Police, world wonder about Conn. shooting motive

NEWTOWN, Conn. (AP) — The massacre of 26 children and adults at a Connecticut elementary school elicited horror and soul-searching around the world even as it raised more basic questions about why the gunman, a 20-year-old described as brilliant but remote, would have been driven to such a crime and how he chose his victims.

Investigators were trying to learn more about the gunman, Adam Lanza, and questioned his older brother, who is not believed to have been involved in the rampage at Sandy Hook Elementary. Police shed no light on the motive for the nation's second-deadliest school shooting.

In tight-knit Newtown on Friday night, hundreds of people packed St. Rose of Lima church and stood outside in a vigil for the 28 dead — 20 children and six adults at the school, the gunman's mother at home, and the gunman himself, who committed suicide. People held hands, lit candles and sang "Silent Night."

"These 20 children were just beautiful, beautiful children," Monsignor Robert Weiss said. "These 20 children lit up this community better than all these Christmas lights we have. ... There are a lot brighter stars up there tonight because of these kids."

Lanza is believed to have suffered from a personality disorder and lived with his mother, said a law enforcement official who was briefed on the investigation.

Lanza shot his mother, Nancy Lanza, drove to the school in her car with at least three guns, including a high-powered rifle that he apparently left in the back of the vehicle, and shot up two classrooms around 9:30 a.m. Friday, law enforcement officials said, speaking on condition of anonymity.

A custodian ran through the halls, warning of a gunman, and someone switched on the intercom, perhaps saving many lives by letting them hear the chaos in the school office, a teacher said. Teachers locked their doors and ordered children to huddle in a corner or hide in closets as shots echoed through the building.

The well-liked principal, Dawn Hochsprung, was believed to be among the dead. A woman who worked at the school was wounded. An update on victims' identities was planned Saturday morning.

A law enforcement official speaking on condition of anonymity said investigators believe Lanza attended the school several years ago but appeared to have no recent connection to it.

At least one parent said Lanza's mother was a substitute teacher there. But her name did not appear on a staff list. And the official said investigators were unable to establish any connection so far between her and the school.

Lanza's older brother, 24-year-old Ryan Lanza, of Hoboken, N.J., was questioned, but a law enforcement official said he was not believed to have had a role in the rampage. Investigators were searching his computers and phone records, but he told law enforcement he had not been in touch with his brother since about 2010.

The officials spoke on the condition of anonymity because they were not authorized to discuss the unfolding investigation.

At one point, a law enforcement official mistakenly identified the gunman as Ryan Lanza. Brett Wilshe, a friend of Ryan Lanza's, said Lanza told him the gunman may have had his identification. Ryan Lanza apparently posted Facebook page updates Friday afternoon that read, "It wasn't me" and "I was at work."

For about two hours late Friday and early Saturday, clergy members and emergency vehicles moved steadily to and from the school. The state medical examiner's office said bodies of the victims would be taken there eventually for autopsies.

The shooter took three guns into the school — a Glock and a Sig Sauer, both pistols, and a .223-caliber Bushmaster rifle, according to an official who was not authorized to discuss information with reporters and spoke on the condition of anonymity. The weapons were registered to his slain mother.

Adam Lanza and his mother lived in a well-to-do part of prosperous Newtown, about 60 miles northeast of New York City, where neighbors are doctors or hold white-collar positions at companies such as General Electric, Pepsi and IBM.

Lanza's parents filed for divorce in 2008, according to court records. His father, Peter Lanza, lives in Stamford, Conn., and works as a tax director for General Electric.

The gunman's aunt Marsha Lanza, of Crystal Lake, Ill., said her nephew was raised by kind, nurturing parents who would not have hesitated to seek mental help for him if he needed it.

"Nancy wasn't one to deny reality," Marsha Lanza said, adding her husband had seen Adam as recently as June and recalled nothing out of the ordinary.

Catherine Urso, of Newtown, said her college-age son knew the killer and remembered him for his alternative style. "He just said he was very thin, very remote and was one of the goths," she said.

Adam Lanza attended Newtown High School, and several news clippings from recent years mention his name among the honor roll students.

Joshua Milas, who graduated from Newtown High in 2009 and belonged to the school technology club with him, said Adam Lanza was generally a happy person but that he hadn't seen him in a few years.

"We would hang out, and he was a good kid. He was smart," Joshua Milas said. "He was probably one of the smartest kids I know. He was probably a genius."

An official who spoke on condition of anonymity said it was not clear that Adam Lanza had a job, and there was no indication of law enforcement interviews or search warrants at a place of business.

The mass shooting is one of the deadliest in U.S. history, and among school attacks is second in victims only to the 2007 Virginia Tech massacre, which left 33 people dead, including the gunman. Reaction was swift and emotional in Newtown, a picturesque New England community of 27,000 people, as well as across the country and around the world.

"It has to stop, these senseless deaths," said Frank DeAngelis, principal of Colorado's Columbine High School, where a massacre in 1999 killed 15 people.

In Washington, the Coalition to Stop Gun Violence organized a vigil at the White House, with some protesters chanting, "Today IS the day" to take steps to curb gun violence. In New York's Times Square, a few dozen people held tea lights in plastic cups, with one woman holding a sign that read: "Take a moment and candle to remember the victims of the Newtown shooting."

President Barack Obama's comments on the tragedy amounted to one of the most outwardly emotional moments of his presidency.

"The majority of those who died were children — beautiful little kids between the ages of 5 and 10 years old," Obama said at a White House news briefing. He paused for several seconds to keep his composure as he teared up and wiped an eye. Nearby, two aides cried and held hands.

Australian Prime Minister Julia Gillard described the attack as a "senseless and incomprehensible act of evil."

"Like President Obama and his fellow Americans, our hearts too are broken," Gillard said in a statement.

In Japan, where guns are severely restricted and there are extremely few gun-related crimes, the attack led the news two days before nationwide parliamentary elections. In China, which has seen several knife rampages at schools in recent years, the attack quickly consumed public discussion.

At the Newtown vigil, Anthony Bloss, whose three daughters survived, said they are doing better than he. "I'm numb. I'm completely numb," he said.

The gunman entered the school through its front door, and authorities are looking into the possibility that he shattered glass next to it to get in, said Newtown Police Lt. George Sinko.

Panicked parents looking for their children raced to Sandy Hook, a kindergarten-through-fourth-grade school where police told youngsters to close their eyes as they were led from the building so that they wouldn't see the blood and broken glass.

Schoolchildren — some crying, many looking frightened — were escorted through a parking lot in a line, hands on one another's shoulders.

Robert Licata said his 6-year-old son was in class when the gunman burst in and shot the teacher. "That's when my son grabbed a bunch of his friends and ran out the door," he said. "He was very brave. He waited for his friends."

He said the shooter didn't utter a word.

Kaitlin Roig, a teacher at the school, said she implored her students to be quiet.

"I told them we had to be absolutely quiet. Because I was just so afraid if he did come in, then he would hear us and just start shooting the door. I said we have to be absolutely quiet. And I said there are bad guys out there now and we need to wait for the good guys to come get us out," Roig told ABC News.

"If they started crying, I would take their face and say it's going to be OK. Show me your smile," she said. "They said, we want to go home for Christmas. Yes, yeah. I just want to hug my mom, things like that, that were just heartbreaking."

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Contributing to this report were Associated Press writers Pat Eaton-Robb and Matt Apuzzo and videographer Robert Ray in Newtown; Bridget Murphy in Boston; Samantha Henry in Newark, N.J.; Pete Yost in Washington; Michael Melia in Hartford; and the AP News Research Center in New York.

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Pentagon to send missiles, 400 troops to Turkey

INCIRLIK AIR BASE, Turkey (AP) — The U.S. will send two batteries of Patriot missiles and 400 troops to Turkey as part of a NATO force meant to protect Turkish territory from potential Syrian missile attack, the Pentagon said Friday.

Defense Secretary Leon Panetta signed a deployment order en route to Turkey from Afghanistan calling for 400 U.S. soldiers to operate two batteries of Patriots at undisclosed locations in Turkey, Pentagon press secretary George Little told reporters flying with Panetta.

Germany and the Netherlands have already agreed to provide two batteries of the U.S.-built defense systems and send up to 400 German and 360 Dutch troops to man them, bringing the total number of Patriot batteries slated for Turkey to six.

German lawmakers voted 461-86 Friday to approve the deployment of two Patriot missile batteries. The mandate allows Germany to deploy a maximum 400 soldiers through January 2014. NATO foreign ministers endorsed Turkey's request for the Patriots on Nov. 30.

A number of Syrian shells have landed in Turkish territory since the conflict in the Arab state began in March 2011. Turkey has condemned the Syrian regime of President Bashar Assad, supported Syrian rebels and provided shelter to Syrian refugees. Ankara is particularly worried that Assad may get desperate enough to use chemical weapons.

During a brief stop at Incirlik Air Base, Panetta told U.S. troops that Turkey might need the Patriots, which are capable of shooting down shorter-range ballistic missiles as well as aircraft.

He said he approved the deployment "so that we can help Turkey have the kind of missile defense it may very well need to deal with the threats coming out of Syria," he said.

The U.S., Germany and the Netherlands are the only NATO members who have the upgraded PAC-3 missiles, capable of missile interception. Each battery has an average of 12 missile launchers, a NATO official said, speaking on condition of anonymity because alliance regulations do not allow him to speak on the record.

In a statement issued Friday NATO spokeswoman Oana Lungescu said "the deployment will be defensive only."

"It will not support a no-fly zone or any offensive operation. Its aim is to deter any threats to Turkey, to defend Turkey's population and territory and to de-escalate the crisis on NATO's south-eastern border," Lungescu said.

Panetta did not mention how soon the two Patriot batteries will head to Turkey or how long they might stay.

Earlier this week in Berlin, German Deputy Foreign Minister Michael Link told lawmakers that current plans call for the missile sites to be stationed at Kahramanmaras, about 60 miles north of Turkey's border with Syria. Dutch Prime Minister Mark Rutte said Thursday that the Netherlands, Germany and the U.S. are working closely with Turkey "to ensure that the Patriots are deployed as soon as possible." But he predicted they would not become operational before the end of January. Turkey joined NATO in 1952, three years after the alliance was formed.

At Incirlik Air Base, about 60 miles north of the Syrian border, an Air Force member asked Panetta what the US would do if Syria used chemical or biological weapons against the rebels. Panetta said he could not be specific in a public setting, but added, "we have drawn up plans" that give President Barack Obama a set of options in the event that U.S. intelligence shows that Syria intends to use such weapons.

Asked by another Air Force member whether he thought Syria would "react negatively" to the Patriot deployments, Panetta said, "I don't think they have the damn time to worry" about the Patriots since the regime's leaders are struggling to stay in power.

He indicated that Syria's reaction to the Patriots was not a major concern to him.

Separately, NATO will deploy its Airborne Warning and Control System aircraft, or AWACS, to Turkey on a training exercise this month, the NATO said.

He said the exercise was not connected to the deployment of the Patriots.

The aircraft, which can detect launches of ground-to-ground missiles, will exercise command and control procedures as well as test the connectivity of various NATO and Turkish communications and data sharing systems, the official said.

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Associated Press writer Slobodan Lekic in Brussels contributed to this report.

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Online gambling companies struggle to clear EU hurdles

LONDON (Reuters) – A partnership stuck on Friday between bwin.party Digital Entertainment and a Belgian casino group has defused one of many disputes pitting online gambling companies against governments across Europe.

The agreement came a month after bwin.party’s co-CEO was questioned by Belgian authorities in an escalating license dispute the company said was costing it 700,000 euros ($ 916,000) in monthly revenue.

By joining forces with Belcasinos, a unit of local casino owner Group Partouche, bwin.party neatly met a requirement to have a presence in Belgium to win a license for online poker, casino and sports betting.

The agreement is a rare bright spot in a tough regulatory environment for online gambling companies across the continent.

Betting online on sports events or playing poker on the Internet are increasingly popular pastimes in Europe, where operators say they are held back by unfair and discriminatory rules in many European Union countries.

“It is not a European Union in any way, it is a patchwork of different countries who happen to be in the EU,” said Professor Leighton Vaughan Williams, director of the betting research unit at Nottingham Business School in central England.

“Different countries have different vested interests and different ideas they are trying to promote. Are they trying to protect consumers or to maximize their tax take?” he said.

The 27 EU member states retain the right to regulate their gambling sectors as they see fit, but rules must comply with EU law, broadly meaning they must be consistent and proportionate.

Some companies are scaling back activities in European markets where, they say, regulatory risks are too high or tax rates are punitive.

Betting exchange operator Betfair for instance said this week it was halting marketing and investment in unregulated markets, including EU members Cyprus, Germany and Greece.

William Hill, Britain‘s largest bookmaker, has joined Betfair in pulling out of Greece and has also stopped offering sports betting to German residents because of a 5 percent turnover tax.

STAKES RISE

The stakes are high. Online gambling is growing at an annual rate of almost 15 percent in the EU and will be worth an estimated 13 billion euros ($ 17 billion) by 2015, according to EU figures.

The European Commission, the EU’s executive, stepped in to the debate in October when it published a medium-term plan to clarify regulations and promote cooperation between member states, ruling out EU-wide legislation for the time being.

“All citizens must be adequately protected, money laundering and fraud must be prevented, sport must be safeguarded against betting-related match-fixing and national rules must comply with EU law,” Internal Market and Services Commissioner Michel Barnier said, setting out his approach.

The online operators accuse the European Commission of failing to follow through properly on complaints lodged about regulation in no fewer than 20 or the 27 EU member states.

Barnier has written to member states accused of breaching EU law in the way they handle gambling, seeking an update on the situation by the end of the year.

However, the industry questions whether the EU will go into battle over gambling when it is facing so many other problems.

“They will chip away at some of the most blatant ones,” said Clive Hawkswood, chief executive of trade body the Remote Gambling Association. “What we really need is for them to take some to the European Court and take enforcement action.”

BRITISH TAXES

Gambling companies themselves have taken advantage of different tax regimes where they work in their favor.

This is illustrated in Britain, historically the biggest betting market in Europe and a place with a well-developed gambling culture where bookmakers have operated in town centers for 50 years.

In recent years, most betting companies have moved their British online betting operations to Britain’s overseas territory of Gibraltar. There they are sheltered from a 15 percent tax on gross profit faced by operators based in Britain.

New legislation will close off that loophole after 2014. The shift to a taxation model based on the location of the consumer was expected to cost gambling companies as much as 270 million pounds ($ 435 million) by 2016-17.

Analyst Nick Batram at brokerage Peel Hunt said smaller players would likely be picked off because of the impact of higher tax and regulatory burdens across Europe.

“It is getting more complicated and more expensive. There is more change afoot but it should ultimately play into the hands of the better-capitalized companies.”

In that vein, William Hill has provisionally agreed a 485 million pound takeover of smaller rival Sportingbet, keen to get its hands on the company’s regulated Australian betting business.

“I think there is a lot more M&A activity to come,” said Batram.

(Additional reporting by Rosalba O’Brien; Editing by David Holmes)

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From 'Sherlock' to 'Star Trek' for Cumberbatch

LONDON (AP) — Benedict Cumberbatch has had a busy 24 hours.

The British actor was nominated for a Golden Globe for "Sherlock" and unveiled the first nine minutes of the new "Star Trek" movie at a special presentation Friday in London.

Cumberbatch's character John Harrison was introduced in the much-anticipated sci-fi sequel, "Star Trek Into Darkness."

Cumberbatch was not allowed to reveal much about the plot, but the 36-year-old did admit that he auditioned for the role of Harrison — who he describes as "a phenomenal one-man weapon of mass destruction" — on an iPhone in his friend's kitchen.

Fans wanting to see the footage can catch it in front of selected IMAX 3D screenings worldwide of "The Hobbit," beginning Friday.

"Star Trek Into Darkness," directed by J.J. Abrams, opens next May.

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Fewer health care options for illegal immigrants

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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U.S. to send missiles, troops to Turkey

INCIRLIK AIR BASE, Turkey (Reuters) - U.S. Defense Secretary Leon Panetta signed an order on Friday to send two Patriot missile batteries to Turkey with 400 American personnel to operate them, in a move by NATO members to bolster Turkey's defenses against the threat of Syrian missiles.

The order was signed shortly before Panetta arrived on an unannounced visit to Turkey to meet American troops stationed at the Incirlik Air Base, the last stop on a week-long trip that took him to Afghanistan and Kuwait.

"The purpose of this deployment is to signal very strongly that the United States, working closely with our NATO allies, is going to support the defense of Turkey, especially with potential threats emanating from Syria," spokesman George Little said.

NATO-member Turkey has repeatedly scrambled jets along the countries' joint frontier and responded in kind when shells from the Syrian conflict came down inside its borders, fanning fears that the civil war could spread to destabilize the region.

The widely expected U.S. move follows similar steps by Germany and the Netherlands, which also said they will send two Patriot batteries. The three countries are the only NATO nations with the most modern type of Patriots.

Little declined to say where the U.S. batteries would be located and said the systems would be deployed to Turkey for an unspecified amount of time.

"We expect them to be deployed in the coming weeks," Little said.

NATO approved Turkey's request for air defense batteries on December 4, in a move meant to calm its fears of coming under missile attack, possibly with chemical weapons, from Syria.

The Patriot system is designed to intercept aircraft or missiles. NATO says the measure is purely defensive, but Russia, Syria and Iran have criticized the decision, saying it increases regional instability.

(Reporting by Phil Stewart; Editing by Nick Tattersall; Editing by Janet Lawrence)

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Afghan suicide bomber wounds 14 in Kandahar attack

KANDAHAR, Afghanistan (AP) — An Afghan official says a suicide bomber on a motorcycle has wounded three NATO troops and 11 civilians in an attack against the main gate of Kandahar Airfield, the main U.S. military base in the south.

Javeed Faisal, who is a spokesman for the provincial governor, said the attack took place just after nightfall Thursday and targeted the gate that provides access to the military side of the city's airport.

Suicide attacks are not uncommon in Kandahar, the birthplace of the Taliban.

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iPad mini deemed a ‘game changer,’ outgrew Kindle Fire by nearly 50%

Smaller tablets in the 7-inch range have been on the market for more than two years now, but it looks like it took Apple (AAPL) just one month to vault to the top of the category. Mobile advertising firm Millennial Media recently published the findings of a study pitting the iPad mini against Amazon’s (AMZN) popular Kindle Fire, which has been an extremely popular iPad alternative since it first launched last year. According to Millennial, iPad mini usage grew about 50% faster during early November than the Kindle Fire did immediately following its successful launch last year, as measured by ad impressions served by the firm’s network.

Millennial found that impressions served to the iPad mini in early November grew at an average daily rate of 28%. In the weeks following the Kindle Fire’s launch last year, usage of Amazon’s tablet grew roughly 19% each day.

“In the first weeks after the iPad mini went on sale, we saw an average daily growth in impressions of 28 percent. Last holiday season, Amazon launched the Kindle Fire to much anticipation, Millennial Media’s Matt Mills wrote on the company’s blog. “As a comparison, we saw Kindle Fire impressions grow at an average daily rate of 19 percent in the first two weeks after it went on sale last year. So, by our math it looks like Apple could have itself another massive holiday season.”

Mills called the iPad mini a “game changer” and said he expects “a massive amount” of iPad mini tablets to be given as gifts this holiday season.

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'Lincoln,' gets a leading 7 Globe nominations

BEVERLY HILLS, Calif. (AP) — Steven Spielberg is bringing new glory to Abraham Lincoln.

The Civil War epic "Lincoln" leads the Golden Globes with seven nominations, among them best drama, best director for Spielberg and acting honors for Daniel Day-Lewis, Sally Field and Tommy Lee Jones.

Tied for second-place Wednesday with five nominations, including best drama are the Iran hostage-crisis thriller "Argo" and the slave-turned-bounty-hunter tale "Django Unchained."

Other best-drama nominees are the shipwreck story "Life of Pi" and the Osama bin Laden manhunt thriller "Zero Dark Thirty."

Nominated for best musical or comedy were: the British retiree adventure "The Best Exotic Marigold Hotel"; the Victor Hugo musical "Les Miserables"; the first-love tale "Moonrise Kingdom"; the fishing romance "Salmon Fishing in the Yemen"; and the lost-soul romance "Silver Linings Playbook.

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Dozens sue pharmacy, but compensation uncertain

NASHVILLE, Tenn. (AP) — Dennis O'Brien rubs his head as he details ailments triggered by the fungal meningitis he developed after a series of steroid shots in his neck: nausea, vomiting, dizziness, drowsiness, blurred vision, exhaustion and trouble with his speech and attention.

He estimates the disease has cost him and his wife thousands of dollars in out-of-pocket expenses and her lost wages, including time spent on 6-hour round trip weekly visits to the hospital. They've filed a lawsuit seeking $4 million in damages from the Massachusetts pharmacy that supplied the steroid injections, but it could take years for them to get any money back and they may never get enough to cover their expenses. The same is true for dozens of others who have sued the New England Compounding Center.

"I don't have a life anymore. My life is a meningitis life," the 59-year-old former school teacher said, adding that he's grateful he survived.

His is one of at least 50 federal lawsuits in nine states that have been filed against NECC, and more are being filed in state courts every day. More than 500 people have gotten sick after receiving injections prepared by the pharmacy.

The lawsuits allege that NECC negligently produced a defective and dangerous product and seek millions to repay families for the death of spouses, physically painful recoveries, lost wages and mental and emotional suffering. Thirty-seven people have died in the outbreak.

"The truth is the chance of recovering damages from NECC is extremely low," said John Day, a Nashville attorney who represents several patients who have been sickened by fungal meningitis.

To streamline the process, attorneys on both sides are asking to have a single judge preside over the pretrial and discovery phases for all of the federal lawsuits.

This approach, called multidistrict litigation, would prevent inconsistent pretrial rulings and conserve resources of all parties. But unlike a class-action case, those lawsuits would eventually be returned to judges in their original district for trial, according to Brian Fitzpatrick, a law professor at Vanderbilt University Law School in Nashville.

Even with this approach, Fitzpatrick noted that federal litigation is very slow, and gathering all the evidence, records and depositions during the discovery phase could take months or years.

"Most of the time what happens is once they are consolidated for pretrial proceedings, there is a settlement, a global settlement between all the lawyers and the defendants before anything is shipped back for trial," he said.

A lawyer representing NECC, Frederick H. Fern, described the consolidation process as an important step.

"A Boston venue is probably the best scenario," Fern said in an email. "That's where the parties, witnesses and documents are located, and where the acts subject to these complaints occurred."

Complicating efforts to recover damages, attorneys for the patients said, NECC is a small private company that has now recalled all its products and laid off its workers. The company's pharmacy licenses have been surrendered, and it's unclear whether NECC had adequate liability insurance.

Fern said NECC has insurance, but they were still determining what the policy covers.

But Day says, "It's clear to me that at the end of the day, NECC is not going to have sufficient assets to compensate any of these people, not even 1 percent."

As a result, many attorneys are seeking compensation from other parties. Among the additional defendants named in lawsuits are NECC pharmacist and co-founder Barry Cadden; co-founder Greg Conigliaro; sister company Ameridose and its marketing and support arm, Medical Sales Management.

Founded in 2006 by Cadden and Conigliaro, Ameridose would eventually report annual revenue of $100 million. An NECC spokesman didn't respond to a request for the pharmacy's revenue.

While Federal Drug Administration regulators have also found contamination issues at Westborough, Mass.-based Ameridose, the FDA has said it has not connected Ameridose drugs to infection or illness.

Under tort law, a lawsuit has to prove a defendant has a potential liability, which in this case could be anyone involved in the medical procedure. However, any such suit could take years and ultimately may not be successful.

"I would not be surprised if doctors, hospitals, people that actually injected the drugs, the people that bought the drugs from the compounding company, many of those people will also be sued," said Fitzpatrick.

Plaintiffs' attorneys said they're considering that option but want more information on the relationships between the compounding pharmacy and the hundreds of hospitals and clinics that received its products.

Day, the attorney in Tennessee, said the clinics and doctors that purchase their drugs from compounding pharmacies or manufacturers could be held liable for negligence because they are in a better position to determine the safety of the medicine than the patients.

"Did they use due care in determining from whom to buy these drugs?" Day said.

Terry Dawes, a Michigan attorney who has filed at least 10 federal lawsuits in the case, said in traditional product liability cases, a pharmaceutical distributor could be liable.

"We are looking at any conceivable sources of recovery for our clients including pharmaceutical supply places that may have dealt with this company in the past," he said.

Ten years ago, seven fungal meningitis illnesses and deaths were linked to injectable steroid from a South Carolina compounding pharmacy. That resulted in fewer than a dozen lawsuits, a scale much smaller than the litigations mounting up against NECC.

Two companies that insured the South Carolina pharmacy and its operators tried unsuccessfully to deny payouts. An appellate court ruled against their argument that the pharmacy willfully violated state regulations by making multiple vials of the drug without specific prescriptions, but the opinion was unpublished and doesn't set a precedent for the current litigation.

The lawsuits represent a way for patients and their families recover expenses, but also to hold the pharmacy and others accountable for the incalculable emotional and physical toll of the disease.

A binder of snapshots shows what life is like in the O'Briens' rural Fentress County, Tenn., home: Dennis hooked up to an IV, Dennis in an antibiotics stupor, bruises on his body from injections and blood tests. He's had three spinal taps. His 11-day stay in the hospital cost over $100,000, which was covered by health insurance.

His wife said she sometimes quietly checks at night to see whether her husband of 35 years is still breathing.

"In my mind, I thought we were going to fight this and get over it. But we are not ever going to get over it," said Kaye O'Brien.

Marjorie Norwood, a 59-year-old grandmother of three who lives in Ethridge, Tenn., has spent just shy of two months total in the hospital in Nashville battling fungal meningitis after receiving a steroid injection in her back. She was allowed to come home for almost a week around Thanksgiving, but was readmitted after her symptoms worsened.

Family members are still dealing with much uncertainty about her recovery, but they have not filed a lawsuit, said their attorney Mark Chalos. He said Norwood will likely be sent to a rehabilitation facility after her second stay in the hospital rather than return home again.

Marjorie Norwood's husband, an autoworker, has taken time off work to care for her and they depend on his income and insurance.

"It doesn't just change her life, it changes everyone else's life around her because we care about her and want her to be happy and well and have everything that she needs," said her daughter, Melanie Norwood.

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