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A 1986 law bars hospital emergency rooms from refusing to examine and stabilize patients who can't pay. Now, federal officials will use the "patient dumping" prohibition to ensure immediate care whether or not insurance pays.
"Despite the terms of any managed care agreements ... federal law requires that stabilization medical treatment be provided in an emergency," said Health and Human Services Department Inspector General June Gibbs Brown.
The 1986 law was intended mainly to protect people without health insurance. However, delays while emergency room staff consult with health plans to see if insurance will pay are on the rise, regulators say. In some cases, federal officials say, patients with potentially serious health conditions have left emergency rooms after being questioned about their insurance.
To deter such incidents, the U.S. government will begin applying to correct delays regulators say may have been caused by attempts to ensure health payment.
American Hospital Association spokesperson Rick Wade said clarification in the law is welcome. But, he said, "It's not going to solve the problem of some plans deciding that they'll use pre-authorization rules as a way not to pay hospitals."
A high-level Pentagon panel that authorizes major defense acquisition programs is due soon to approve the Navy's concept for turning its fleet of Aegis cruisers and destroyers into mobile platforms for launching high-altitude interceptors, a legacy of former President Ronald Reagan's "Star Wars" dream.
With the Army's $14 billion effort faltering badly amid a host of quality-control problems and five consecutive intercept test failures, the Navy program has emerged in the eyes of many missile defense advocates as the nation's best hope for fielding an effective medium-range antimissile system.
But the project is less tested than the Army option. Intercept flight tests will not begin until 2000. And senior Pentagon officials are skeptical that the Navy can meet its aim of developing a modest initial capability by 2005.
``The program has been long on view graphs and short on engineering work,'' said one senior defense official involved in supervising the Pentagon's antimissile efforts.
Further, Navy officials, although confident of achieving a basic workable system over the next six years, acknowledge having little idea of how much more time and money they
will need to make it effective against more advanced missile threats on the horizon. The earliest version of the Navy system is designed to shoot down missiles equivalent to
North Korea's No Dong and Iran's Shahab 3, which have ranges of 600 to 800 miles. But North Korea has tested a longer-range Taepo Dong reaching 1,340 miles, and Iran
aims to acquire a similar weapon, according to administration officials.
With Congress pressing for faster development of U.S. antimissile defenses, the Navy already has invested $1.1 billion in perfecting the concept for its Theater Wide system
since 1995. Of that, $628 million came in the form of congressional add-ons to administration budget requests, pushed by Republican lawmakers more enamored of the Navy's
project than administration officials. One of the principal promoters has been Rep. Bob Livingston, R-La., the Appropriations Committee chairman who is speaker-designate of
the House.
The Pentagon's five-year budget provides another $1.5 billion for the program. But the Navy says it will need nearly twice that amount to meet the 2005 target date.
The Navy's concept rests on making the most of what the Navy already has lots of: ships equipped with an integrated network of radars and weapon controls known as the Aegis
combat system. Instead of trying to build an antimissile weapon from scratch, as the Army has attempted with its ill-fated Theater High-Altitude Area Defense (THAAD), the
Navy wants to capitalize on its $57 billion, 65-ship investment in Aegis gadgetry now used to track aircraft and vessels.
By tweaking the Aegis radar to scan higher altitudes and boosting the ship-launched Standard missile to make it fast enough to chase enemy missiles, the Navy contends it can
provide a protective umbrella over land and water. A ship in the Sea of Japan, for instance, could defend U.S. troops in Japan and South Korea against North Korean attack.
Similarly, a ship in the Persian Gulf could counter missiles launched by Iraq or Iran.
``One of the advantages that the Navy has is that we're building on proven systems,'' said Rear Adm. Phillip Balisle, vice commander of the Naval Sea Systems Command.
``But I would not want to lead you to believe we have underestimated the complexity of the mission.''
Both the Navy and Army systems are designed to protect regions where troops are deployed. As such, they are forerunners of a more ambitious and controversial plan to build a
network of land-based interceptors for guarding all 50 U.S. states from missile attack.
Some Republican supporters see the Navy system as having the potential to shield U.S. territory in addition to battlefield forces. They say that if U.S. warships in the Pacific and
Atlantic oceans were able to shoot down intercontinental ballistic missiles headed toward the United States, there would be little need for the land-based national plan, which has
been costing nearly $1 billion a year to develop.
Using interceptors aboard ships to guard U.S. skies, however, would violate the 1972 Anti-Ballistic Missile (ABM) Treaty signed with the Soviet Union and in force with
Russia. In some measure, the strong Republican backing for the Navy's project reflects support within the GOP for scrapping the treaty as a Cold War relic. But the Clinton
administration intends to limit the Navy system to battlefield defense and argues for preserving the ABM accord to keep Russia from reneging on commitments to reduce its
nuclear arsenal.
Senior Pentagon officials are reluctant to move ahead with the Aegis-based program too quickly. The Navy system faces unresolved technical issues involving the ability of the
interceptor's sensors to identify enemy warheads in space, the ability of the guidance and thruster components to steer interceptors into high-speed collisions and the ability of
computerized networks to process all the data.
Defense officials are mindful that the history of missile defense is littered with projects that looked great on paper but failed to perform. Much of the Pentagon's antimissile effort
has focused on inventing a ``hit-to-kill'' system-that is, a system based on interceptors able to find and ram enemy missiles. But hit-to-kill technology was demonstrated in only a
couple of experimental military programs during the 1980s, and never reliably.
The Navy is close to fielding a short-range antimissile system for ``area'' defense, which would provide localized coverage of ports and coastal facilities from distances up to
about 120 miles. But those interceptors lack the precision and speed required of the Theater Wide system, which promises a range four or five times greater. The more advanced
system will involve adding a third stage to the booster rocket, inventing a front-end ``kill vehicle'' with infrared thermal sensors to serve as the interceptor's eyes and writing
complicated computer software code to integrate all the parts.
In contrast to the Army's THAAD, which is meant to operate both within Earth's atmosphere and in space, the Navy system is focused only on intercepts in space. The aim is to
hit an enemy missile earlier in its trajectory, in what officials call the ``ascent'' phase, although later hits in the ``midcourse'' and ``descent'' phases also are envisioned.
That approach, Navy officials say, allows more time for successive shots and reduces the risk that debris from a partial intercept would fall on allied troops or civilians. But it
requires a faster missile.
It also requires a ``smarter'' one: The interceptor must do more of its own targeting because the Navy lacks the sophisticated ground-based tracking radar that the Army developed
for THAAD. In what, some experts worry, may prove to be the sea-based system's biggest weakness, the Navy plans to rely on shipboard SPY-1 radars to guide its interceptors.
SPY-1 radars have a full load of tasks during combat. They scan for enemy aircraft as well as unfriendly ships and submarines. Requiring them also to look for incoming ballistic
missiles could badly strain the system, according to some air defense experts. A Navy study, completed in early 1998, warned of radar overload during ``high-density'' missile
raids.
``At some point, the raid density can overwhelm a single ship,'' acknowledged Rear Adm. Rodney Rempt, deputy assistant secretary for theater combat systems. ``But we do not
anticipate, in any large use of theater ballistic missiles, that we would have only a single ship on location.''
By networking ships' defenses, Navy officials hope to ease the burden on any single vessel. They also say the SPY-1 radars could be enhanced through links with space-based
satellites, surveillance aircraft or early warning radars in Greenland and Britain. But such information-sharing is outlawed by the ABM Treaty, which effectively restricts the
sources of a ship's antimissile targeting information to the ship's own sensors.
With so much money and prestige riding on which of the military branches succeeds in developing the most reliable high-altitude antimissile system, Navy and Army
representatives are prone to tout their own programs at the other's expense.
Navy officials argue that deploying their system would not require the expensive manpower and logistics support associated with moving ground-based alternatives like THAAD
into conflict areas. They also contend that a sea-based system would offer the most effective defense for such strategic islands as Guam, Okinawa and Japan.
Those in the Army's camp suspect the Navy may be exaggerating its coverage claims. Because the Navy system operates only from sea and at very high altitudes, Army experts
say it has limited use against enemy missiles flying low or well inland.
``The Navy makes it seem in some briefings that the Theater Wide system can do everything,'' said Dan Augustine, a recently retired Army officer who specialized in antimissile
systems and works for a technology consulting firm in Arlington. ``But if you look more closely, it would be only a partial replacement or none at all for THAAD in some
scenarios.''
The Navy expects that in the next month or two, its Theater Wide system will be designated a full-fledged acquisition program by the Pentagon's Defense Acquisition Board.
``We need to focus on getting something out there, even if it's not perfect,'' Rempt said. ``Something is better than nothing.''
LA TIMES-WASHINGTON POST--11-29-98 2140EST
She was one of the nine original Mouseketeers who appeared in the first season of the "Mickey Mouse Club" and stayed for the duration of the show's 1955-1959 run.
Now the 56-year-old Gillespie is back in the public eye, with jury selection beginning Monday for her trial on stock fraud charges. Her fiance has pleaded guilty in the case and been sentenced to prison.
Ms. Gillespie and her fiance, Jerry Fraschilla, were charged in a complex stock fraud scheme that involved "free riding," or the purchase of stock without paying for it, and obstruction of justice.
The American message was conveyed by U.S. Ambassador Edward Walker, who met with Netanyahu before Israel's top security ministers convened for a special cabinet meeting on Lebanon.
The meeting yielded no public decisions on southern Lebanon, where Israeli troops have fought a low-intensity war of attrition with guerrillas of the pro-Iranian Hezbollah movement since 1985.
Washington is worried that the combat deaths of seven Israeli soldiers in the last two weeks will prompt Netanyahu to order harsh retaliatory raids. Following guerrilla attacks in 1996, Israel launched major air and artillery attacks on Lebanon, killing nearly 200 people, most of them civilians.
Yesterday, Netanyahu sided with his top army and intelligence officials in rejecting growing public calls for a unilateral Israeli withdrawal from southern Lebanon. But he did pledge to take the fight to Hezbollah.
"As long as we have no way to leave Lebanon in a way that ensures the security of the north, we will stay with the main goal of defending our soldiers, reducing harm to them and increasing damage to Hezbollah," the prime minister said.
in the northern city of Haifa.
While Netanyahu gave no indication what action might follow Sunday's meeting, some ministers made no secret of their desire to force Lebanon _ and the regional power
broker there, Syria _ to rein in Hezbollah. One option favored by some Israelis is air strikes on Lebanon's key civilian facilities.
``The way to make them want this is to let Beirut wake up in the morning without water and electricity and then, believe me, (the Lebanese) will send forces (to restrain
Hezbollah) and so will the Syrians,'' said Avigdor Kahalani, the public-security minister.
Israeli forces occupy a nine-mile-deep swath of Lebanese territory along the countries' common border in a deployment Israel says is necessary to prevent attacks on its own
territory. Israel has said it will withdraw if the Lebanese army will guarantee the safety of the border. But Syria and Lebanon have rejected the offer, insisting Israel's pullout
must be unconditional.
Syria provides arms and ammunition to Hezbollah and regards the war in southern Lebanon as a useful lever to press Israel into resuming talks on returning the Golan
Heights, which Israel captured from Syria in 1967. Those talks were broken off two years ago.
Left out of the Paris meetings that produced the tentative agreement - at a session restricted to heads of state - rebel leaders yesterday neither embraced nor rejected the accord, described as an agreement in principle. Rather, the insurgents simply issued a pointed reminder of their significance.
"We have always been ready for negotiations, even talks leading to a cease-fire," said Ernest Wamba dia Wamba, political leader of the Congolese Rally for Democracy, a breakaway faction of the Congolese army. "But deals that exclude us won't be effective because they won't be implemented."
Dia Wamba spoke with reporters via satellite phone from the northeastern Congo town of Bunia, but he had not yet received details of the pact from rebel representatives in Paris, where 49 African heads of state are gathered for a biennial summit.
Previous attempts to broker a peace accord in the 4-month-old conflict have foundered in part because the rebels were not included. Dia Wamba Sunday repeated the rebel demand for face-to-face talks with Congo President Laurent Kabila, the man they are trying to depose.
11-30-98
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