City Room: Cuomo Declares Public Health Emergency Over Flu Outbreak

With the nation in the grip of a severe influenza outbreak that has seen deaths reach epidemic levels, New York State declared a public health emergency on Saturday, making access to vaccines more easily available.

There have been nearly 20,000 cases of flu reported across the state so far this season, officials said. Last season, 4,400 positive laboratory tests were reported.

“We are experiencing the worst flu season since at least 2009, and influenza activity in New York State is widespread, with cases reported in all 57 counties and all five boroughs of New York City,” Gov. Andrew M. Cuomo said in a statement.

Under the order, pharmacists will be allowed to administer flu vaccinations to patients between 6 months and 18 years old, temporarily suspending a state law that prohibits pharmacists from administering immunizations to children.

While children and older people tend to be the most likely to become seriously ill from the flu, Mr. Cuomo urged all New Yorkers to get vaccinated.

On Friday, the Centers for Disease Control and Prevention in Atlanta said that deaths from the flu had reached epidemic levels, with at least 20 children having died nationwide. Officials cautioned that deaths from pneumonia and the flu typically reach epidemic levels for a week or two every year. The severity of the outbreak will be determined by how long the death toll remains high or if it climbs higher.

There was some evidence that caseloads may be peaking, federal officials said on Friday.

In New York City, public health officials announced on Thursday that flu-related illnesses had reached epidemic levels, and they joined the chorus of authorities urging people to get vaccinated.

“It’s a bad year,” the city’s health commissioner, Dr. Thomas A. Farley, told reporters on Thursday. “We’ve got lots of flu, it’s mainly type AH3N2, which tends to be a little more severe. So we’re seeing plenty of cases of flu and plenty of people sick with flu. Our message for any people who are listening to this is it’s still not too late to get your flu shot.”

There has been a spike in the number of people going to emergency rooms over the past two weeks with flulike symptoms – including fever, fatigue and coughing – Dr. Farley said.

Mayor Michael R. Bloomberg and Mr. Cuomo made a public display of getting shots this past week.

In a briefing with reporters on Friday, officials from the C.D.C. said that this year’s vaccine was effective in 62 percent of cases.

As officials have stepped up their efforts encouraging vaccinations, there have been scattered reports of shortages. But officials said plenty of the vaccine was available.

According to the C.D.C., makers of the flu vaccine produced about 135 million doses for this year. As of early this month, 128 million doses had been distributed. While that would not be enough for every American, only 37 percent of the population get a flu shot each year.

Federal health officials said they would be happy if that number rose to 50 percent, which would mean that there would be more than enough vaccine for anyone who wanted to be immunized.

Two other diseases – norovirus and whooping cough – are also widespread this winter and are contributing to the number of people getting sick.

The flu can resemble a cold, though the symptoms come on more rapidly and are more severe.

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Aaron Swartz dies at 26; Internet folk hero founded Reddit

Aaron Swartz, who co-founded Reddit and became an Internet folk hero for fighting to make online content free to the public, committed suicide Friday. He was 26.

Swartz hanged himself in his Brooklyn, N.Y., apartment, said a statement released by his family and his girlfriend.

"Aaron's commitment to social justice was profound, and defined his life," the statement said. "He used his prodigious skills as a programmer and technologist not to enrich himself but to make the Internet and the world a fairer, better place."

On his blog, Swartz had written of his history of depression.

He was a Harvard University fellow studying ethics when he was charged in 2011 with stealing nearly 5 million articles from a computer archive at the Massachusetts Institute of Technology.

He faced 13 felony charges, including wire fraud, computer fraud and unlawfully obtaining information from a protected computer. Prosecutors said he intended to distribute the articles on file-sharing websites.

Swartz pleaded not guilty, and his trial in federal court was scheduled to begin next month. If convicted, he could have faced decades in prison and steep fines.

On Saturday, his family and girlfriend called his death "the product of a criminal justice system rife with intimidation and prosecutorial overreach" and blamed decisions by the Massachusetts U.S. attorney's office and MIT for contributing to his death.

Some legal experts believe the charges are unfounded since Swartz had been a university fellow, which gave him the right to access the articles.

In 2011, Carmen M. Ortiz, the U.S. attorney for Massachusetts, defended the charges, telling the New York Times: "Stealing is stealing, whether you use a computer command or a crowbar, and whether you take documents, data or dollars."

The Electronic Frontier Foundation, a San Francisco-based digital rights group, called him "an extraordinary hacker and activist."

"Aaron did more than almost anyone to make the Internet a thriving ecosystem for open knowledge, and to keep it that way," the foundation said in a tribute on its website.

On Saturday, American historian Rick Perlstein, who was a friend, called Swartz a philosopher as well as an activist. Swartz had also co-founded the political action group Demand Progress, which campaigns against Internet censorship.

"He had this feeling for data and what it could do, how to master it instead of letting it master us," Perlstein told The Times. "He just insisted on and struggled to live a life of maximal authenticity and integrity."

Born in 1986 in Chicago, Swartz created his first Web application — an online encyclopedia that operated much like Wikipedia — when he was 13.

High school bored him, he later said. After his freshman year, he studied at home and took community college classes that included logic and number theory.

At 14, he helped develop the software behind RSS feeds, which distribute content over the Internet.

He was soon working on such major projects as creating universal ways to exchange information through a group founded by Tim Berners-Lee, the computer scientist considered the father of the World Wide Web.

As a freshman at Stanford University, he studied sociology but left after a year because "I didn't find it a very intellectual atmosphere," he later said.

Swartz moved to Cambridge, where he began to work on a project that in 2005 turned into the social news website Reddit, which taps "the wisdom of the crowds" by letting users submit and rank news and other online content.

Conde Nast purchased Reddit the next year for a figure insiders put at less than $5 million, Forbes reported in November.

In a 2007 speech called "How to Get a Job Like Mine," given at a computer conference, Swartz gave such advice as "be curious," "say yes to everything" and "assume nobody else has any idea what they're doing either."

Swartz is survived by his parents, Robert and Susan Swartz; his younger brothers, Noah and Ben; and his partner, Taren Stinebrickner-Kauffman.

Times staff writer Jessica Guynn contributed to this report.

valerie.nelson@latimes.com

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James' spending in mayor's race far outpaces fundraising

Kevin James, the sole Republican among the main contenders in the Los Angeles mayor's race, raised a little more than $42,000 in the final quarter of 2012, but spent more than four times that amount, largely on high-priced political consultants.

James, an attorney and former talk radio host who has never held elected office, spent $178,595 in the fourth quarter, a few thousand shy of top-tier candidate and key rival Wendy Greuel, according to campaign finance documents filed with the City Ethics Commission on Thursday. Greuel has vastly outpaced James in fundraising, raising roughly $630,000 more than James in the same period.

The biggest beneficiaries of James' spending are political consultants, including John Weaver, a top national GOP operative who was a senior advisor to the short-lived presidential campaign of Jon Huntsman in the 2012 presidential campaign. Weaver's firm, the Network Companies, billed James for $78,000 for work in the final three months of the year, and a total of $88,000 for all of 2012.

For the entire campaign, James' expenses also included $122,160 for Thomas Partners Strategies, $68,493 for the Prise Group, $40,175 for Capital Campaigns, $25,586 for Crummitt & Associates, $18,011 for Midnite Oil Media and $10,000 for Venture Strategic.

James' representatives said these expenditures represented a strategic decision to build a robust campaign.

"These investments will lead him to victory and get him into the runoff," campaign manager Jeff Corless said. "He has a professional team that has helped him achieve great success thus far in the campaign."

He added that a fundraising lull at the end of 2012 was to be expected because of the holidays and political fatigue. The campaign has seen a surge in fundraising in recent weeks and planned to start reaching out to voters Monday, Corless said.

In heavily Democratic Los Angeles, James is a long-shot candidate. But his outsider message has attracted attention, and some see a path for him earn a top-two spot in the March primary, advancing him to a May runoff. To do so, James must make sure Republicans turn out while also siphoning support of conservative Democrats, notably in the San Fernando Valley, from Greuel.

Greuel's campaign said James' spending showed that his effort will be futile, not only because of the rate of spending, but because of what he is spending his resources on.

"Kevin James is quickly burning a hole in his pocket, and if he keeps up his anemic fundraising pace, soon he'll be flat broke and in the hole," said Rose Kapolczynski, Greuel's campaign manager.

James' saving grace could rest on the success of an independent committee formed to support his candidacy that can collect unlimited donations.

"It's been fairly clear for a while now that if James is going to make a race of it, it's going to come predominantly through outside spending. The amount he's raised and spent on his own campaign is less relevant," said Dan Schnur, director of the Jesse M. Unruh Institute of Politics at USC and a former GOP political operative. "James can't get elected solely on the strength of Super PAC money but a well-funded outside campaign can do significant damage to the other candidates."

But Schnur said the amount the Super PAC has collected so far, $200,000 is not sufficient.

Fred Davis, the GOP ad specialist who is running the group, Better Way L.A., said that he remains confident.

"The frustrating thing was the holidays. We really didn't get started until Jan. 4 and 5. It just was a tough time," he said. "But over the last week, we've been on daily conference calls. Things look good . It will be a race down the wire, we still think we'll make it into the runoff."

seema.mehta@latimes.com

Times staff writer Maeve Reston contributed to this report.

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Britney Spears and fiance end yearlong engagement

LOS ANGELES (AP) — Britney Spears announced Friday that she has ended her yearlong engagement, capping a week of changes that included her leaving "The X Factor" and promising fans she was returning her focus to music.

Within hours of confirming her departure from the Fox reality series, Spears also announced that her relationship with talent agent Jason Trawick had ended.

"Jason and I have decided to call off our engagement," Spears said in the statement. "I'll always adore him and we will remain great friends."

Spears' publicist Jeff Raymond said the breakup was a difficult decision made by "two mature adults."

"I love and cherish her and her boys, and we will be close forever," Trawick said in a joint statement that was first reported by People magazine.

Trawick also resigned his role Friday as a Spears' co-conservator, with Superior Court Judge Reva Goetz approving his departure from the case.

Spears and Trawick got engaged in December 2011 and he was added as her co-conservator in April.

Spears, 31, has been under a court-supervised conservatorship since February 2008, with her father and another co-conservator, Andrew Wallet, having control over numerous aspects of her personal life. The case was opened after several incidents of erratic behavior by the pop singer and a pair of hospitalizations, but Spears has recovered and she appeared weekly on "X Factor."

She said in a statement that judging young talent made her miss performing. "I can't wait to get back out there and do what I love most," she said in a statement.

Her father Jamie Spears met with Goetz for about an hour on Friday but left before a hearing where Trawick's resignation was announced.

Trawick has served as Spears' agent and the pair started dating in 2009.

Trawick did not have authority over Spears' finances, which have rebounded since her public meltdown. Goetz recently reviewed and approved of an accounting that showed Spears ended 2010 with more than $27.5 million in assets, including nearly $15 million in cash.

Attorneys handling the case are expected to file updated financial statements in the coming months.

___

Anthony McCartney can be reached at http://twitter.com/mccartneyAP .

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No Jail Time for Doctor, 85, Convicted of Drug Charge

The former doctor sat in courton Friday waiting to be sentenced for a crime that breached every tenet of his professional code. He had run his house in Staten Island like a drug mill, selling the prescription painkiller oxycodone to all comers — including undercover federal agents. The guideline sentence for his crimes was up to six years.

But just by the look of the defendant, Felix Lanting, it seemed likely that he would never serve that much time. Frail and hunched-over at 85, he could only hope to live that long. And with a wife even frailer who depends on him for care, he posed a special challenge for the sentencing judge, Roslynn R. Mauskopf.

A lawyer for Mr. Lanting, James R. Froccaro, asked that his client receive no jail time at all.

“I’m agonizing about what to do,” said Judge Mauskopf, who presided over the case in United States District Court for the Eastern District.

Mr. Lanting’s crimes are typically committed by men a generation younger. A 2010 investigation by the Federal Bureau of Investigation found that in seven months, Mr. Lanting wrote and sold more than 3,000 prescriptions for oxycodone, an average of 15 per day, seven days a week.

Neighbors complained about the foot traffic. A relative of someone who overdosed on the pills attacked the front door of Mr. Lanting’s house with an ax. Mr. Lanting hired bouncers to protect his growing business, but they did not stop the undercover agents. When F.B.I. agents arrested him, they found $37,000 in cash and 100 solid silver bars. Eighty thousand dollars more turned up in a safe-deposit box.

In court on Friday, Mr. Lanting, who lost his medical license, stood and pleaded for his life and that of his wife. “I beg the court not to put me in jail because my wife will die,” he said. “I am the only one who is taking care of her.”

He began to cry. “I’m very sorry. I made a mistake. If I could undo it, I would. I’m begging you please.” Judge Mauskopf called a five-minute recess to think.

“If there ever were a case that cried out for mitigation, it is this one, based on the defendant’s age and based on the responsibilities to his wife,” Judge Mauskopf said when she returned. But she said she wanted to punish him.

She sentenced him to six months of house arrest, five years of probation and a $25,000 fine. She said Mr. Lanting might have to get someone else to take his wife to her medical visits.

“You need to feel the restrictions on your liberty,” she said. “The fine is meant to hurt and to punish you for what you did.”

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Boeing Dreamliner to undergo federal safety review

Plagued by one mishap after another, Boeing Co.'s much-heralded 787 Dreamliner passenger jet for the 21st century is feeling new heat from federal regulators.

Days after one of the planes caught fire while parked in Boston and another experienced a fuel leak, the Federal Aviation Administration has launched an unusual "comprehensive safety review of Boeing 787 critical systems." This includes a sweeping evaluation of the way Boeing designs, manufactures and assembles the aircraft.

The review — just 17 months after the FAA gave the go-ahead to the new $200-million-plus plane — does not ground the 50 Dreamliners currently being flown by eight airlines around the globe.

Since the inception of its next-generation passenger jet, Boeing has touted the revolutionary way the Dreamliner is made and the way it operates. But those novel technologies will now attract greater scrutiny from U.S. regulators after recent events have raised questions about Dreamliner safety.

New planes, in general, have "teething" issues as they are introduced. But, industry analysts said, the type of review the Dreamliner is undergoing is rare, and passenger jets haven't been subject to this sort of sweeping government review for decades.

Boeing said it will participate in the review with the FAA and believes the process will underscore customers' and the traveling public's confidence in the reliability of the aircraft.

U.S. Transportation Secretary Ray LaHood and FAA chief Michael Huerta launched the effort Friday at a news conference in Washington, revealing plans for a "comprehensive safety review of Boeing 787 critical systems." This includes a complete evaluation of the aircraft, including an assessment of the way Boeing designs, manufactures and assembles the aircraft.

The move comes despite the "unprecedented" certification process in which FAA technical experts logged 200,000 hours of work over nearly two years and flew on numerous test flights, Huerta said. There were more than a dozen new special conditions developed during the certification process because of the Dreamliner's innovative design.

"The purpose of the review is to validate the work that we've done," Huerta said, "and to look at the quality and other processes to ensure that effective oversight is being done."

Certification of the Dreamliner was completed Aug. 25, 2010, and the first plane was delivered to All Nippon Airways a month later. It was more than three years late because of design problems and supplier issues.

The Dreamliner, a twin-aisle aircraft that can seat 210 to 290 passengers, is the first large commercial jet with more than half its structure made of composite materials (carbon fibers meshed together with epoxy) rather than aluminum sheets. Another innovative application is the changeover from hydraulically actuated systems typically found on passenger jets to electrically powered systems involving lithium ion batteries.

For instance, Boeing has said electric brakes "significantly reduce the mechanical complexity of the braking system and eliminate the potential for delays associated with leaking brake hydraulic fluid, leaking valves and other hydraulic failures." Because of these technologies, Boeing says, the new plane burns 20% less fuel than other jetliners of a similar size.

But the use of such extensive electronic systems was called into question when a smoldering fire was discovered Monday on the underbelly of a Dreamliner operated by Japan Airlines Co. after the 173 passengers and 11 crew members had deplaned at the gate.

The incident prompted the FAA and the National Transportation Safety Board to investigate.

"We don't know the cause of the fire, but it's a serious issue," said Scott Hamilton, an aviation industry consultant and managing director of Leeham Co. in Issaquah, Wash. "Did the FAA miss something? Did Boeing have an oversight in the design process? Was there a problem in the supply chain? These are questions we don't have answers to."

In December, the FAA ordered inspections of fuel line connectors because of risks of leaks and fires.

On the same day, a United Airlines Dreamliner flight from Houston to Newark, N.J., was diverted to New Orleans after an electrical problem popped up mid-flight. Qatar Airways, which had accepted delivery of a Dreamliner just a month earlier, grounded the aircraft for the same problem that United experienced.

Still, both LaHood and Huerta insist the Dreamliner is safe. Ray Conner, Boeing's chief executive of commercial aircraft, attended the conference and said the company was "fully committed to resolving any issue related to the safety" of the Dreamliner.

The Chicago company has taken 848 orders for Dreamliners from airlines and aircraft leasing firms around the world. The price ranges from $206.8 million to $243.6 million per jet, depending on the version ordered.

Major parts for the plane are assembled at various locations worldwide — including Southern California, Russia, Japan and Italy — and then shipped to Boeing's facilities in Everett, Wash., where they are "snapped together" in three days once production hits full speed, compared with a month the conventional way.

Boeing currently is making five Dreamliners a month. The company plans to reach 10 a month late this year.

Richard Aboulafia, an aerospace analyst with Teal Group Corp., a Virginia research firm, said the review will be beneficial for the Dreamliner program in the long run.

"There's no showstopper here; it's a short-term embarrassment for the company," he said. "Then again, this program is full of short-term embarrassments."

william.hennigan@latimes.com

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Irvine City Council overhauls oversight, spending on Great Park

Capping a raucous eight-hour-plus meeting, the Irvine City Council early Wednesday voted to overhaul the oversight and spending on the beleaguered Orange County Great Park while authorizing an audit of the more than $220 million that so far has been spent on the ambitious project.

A newly elected City Council majority voted 3 to 2 to terminate contracts with two firms that had been paid a combined $1.1 million a year for consulting, lobbying, marketing and public relations. One of those firms — Forde & Mollrich public relations — has been paid $12.4 million since county voters approved the Great Park plan in 2002.

"We need to stop talking about building a Great Park and actually start building a Great Park," council member Jeff Lalloway said.

The council, by the same split vote, also changed the composition of the Great Park's board of directors, shedding four non-elected members and handing control to Irvine's five council members.

The actions mark a significant turning point in the decade-long effort to turn the former El Toro Marine base into a 1,447-acre municipal park with man-made canyons, rivers, forests and gardens that planners hoped would rival New York's Central Park.

The city hoped to finish and maintain the park for years to come with $1.4 billion in state redevelopment funds. But that money vanished last year as part of the cutbacks to deal with California's massive budget deficit.

"We've gone through $220 million, but where has it gone?" council member Christina Shea said of the project's initial funding from developers in exchange for the right to build around the site. "The fact of the matter is the money is almost gone. It can't be business as usual."

The council majority said the changes will bring accountability and efficiencies to a project that critics say has been larded with wasteful spending and no-bid contracts. For all that has been spent, only about 200 acres of the park has been developed and half of that is leased to farmers.

But council members Larry Agran and Beth Krom, who have steered the course of the project since its inception, voted against reconfiguring the Great Park's board of directors and canceling the contracts with the two firms.

Krom has called the move a "witch hunt" against her and Agran. Feuding between liberal and conservative factions on the council has long shaped Irvine politics.

"This is a power play," she said. "There's a new sheriff in town."

The council meeting stretched long into the night, with the final vote coming Wednesday at 1:34 a.m. Tensions were high in the packed chambers with cheering, clapping and heckling coming from the crowd.

At one point council member Lalloway lamented that he "couldn't hear himself think."

During public comments, newly elected Orange County Supervisor Todd Spitzer chastised the council for "fighting like schoolchildren." Earlier this week he said that if the Irvine's new council majority can't make progress on the Great Park, he would seek a ballot initiative to have the county take over.

And Spitzer angrily told Agran that his stewardship of the project had been a failure.

"You know what?" he said. "It's their vision now. You're in the minority."

mike.anton@latimes.com

rhea.mahbubani@latimes.com

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Warner wins legal victory for control of Superman

SAN FRANCISCO (AP) — Just in time for the summer release of a hoped-for blockbuster movie "Man of Steel," Warner Bros. won a second significant legal victory Thursday giving it complete commercial control of the lucrative Superman franchise.

A three-judge panel of the 9th U.S. Circuit of Appeals unanimously ruled that the heirs of Superman's co-creator Jerome Siegel must abide by a 2001 letter written by the family's attorney accepting Warner Bros.' offer for their 50 percent share of Superman. Though the five-page letter was never formalized into a contract, the appeals court said it was still binding.

"Statements from the attorneys for both parties establish that the parties had undertaken years of negotiations, that they had resolved the last outstanding point in the deal during a conversation on Oct. 15, 2001, and that the letter accurately reflected the material terms they had orally agreed to on that day," Judge Stephen Reinhardt wrote for the panel.

The ruling Thursday undoes a 2008 trial court decision ordering Warner Bros. to share an undetermined amount of money earned since 1999 with the heirs, and to give the family control of key components of the Superman story, including his costume. If that decision were to stand, the studio would have had to negotiate a new costly royalty agreement with the family.

"The court's decision paves the way for the Siegel finally to receive the compensation they negotiated for and which DC has been prepared to pay for over a decade," Warner Bros. said in a prepared statement, referring to its DC Comics division. "We are extremely pleased that Superman's adventures can continue to be enjoyed across all media platforms worldwide for generations to come."

The family's attorney, Marc Toberoff, didn't respond to a request for comment.

Toberoff said earlier that he would appeal another significant Warner Bros. victory won in October involving the family of Superman's other creator, Joseph Shuster, and their bid for half the commercial rights. Toberoff also represents the Shuster heirs, who lost their bid to retain a 50 percent share of Superman.

A federal judge in Los Angeles had ruled that Shuster's sister and brother relinquished any chance to reclaim Superman copyrights in exchange for annual pension payments from DC Comics. U.S. District Judge Otis Wright noted in that case that the families of both creators have been paid in excess of $4 million since 1978, plus undefined bonuses and medical benefits.

In April, the $412 check that DC Comics wrote in 1938 to acquire Superman and other creative works by Shuster and Siegel sold for $160,000 in an online auction.

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Fatally Ill, and Making Herself the Lesson

SOUTH HADLEY, Mass. — It was early November when Martha Keochareon called the nursing school at Holyoke Community College, her alma mater. She had a proposal, which she laid out in a voice mail message.

“I have cancer,” she said after introducing herself, “and I’m wondering if you’ll need somebody to do a case study on, a hospice patient.”

Perhaps some nursing students “just want to feel what a tumor feels like,” she went on. Or they could learn something about hospice care, which aims to help terminally ill people die comfortably at home.

“Maybe you’ll have some ambitious student that wants to do a project,” Ms. Keochareon (pronounced CATCH-uron) said after leaving her phone number. “Thank you. Bye.”

Kelly Keane, a counselor at the college who received the message, was instantly intrigued. Holyoke’s nursing students, like most, learn about cancer from textbooks. They get some experience with acutely ill patients during a rotation on the medical-surgical floor of a hospital. They practice their skills in the college’s simulation lab on sophisticated mannequins that can “die” of cancer, heart attacks and other ailments. But Ms. Keochareon, 59, a 1993 graduate of Holyoke’s nursing program, was offering students something unique: an opportunity not only to examine her, but to ask anything they wanted about her experience with cancer and dying.

“She is allowing us into something we wouldn’t ever be privy to,” Ms. Keane said.

So it was that a few weeks later, two first-year nursing students, Cindy Santiago, 26, and Michelle Elliot, 52, arrived at Ms. Keochareon’s tiny house, a few miles from the college. She was bedbound, cared for by a loyal band of relatives, hospice nurses and aides. Both students were anxious.

“Sit on my bed and talk to me,” Ms. Keochareon said. The students hesitated, saying they had been taught not to do that, to prevent transmission of germs. What they knew of nursing in hospitals — “I’m here to take your vitals, give you your medicine, O.K., bye,” as Ms. Santiago put it — was different, after all.

They had come with a list of questions. Ms. Keochareon was suffering from pancreatic cancer, and they had researched the disease ahead of time. They were particularly curious about why she had survived for so long. She had lived with her illness for more than six years — an extraordinary span for pancreatic cancer, which often kills within months after diagnosis.

Why, the students asked, had she managed to keep eating and keep on weight? What was she taking for the pain? How long had it taken for doctors to give her a diagnosis?

“They ask good questions,” Ms. Keochareon said one morning, her lips stained red from the liquid oxycodone she was sipping frequently between doses of other drugs. “I forget half the stuff I learned as a nurse, but I remember everything about pancreatic cancer. Because I’m living it.”

For Ms. Keochareon, this was a chance to teach something about the profession she had found late and embraced — she became a nurse at 40, after raising her daughter and working for years on a factory floor.

“When I was a nurse, it seemed like most of the other nurses were never too happy having a student to teach,” she said, lying in her bedroom lined with pictures of relatives, friends, and herself in healthier times. “I loved it.”

A Last Project

Now, her disease had left her passing the days watching Animal Planet, reading a book about heaven and calling friends — so much that her cordless phone never left her side. She also was planning meticulously for her death, down to the green wool cardigan and embroidered shirt she would be buried in. But Ms. Keochareon wanted more as she prepared to die. The project she envisioned would be not just for students, but also for her — a way to squeeze one more chapter out of life.

Spending time with the dying is not fundamental to nurse training, partly because there are not enough clinical settings to provide the experience. The End-of-Life Nursing Education Consortium, a project of the American Association of Colleges of Nursing, has provided training in palliative care to some 15,000 nurses and nursing instructors around the nation since 2000, focusing not just on pain management but also on how to help terminally ill patients and their families prepare for death.

In addition, some students do rotations with hospice nurses, said Pam Malloy, the project’s director. But Ms. Malloy said that nursing schools still do not focus on end-of-life care nearly as much as they should. “We live in a death-denying society, and that includes nursing,” she said. “People have begun to understand it’s important, but we’re nowhere where we need to be at this point.”

In their conversations with Ms. Keochareon, the students learned that her symptoms had included a burning sensation after eating, for which doctors prescribed an acid blocker. Then came wrenching abdominal pain, which she said doctors dismissed as psychosomatic. She also developed diabetes, another potential sign of pancreatic cancer, and itchiness, possibly from blocked bile ducts.

In 2006, after she had felt sick for several years, a doctor finally ordered a CT scan, and the cancer was diagnosed. Ms. Keochareon was 53 and working at a hospital in Charleston, S.C. She was told that she would probably die within a year or two.

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Herbalife fires back at hedge fund giant

Herbalife Chief Executive Michael Johnson was tired of a powerful hedge fund manager bad-mouthing his company.

So he put on a show Thursday before hundreds of investors at the Four Seasons hotel in Manhattan, rebutting claims that the Los Angeles nutritional supplement company is a pyramid scheme. The presentation accused hedge fund giant Bill Ackman of lies and snobbery, compared Herbalife to the Girl Scouts and featured the company's president entreating that "the world needs more hugs."

Who says Wall Street is more boring these days?

The company's two-hour defense of itself is the latest in a battle since Ackman's Pershing Square Capital Management labeled Herbalife as "the best-managed pyramid scheme in the history of the world," during a similar presentation he made late last month. The outspoken fund manager has made a $1-billion bet that the stock would plunge in value.

"Just the very nature of the 'battle' has never been seen in the history of the Earth," said Tim Ramey, an analyst with D.A. Davidson and Co. "This was a very, very orchestrated attack."

Herbalife has hired a battalion of researchers to prove that it has a legitimate and stable business model. Executives held back no punches Thursday before a crowd of investors and analysts, labeling Ackman an elitist who made "false statements," "distortions" and "misrepresentations" about Herbalife and vowing to use "every means available to protect our reputation."

"In recent weeks, there's been a tremendous amount of misinformation about Herbalife," Johnson said. "This misinformation has found its way into the marketplace. Therefore we are sitting with you to correct some of this today."

In addition to outside experts brought in to bolster Herbalife's claims, company executives went through Pershing's presentation last month, disputing individual slides.

To the complaint that Herbalife is not focused on its products, Chief Operating Officer Rich Goudis showed figures indicating that the company spends millions on research and development.

To a Pershing slide that accused Herbalife of having a small distribution network, the company countered with a map of more than 300 company-run distribution points and showing its expansion in Indonesia and South Korea.

To a Pershing slide showing Herbalife products as more expensive than competitors' per 200-calorie servings, the company offered its own slide that compared the prices of the products per unit and showed costs in line with those of its competitors.

"Pershing intentionally used a misleading metric," Goudis said. "They did this to knowingly create a false impression."

They paraded out experts.

Kim Rory, representing Lieberman Research Worldwide, said distributors she surveyed had joined Herbalife because they wanted to get a discount on the products for personal use. Few signed up because they thought they'd make a large amount of money, and about two-thirds would recommend being a distributor to friends, she said.

Anne Coughlan, a professor at the Kellogg School of Management, defended Herbalife's marketing structure and disputed the allegation that it is a pyramid scheme.

"I didn't even see a scintilla of evidence that would suggest to me any hint that this company is running anything but a legitimate multi-level marketing program," she said.

Perhaps the most personal attacks came from Herbalife President Des Walsh, who said he was "highly offended" by Ackman's portrayal of Herbalife's nutrition clubs and defended the company for bringing nutritional products to poor neighborhoods.

After showing a video featuring happy distributors in crowded nutrition clubs, Walsh suggested that Ackman was out of touch with real America.

"This doesn't look like a country club in Westchester, Connecticut, but let me tell you, inside this club is real America," he said. (Earlier in the presentation, Walsh explained that people come to the club for a hug, adding, "the world needs more hugs.")

His comments echo a note sent out last week by D.A. Davidson analyst Ramey, who has a "buy" rating on Herbalife.

"Perhaps where Mr. Ackman lives he never sees a car with the 'Lose weight, ask me how' message across the rear window," he wrote. "I can tell Mr. Ackman that in my hometown, which is not quite Chappaqua, Herbalife is an iconic and widely recognized brand."

Ackman responded quickly Thursday, saying that Herbalife's presentation "distorted, mischaracterized and outright ignored large portions of our presentation," and that he had been contacted by people who provided more information into Herbalife's business practices, which he will soon reveal.

The unusual fight on Wall Street ramped up in December, when Ackman laid out his case against Herbalife in a three-hour, 200-plus slide presentation. He questioned whether the company was focused on recruiting new distributors, who pay to join the company, instead of on selling products. His announcement sent the company's stock down 36% and turned heads when analysts heard he'd sold short 20 million Herbalife shares.

Ackman's biggest beef with Herbalife focused on its so-called multi-level marketing model, which he said led to only those at the top of the company making money. More than 90% of distributors break even or lose money, he said. Ackman even drew UCLA into the controversy, saying Herbalife mentioned a lab at the university multiple times during each investor presentation to lend itself legitimacy.

Herbalife shares recovered some of their losses in the weeks after Ackman's presentation as some investors expressed confidence in the company. Hedge fund Third Point said it was taking an 8.2% stake in Herbalife, betting that the company would survive Ackman's assault.

Analysts at Thursday's meeting seemed supportive of Herbalife, with some expressing their belief in the company during a question-and-answer period after the presentation. One analyst urged the company to fight back against Pershing Square's method of "slandering" the company.

"It was a good, thorough presentation that certainly accomplished the job of defending the legitimacy of their business model," Ramey said.

Still, not all investors were convinced by the presentation. Herbalife's stock closed down 71 cents, or 1.8%, at $39.24. That may be because on Wednesday the Securities and Exchange Commission opened an investigation into Herbalife, according to published reports.

alana.semuels@latimes.com

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