Healthcare law will have new California Legislature scrambling

SACRAMENTO — When state lawmakers are sworn in Monday for the new legislative session, they will have little time to enjoy the pomp and circumstance.

Facing a federal deadline, the Legislature must move quickly to pass measures to implement President Obama's healthcare law and revamp the state's insurance market. New legislation will help extend coverage to millions of uninsured Californians and solidify the state's reputation as a key laboratory for the federal law.

Legislative leaders have said they also want to overhaul environmental regulations, curb soaring tuition at public colleges, and tweak the state's tax structure and ballot-initiative system.

But healthcare remains one of the largest and most immediate challenges.

The federal Affordable Care Act takes effect in January 2014, when most Americans face the requirement to buy health insurance or pay a penalty. State lawmakers must pass a series of rules to clear the way for enrollment in a new state-run insurance market next fall, including a requirement for insurers to cover consumers who have preexisting medical conditions and limits on how much they can charge based on age.

Gov. Jerry Brown is expected to call a special session of the Legislature next month — concurrent with the regular session — so healthcare bills that he signs can take effect within 90 days rather than the next year.

"It's a very, very big undertaking to make the promise of the Affordable Care Act a reality," said state Health and Human Services Secretary Diana Dooley. "We are working as hard and as fast as we can in a very complex area with a lot of conflicting information."

As an early adopter of the Affordable Care Act, California has already laid much of the groundwork.

It was the first state to establish an insurance exchange after Congress passed the legislation in 2010. More than 30 other states have since sought federal help in enacting their own. Millions of Californians will be able to purchase coverage, with federal subsidies earmarked for families earning about $92,000 or less annually.

One of the most significant proposals will be an expansion of Medi-Cal, the state's health insurance program for the poor. About 2 million low-income Californians would be newly eligible under the expansion, with the federal government subsidizing costs for the first three years. The state would then shoulder a portion of the bill.

According to a Kaiser Family Foundation study, the expansion could cost the state $6.3 billion over a decade, meaning a 1.7% increase in the amount California spends on Medi-Cal.

California got a head start on the effort by signing up more than 550,000 low-income people in a temporary program. They are expected to automatically move into Medi-Cal in 2014.

Lawmakers will also consider legislation that would create a health plan for people who cannot afford insurance on the open market but make too much money to qualify for Medi-Cal. The option, known as the Basic Health Plan, would provide coverage for individuals with incomes between 133% and 200% of the federal poverty level, or between $15,000 and $21,800 a year.

State Sen. Ed Hernandez (D-West Covina), chairman of the Senate Health Committee and author of the proposal, said the plan was needed to help California's working poor. "I don't think they should be choosing between putting food on the table and buying health insurance," he said.

Insurers urged lawmakers to resist requirements that could make policies offered through the exchange unaffordable.

"We think the Affordable Care Act does much to get millions of people coverage, but new insurance taxes, costly benefit requirements and age pricing restrictions all have the potential of driving up costs," said Nicole Evans, a spokeswoman for the California Assn. of Health Plans.

Healthcare advocates said it was critical for the Legislature to promote policies that would ensure a mix of healthy and sick policyholders to keep premiums affordable.

"It should be a goal of the state to have millions of people enrolled on Day 1," said Anthony Wright, executive director of the consumer group Health Access California, "to bring in those federal dollars and make healthcare cheaper for everybody."

michael.mishak@latimes.com

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After Death of Sattar Beheshti, Iranian Blogger, Head of Tehran’s Cybercrimes Unit Is Fired

TEHRAN — Iranian’s national police chief fired the commander of Tehran’s cybercrimes police unit on Saturday for negligence in the death of a blogger in prison.

The dismissal of the commander, Gen. Saeed Shokrian, follows investigations by Parliament and Iran’s judiciary into the unexplained death of the blogger, Sattar Beheshti, 35, who died in early November just a few days after being arrested by the cybercrimes police unit, known here as FATA.

“Tehran’s FATA should be held responsible for the death of Sattar Beheshti,” said Iran’s national police chief, Ismael Ahmadi-Moqaddam, according to the Iranian Labor News Agency.

It is unclear whether General Shokrian will also face judicial charges over the blogger’s death.

The public nature of his dismissal suggests that he will bear most of the responsibility for the death. In similar cases in the past, officials have been punished, but it is rare for them to be named and publicly dismissed on the same day.

Mr. Beheshti’s Web site, My Life for My Iran, criticized Iran’s financial contributions to the Hezbollah movement in Lebanon. Mr. Beheshti posted pictures of Lebanese youths having parties alongside images of Iranians living in poverty.

The exact cause of Mr. Beheshti’s death remains murky. Mr. Ahmadi-Moqaddam said Tuesday that investigations had ruled out torture as a cause of death, saying it was possible that Mr. Beheshti, who in pictures looks big and strong, died of “psychological shock.”

Iranian activists and bloggers say Mr. Beheshti died of injuries following beatings. Iran’s judiciary spokesman, Gholam Hussein Mohseni-Ejei, recently admitted that Mr. Beheshti — while in prison — had lodged a written complaint against an interrogator, in which he accused the man of having beaten him during his detention in Tehran’s Evin prison.

“I, Sattar Beheshti, was arrested by FATA and beaten and tortured with multiple blows to my head and body,” read the document, published by the opposition Kalame Web site. He added, “If anything happens to me, the police are responsible.”

Mr. Ahmadi-Moqaddam said that Mr. Beheshti was given tranquilizers while in the prison’s clinic, but that when handed over to the cybercrimes unit its officers denied him the same tranquilizers. “This might be regarded as neglect,” he said. “However, there were no signs of beatings on his body.”

Official statements on the cause of death have been contradictory. An influential member of Parliament who earlier denied that Mr. Beheshti had been tortured in any way told the Tabnak Web site that the blogger had been beaten, but died of shock and fear.

“Definitely he was beaten inside the FATA detention center,” the lawmaker, Alaeddin Borujerdi, told the Web site, “but he didn’t die as a result of these beatings.” He also stressed that the cybercrimes unit must change the way it deals with prisoners.

Iranian activists who have been in contact with Mr. Beheshti’s family say his relatives were not allowed to see his body before a hurried funeral on Nov. 6 in his hometown, Robat Karim, 30 miles southwest of the capital, Tehran.

In Mr. Beheshti’s final post, on Oct. 29, a day before his arrest, he said he was being threatened by security officials. “They told me that if I didn’t close my big mouth my mother should prepare to wear black clothes,” for mourning.

The Iranian Parliament’s special investigator into the case, Mehdi Davatgari, said he welcomed the commander’s removal. “This move shows the civil rights of our citizens are our top priority,” he said.

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Ashley Hebert and J.P. Rosenbaum Are Married

People Exclusive

By Monica Rizzo

12/01/2012 at 06:15 PM EST

J.P. Rosenbaum and Ashley Hebert

Victor Chavez/Getty

It’s official: Bachelorette star Ashley Hebert and her fiancé J.P. Rosenbaum tied the knot Saturday afternoon in Pasadena, Calif.

Surrounded by family, friends and fellow Bachelor and Bachelorette alumni like Ali Fedotowsky, Emily Maynard, and Jason and Molly Mesnick, the couple said "I do" in an outdoor ceremony officiated by franchise host Chris Harrison.

"Today is all about our friends and family," Hebert, whose nuptials will air Dec. 16 on a two-hour special on ABC, tells PEOPLE. "It's about standing with J.P., looking around at all the people we love in the same room there to celebrate our love."

The 28-year-old dentist from Madawaska, Maine, met New York construction manager Rosenbaum, 35, on season 7 of The Bachelorette. The couple became engaged on the season finale.

Hebert and Rosenbaum are the second couple in the franchise's 24 seasons to make it from their show finale to the altar, following in the footsteps of Bachelorette Trista Rehn, who married Vail, Colo., firefighter Ryan Sutter in 2003.

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Asperger's dropped from revised diagnosis manual

CHICAGO (AP) — The now familiar term "Asperger's disorder" is being dropped. And abnormally bad and frequent temper tantrums will be given a scientific-sounding diagnosis called DMDD. But "dyslexia" and other learning disorders remain.

The revisions come in the first major rewrite in nearly 20 years of the diagnostic guide used by the nation's psychiatrists. Changes were approved Saturday.

Full details of all the revisions will come next May when the American Psychiatric Association's new diagnostic manual is published, but the impact will be huge, affecting millions of children and adults worldwide. The manual also is important for the insurance industry in deciding what treatment to pay for, and it helps schools decide how to allot special education.

This diagnostic guide "defines what constellations of symptoms" doctors recognize as mental disorders, said Dr. Mark Olfson, a Columbia University psychiatry professor. More important, he said, it "shapes who will receive what treatment. Even seemingly subtle changes to the criteria can have substantial effects on patterns of care."

Olfson was not involved in the revision process. The changes were approved Saturday in suburban Washington, D.C., by the psychiatric association's board of trustees.

The aim is not to expand the number of people diagnosed with mental illness, but to ensure that affected children and adults are more accurately diagnosed so they can get the most appropriate treatment, said Dr. David Kupfer. He chaired the task force in charge of revising the manual and is a psychiatry professor at the University of Pittsburgh.

One of the most hotly argued changes was how to define the various ranges of autism. Some advocates opposed the idea of dropping the specific diagnosis for Asperger's disorder. People with that disorder often have high intelligence and vast knowledge on narrow subjects but lack social skills. Some who have the condition embrace their quirkiness and vow to continue to use the label.

And some Asperger's families opposed any change, fearing their kids would lose a diagnosis and no longer be eligible for special services.

But the revision will not affect their education services, experts say.

The new manual adds the term "autism spectrum disorder," which already is used by many experts in the field. Asperger's disorder will be dropped and incorporated under that umbrella diagnosis. The new category will include kids with severe autism, who often don't talk or interact, as well as those with milder forms.

Kelli Gibson of Battle Creek, Mich., who has four sons with various forms of autism, said Saturday she welcomes the change. Her boys all had different labels in the old diagnostic manual, including a 14-year-old with Asperger's.

"To give it separate names never made sense to me," Gibson said. "To me, my children all had autism."

Three of her boys receive special education services in public school; the fourth is enrolled in a school for disabled children. The new autism diagnosis won't affect those services, Gibson said. She also has a 3-year-old daughter without autism.

People with dyslexia also were closely watching for the new updated doctors' guide. Many with the reading disorder did not want their diagnosis to be dropped. And it won't be. Instead, the new manual will have a broader learning disorder category to cover several conditions including dyslexia, which causes difficulty understanding letters and recognizing written words.

The trustees on Saturday made the final decision on what proposals made the cut; recommendations came from experts in several work groups assigned to evaluate different mental illnesses.

The revised guidebook "represents a significant step forward for the field. It will improve our ability to accurately diagnose psychiatric disorders," Dr. David Fassler, the group's treasurer and a University of Vermont psychiatry professor, said after the vote.

The shorthand name for the new edition, the organization's fifth revision of the Diagnostic and Statistical Manual, is DSM-5. Group leaders said specifics won't be disclosed until the manual is published but they confirmed some changes. A 2000 edition of the manual made minor changes but the last major edition was published in 1994.

Olfson said the manual "seeks to capture the current state of knowledge of psychiatric disorders. Since 2000 ... there have been important advances in our understanding of the nature of psychiatric disorders."

Catherine Lord, an autism expert at Weill Cornell Medical College in New York who was on the psychiatric group's autism task force, said anyone who met criteria for Asperger's in the old manual would be included in the new diagnosis.

One reason for the change is that some states and school systems don't provide services for children and adults with Asperger's, or provide fewer services than those given an autism diagnosis, she said.

Autism researcher Geraldine Dawson, chief science officer for the advocacy group Autism Speaks, said small studies have suggested the new criteria will be effective. But she said it will be crucial to monitor so that children don't lose services.

Other changes include:

—A new diagnosis for severe recurrent temper tantrums — disruptive mood dysregulation disorder. Critics say it will medicalize kids' who have normal tantrums. Supporters say it will address concerns about too many kids being misdiagnosed with bipolar disorder and treated with powerful psychiatric drugs. Bipolar disorder involves sharp mood swings and affected children are sometimes very irritable or have explosive tantrums.

—Eliminating the term "gender identity disorder." It has been used for children or adults who strongly believe that they were born the wrong gender. But many activists believe the condition isn't a disorder and say calling it one is stigmatizing. The term would be replaced with "gender dysphoria," which means emotional distress over one's gender. Supporters equated the change with removing homosexuality as a mental illness in the diagnostic manual, which happened decades ago.

___

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

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Asian tourists flock to South Coast Plaza

It's Day 3 of his four-day visit, and, of course, Yuki Izuka — for the third time — is back at South Coast Plaza.

Sporting black slacks, leather tote, a pinstripe jacket and crisp tie, the pharmacist from Gunma, Japan, heads straight for the most glittering of shops: Tiffany.

He's on a mission to find a ring for his wife. "It is very expensive — but even more expensive in my home," he says. "Better if I can get something here."

Skipping tariffs and taxes, foreign shoppers flush with cash fill their Southern California trips with shopping sprees at places like South Coast Plaza, and increasingly, employees at the luxury shopping center are taking extraordinary steps to host them, trained to fulfill the tiniest of needs.

South Coast Plaza has become a destination for overseas Asians, who bundle trips to Disneyland with carefully plotted excursions to the retail mecca, stocking up on snug blue jeans, watches, luggage, purses and flashy sunglasses selling for $500 a pair.

"We could have seen it in American Vogue and we're here to get it," said Izuka, looking magazine model-sleek as he and his buddies walk past an Italian cafe and ride an escalator toward the center's Jewel Court, a cluster of high-end jewelry boutiques where foreigners pay cash for $100,000 necklaces or other sparkling baubles.

"I like to buy whatever I can because the prices are so low," says Lucas Xu, comparing the costs to those in China, his homeland.

"And every store has an Asian assistant," said Xu, an economics major in Colorado who has flown in with friends for a shopping excursion. "Wow."

"It's not just about selling somebody something. It's about making them feel important," says South Coast Plaza veteran Werner Escher.

In a sense, Escher is the director of foreign affairs at the center, though technically his title is director of domestic and international markets. He's been on the job more than four decades and travels to China at least once a year to firm up connections with influence makers. He partners with Disneyland and the Nixon Presidential Library & Museum, ready to whisk dignitaries from Beijing and Shanghai to the shopping center, even providing them chauffeurs and guides.

Under his direction, the staff is tightly focused on the foreign traveler.

There's a language-assistance program, with mall and store employees speaking more than 40 languages and dialects. Maps and directions are printed in Korean, Japanese, Spanish and Chinese, among others. Center executives carry business cards featuring Asian characters.

South Coast Plaza is now the first shopping center in the nation to accept UnionPay, China's leading credit card. Center reps also hand out VIP Passport booklets with exclusive offers for travelers. One afternoon, Escher shows it to Shelley Chen, who is from Guangzhou, an economic hub on China's southern coast. He bows and shakes her hand as she's on her way to look for a Gucci purse, having just graduated from law school.

"I like the famous names here," she says of the retailers. "My friends said I must come here."

Scott Hung, a sales director for a semiconductor company in Taiwan, wants to take home gifts for his twin boys. His boss is familiar with South Coast Plaza "and suggested me to go to this place," he said, asking about shops that carry children's goods and that have iPhone docking stations.

Visitors who are overseas celebrities get preferred treatment.

When Yang Mi, one of China's leading actresses, who boasts 22 million followers on Sina Weibo — similar to Twitter — came to South Coast, center officials entertained the actress and her entourage in a plush VIP Access Suite near Saks Fifth Avenue. They hosted the Chinese press corps, which swarmed in to interview and photograph her.

"For her to be here is major," Escher says. "It fills out the playlist of the people we want to attract."

Not to miss a beat, the center — which bills itself as a "shopping resort" — served as a ping-pong tournament venue to the top players in the U.S. and China. The cast of "Raise the Red Lantern," a production of the National Ballet of China, also descended on South Coast, accompanied by diplomats.

That's apart from outreach directed at the local Asian clientele, highlighting the lunar new year and the autumn moon festival. Managers at anchor stores like Macy's scramble to hire Chinese-speaking staff. And shopping at South Coast means visitors might avoid three taxes for luxury items imported to China: customs tariffs, value-added tax and consumption tax. Trade missions between Southern California and China can include a stop at one of the most upscale malls in America.

Concierge Stepheny Southa came to the aid of a pregnant guest recently. Speaking in Mandarin, the woman told her: "You're my size. I need to buy some clothes that I can wear after having the baby."

Southa said she went with the expectant mother to try on multiple outfits for her.

"We have the ability to satisfy someone who comes from a long distance," Southa says.

Robert Sun, founder of the American Chinese CEO Society, says he has taken guests from China's Shandong province to South Coast for dinner and to buy presents.

"They fall in love because of the large number of brand names. No other place can compare," he recalls. Foreign visitors are familiar with Beverly Hills and Rodeo Drive, Sun added, "but now they see South Coast as the best shopping. When somebody has a good experience buying, like, a bag, they go and tell their friends."

If there's one thing missing from the experience for shoppers from China, it's a Chinese restaurant. And shoppers have pointed that out, said Escher, who's been scouting candidates when he travels overseas. Officials hope to make an announcement by the lunar new year in February, an event they anticipate will be covered prominently by the ethnic media.

"Shopping," Escher says, "is the No. 1 activity when people travel."

anh.do@latimes.com

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Israel Moves to Expand Settlements in East Jerusalem

Ronen Zvulun/Reuters

A worker at a construction site in the West Bank Israeli settlement of Maale Adumim, near Jerusalem, in June. Israel plans to link the settlement with Jerusalem. More Photos »

JERUSALEM — Israel is moving forward with development of Jewish settlements in a contentious area east of Jerusalem, defying the United States by advancing a project that has long been condemned by Washington as effectively dooming any prospect of a two-state solution to the Israeli-Palestinian conflict.

A day after the United Nations General Assembly voted overwhelmingly to upgrade the status of the Palestinians, a senior Israeli official said the government would pursue “preliminary zoning and planning preparations” for a development that would separate the West Bank cities of Ramallah and Bethlehem from Jerusalem. If such a project were to go beyond blueprints, it could prevent the creation of a viable, contiguous Palestinian state.

The development, in an open, mostly empty area known as E1, would connect the large settlement town of Maale Adumim to Jerusalem. Israeli officials also authorized construction of 3,000 housing units in parts of East Jerusalem and the West Bank.

The timing of the twin actions seemed aimed at punishing the Palestinians for their United Nations bid, and appeared to show that hard-liners in the government had prevailed after days of debate over how to respond. That represented a surprising turnaround, after a growing sense that Israeli leaders had acceded to pressure from Washington not to react quickly or harshly.

The Obama administration swiftly condemned the move as unhelpful. Senior officials expressed frustration that it came after Israeli officials had played down the importance of the Palestinian bid and suggested that they would only employ harsh retaliatory measures if the Palestinians used their new status to go after Israel in the International Criminal Court.

“We reiterate our longstanding opposition to settlements and East Jerusalem construction and announcements,” a spokesman for the National Security Council, Tommy Vietor, said. “We believe these actions are counterproductive and make it harder to resume direct negotiations or achieve a two-state solution.”

Secretary of State Hillary Rodham Clinton, in a Saban Forum speech on Friday night at a Washington hotel, criticized Israel’s decision to proceed with plans for construction without referring to any settlements directly by name. “These activities set back the cause of a negotiated peace,” Mrs. Clinton said.

Israel gave the United States only a few hours’ notice of the plan, and President Obama did not call Prime Minister Benjamin Netanyahu, a senior official said. For Mr. Obama, whose most bitter clashes with Mr. Netanyahu have come over settlements, the Israeli move could undermine a series of developments in recent weeks — from the violence in Gaza to the Palestinian vote — in which the two leaders appeared to draw closer together.

In her speech, Mrs. Clinton condemned the General Assembly vote as “a step that will not bring us any closer to peace,” and reiterated America’s deep commitment to Israel.

“America has Israel’s back,” she said, “and this month we proved it again.” After listing many ways in which the United States has supported Israel, Mrs. Clinton articulated the two-state vision, what she called the need for a “political horizon.”

“There is more the Israelis need to do,”she said, adding, “There is still an opportunity with the West Bank Palestinians” to have a different status quo that would be in Israel’s interest.For years, American and European officials have told the Israelis that E1 is a red line. The leaked, somewhat vague, announcement of plans to proceed with building is the diplomatic equivalent of what the Israeli military did last month when it massed tens of thousands of ground troops at the Gaza border. It is a potent threat that may well, in the end, not be carried out because the Israeli government worries about its consequences.

The Palestinian Authority described the plan as “a new act of defiance from the Israeli government.” Saeb Erekat, the chief negotiator, said in a statement, “At a moment where the Palestinian leadership is doing every single effort to save the two-state solution, the Israeli government does everything possible to destroy it.”

Mr. Netanyahu’s office declined to comment on the zoning and construction decisions, which were made Thursday night around the time of the General Assembly vote.

Jodi Rudoren reported from Jerusalem, and Mark Landler from Washington. Michael R. Gordon contributed reporting from Washington; Peter Baker from Hatfield, Pa.; and Ethan Bronner from New York.

This article has been revised to reflect the following correction:

Correction: November 30, 2012

An earlier version of this article misspelled the given name and surname of the leader of the Israeli Labor Party. She is Shelly Yacimovich, not Shelley Yachnimovich.

This article has been revised to reflect the following correction:

Correction: November 30, 2012

An earlier version of this article misidentified the location of Secretary of State Hillary Rodham Clinton’s Saban Forum speech in Washington. It was at a hotel, not at the Brookings Institution.

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Dennis Quaid Files for Divorce, Seeks Joint Custody

By Mike Fleeman

11/30/2012 at 09:20 PM EST

Kimberly Buffington-Quaid and Dennis Quaid

Casey Rodgers/NBC/AP

Dennis Quaid is ready to end his marriage for good.

After his wife of eight years, Kimberly Buffington-Quaid, sought legal separation in October, the Vegas star filed Friday for divorce in Los Angeles Superior Court.

The actor requests joint physical and legal custody of their 4-year-old twins, Thomas and Zoe, and offers to pay spousal support, according to the petition.

This will be the third divorce for Quaid, 58, who was previously married to Meg Ryan and P.J. Soles.

Kimberly, a former real estate agent, initially filed for divorce in March. She
put the divorce on hold a month later, pulling the papers so they could work on their marriage, before then filing for separation.

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Kenya village pairs AIDS orphans with grandparents

NYUMBANI, Kenya (AP) — There are no middle-aged people in Nyumbani. They all died years ago, before this village of hope in Kenya began. Only the young and old live here.

Nyumbani was born of the AIDS crisis. The 938 children here all saw their parents die. The 97 grandparents — eight grandfathers among them — saw their middle-aged children die. But put together, the bookend generations take care of one another.

Saturday is World AIDS Day, but the executive director of the aid group Nyumbani, which oversees the village of the same name, hates the name which is given to the day because for her the word AIDS is so freighted with doom and death. These days, it doesn't necessarily mean a death sentence. Millions live with the virus with the help of anti-retroviral drugs, or ARVs. And the village she runs is an example of that.

"AIDS is not a word that we should be using. At the beginning when we came up against HIV, it was a terminal disease and people were presenting at the last phase, which we call AIDS," said Sister Mary Owens. "There is no known limit to the lifespan now so that word AIDS should not be used. So I hate World AIDS Day, follow? Because we have moved beyond talking about AIDS, the terminal stage. None of our children are in the terminal stage."

In the village, each grandparent is charged with caring for about a dozen "grandchildren," one or two of whom will be biological family. That responsibility has been a life-changer for Janet Kitheka, who lost one daughter to AIDS in 2003. Another daughter died from cancer in 2004. A son died in a tree-cutting accident in 2006 and the 63-year-old lost two grandchildren in 2007, including one from AIDS.

"When I came here I was released from the grief because I am always busy instead of thinking about the dead," said Kitheka. "Now I am thinking about building a new house with 12 children. They are orphans. I said to myself, 'Think about the living ones now.' I'm very happy because of the children."

As she walks around Nyumbani, which is three hours' drive east of Nairobi, 73-year-old Sister Mary is greeted like a rock star by little girls in matching colorful school uniforms. Children run and play, and sleep in bunk beds inside mud-brick homes. High schoolers study carpentry or tailoring. But before 2006, this village did not exist, not until a Catholic charity petitioned the Kenyan government for land on which to house orphans.

Everyone here has been touched by HIV or AIDS. But only 80 children have HIV and thanks to anti-retroviral drugs, none of them has AIDS.

"They can dream their dreams and live a long life," Owens said.

Nyumbani relies heavily on U.S. funds but it is aiming to be self-sustaining.

The kids' bunk beds are made in the technical school's shop. A small aquaponics project is trying to grow edible fish. The mud bricks are made on site. Each grandparent has a plot of land for farming.

The biggest chunk of aid comes from the United States President's Emergency Plan for AIDS Relief (PEPFAR), which has given the village $2.5 million since 2006. A British couple gives $50,000 a year. A tree-growing project in the village begun by an American, John Noel, now stands six years from its first harvest. Some 120,000 trees have already been planted and thousands more were being planted last week.

"My wife and I got married as teenagers and started out being very poor. Lived in a trailer. And we found out what it was like to be in a situation where you can't support yourself," he said. "As an entrepreneur I looked to my enterprise skills to see what we could do to sustain the village forever, because we are in our 60s and we wanted to make sure that the thousand babies and children, all the little ones, were taken care of."

He hopes that after a decade the timber profits from the trees will make the village totally self-sustaining.

But while the future is looking brighter, the losses the orphans' suffered can resurface, particularly when class lessons are about family or medicine, said Winnie Joseph, the deputy headmaster at the village's elementary school. Kitheka says she tries to teach the kids how to love one another and how to cook and clean. But older kids sometimes will threaten to hit her after accusing her of favoring her biological grandchildren, she said.

For the most part, though, the children in Nyumbani appear to know how lucky they are, having landed in a village where they are cared for. An estimated 23.5 million people in sub-Saharan Africa have HIV as of 2011, representing 69 percent of the global HIV population, according to UNAIDS. Eastern and southern Africa are the hardest-hit regions. Millions of people — many of them parents — have died.

Kitheka noted that children just outside the village frequently go to bed hungry. And ARVs are harder to come by outside the village. The World Health Organization says about 61 percent of Kenyans with HIV are covered by ARVs across the country.

Paul Lgina, 14, contrasted the difference between life in Nyumbani, which in Swahili means simply "home," and his earlier life.

"In the village I get support. At my mother's home I did not have enough food, and I had to go to the river to fetch water," said Lina, who, like all the children in the village, has neither a mother or a father.

When Sister Mary first began caring for AIDS orphans in the early 1990s, she said her group was often told not to bother.

"At the beginning nobody knew what to do with them. In 1992 we were told these children are going to die anyway," she said. "But that wasn't our spirit. Today, kids we were told would die have graduated from high school."

___

On the Internet:

http://www.trees4children.org/

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South L.A. frustrated by delays in building new King hospital

Earlier this year, Joane Austin rushed her elderly mother to the emergency room for fear she was having a heart attack.

Austin normally would have made the short trip to Martin Luther King Jr./Drew Medical Center, the landmark hospital in South Los Angeles. But King/Drew has been closed for five years, so Austin drove several miles to the emergency room at Centinela Hospital Medical Center in Inglewood.

"I prayed all the lights would stay green," she said. "It was scary."

Once they arrived, doctors determined that Austin's mother needed emergency surgery to remove scar tissue around her intestines.

For years, King/Drew provided emergency, trauma and inpatient care to residents from throughout South Los Angeles. After a series of medical errors resulted in patient deaths, Los Angeles County closed it in 2007. County officials promised the community a better, safer new medical center in a few years.

But the opening has been repeatedly delayed, and the community is still waiting. Originally, officials hoped to have the new facility ready by 2010. Then it was pushed to 2012. Now, officials say they plan to have construction completed next year and the hospital opening its doors in 2014.

Without a nearby hospital, patients have had to travel to such places as Bellflower, Inglewood and Long Beach for emergency room and inpatient care.

Several local hospitals — California Hospital Medical Center, L.A. County/USC Medical Center and Harbor-UCLA Medical Center — received an influx of former King patients after the closure. The closest hospital, St. Francis Medical Center in Lynwood, reported an increase of 20% to 30% in emergency room visits since King/Drew closed, though other factors also may have contributed to the rise.

Getting to other hospitals has presented a challenge for many in the low-income neighborhood, said William Hobson, president and chief executive of the Watts Healthcare Corp. "Just the fact that it is a long way away may discourage them from going," he said.

The closure of King/Drew, which was born out of the Watts riots and opened in 1972, created a healthcare gap in a community where rates of chronic disease are high and vast swaths of the population lack insurance, said David Carlisle, president of the adjacent Charles R. Drew University of Medicine and Science. South Los Angeles has a shortage of doctors, inpatient beds and outpatient services, according to both experts and research.

Despite King/Drew's many medical lapses, which earned it the nickname "Killer King," many in the community remained fiercely loyal to the hospital and the services it provided.

Studies examining the impact of King/Drew's closure found that it led to delays in care for elderly blacks and Latinos and a dramatic increase in patient admissions at other trauma centers. Physicians throughout the county also reported more overcrowding in other emergency rooms and said they saw sicker patients who didn't know where to go or couldn't afford transportation elsewhere.

"It is fearful to think about how many lives may have been saved had this thing been opened by now," said Lark Galloway-Gilliam, executive director of the advocacy group Community Health Councils. "It shouldn't take five years to build a facility."

Patrick Wooten, 49, went to St. Francis when he had a dislocated kneecap a few years ago. Wooten, who is uninsured, said he received good care at the private hospital but then got a $3,200 bill. Wooten said he is frustrated that the new King hospital still hasn't opened and won't until 2014. "What you do until then, God only knows," he said. "Hopefully we can wait it out."

Last year, Sandira Gonzalez, 29, took her 5-year-old son to the Martin Luther King urgent care center when he had a fever. But when the center closed for the night, her son had to be taken by ambulance to Harbor-UCLA near Torrance, where he was treated for an infection.

Community members and advocates said they are disappointed by the long wait, caused by a combination of bureaucratic delays and the complexity of the project. But when it does open, they said, they are hopeful that it will be a better, and safer, hospital.

The county is building the hospital and will help support it financially but will not be responsible for day-to-day operations. Instead, an independent, nonprofit organization will run the facility, to be known as Martin Luther King Jr. Community Hospital, and the University of California will help staff it and ensure the quality of patient care. Construction is progressing, but the grand opening may still be nearly two years away.

"It will be a significantly different kind of institution, with the right kind of accountability," said Robert K. Ross, president and chief executive of the California Endowment. "Now we just need the institution to open up on budget and on time."

Los Angeles County Supervisor Mark Ridley-Thomas said it takes time to create a state-of-the-art hospital — and a whole medical complex — that could become a model for others around the nation. "A lot of eyes are on this," he said. "We want to do this well and we want to do it right.... Nothing else is acceptable."

The nonprofit's board recognizes how critical the facility is to the area, said board President Manny Abascal. "Every day this hospital is not open, people are suffering," he said. At the same time, he added, the board is committed to ensuring that the new hospital is a high-quality institution. "If you open it … and there are some of the same problems you had before, then it's going to be devastating," he said.

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General Assembly Grants Palestine Upgraded Status in U.N.

Damon Winter/The New York Times

The Palestinian Authority president, Mahmoud Abbas, center, was congratulated by Turkey’s foreign minister, Ahmet Davutoglu. More Photos »

UNITED NATIONS — More than 130 countries voted on Thursday to upgrade Palestine to a nonmember observer state of the United Nations, a triumph for Palestinian diplomacy and a sharp rebuke to the United States and Israel.

But the vote, at least for now, did little to bring either the Palestinians or the Israelis closer to the goal they claim to seek: two states living side by side, or increased Palestinian unity. Israel and the militant group Hamas both responded critically to the day’s events, though for different reasons.

The new status will give the Palestinians more tools to challenge Israel in international legal forums for its occupation activities in the West Bank, including settlement-building, and it helped bolster the Palestinian Authority, weakened after eight days of battle between its rival Hamas and Israel.

But even as a small but determined crowd of 2,000 celebrated in central Ramallah in the West Bank, waving flags and dancing, there was an underlying sense of concerned resignation.

“I hope this is good,” said Munir Shafie, 36, an electrical engineer who was there. “But how are we going to benefit?”

Still, the General Assembly vote — 138 countries in favor, 9 opposed and 41 abstaining — showed impressive backing for the Palestinians at a difficult time. It was taken on the 65th anniversary of the vote to divide the former British mandate of Palestine into two states, one Jewish and one Arab, a vote Israel considers the international seal of approval for its birth.

The past two years of Arab uprisings have marginalized the Palestinian cause to some extent as nations that focused their political aspirations on the Palestinian struggle have turned inward. The vote on Thursday, coming so soon after the Gaza fighting, put the Palestinians again — if briefly, perhaps — at the center of international discussion.

“The question is, where do we go from here and what does it mean?” Salam Fayyad, the Palestinian prime minister, who was in New York for the vote, said in an interview. “The sooner the tough rhetoric of this can subside and the more this is viewed as a logical consequence of many years of failure to move the process forward, the better.” He said nothing would change without deep American involvement.

President Mahmoud Abbas of the Palestinian Authority, speaking to the assembly’s member nations, said, “The General Assembly is called upon today to issue a birth certificate of the reality of the state of Palestine,” and he condemned what he called Israeli racism and colonialism. His remarks seemed aimed in part at Israel and in part at Hamas. But both quickly attacked him for the parts they found offensive.

“The world watched a defamatory and venomous speech that was full of mendacious propaganda against the Israel Defense Forces and the citizens of Israel,” Prime Minister Benjamin Netanyahu of Israel responded. “Someone who wants peace does not talk in such a manner.”

While Hamas had officially backed the United Nations bid of Mr. Abbas, it quickly criticized his speech because the group does not recognize Israel.

“There are controversial issues in the points that Abbas raised, and Hamas has the right to preserve its position over them,” said Salah al-Bardaweel, a spokesman for Hamas in Gaza, on Thursday.

“We do not recognize Israel, nor the partition of Palestine, and Israel has no right in Palestine,” he added. “Getting our membership in the U.N. bodies is our natural right, but without giving up any inch of Palestine’s soil.”

Israel’s ambassador to the United Nations, Ron Prosor, spoke after Mr. Abbas and said he was concerned that the Palestinian Authority failed to recognize Israel for what it is.

“Three months ago, Israel’s prime minister stood in this very hall and extended his hand in peace to President Abbas,” Mr. Prosor said. “He reiterated that his goal was to create a solution of two states for two peoples, where a demilitarized Palestinian state will recognize Israel as a Jewish state.

“That’s right. Two states for two peoples. In fact, President Abbas, I did not hear you use the phrase ‘two states for two peoples’ this afternoon. In fact, I have never heard you say the phrase ‘two states for two peoples’ because the Palestinian leadership has never recognized that Israel is the nation-state of the Jewish people.”

The Israelis also say that the fact that Mr. Abbas is not welcome in Gaza, the Palestinian coastal enclave run by Hamas, from which he was ejected five years ago, shows that there is no viable Palestinian leadership living up to its obligations now.

Jennifer Steinhauer contributed reporting from Washington, Isabel Kershner from Jerusalem, and Khaled Abu Aker from Ramallah, West Bank.

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