Fla. man presumed dead after sinkhole opens under his bed

SEFFNER, Fla. A man was missing and feared dead early Friday after a large sinkhole opened under the bedroom of a house near Tampa.

Jeff Bush is presumed dead after a sinkhole opened under his bed.

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CBS

His brother says Jeff Bush screamed for help before he disappeared.

The 36-year-old man's brother, Jeremy Bush, told rescue crews he heard a loud crash around 11 p.m. Thursday, then heard his brother screaming for help.

"When he got there, there was no bedroom left," Hillsborough County Fire Rescue spokeswoman Jessica Damico said. "There was no furniture. All he saw was a piece of the mattress sticking up."

Jeremy Bush called 911 and frantically tried to help his brother Jeff. He said he jumped into the hole and dirt was quickly up to his neck.

"The floor was still giving in and the dirt was still going down, but I didn't care. I wanted to save my brother," Jeremy said. "But I just couldn't do nothing."

An arriving deputy pulled Jeremy Bush from the still-collapsing house.

28 Photos

Sinkholes

"I reached down and was able to actually able to get him by his hand and pull him out of the hole," Hillsborough County Sheriff's Deputy Douglas Duvall said. "The hole was collapsing. At that time, we left the house."

Engineers worked to determine the size of the sinkhole. At the surface, officials estimated it was about 30 feet across. Below the surface, officials believed it was 100 feet wide.

"The entire house is on the sinkhole," Damico said.

Hillsborough County Fire Chief Ron Rogers told a news briefing that extra-sensitive listening devices and cameras were inserted into the sinkhole. "They did not detect any signs of life," he said.

By early Friday, Hillsborough County Fire Rescue officials determined the home had become too unstable to continue rescue efforts.

Neighbors on both sides of the home have been evacuated.

Sinkholes are common in seaside Florida, whose underlying limestone and dolomite can be worn away by water and chemicals, then collapse.

Engineers condemned the house, reports CBS Tampa affiliate WTSP.

From the outside of the small, sky blue house, nothing appeared wrong. There wear no cracks and the only sign something was amiss was the yellow caution tape circling the house.

Hillsborough County Sheriff's Office spokesman Larry McKinnon said authorities asked sinkhole and engineering experts, and they were using equipment to see if the ground can support the weight of heavy machinery needed for the recovery effort.

Jeremy Bush stood in a neighbor's yard across the street from the house Friday and recounted the harrowing collapse.

"He was screaming my name. I could swear I heard him hollering my name to help him," he said of his brother Jeff.

Jeremy Bush's wife and his 2-year-old daughter were also inside the house. "She keeps asking where her Uncle Jeff is," he said. "I lost everything. I work so hard to support my wife and kid and I lost everything."

Janell Wheeler told the Tampa Bay Times newspaper she was inside the house with four other adults and a child when the sinkhole opened.

"It sounded like a car hit my house," she said.

The rest of the family went to a hotel but she stayed behind, sleeping in her car.

"I just want my nephew," she said through tears.

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Syria war is everybody's problem

Syrians search for survivors and bodies after the Syrian regime attacked the city of Aleppo with missiles on February 23.

STORY HIGHLIGHTS

• Frida Ghitis: We are standing by as Syria rips itself apart, thinking it's not our problem


• Beyond the tragedy in human terms, she says, the war damages global stability


• Ghitis: Syria getting more and more radical, jeopardizing forces of democracy


• Ghitis: Peace counts on moderates, whom we must back with diplomacy, training arms

Editor's note: Frida Ghitis is a world affairs columnist for The Miami Herald and World Politics Review. A former CNN producer and correspondent, she is the author of "The End of Revolution: A Changing World in the Age of Live Television." Follow her on Twitter: @FridaGColumns

(CNN) -- Last week, a huge explosion rocked the Syrian capital of Damascus, killing more than 50 people and injuring hundreds. The victims of the blast in a busy downtown street were mostly civilians, including schoolchildren. Each side in the Syrian civil war blamed the other.

In the northern city of Aleppo, about 58 people -- 36 of them children -- died in a missile attack last week. Washington condemned the regime of Bashar al-Assad; the world looked at the awful images and moved on.

Syria is ripping itself to pieces. The extent of human suffering is beyond comprehension. That alone should be reason enough to encourage a determined effort to bring this conflict to a quick resolution. But if humanitarian reasons were not enough, the international community -- including the U.S. and its allies -- should weigh the potential implications of allowing this calamity to continue.

Frida Ghitis

We've all heard the argument: It's not our problem. We're not the world's policeman. We would only make it worse.

This is not a plea to send American or European troops to fight in this conflict. Nobody wants that.

But before we allow this mostly hands-off approach to continue, we would do well to consider the potential toll of continuing with a failed policy, one that has focused in vain over the past two years searching for a diplomatic solution.

U. S. Secretary of State John Kerry has just announced that the U.S. will provide an additional $60 million in non-lethal assistance to the opposition. He has hinted that President Obama, after rejecting suggestions from the CIA and previous Secretary of State Hillary Clinton to arm Syrian rebels, might be ready to change course. And not a day too soon.

The war is taking longer than anyone expected. The longer it lasts, the more Syria is radicalized and the region is destabilized.

If you think the Syrian war is the concern of Syrians alone, think about other countries that have torn themselves apart over a long time. Consider Lebanon, Afghanistan or Somalia; each with unique circumstances, but with one thing in common: Their wars created enormous suffering at home, and the destructiveness eventually spilled beyond their borders. All of those wars triggered lengthy, costly refugee crises. They all spawned international terrorism and eventually direct international -- including U.S. -- intervention.

The uprising against al-Assad started two years ago in the spirit of what was then referred to -- without a hint of irony -- as the Arab Spring. Young Syrians marched, chanting for freedom and democracy. The ideals of equality, rule of law and human rights wafted in the air.

Al-Assad responded to peaceful protests with gunfire. Syrians started dying by the hundreds each day. Gradually the nonviolent protesters started fighting back. Members of the Syrian army started defecting.

The opposition's Free Syrian Army came together. Factions within the Syrian opposition took up arms and the political contest became a brutal civil war. The death toll has climbed to as many as 90,000, according to Kerry. About 2 million people have left their homes, and the killing continues with no end in sight.

In fairness to Washington, Europe and the rest of the international community, there were never easy choices in this war. Opposition leaders bickered, and their clashing views scared away would-be supporters. Western nations rejected the idea of arming the opposition, saying Syria already has too many weapons. They were also concerned about who would control the weaponry, including an existing arsenal of chemical and biological weapons, after al-Assad's fall.

These are all legitimate concerns. But inaction is producing the worst possible outcome.

The moderates, whose views most closely align with the West, are losing out to the better-armed Islamists and, especially, to the extremists. Moderates are losing the ideological debate and the battle for the future character of a Syria after al-Assad.

Radical Islamist groups have taken the lead. Young people are losing faith in moderation, lured by disciplined, devout extremists. Reporters on the ground have seen young democracy advocates turn into fervent supporters of dangerous groups such as the Nusra Front, which has scored impressive victories.

The U.S. State Department recently listed the Nusra Front, which has close ties to al Qaeda in Iraq and a strong anti-Western ideology, as a terrorist organization.

Meantime, countries bordering Syria are experiencing repercussions. And these are likely to become more dangerous.

Jordan, an important American ally, is struggling with a flood of refugees, as many as 10,000 each week since the start of the year. The government estimates 380,000 Syrians are in Jordan, a country whose government is under pressure from its own restive population and still dealing with huge refugee populations from other wars.

Turkey is also burdened with hundreds of thousands of refugees and occasional Syrian fire. Israel has warned about chemical weapons transfers from al-Assad to Hezbollah in Lebanon and may have already fired on a Syrian convoy attempting the move.

Lebanon, always perched precariously on the edge of crisis, lives with growing fears that Syria's war will enter its borders. Despite denials, there is evidence that Lebanon's Hezbollah, a close ally of al-Assad and of Iran, has joined the fighting on the side of the Syrian president. The Free Syrian Army has threatened to attack Hezbollah in Lebanon if it doesn't leave Syria.

The possible outcomes in Syria include the emergence of a failed state, stirring unrest throughout the region. If al-Assad wins, Syria will become an even more repressive country.

Al-Assad's survival would fortify Iran and Hezbollah and other anti-Western forces. If the extremists inside the opposition win, Syria could see factional fighting for many years, followed by anti-democratic, anti-Western policies.

The only good outcome is victory for the opposition's moderate forces. They may not be easy to identify with complete certainty. But to the extent that it is possible, these forces need Western support.

They need training, funding, careful arming and strong political and diplomatic backing. The people of Syria should know that support for human rights, democracy and pluralism will lead toward a peaceful, prosperous future.

Democratic nations should not avert their eyes from the killings in Syria which are, after all, a warning to the world.

Follow us on Twitter @CNNOpinion.

Join us on Facebook/CNNOpinion.

The opinions expressed in this commentary are solely those of Frida Ghitis.

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US manufacturing rises for 3rd straight month: ISM

WASHINGTON, March 1, 2013 (AFP) - US manufacturing activity expanded in February for the third month in a row, hitting the highest level since 2011, according to the ISM survey of purchasing managers released Friday.

The Institute for Supply Management's manufacturing sector index rose to 54.2 from 53.1 in January, boosted by a 4.5 percent surge in new orders.

Manufacturing appeared to be pulling out of a holding pattern in the second half of 2012, when the index hovered around the 50 break-even line between growth and contraction.

The index, based on a nationwide survey of manufacturing purchasing executives, showed across-the-board gains for the second straight month.

The February reading was the highest since June 2011 and unexpectedly strong.

Most analysts estimated the index would fall to 52.4.

Gains were seen in all five sub-indexes: new orders, production, employment, supplier deliveries and inventories.

Of the 18 manufacturing industries surveyed, 15 reported growth, compared with 13 in January.

Executives polled in the survey generally appeared upbeat about demand, although some indicated worry about the government's drastic "sequester" spending cuts that were to begin Friday.

"Overall business is good," said an executive in the food, beverage and tobacco products industry.

A furniture executive said: "Business seems to be on an uptick. The normal seasonal downturn for us has been much shorter and not as severe as in the past four years."

But an executive in computers and electronics pointed to government cuts in defense spending as a problem for his industry, one of the three reporting a contraction in February.

- AFP/ch

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Lawmakers leave before deadline

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Two U.S. sailors convicted in Okinawa rape

Updated 4:30 a.m. EST

TOKYO Two U.S. Navy sailors were convicted and sentenced to prison on Friday for raping and robbing a woman on Okinawa in a crime that outraged many on the southern Japanese island.

Seaman Christopher Browning, of Athens, Texas, and Petty Officer 3rd Class Skyler Dozierwalker, of Muskogee, Oklahoma, were found guilty by the Naha District Court of raping and robbing a woman in her 20s in a parking lot in October. Both admitted committing the crime.

Browning, 24, was sentenced to 10 years and Dozierwalker, 23, received nine years.

The case outraged many Okinawans, who have long complained of military-related crime on their island, which hosts thousands of U.S. troops. It also sparked tougher restrictions for all 50,000 U.S. military personnel in Japan, including a curfew and drinking restrictions.

Prosecutors had sought up to 12 years in prison for Browning, who they said also robbed the woman after the rape. Both men admitted their guilt, but the defense had argued that such a long sentence would be excessive.

In handing down the verdict, presiding judge Hideyuki Suzuki said the sentences were in line with the severity of the crimes, which he called "contemptible and violent."

Tensions between U.S. troops and Okinawans are endemic because of islanders' complaints of noise, the danger of accidents and crimes committed by servicemen. The rape in October came amid large protests over the U.S. military's decision to base a new kind of aircraft at an Okinawan Marine facility.

Although most crimes committed by U.S. military personnel in Japan are handled by military courts, they can be prosecuted in Japanese courts in cases that occur off base and are deemed to be particularly serious, such as murder and rape.

The sailors were temporarily deployed to Japan with their unit, the VR-59 reserve air detachment based at Joint Naval Air Station, Fort Worth, Texas. According to police, they arrived in Okinawa two days before the crime on a brief stopover and were staying in an off-base hotel. They were reportedly drinking before the rape took place.

They will serve their sentences in a Japanese prison.

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Sequestration: Surrender is in the Air

The budget ax is about to fall, and there's little lawmakers in Washington are doing to stop it.

Despite a parade of dire warnings from the White House, an $85 billion package of deep automatic spending cuts appears poised to take effect at the stroke of midnight on Friday.

The cuts – known in Washington-speak as the sequester – will hit every federal budget, from defense to education, and even the president's own staff.

On Capitol Hill, Senate Democrats and Republicans each staged votes Thursday aimed at substituting the indiscriminate across-the-board cuts with more sensible ones. Democrats also called for including new tax revenue in the mix. Both measures failed.

Lleaders on both sides publicly conceded that the effort was largely for show, with little chance the opposing chamber would embrace the other's plan. They will discuss their differences with President Obama at the White House on Friday.

"It isn't a plan at all, it's a gimmick," Senate Minority Leader Mitch McConnell, R-Ky., said today of the Democrats' legislation.

"Republicans call the plan flexibility" in how the cuts are made, said Senate Majority Leader Harry Reid. "Let's call it what it is. It is a punt."

The budget crisis is the product of a longstanding failure of Congress and the White House to compromise on plans for deficit reduction. The sequester itself, enacted in late 2011, was intended to be so unpalatable as to help force a deal.

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Republicans and Democrats, however, remain gridlocked over the issue of taxes.

Obama has mandated that any steps to offset the automatic cuts must include new tax revenue through the elimination of loopholes and deductions. House Speaker John Boehner and the GOP insist the approach should be spending cuts-only, modifying the package to make it more reasonable.

"Do we want to close loopholes? We sure do. But if we are going to do tax reform, it should focus on creating jobs, not funding more government," House Speaker John Boehner said, explaining his opposition to Obama's plan.

Boehner, McConnell, Reid and House Minority Leader Nancy Pelosi will huddle with Obama at the White House on Friday for the first face-to-face meeting of the group this year.

"There are no preconditions to a meeting like this," White House spokesman Jay Carney said today. "The immediate purpose of the meeting is to discuss the imminent sequester deadline and to avert it."

Even if the leaders reach a deal, there's almost no chance a compromise could be enacted before the deadline. Lawmakers are expected to recess later today for a long weekend in their districts.

What will be the short-term impact of the automatic cuts?

Officials say it will be a gradual, "rolling impact" with limited visible impact across the country in the first few weeks that the cuts are allowed to stand.

Over the long term, however, the Congressional Budget Office and independent economic analysts have warned sequester could lead to economic contraction and possibly a recession.

"This is going to be a big hit on the economy," Obama said Wednesday night.

"It means that you have fewer customers with money in their pockets ready to buy your goods and services. It means that the global economy will be weaker," he said. "And the worst part of it is, it's entirely unnecessary."

Both sides say that if the cuts take effect, the next best chance for a resolution could come next month when the parties need to enact a new federal budget. Government funding runs out on March 27, raising the specter of a federal shutdown if they still can't reach a deal.

"As we anticipate an across-the-board budget cuts across our land, we still expect to see your goodness prevail, O God, " Senate Chaplain Barry Black prayed on the Senate floor this morning, "and save us from ourselves."

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Syria war is everybody's problem

STORY HIGHLIGHTS

• NEW: France considers sending Syrian rebels night-vision gear and body armor, a source says


• Britain's foreign secretary says the UK will announce new aid soon


• The statements after European Union loosens restrictions to allow nonlethal aid to rebels


• The U.S. will also send non-lethal aid to rebels for first time, plus $60 million in administrative aid

Rome (CNN) -- The United States stepped further into Syria's civil war Thursday, promising rebel fighters food and medical supplies -- but not weapons -- for the first time in the two-year conflict that has claimed more than 60,000 lives and laid waste to large portions of the country.

Meanwhile, European nations began to explore ways to strengthen rebel fighters that stop short of arming them after a European Council decision allowing such aid to flow to Syria.

U.S. Secretary of State John Kerry said the aid would help fighters in the high-stakes effort to topple Syrian President Bashar al-Assad, a conflict that has already spawned an enormous humanitarian crisis as refugees flee the fighting.

The ongoing fighting also poses the persistent threat of widening into a destabilizing regional crisis, including concerns that Hezbollah, Iran or others could gain control in Damascus after al-Assad's government falls.

"The United States' decision to take further steps now is the result of the continued brutality of a superior armed force propped up by foreign fighters from Iran and Hezbollah, all of which threatens to destroy Syria," Kerry said after meeting opposition leaders in Rome.

Kerry didn't say how much that aid would be worth, but did announce that the United States would separately give $60 million to local groups working with the Syrian National Council to provide political administration and basic services in rebel-controlled areas of Syria.

READ: U.S. weighing nonlethal aid to Syrian opposition

That's on top of $50 million in similar aid the United States has previously pledged to the council, as well as $385 million in humanitarian assistance, Kerry said.

"This funding will allow the opposition to reach out and help the local councils to be able to rebuild in their liberated areas of Syria so that they can provide basic services to people who so often lack access today to medical care, to food, to sanitation," he said.

Islamist Influence

That aid is partly an effort to hem in radical Islamist groups vying for influence in Syria after the fall of al-Assad, a senior State Department official told CNN.

"If the Syrian opposition coalition can't touch, improve and heal the lives of Syrians in those places that have been freed, then extremists will step in and do it," the official said.

Sheikh Ahmed Moaz al-Khatib, president of the Syrian National Council, said concerns about Islamist influence had been overstated.

"We stand against every radical belief that aims to target Syria's diverse social and religious fabric," he said.

READ: Inside Syria: Exclusive look at pro-Assad Christian militia

U.S. officials hope the aid will help the coalition show what it can do and encourage al-Assad supporters to "peel away from him" and help end the fighting, the official said.

The opposition council will decide where the money goes, Kerry said.

But the United States will send technical advisers through its partners to the group's Cairo headquarters to make sure the aid is being used properly, the senior State Department official said.

Additional aid possible

The European Council carved out an exception in its sanctions against Syria on Thursday to allow for the transfer of nonlethal equipment and technical assistance for civilian protection only.

The council didn't specify what kind of equipment could be involved.

British Foreign Secretary William Hague said Friday on Twitter that his country would be pledging new aid because "we cannot stand still while the crisis worsens and thousands of lives are at stake."

A diplomatic official at the French Foreign Ministry told CNN that France is studying the possibility of supplying night-vision equipment or body armor.

"It is in the scope of the amendment," the official said.

In the United States, President Barack Obama is thinking about training rebels and equipping them with defensive gear such as night-vision goggles, body armor and military vehicles, according to sources familiar with the discussions.

The training would help rebels decide how to use their resources, strategize and maybe train a police force to take over after al-Assad's fall, one of the sources said.

READ: Syrian army in Homs is showing strains of war

Kerry did not announce that sort of aid Thursday, but said the United States and other countries backing the rebels would "continue to consult with each other on an urgent basis."

An official who briefed reporters said the opposition has raised a lot of needs in the Rome meetings and the administration will continue to "keep those under review."

"We will do this with vetted individuals, vetted units, so it has to be done carefully and appropriately," the official said.

Humanitarian crisis

The conflict began with demands for political reform after the Arab Spring movement that swept the Middle East and Africa, but descended into a brutal civil war when the al-Assad regime began a brutal crackdown on demonstrators.

At least 60,000 people have died since the fighting began in March 2011, the United Nations High Commissioner for Human Rights said in early January.

Another 940,000 had fled the country as of Tuesday, while more than one in 10 of Syria's 20 million residents have been forced to move elsewhere inside the country because of the fighting, the Office of the United Nations High Commissioner for Refugees said.

The situation is nearing crisis proportions, with the dramatic influx of refugees threatening to break the ability of host nations to provide for their needs, Assistant High Commissioner Erika Feller told the U.N. Human Rights Council on Tuesday

"The host states, including Jordan, Lebanon, Turkey, Iraq, Egypt and the North African countries, have been exemplary in their different ways, but we fear the pressure will start to overwhelm their capacities," she told the council, according to a text of her remarks posted on the United Nations website.

Al-Khatib said it's time for the fighting to stop.

"I ask Bashar al-Assad for once, just once, to behave as a human being," he said. "Enough massacres, enough killings. Enough of your bloodshed and enough torture. I urge you to make a rational decision once in your life and end the killings."

READ: Syrian war is everybody's problem

Jill Dougherty reported from Rome, and Michael Pearson reported and wrote from Atlanta. CNN's Nick Paton Walsh and Elise Labott also contributed to this report.

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Pope leaves Vatican on historic final day

VATICAN CITY: Pope Benedict XVI left the Vatican on Thursday for the last time as pontiff before he steps down as leader of the world's 1.2 billion Catholics, becoming the first pope to resign in 700 years.

Benedict boarded a white helicopter emblazoned with the Vatican flag for the papal summer residence of Castel Gandolfo near Rome, flying over the Vatican for the last time as pope.

As he took leave of his closest aides in an emotional parting ceremony in the Vatican, staff lined the route of his motorcade and applauded.

The bells of St Peter's Basilica rang out as the helicopter took off from the Vatican's helipad.

"Thank you for your love and support," the pope said in a final tweet sent from his @pontifex Twitter account just before taking off.

"May you always experience the joy that comes from putting Christ at the centre of your lives."

The Twitter account will now be suspended until a new pope is elected in a conclave next month.

The 85-year-old, who has said he can no longer carry on, will then bid one last goodbye to residents of Castel Gandolfo before retiring out of the public eye forever to a life of prayer.

At 1900 GMT, Benedict will no longer be pope.

The Swiss Guards -- a military corps that has protected the papacy since the 15th century and is best known for its brightly-coloured uniforms -- will then leave their posts and return to Rome.

Following tradition, staff in the Vatican will meanwhile apply seals to the doors of the papal apartments and the lift that leads up to them -- to be broken only once a new pope has been elected.

Benedict is only the second pope to resign in the Church's 2,000-year history and in his final hours as pope on Thursday he took the unprecedented step of pledging allegiance to his successor.

"Among you there is also the future pope to whom I promise my unconditional obedience and reverence," the pope said as he bade farewell to cardinals in the Vatican's ornate Clementine Hall.

"Let the Lord reveal the one he has chosen," said the pope, wearing an ermine-lined red stole over his white cassock as cardinals doffed their berettas and lined up to kiss the papal ring.

Benedict will remove the personalised signet ring -- known as the "Fisherman's Ring" -- before he leaves office and it will be destroyed, a tradition to ensure the papal seal is not misused.

"We have experienced, with faith, beautiful moments of radiant light together, as well as times with a few clouds in the sky," Benedict told the cardinals, reprising his remarks to a crowd of 150,000 faithful in St Peter's Square on Wednesday.

"Let us remain united, dear brothers," he said, in the final moments of an eight-year pontificate often overshadowed by infighting at the Vatican and divisions between reformers and traditionalists in the Catholic Church.

The Vatican has said pope will live in Castel Gandolfo for the next two months before taking up permanent residence inside a former convent on a hilltop in the Vatican grounds overlooking Rome.

The German pope stunned the globe when he announced on February 11 his decision to step down, saying he no longer had the "strength of mind and body" required by a fast-changing world.

The news has captured massive media attention, with the Vatican saying that 3,641 journalists from 61 countries will cover the upcoming conclave -- on top of the regular Vatican press corps.

The ex-pontiff will formally carry the new title of "Roman Pontiff Emeritus" or "pope emeritus" for short, although he will still be addressed as "Your Holiness Benedict XVI".

The only other pope who resigned by choice was Celestine V, a humble hermit who stepped down in 1294 after just a few months in office out of disgust with Vatican corruption and intrigue.

Once Benedict takes up residence inside the Vatican, the Church will be in the unprecedented situation of having a pope and his predecessor living within a stone's throw of each other.

Commenting on the new arrangement, Vatican spokesman Federico Lombardi said that Benedict "has no intention of interfering in the positions, decisions or activities of his successor".

Benedict has said he will live "hidden from the world" but the Vatican indicated he could provide "spiritual guidance" to the next pope.

Vatican analysts have suggested his sudden exit could set a precedent for ageing popes in the future, and many ordinary Catholics say a more youthful, pastoral figure could breathe new life into a Church struggling on many levels.

From Catholic reformers calling for women clergy and for an end to priestly celibacy, to growing secularism in the West and ongoing scandals over sexual abuses by paedophile priests going back decades, the next pope will have a tough agenda.

Meanwhile the suspense was building up in Castel Gandolfo -- a tiny mediaeval hilltop town which has hosted visiting popes for centuries and where many locals work at the sprawling papal residence.

"It's a very emotional day," said Patrizia Gasperini, 40, who works in a gift shop next to the imposing wooden doors Swiss Guards will shut at 1900 to signal the end of Benedict's papacy.

Gasperini, who named her eight-year-old daughter Benedetta in his honour, said: "We've been privileged to see a different, more humane side to him over the years, and grown to love him."

-AFP/ac

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Medicare paid billions to sub-par nursing homes: HHS

SAN FRANCISCO Medicare paid billions in taxpayer dollars to nursing homes nationwide that were not meeting basic requirements to look after their residents, government investigators have found.

The report, released Thursday by the Department of Health and Human Services' inspector general, said Medicare paid about $5.1 billion for patients to stay in skilled nursing facilities that failed to meet federal quality of care rules in 2009, in some cases resulting in dangerous and neglectful conditions.

One out of every three times patients wound up in nursing homes that year, they landed in facilities that failed to follow basic care requirements laid out by the federal agency that administers Medicare, investigators estimated.

By law, nursing homes need to write up care plans specially tailored for each resident, so doctors, nurses, therapists and all other caregivers are on the same page about how to help residents reach the highest possible levels of physical, mental and psychological well-being.

Not only are residents often going without the crucial help they need, but the government could be spending taxpayer money on facilities that could endanger people's health, the report concluded. The findings come as concerns about health care quality and costs are garnering heightened attention as the Obama administration implements the nation's sweeping health care overhaul.

"These findings raise concerns about what Medicare is paying for," the report said.

Investigators estimate that in one out of five stays, patients' health problems weren't addressed in the care plans, falling far short of government directives. For example, one home made no plans to monitor a patient's use of two anti-psychotic drugs and one depression medication, even though the drugs could have serious side effects.

In other cases, residents got therapy they didn't need, which the report said was in the nursing homes' financial interest because they would be reimbursed at a higher rate by Medicare.

In one example, a patient kept getting physical and occupational therapy even though the care plan said all the health goals had been met, the report said.

The Office of Inspector General's report was based on medical records from 190 patient visits to nursing homes in 42 states that lasted at least three weeks, which investigators said gave them a statistically valid sample of Medicare beneficiaries' experiences in skilled nursing facilities.

That sample represents about 1.1 million patient visits to nursing homes nationwide in 2009, the most recent year for which data was available, according to the review.

Overall, the review raises questions about whether the system is allowing homes to get paid for poor quality services that may be harming residents, investigators said, and recommended that the Centers for Medicare & Medicaid Services tie payments to homes' abilities to meet basic care requirements. The report also recommended that the agency strengthen its regulations and ramp up its oversight. The review did not name individual homes, nor did it estimate the number of patients who had been mistreated, but instead looked at the overall number of stays in which problems arose.

In response, the agency agreed that it should consider tying Medicare reimbursements to homes' provision of good care. CMS also said in written comments that it is reviewing its own regulations to improve enforcement at the homes.

"Medicare has made significant changes to the way we pay providers thanks to the health care law, to reward better quality care," Medicare spokesman Brian Cook said in a statement to The Associated Press. "We are taking steps to make sure these facilities have the resources to improve the quality of their care, and make sure Medicare is paying for the quality of care that beneficiaries are entitled to."

CMS hires state-level agencies to survey the homes and make sure they are complying with federal law, and can require correction plans, deny payment or end a contract with a home if major deficiencies come to light. The agency also said it would follow up on potential enforcement at the homes featured in the report.

Greg Crist, a Washington-based spokeswoman for the American Health Care Association, which represents the largest share of skilled nursing facilities nationwide, said overall, nursing home operators are well regulated and follow federal guidelines, but added that he could not fully comment on the report's conclusions without having had the chance to read it.

"Our members begin every treatment with the individual's personal health needs at the forefront. This is a hands-on process, involving doctors and even family members in an effort to enhance the health outcome of the patient," Crist said.

Virginia Fichera, who has relatives in two nursing homes in New York, said she would welcome a greater push for accountability at skilled nursing facilities.

"Once you're in a nursing home, if things don't go right, you're really a prisoner," said Fichera, a retired professor in Sterling, N.Y. "As a concerned relative, you just want to know the care is good, and if there are problems, why they are happening and when they'll be fixed."

Once residents are ready to go back home or transfer to another facility, federal law also requires that the homes write special plans to make sure patients are safely discharged.

Investigators found the homes didn't always do what was needed to ensure a smooth transition.

In nearly one-third of cases, facilities also did not provide enough information when the patient moved to another setting, the report found.

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