchanges open in each state.

The coverage generally is better than what's now available to people buying individual policies, but close to what medium-size companies offer, with some important improvements in areas such as mental health care.

Benefits include hospital and outpatient care, emergency services, maternity and newborn care, prescriptions, prevention, rehabilitation and ongoing assistance for people with potentially disabling conditions, and dental and vision care for children.

All plans will have to cover the same benefits, but their premiums and cost sharing will vary. There will be four level of coverage — bronze, silver, gold and platinum. Bronze plans will cover 60 percent of expected costs while platinum plans will cover 90 percent.

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Online:

Health and Human Services Department: http://tinyurl.com/au6lzeo

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Tourist's body found stuffed in hotel water tank; guest horrified

There were few details Wednesday on how the body of a missing Canadian tourist ended up at the bottom of a water tank on the roof of a downtown hotel.

For days, residents of the Cecil Hotel thought something was amiss. At least one said there was flooding in one of the fourth-floor rooms, while others complained about weak water pressure.
One of those complaints led a hotel maintenance worker to check Tuesday on one of the large metal water cisterns on the roof, where he discovered the body of an unidentified woman in her 20s at the bottom of the tank.

Authorities said late Tuesday the body was that of Elisa Lam, 21, a Vancouver, Canada, woman last seen at the hotel Jan. 31.

"We're not ruling out foul play," said LAPD Sgt. Rudy Lopez, noting that the location of the remains "makes it suspicious."

Los Angeles police investigators searched the roof of the Cecil with the aid of dogs when Lam was reported missing about three weeks ago. Lopez said he didn't know if the tanks were examined.

"We did a very thorough search of the hotel," he said. "But we didn't search every room; we could only do that if we had probable cause" that a crime had been committed.

Once a destination for the rich and famous in the 1930s and '40s, the Cecil has gradually deteriorated, mirroring the decay of downtown Los Angeles, particularly in the skid row area. With rock-bottom rents and flexible stays, the historic 1927 building attracted those who were a step away from homelessness.

The Cecil also became a magnet for criminal activity. Most notably it was the occasional home to infamous serial killers Jack Unterweger and Richard "Night Stalker" Ramirez. Even after a multimillion-dollar makeover in 2008, police said they frequently respond to the Cecil for calls relating to domestic abuse and narcotics.

In 2010, the hotel was the scene of a bizarre incident in which a Los Angeles city firefighter who had been honored as paramedic of the year said he was stabbed while responding to a distress call. But police found inconsistencies in the story and no assailant was ever located.

On Tuesday, the Cecil grappled with a deeper mystery.
According to detectives with the LAPD's Robbery-Homicide Division, Lam came to Los Angeles from Vancouver on Jan. 26. While they did not discuss her exact movements or whether she visited anyone here, they believe her ultimate destination was Santa Cruz. Lam's reasons for visiting California were unclear, detectives said.

She was last seen Jan. 31 inside the elevator of the hotel. In surveillance footage, Lam is seen pushing buttons for multiple floors and at one point stepping out of the elevator, waving her arms.
A cause of death is still to be determined by county coroner’s officials, Lopez said.

A locked door that only employees have access to and a fire escape are the only ways to get to the roof. The door is equipped with an alarm system that notifies  hotel personnel if someone is up there, Lopez said.

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At War Blog: General Allen's Tenure in Afghanistan

Most Americans probably know of him only as a secondary character in the sweeping drama of David H. Petraeus’s affair with his biographer, Paula Broadwell. But Gen. John R. Allen, who announced Tuesday that he would retire from the Marine Corps rather than become the top commander of NATO, was for more than a year and a half the commander of NATO forces in Afghanistan. And when he said farewell to the job recently, he made clear that he wanted to be remembered for more than his bit role in that scandal.

After receiving a medal for his service, just before turning over his command to a fellow Marine, Gen. Joseph Dunford, General Allen surprised some in the audience by declaring unequivocally: “This campaign is successful. We are winning. We are winning.”

During a news conference with a small group of reporters later, General Allen expanded on his confident description of the war – one, polls suggest, that is not shared by many Americans.

“There is no, in the Napoleonic sense, there is no decisive battle,” he said. But he said he saw daily evidence that the Afghan National Security Forces, or A.N.S.F., were getting better. “I see it contributing to the end state, which ultimately is the A.N.S.F. moving into the lead and creating space ultimately for the government of Afghanistan to get up on its feet,” he said.

“We’re not done,” he added. “But I’m comfortable that the trajectory is moving us in the direction we ultimately want to go.”

Asked if widespread corruption by the Afghan government had irreparably undermined its credibility with the people and pushed them toward the Taliban, General Allen acknowledged concerns.

“I think we all have to recognize the limits of the capacity of the Afghan people and the government at this particular moment,” he said. “We’re coming out of 33 years of conflict. Coming out of an environment where the school system was largely decimated or devastated, whichever D-word you want to apply to it.”

The key to the government’s continued stability – and to an international willingness to continue providing it aid – will be its ability to hold a safe and credible presidential election in 2014, General Allen said.

“We’ve reached the point where the rhetoric, while it was encouraging, isn’t enough anymore,” he said. “The rhetoric has to be accompanied by action. The rhetoric has to be accompanied by real and meaningful reform. Reform that reduces the capacity of the criminal patronage networks to grip and weaken institutions of state. Reform that genuinely takes care of the rights of minorities, and particularly the rights of women.”

During his tenure, General Allen had more than his share of crises: a video of Marines urinating on Taliban corpses; the burning of Korans by American soldiers; civilian deaths in allied airstrikes; the massacre of 16 civilians, in which an American soldier has been charged; and a spate of insider attacks by Afghan forces on NATO troops.

He also had to work hard to repair frayed relationships with President Hamid Karzai, who clashed openly with Mr. Petraeus, General Allen’s predecessor as head of international forces in Afghanistan. As The Times’s Matthew Rosenberg noted in a recent article, General Allen established an amicable enough relationship that Mr. Karzai called him to offer condolences while the general was on home leave in Virginia last year for his mother’s funeral.

As Mr. Rosenberg tells it, General Allen had not told anyone in the Afghan government before flying home to bury her. Then, while eating with his family in the Shenandoah Valley, he got a phone call from President Karzai.

“So I’m in the parking lot, it’s just surreal,” General Allen said. “Talking to the president of Afghanistan, who is gripped with emotion saying words to the effect that our mothers are so precious to us.”

A transcript of the interview that accompanied that article, in which General Allen described how he dealt with the Koran burnings, the Panjwai massacre and other crises, can be found here.

As if juggling all that were not enough, General Allen’s reputation came under a cloud when e-mails between him and a socialite in Tampa, Fla., Jill Kelley, emerged during the investigation of General Petraeus’s affair with Ms. Broadwell. After a lengthy review of those e-mails, the Defense Department’s inspector general cleared General Allen of any wrongdoing. The decision allowed President Obama’s nomination of General Allen to become the top NATO commander and head of the United States European Command to proceed.

But during his farewell at his headquarters in Kabul on Feb. 10, General Allen sent what might have been a signal about his plans to retire. He closed his remarks with generous praise of his wife, noting that many generations of her family had served in the military and that she had patiently endured 29 moves with him during 35 years of marriage. General Allen told The Washington Post that he was retiring to help his wife, Kathy, cope with chronic health problems.

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Vin Diesel Re-cuts His Rihanna Rendition

By Maggie Coughlan

02/19/2013 at 05:00 PM EST

Rihanna and Vin Diesel

Larry Busacca/WireImage; Jon Kopaloff/FilmMagic

Vin Diesel: an action star and a gentleman.

After showing off his vocal range with a cover of Rihanna's "Stay" on Friday, The Fast and the Furious star is revealing the inspiration behind his touching performance (and his re-cut clip, below).

After seeing Rihanna perform the song at the Grammy Awards, Diesel, 45, decided to record himself singing the tune and dedicate it to his longtime girlfriend, Paloma Jimenez, in lieu of a traditional Valentine's Day card.

With the help of his daughter, Diesel obtained a mic and an amp while Jimenez was on a flight and "the rest is history," he tells PEOPLE.

And the response his romantic video has been getting has been even better.

"People say 'I didn't know you were a Rihanna fan?' " he says. "How could you not be a fan of her voice, her gift."

But while the actor says he's been putting out fun singing videos "for years" – and sang in Saving Private Ryan – he adds that "no one ever took it this [seriously]."

• With Reporting By JULIE JORDAN

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Costlier robotic surgery soars for hysterectomies

CHICAGO (AP) — Robotic surgery is increasingly being used for women's hysterectomies, adding at least $2,000 to the cost without offering much benefit over less high-tech methods, a study found.

The technique was used in just 0.5 percent of operations studied in 2007, but that soared to almost 10 percent by early 2010. Columbia University researchers analyzed data on more than 260,000 women who had their wombs removed at 441 U.S. hospitals for reasons other than cancer. The database covered surgeries performed through the first few months of 2010.

Women who had the robotic operations were slightly less likely to spend more than two days in the hospital, but hospital stays were shorter than that for most women. Also, complications were equally rare among robotic surgery patients and those who had more conventional surgeries. Average costs for robotic hysterectomies totaled nearly $9,000, versus about $3,000 for the least expensive method, a different type of minimally invasive technique using more conventional surgery methods.

Traditionally hysterectomies were done by removing the womb through a large abdominal incision. Newer methods include removing the uterus through the vagina and minimally invasive "keyhole" abdominal operations using more conventional surgery methods, or surgeon-controlled robotic devices.

Robotic operations involve computer-controlled long, thin robot-like "arms" equipped with tiny surgery instruments. Surgeons operate the computer and can see inside the body on the computer screen, through a tiny camera attached to the robotic arms. The initial idea was for surgeons to do these operations miles away from the operating room, but robotic operations now are mostly done with the surgeon in the same room as the patient.

Theoretically, robotic surgeries make it easier to maneuver inside the patient, and are increasingly used for many types of operations, not just hysterectomies.

The main explanation for the big increase "is that robotic surgery has been marketed extensively to not only hospitals and physicians, but also directly to patients. There is minimal data in gynecology that it is advantageous," said Dr. Jason Wright, an assistant professor of women's health and the study's lead author.

The study was published Tuesday in the Journal of the American Medical Association.

"Our findings highlight the importance of developing rational strategies to implement new surgical technologies," the researchers wrote.

They note that 1 in 9 U.S. women will undergo a hysterectomy, usually after the age of 40. Reasons include fibroids and other non-cancerous growths, abnormal bleeding, and cancer.

Traditional abdominal operations remain common and more than 40 percent of women studied had them, costing on average about $6,600.

A JAMA editorial says the study doesn't answer whether the robotic method might be better for certain women, and says more research comparing methods is needed. Still, it says doctors and hospitals have a duty to inform patients about costs of different surgery options.

Dr. Myriam Curet of manufacturer Intuitive Surgical of Sunnyvale, Calif., said surgical robots can help surgeons overcome the limitations of other minimally invasive methods for very overweight patients, those with scarring from other surgeries and other complexities.

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JAMA: http://www.jama.ama-assn.org

Robotic surgery: http://tinyurl.com/byuljds

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

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Rapes may be tied to Christian dating website, officials say

Police in the San Diego suburb of La Mesa are investigating whether a 37-year-old man charged with raping a woman he met on the ChristianMingle website may have victimized other women he met on the dating website.

Sean Banks of Del Mar is charged with rape, burglary and penetration by force involving a woman in La Mesa, according to court records. He was arrested Feb. 11 and has pleaded not guilty.

Banks, a computer technician, worked in various locations across the United States. Police said they are investigating whether he may have lured other victims through ChristianMingle and other websites, possibly using pseudonyms, including Rylan Butterwood and Rylan Harbough.

In the La Mesa case, he used the name Rarity, police said. The alleged attack occurred in the woman's home the first time the two met in person after carrying on conversations over the Internet, police said.

Beverly Hills-based ChristianMingle is cooperating with the investigation, police said.

Anyone with information about Banks or other possible victims should call the La Mesa Police Department at (619) 667-7538.

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Photo: Sean Banks. Credit: La Mesa Police Department

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Mikhail Pakhomov’s Body Is Found Near Moscow in Cement-Filled Barrel

MOSCOW — The body of a missing city legislator and construction tycoon has been found in a private basement garage on the city’s outskirts, inside a rusted metal barrel filled with cement, the police said Monday.

Russian television showed investigators removing the body of the man, Mikhail Pakhomov, 36, on Sunday evening from the garage, 20 miles east of Moscow, where the police said he had been tortured and killed over an outstanding $80 million loan.

The killing recalled the brutal violence that routinely emerged from business disputes in the 1990s. Mr. Pakhomov, who was reported missing last Tuesday, was a promising young star in United Russia, the ruling party founded by President Vladimir V. Putin, and had served as head of a construction company that was reported to have won large contracts to develop utilities and infrastructure in several cities.

Sergei B. Ivanov, Mr. Putin’s chief of staff, last year called housing and utilities services one of Russia’s most corrupt sectors. Many lucrative contracts are doled out on the municipal level, and large sums of money are at stake.

Politicians who have tried to battle graft in the system have met with violence. In 2011, Yevgeny Dushko, the mayor of Sergiyev Posad, was gunned down in his driveway in a contract killing that investigators said was most likely linked to his disputes with the city’s utility contractors.

The police have identified the likely mastermind of Mr. Pakhomov’s killing as Yevgeny Kharitonov, a former deputy minister for housing and utilities services in the Moscow region. . They said Mr. Kharitonov had Mr. Pakhomov followed since last November and was pressing the legislator to repay a debt of $80 million. Mr. Kharitonov has been arrested, but so far, he has been charged only with kidnapping. Seven other people were also arrested.

Mr. Pakhomov was reported missing on Feb. 12 from Lipetsk, an industrial city 270 miles southeast of Moscow, where he served as a regional lawmaker. Witnesses said three men had dragged him from his car, and the police said they found traces of blood at the scene.

The search continued for almost a week, until people questioned by the police led investigators to the body.

“A similar event has never happened with a V.I.P. in our city,” read an editorial published in Gorod48, a news Web site based in Lipetsk. “Even in the ‘evil ’90s’ nobody disappeared: businessmen were killed right where they lived or worked, and bandits from competing groups shot or blew each other up wherever they happened to be.”

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The Bachelor: AshLee Dishes on Her Connection with Sean - and Tierra

TV Watch

The Bachelor

By Carrie Bell

02/18/2013 at 04:25 PM EST

For The Bachelor's AshLee Frazier, 32, the week spent with Sean Lowe in St. Croix was a series of emotional highs and lows, from coming clean with the final skeleton in her closet to a super-charged confrontation with Tierra. The Houston-based professional organizer spoke with reporters about what she sees in her show squeeze, how it felt to tell him she'd been married before (and in high school no less!), and if she really feared elimination.

Why wait so long to tell him about your high school marriage?
Obviously, I wasn't going to tell him on our very first date. I want to know somebody and make sure the vibe is there before I divulge my story. Every other time was either a group date or the rose ceremony and that just wasn't the appropriate time to talk. He had a few more questions about it [than aired on TV], but he was so loving and genuine about it. He made me feel like a huge weight lifted, like it was OK.

Can you explain how it ended?
The details are pretty simple. I got a divorce. I was young and I didn't handle [going through the rough patch with my family] the best way. It wasn't a bad breakup. It was more like I woke up and [realized], "Oops. What did I do?" We discussed it and both came to the conclusion that we made a bad decision.

You had a great date and said, "I love you." Yet you seemed convinced you would be eliminated. Why?
One hundred percent I was scared this might be the time I go home. I felt safe up until the argument happened and even until Sean came in before the rose ceremony and said that he didn't want anyone with these dramatic spells in his life. I was part of the [drama with Tierra]. I didn't get a chance to talk to him and explain my side of it because there was no cocktail party.

How'd it feel to hear Tierra mock your age and call you high school?
I laughed because what are you gonna do? Go back in time? I'm 32. I've never thought about my age so much in my life. It doesn't bother me. It speaks for itself who was being immature. It was not a very nice thing to say, but that's the difference between her character and mine.

Ever wonder how he could dig Tierra and you simultaneously?
I couldn't sit and wonder why he was keeping Tierra. You have to compartmentalize your feelings and focus on the end and your relationship with Sean. Sean is smart. I knew he'd eventually come to and realize it.

Why do you two mesh?
We come from the same background, have a very similar strong family upbringing and are compatible. He was classy, charismatic and a solid gentleman who made me laugh all the time. You have to balance each other out. I think it was a ying to a yang. He wants to adopt and [great for] my heart to hear. That's a solid foundation to build a perfect relationship.

People have said you might not be enough of a goofball to be the one.
When it came to our relationship. I took it more seriously because this is my future. This is marriage and that's not something I want to tread into lightly. But for the most part, I'm not sure where that comes from. I joked. I laughed. I played a lot of Apples to Apples. I had a blast.

Do you see connections between him and other girls?
I see the possibility. Lindsay is very fun. She's always cracking jokes. Catherine has a big heart. Desiree has a sense of stability. Sean said he wanted someone that was genuine, nice, ready for marriage and somebody with a good heart who loved family and if that's what he wanted, I'm the best match for that.

Is everyone left ready to get married?
If they say they are, I would take it at face value. I would hope that anybody who comes on the show is ready. I can only vouch for myself. I was 100 percent ready to give my heart to somebody and fall in love.

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Study: Better TV might improve kids' behavior

SEATTLE (AP) — Teaching parents to switch channels from violent shows to educational TV can improve preschoolers' behavior, even without getting them to watch less, a study found.

The results were modest and faded over time, but may hold promise for finding ways to help young children avoid aggressive, violent behavior, the study authors and other doctors said.

"It's not just about turning off the television. It's about changing the channel. What children watch is as important as how much they watch," said lead author Dr. Dimitri Christakis, a pediatrician and researcher at Seattle Children's Research Institute.

The research was to be published online Monday by the journal Pediatrics.

The study involved 565 Seattle parents, who periodically filled out TV-watching diaries and questionnaires measuring their child's behavior.

Half were coached for six months on getting their 3-to-5-year-old kids to watch shows like "Sesame Street" and "Dora the Explorer" rather than more violent programs like "Power Rangers." The results were compared with kids whose parents who got advice on healthy eating instead.

At six months, children in both groups showed improved behavior, but there was a little bit more improvement in the group that was coached on their TV watching.

By one year, there was no meaningful difference between the two groups overall. Low-income boys appeared to get the most short-term benefit.

"That's important because they are at the greatest risk, both for being perpetrators of aggression in real life, but also being victims of aggression," Christakis said.

The study has some flaws. The parents weren't told the purpose of the study, but the authors concede they probably figured it out and that might have affected the results.

Before the study, the children averaged about 1½ hours of TV, video and computer game watching a day, with violent content making up about a quarter of that time. By the end of the study, that increased by up to 10 minutes. Those in the TV coaching group increased their time with positive shows; the healthy eating group watched more violent TV.

Nancy Jensen, who took part with her now 6-year-old daughter, said the study was a wake-up call.

"I didn't realize how much Elizabeth was watching and how much she was watching on her own," she said.

Jensen said her daughter's behavior improved after making changes, and she continues to control what Elizabeth and her 2-year-old brother, Joe, watch. She also decided to replace most of Elizabeth's TV time with games, art and outdoor fun.

During a recent visit to their Seattle home, the children seemed more interested in playing with blocks and running around outside than watching TV.

Another researcher who was not involved in this study but also focuses his work on kids and television commended Christakis for taking a look at the influence of positive TV programs, instead of focusing on the impact of violent TV.

"I think it's fabulous that people are looking on the positive side. Because no one's going to stop watching TV, we have to have viable alternatives for kids," said Dr. Michael Rich, director of the Center on Media and Child Health at Children's Hospital Boston.

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Online:

Pediatrics: http://www.pediatrics.org

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Contact AP Writer Donna Blankinship through Twitter (at)dgblankinship

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Attorney killed wife on Italian cruise for her money, police say

A former Orange County attorney allegedly killed his ex-wife for financial gain in 2006 by strangling her and throwing her overboard while on a cruise along the Italian coast, authorities said.

Lonnie Kocontes, 55, a former Mission Viejo resident, was arrested Friday at his home in Safety Harbor, Fla., in connection with the death of his former wife, Micki Kanesaki, 52, of Ladera Ranch, authorities said. He is charged with one felony count of special circumstances for financial gain.

If convicted, he faces a maximum life sentence in state prison without the possibility of parole and is eligible for the death penalty, authorities said. Kocontes, who is being held without bail, also faces extradition proceedings at a date to be determined.

He is accused of financially benefiting from Kanesaki’s death because he was the beneficiary of several of their bank accounts and property and was receiving the proceeds from the sale of their home, authorities said.

The couple divorced in 2001 and were in the midst of a court battle when they decided to put aside their rancor and take a Mediterranean vacation together.

Kocontes is suspected of killing his wife on the night of May 25, 2006, or the morning of May 26, by strangling her and throwing her body overboard, authorities said.

At the time, Kocontes reported his wife missing. He told authorities that the couple had retired to bed when about 1 a.m. Kanesaki stepped out to get a cup of tea to help her relax and never returned.

Her body was found on the morning of May 27 by the Italian coast guard, floating in the sea near Reggio di Calabria.

"I wish I knew what happened," Kocontes was quoted as saying at the time. He told authorities that his former wife had previously talked of suicide.

But an autopsy revealed Kanesaki had been strangled, authorities said.

In 2008, Kocontes is accused of attempting to transfer $1 million between various banks accounts with his new wife, Katherine, authorities said. The FBI began investigating the money transfers for possible illegal activity and the U.S. attorney’s office ultimately seized the money from Kocontes’ bank account.

The Orange County district attorney’s office was contacted and subsequently the Sheriff’s Department relaunched its investigation, authorities said.

On Wednesday, the district attorney filed its murder case against Kocontes.      

The FBI and the Orange County Sheriff's Department are continuing the investigation.

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