Fewer health care options for illegal immigrants

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

___

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

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

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Critics Faulted Rice's Work on Benghazi, Africa

United Nations Ambassador Susan Rice removed herself from possible consideration as secretary of state after becoming yet another player in the divide between the left and right.

Rice, who withdrew her name Thursday, has faced months of criticism over how she characterized the Sept. 11 attack on a U.S. consulate in Benghazi, Libya. She also has come under fire for her approach to dealing with African strongmen.

Rice became a target for conservatives when she went on Sunday morning current affairs shows such as ABC News' "This Week" following the Benghazi attack and failed to characterize it as a pre-meditated act of terror. Instead, she said it was a spontaneous response to an anti-Islam film produced in the United States and cited in the region as an example of anti-Islamicism in the West.

After it became clear that Rice's assertions were untrue and elements of the Obama administration may have known that to be the case, Republican Sens. Lindsey Graham, John McCain and Kelly Ayotte said they would do whatever they could to block Rice's possible nomination to replace Hillary Clinton as secretary of state.

Susan Rice Withdraws From Consideration for Secretary of State Watch Video

GOP Senators 'Troubled' After Meeting With Ambassador Rice Watch Video

President Obama to Senator McCain: 'Go After Me' Watch Video

"This is about the role she played around four dead Americans when it seems to be that the story coming out of the administration -- and she's the point person -- is so disconnected to reality, I don't trust her," Graham said. "And the reason I don't trust her is because I think she knew better. And if she didn't know better, she shouldn't be the voice of America."

Members of the administration defended Rice. At his testimony before Congress, Gen. David Petraeus, the former CIA director, said Rice was speaking from unclassified talking points given to her by the CIA.

Senate Intelligence Committee Chairwoman Dianne Feinstein, D-Calif., reiterated what Petraeus said outside his closed-door hearing before the Senate.

"The key is that they were unclassified talking points at a very early stage. And I don't think she should be pilloried for this. She did what I would have done or anyone else would have done that was going on a weekend show," Feinstein said. "To say that she is unqualified to be secretary of state, I think, is a mistake. And the way it keeps going, it's almost as if the intent is to assassinate her character."

Minutes after she announced her withdrawal from the process, Graham tweeted, "I respect Ambassador Rice's decision."

McCain's office released a paper statement saying, "Senator McCain thanks Ambassador Rice for her service to the country and wishes her well. He will continue to seek all the facts surrounding the attack on our consulate in Benghazi that killed four brave Americans."

Over the last few weeks, criticism of Rice had grown beyond her response to Benghazi to include a closer scrutiny of her work in Africa, where she had influence over U.S. policy during the Clinton administration.

Critics of her Africa dealings were not partisan -- but included human rights workers, journalists and some Africans themselves.

Among the most serious critiques was the accusation that she actively protected Rwandan President Paul Kagame and senior members of his government from being sanctioned for funding and supporting the rebels that caused Eastern Congo's recent violence.

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U.S., rebels urge gloomy Moscow to help oust Assad

BEIRUT (Reuters) - Syria's rebel leadership and the United States seized on Russian pessimism over President Bashar al-Assad's future to urge Moscow to help push its ally into ceding power and end the battles closing in around his capital.

"We want to commend the Russian government for finally waking up to the reality and acknowledging that the regime's days are numbered," the U.S. State Department spokeswoman said after a senior Kremlin envoy conceded publicly on Thursday that Assad's opponents could win the 20-month-old civil war.

"The question now is, will the Russian government join those of us in the international community who are working with the opposition to try to have a smooth democratic transition?" U.S. spokeswoman Victoria Nuland added in Washington.

In Marrakech, where his new coalition won recognition from other international powers as the legitimate leadership of Syria, rebel political leader Mouaz al-Khatib said he believed Russia, ally and arms supplier to the Assad dynasty since Soviet times, was looking for ways out of its support for a lost cause.

"I believe that the Russians have woken up and are sensing that they have implicated themselves with this regime, but they don't know how to get out," al-Khatib told Reuters. He held them "particularly responsible" for helping Assad with arms but said Moscow need not "lose everything" in Syria if it changed tack.

Under President Vladimir Putin, wary since last year's Libyan war of what Russia sees as a Western drive to use the United Nations to overthrow national leaders it dislikes, Russia has blocked U.N. efforts to squeeze Assad, who has also had strong support from his long-time sponsor Iran.

But Mikhail Bogdanov, a deputy foreign minister and the Kremlin's special envoy for Middle East affairs, was quoted as saying in Moscow: "One must look the facts in the face."

"Unfortunately, the victory of the Syrian opposition cannot be ruled out." The Syrian government, he said, was "losing control of more and more territory" and Moscow was preparing to evacuate Russian citizens if necessary.

Nuland said Bogdanov's comments demonstrated that Moscow now "sees the writing on the wall" on Syria and said Russia should now rally behind U.N. efforts to prevent a wider bloodbath.

"They can withdraw any residual support for the Assad regime, whether it is material support (or) financial support," she said. "They can also help us to identify people who might be willing, inside of Syria, to work on a transitional structure."

DIPLOMACY

International envoy Lakhdar Brahimi, who has met Russian and U.S. officials twice in the past week, is seeking a solution based on an agreement reached in Geneva in June that called for the creation of a transitional government in Syria.

But Russia has repeated warnings that recognition of al-Khatib's coalition, notably by the United States, is undermining diplomacy, and rejected U.S. contentions that the Geneva agreement sent a clear message that Assad should step down.

Nuland said the Brahimi meetings could lay the framework for a political structure to follow Assad:

"We've said all along to the Russians that we are concerned that the longer that this goes on, and the longer it takes us to get to an alternative political path for Syria, the only path is going to be the military one and that is just going to bring more violence.

"We all ought to be working together."

Bogdanov, whose government has suggested that Assad himself should be allowed to see through a transition he has promised, suggested the rebels and their allies were set on a military solution and he gave little hint of detente with Washington.

"The fighting will become even more intense and (Syria) will lose tens of thousands and, perhaps, hundreds of thousands of civilians," Bogdanov was quoted as saying. "If such a price for the removal of the president seems acceptable to you, what can we do? We, of course, consider it absolutely unacceptable."

The head of NATO, Anders Fogh Rasmussen, said elsewhere: "I think the regime in Damascus is approaching collapse."

A U.S. official said: "Assad probably still believes that Syria is his and illusions can die hard. But Assad and those closest to him have got to be feeling the psychological strain of fighting a long war that is not going their way."

DAMASCUS BATTLES

But Al-Khatib, who played down Western concerns of sectarian Sunni Islamists in rebel ranks, warned that the fighting was far from over, even as it has begun to rattle the heart of Assad's power in Damascus. On Wednesday, a car bomb killed at least 16 people in a nearby town which is home to many military families.

"The noose is tightening around the regime," al-Khatib said.

"(But) the regime still has power. People think that the regime is finished, but it still has power left, but it is demoralized and however long it lasted its end is clear."

Day and night, Damascenes can hear the thunderous sound of bombardment aimed at rebel-held and contested neighborhoods.

The city's streets have now turned into a labyrinth of checkpoints and road blocks, with several major roads permanently closed off to traffic by concrete barriers.

"We escape from one place and trouble follows," said one grandmother, Um Hassan, as she described to Reuters her family's flight from one neighborhood to another as fighting seeps into the capital. "I don't know where we can keep running to."

Nonetheless, al-Khatib played down demands for their allies to provide heavier weaponry - a request long resisted by governments wary of anti-aircraft missiles and other hardware reaching Islamist rebels who might turn them against the West.

"The Syrian people ... no longer need international forces to protect them," he said, not specifying whether he meant a no-fly zone, arms supplies or other military support.

The opposition chief said he was willing to listen to proposals for Assad to escape with his life - "The best thing is that he steps down and stops drinking the blood of the Syrian people" - and outlined three scenarios for a change of power:

Al-Khatib ruled out the Russian proposal suggesting Assad hand over power to a transitional government while remaining president, saying it was "disgraceful for a slaughtered nation to accept to have a killer and criminal at its head".

The British-based Syrian Observatory said war planes bombed rebel-held eastern suburbs of Damascus on Thursday and artillery was hitting Daraya and Moadamiyeh, southwestern areas near the centre where rebels have been fighting for a foothold.

Syria has relied on war planes and helicopters to bombard rebel districts but Damascus denied accusations by U.S. and NATO officials that it had fired Scud missiles in recent days. The foreign ministry said the long-range missiles were not used against "terrorist groups," a term it uses for the rebels.

At least 40,000 people have been killed in Syria's uprising, which started in March 2011 with street protests which were met with gunfire by Assad's security forces, and which spiraled into the most enduring and destructive of the Arab revolts.

(Additional reporting by Steve Gutterman in Moscow and Andrew Quinn in Washington; Writing by Alastair Macdonald; Editing by Michael Roddy) For an interactive look at the uprising in Syria, please click on http://link.reuters.com/rut37s

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Two dead, 10 missing after South Korea barge capsizes

SEOUL: Two construction workers were confirmed killed late Friday and 10 others missing after a barge carrying a crane capsized off South Korea's southeast coast, the coastguard said.

The 2,600-ton barge sank off the city of Ulsan after the 80-metre (264-foot) crane collapsed, Yonhap news agency quoted coastguard officials as saying.

Twelve people have so far been rescued with two others confirmed dead, and a search is underway for the 10 missing workers.

The accident happened during construction of a new port.

- AFP/lp

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Pakistan jail staff suspects Indian prisoners and bars them from writing letters

AMRITSAR: Many Indian prisoners lodged in Pakistani jails are still suspected and are even not allowed to write letters to their dear ones in India.

Revealing this, Pakistani advocate Awaish Sheikh , who is also contesting the case of Sarabjit Singh, informed TOI on Friday that during his meeting with Indian prisoner Kuldeep Singh in Central jail on December 13th the deputy superintendent of central jail refused Kuldeep Singh to write a message for his family.

Kuldeep Singh was reportedly arrested from Shakargarh area of Pakistan in 1992 on charges of spying and was sentenced to life imprisonment by a military court on May 1996 and had already spent 20 years in Pak jail. Sheikh informed that he met Kuldeep Singh in jail after approval of home secretary .

"But to my surprise a major of Pakistan army and his junior were unofficially present in the meeting along with deputy superintendent of jail", said Sheikh adding that representatives of special branch(CID) and counter terrorism departments also accompanied him. He said this was for the first time that any lawyer met him in jail in all these years and he also gave him some eatables.

He said he handed over him a draft of mercy petition for his release on humanitarian grounds in Urdu language and also two papers for writing messages for his mother, wife and son back home so that they could be delivered to them."A jail staffer took those papers from him and gave to deputy superintendent of jail who refused to handover to me after reading them" said Sheikh adding that he was informed that he couldn't take these papers on the plea that correspondence of inmates were not allowed.

"I tried to convince him but he d idn't listen to me" said Sheikh. However he said that Kuldeep gave him a hand made key ring and asked him to convey his well being to his family members.

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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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Mall Shooter Quit Job, Was Hawaii Bound

In the days before he stole a semiautomatic weapon and stormed into an Oregon shopping mall, killing two people in a shooting spree, Jacob Roberts quit his job, sold his belongings and began to seem "numb" to those closest to him.

Roberts' ex-girlfriend, Hannah Patricia Sansburn, 20, told ABC News today that the man who donned a hockey mask and opened fire on Christmas shoppers was typically happy and liked to joke around, but abruptly changed in the week before the shooting.

Roberts unleashed a murderous volley of gunfire on the second floor of the Clackamas Town Center on Tuesday while wearing the mask and black clothing, and carrying an AR-15 semiautomatic weapon and "several" magazines full of ammunition. He ended his barrage by walking down to the first floor of the mall and committing suicide.

READ: Why Mass Shooters Wear Masks

"I don't understand," Sansburn said. "I was just with him. I just talked to him. I didn't believe it was him at all. Not one part of me believed it."

She said that in recent weeks, Roberts quit his job at a gyro shop in downtown Portland and sold all of his belongings, telling her that he was moving to Hawaii. He had even purchased a ticket.

She now wonders if he was really planning to move.

Oregon Mall Shooting: Gunman Identified as Jacob Tyler Roberts Watch Video

Oregon Mall Shooting: Suspect Jacob Tyler Roberts Identified Watch Video

Oregon Mall Shooting: 2 Dead in Clackamas Town Center Watch Video

"He was supposed to catch a flight Saturday and I texted him, and asked how his flight went, and he told me, 'oh, I got drunk and didn't make the flight,'" she said. "And then this happens... It makes me think, was he even planning on going to Hawaii? He quit his job, sold all of his things."

Roberts described himself on his Facebook page as an "adrenaline junkie," and said he is the kind of person who thinks, "I'm going to do what I want."

Roberts, who attended Clackamas Community college, posted a picture of himself on his Facebook page firing a gun at a target. His Facebook photo showed graffiti in which the words "Follow Your Dreams" were painted over with the word "Cancelled."

Sansburn said the pair had dated for nearly a year but had broke up over the summer. Throughout their relationship, she had never seen him act violently or get angry.

"Jake was never the violent type. He didn't go out of his way to try to hurt people or upset people. His main goal was to make you laugh, smile, make you feel comfortable. I never would have guessed him to do anything like this ever," she said.

"You can't reconcile the differences. I hate him for what he did, but I can't hate the person I knew because it was nothing like the person who would go into a mall and go on a rampage. I would never associate the two at all."

The last time she saw him, which was last week, he "seemed numb," and she didn't understand why, she said.

"I just talked to him, stayed the night with him, and he just seemed numb if anything. He's usually very bubbly and happy, and I asked him why, what had changed, and said 'nothing.' He just had so much he had to do before he went to Hawaii that he was trying to distance himself from Portland," Sansburn said.

Sansburn said the last message she sent Roberts was a text, asking him to stay, and saying she didn't want him to leave. He replied "I'm sorry," with a sad face emoticon.

Police are still seeking information about what Roberts was doing in the days leading up to the shooting. They said today they believe Roberts stole the gun he used in the rampage from someone he knew. They have searched his home and his car for other clues into his motive.

Read ABC News' full coverage of the Oregon Mall Shooting

Clackamas County Sheriff Craig Roberts said earlier today on "Good Morning America" that he believes Roberts went into the mall with the goal of killing as many people as he could.

"I believe, at least from the information that's been provided to me at this point in time, it really was a killing of total strangers. To my knowledge at this point in time he was really trying, I think, to kill as many people as possible."

Sansburn said she has not talked to police.

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Russia says Syrian rebels might win

MOSCOW/BEIRUT (Reuters) - Syrian rebels are gaining ground and might win, Russia's Middle East envoy said on Thursday, in the starkest such admission from a major ally of President Bashar al-Assad in 20 months of conflict.

"One must look the facts in the face," Russia's state-run RIA quoted Mikhail Bogdanov as saying. "Unfortunately, the victory of the Syrian opposition cannot be ruled out."

Bogdanov, a deputy foreign minister and the Kremlin's special envoy for Middle East affairs, said the Syrian government was "losing control of more and more territory" and Moscow was preparing to evacuate Russian citizens if necessary.

Advancing rebels now hold an almost continuous arc of territory from the east to the southeast of Damascus, despite fierce army bombardments designed to drive them back.

The head of NATO said he thought Assad's government was nearing collapse and the new leader of Syria's opposition told Reuters the people of Syria no longer needed international forces to protect them.

"The horrific conditions which the Syrian people endured prompted them to call on the international community for military intervention at various times," said Mouaz al-Khatib, a preacher who heads Syria's National Coalition.

"Now the Syrian people have nothing to lose. They handled their problems by themselves. They no longer need international forces to protect them. The international community has been in a slumber, silent and late (to react) as it saw the Syrian people bleeding and their children killed for the past 20 months," he added in the interview on Wednesday night.

He did not specify whether by intervention he meant a no-fly zone that rebels have been demanding for month, a ground invasion - which the opposition has warned against - or arms shipments.

He said the opposition would consider any proposal from Assad to surrender power and leave the country, but would not give any assurances until it saw a firm proposal.

In the latest blow to the government, a car bomb killed at least 16 men, women and children in Qatana, a town about 25 km (15 miles) southwest of Damascus where many soldiers live, activists and state media said.

The explosion occurred in a residential area for soldiers in Qatana, which is near several army bases, said Rami Abdelrahman, head of the pro-opposition Syrian Observatory for Human Rights.

He put the death toll as 17, including seven children and two women. State news agency SANA said 16 people had died.

State television blamed the blast on "terrorists" - its term for rebels - and showed footage of soldiers walking by a partly collapsed building, with rubble and twisted metal on the road.

The attack follows three bombs at the Interior Ministry on Wednesday evening, in which state news agency SANA said five people were killed, including Abdullah Kayrouz, a member of parliament from the Syrian Social Nationalist Party.

Apart from gaining territory in the outskirts of Damascus in recent weeks, rebels have also made hit-and-run attacks or set off bombs within the capital, often targeting state security buildings or areas seen as loyal to Assad, such as Jaramana, where twin bombs killed 34 people in November.

The Pakistani Foreign Office said on Thursday security concerns had prompted it to withdraw the ambassador and all Pakistani staff from the embassy in the central suburb of East Mezzeh, a couple miles from the Interior Ministry.

BACK TO THE WALL

Insurgents launched an offensive on Damascus after a July 18 bombing that killed four of Assad's closest aides, including his feared brother-in-law Assef Shawkat, but were later pushed back.

With his back to the wall, Assad is reported to be turning ever deadlier weapons on his adversaries.

"I think the regime in Damascus is approaching collapse," NATO Secretary-General Anders Fogh Rasmussen said on Thursday.

U.S. NATO officials said on Wednesday the Syrian military had fired Scud-style ballistic missiles, which are powerful but not very accurate, against rebels in recent days.

Human Rights Watch said some populated areas had been hit by incendiary bombs, containing flammable materials such as napalm, thermite or white phosphorous, which can set fire to buildings or cause severe burns and respiratory damage.

The British-based Syrian Observatory said war planes were bombing rebel-held eastern suburbs of Damascus on Thursday and artillery was hitting Daraya and Moadamiyeh, southwestern areas near the centre where rebels have been fighting for a foothold.

At least 40,000 people have been killed in Syria's uprising, which started in March 2011 with street protests which were met with gunfire by Assad's security forces, and which spiraled into the most enduring and destructive of the Arab revolts.

The United States, European powers and Arab states bestowed their official blessing on Syria's newly-formed opposition coalition on Wednesday, despite increasing signs of Western unease at the rise of militant Islamists in the rebel ranks.

Western nations at "Friends of Syria" talks in Marrakech, Morocco rallied around a new opposition National Coalition formed last month under moderate Islamist cleric Mouaz Alkhatib.

Russia, which along with China has blocked any U.N. Security Council measures against Assad, criticized Washington's decision to grant the coalition formal recognition, saying it appeared to have abandoned any effort to reach a political solution.

Bogdanov's remarks were the clearest sign yet that Russia is preparing for the possible defeat of Assad's government.

"We are dealing with issues of preparations for an evacuation. We have mobilization plans and are clarifying where our citizens are located," Bogdanov said.

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US retail sales rebound in November

WASHINGTON: US retail sales rebounded in November, reversing October's decline as auto sales surged, the Commerce Department said on Thursday.

Retail sales rose 0.3 percent after a 0.3 percent drop the prior month.

Excluding automobile sales, up 1.4 percent after a 1.9 percent tumble in October, retail sales were unchanged from October.

The Commerce Department said that Hurricane Sandy, which wreaked havoc on the Northeast in late October and early November, had both positive and negative effects on the two months' data.

The data, which is not adjusted for price changes, showed a mixed performance across sectors in November.

Sales gains for automobiles, furniture and home furnishings, building materials, electronics and other sectors were offset by a sharp drop in gasoline sales.

Year-over-year growth in retail sales was 3.7 percent, unchanged from October.

The retail sales data, which includes restaurant and bar sales, is a key indicator of consumer spending that accounts for about 70 percent of US economic activity.

The modest rise in the headline number masked the true direction of consumer demand, said Joel Naroff of Naroff Economic Advisors.

"Gasoline prices were down sharply over the month and if you exclude them, spending increased sharply," he said.

- AFP/de

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Punish those who dirty streets: Himachal HC

SHIMLA: The green bench of Himachal Pradesh high court has ordered imposition of up to Rs.200 as fine for first-time offenders littering public spaces and asked the government to consider imposing a higher penalty.

The court, in a recent judgment, also ordered that for subsequent offences, week-long community service could be imposed as punishment.

The judgment, which could go a long way in making for cleaner streets, came as the court was hearing a petition filed by Abhishek Rai of Kullu, on the pollution of rivers Beas and Sarwari.

"The time has come for harsh measures against those members of the public who violate municipal laws. We are also of the view that penal provisions should include forcing the offender to do community service," observed Justices Deepak Gupta and Sanjay Karol in their order copies of which were made available to the media Thursday.

"Some of our citizens do not hesitate to dirty the streets and the areas around their houses, but when they go abroad they comply with all the civic laws of that country."

"Now, the time has come when the penalty for dirtying should not be less than Rs.2,500 and the government should seriously consider imposing the minimum penalty of Rs.2,500 for violation of such municipal laws."

The court directed the government to take a call on the issue by March 31 next year.

Till the government takes a decision in the matter, the court authorised the municipal councils of Kullu and Manali and the nagar panchayat of Bhuntar to levy a fine ranging from Rs.25 to Rs.200 on commission of the first offence.

"In case of a repeat offender, he can be punished by directing him to personally render community service by personally cleaning the public area in and around his premises in question under the supervision of a senior officer of the municipal council for a period of at least one week. Video of this shall be taken to be produced in the court," it said.

The bench said: "If a person continues to pollute and dirty the area outside his house or shop or other premises and does not improve despite two opportunities given to him, the municipal council can stop the provision of municipal facilities, like water etc. In case of offences relating to commercial establishments, i.e. shops etc., their licences shall be cancelled."

The court said the government might consider the framing of penal provisions to suitably deter littering.

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