The Neediest Cases: The Daughter of a Sick Woman Falls Prey to a Craigslist Scam





Sitting side by side on their living room sofa, Patricia Morales and her daughter, Katherine, could be any mother-daughter duo. Both have dark hair, dark eyes and welcoming, infectious smiles.







Librado Romero/The New York Times

Patricia Morales, 62, at home in the Bronx. Her treatment for ailments like rheumatoid arthritis and hepatitis C led to depression.




The Neediest CasesFor the past 100 years, The New York Times Neediest Cases Fund has provided direct assistance to children, families and the elderly in New York. To celebrate the 101st campaign, an article will appear daily through Jan. 25. Each profile will illustrate the difference that even a modest amount of money can make in easing the struggles of the poor.


Last year donors contributed $7,003,854, which was distributed to those in need through seven New York charities.








2012-13 Campaign


Previously recorded:

$3,375,394



Recorded Wednesday:

182,251



*Total:

$3,557,645



Last year to date:

$3,320,812




*Includes $709,856 contributed to the Hurricane Sandy relief efforts.


The Youngest Donors


If your child or family is using creative techniques to raise money for this year’s campaign, we want to hear from you. Drop us a line on Facebook or talk to us on Twitter.





But the ties that bind them go beyond their genes, beyond the bodies they were born with.


“It’s called a neck ring. It’s a silver curved barbell, one inch,” Katherine, 20, said as she swept aside her shoulder-length black hair to show the piercing in the back of her neck, a show of solidarity with her mother. She had it done when she was 16. “I wanted to know what it felt like for my mom.”


Her mother then turned around and outlined with her finger two lengthy scars that run down her back.


“I’ve had a lot of physical problems,” Ms. Morales, 62, said. Shaking her head at her daughter’s piercing, she added, “I’ve had rods put in my upper and lower spine, but I could never do that.”


The rods were surgically planted to treat herniated discs, the result of having a cruel combination of osteoporosis, hepatitis C, fibromyalgia and rheumatoid arthritis. Ms. Morales contracted hepatitis C from a blood transfusion she received in 1972 after the birth of her only son, she said.


“I didn’t even know about it until 10 years ago,” she said. “My liver blood count was a little high.”


Since the diagnosis, Ms. Morales, a former schoolteacher, has ridden the arduous highs and lows common to patients with hepatitis C. Her treatments for the disease, which debilitates the liver over time, have included pills and injections that can cause depression. Ms. Morales, a single parent, found an unforgiving salve in alcohol.


“I was depressed; I was totally drunk,” she said. “I didn’t want to live anymore.”


Then, about a year ago, she reached a turning point when visiting her hepatitis C specialist.


“I was 210 pounds,” she said. “The doctor said: ‘You have to stop drinking. You have to lose weight.’ ”


To help combat the depression, her doctor referred her to Jewish Association Serving the Aging, a beneficiary agency of UJA-Federation of New York, one of the organizations supported by The New York Times Neediest Cases Fund. She began weekly counseling sessions with a social worker and started taking an antidepressant medication. The federation drew about $600 from the fund in May so that Ms. Morales could buy a mattress.


“I had a horrible bed,” she said. “I felt like I was sleeping on rocks, and with rods in my back, I was waking up every hour.”


After several months of therapy and starting a diet, Ms. Morales was on her way to losing 60 pounds. Today, she weighs 148.


Light was starting to show itself again when the family took an unexpected financial hit this summer. While taking time off from attending Hostos Community College, Katherine Morales looked for work on Craigslist.


“I saw my mom, and I realized I needed to get a job,” Katherine said shyly. “This guy asked me to be his personal assistant, and he asked me to wire money.”


Offering $400 a week, the man requested help transferring almost $2,000 from what he said was his wife’s account. He transferred the money to Katherine’s account, asking her to wire it to a bank account in Malaysia.


Shortly after she wired the money, the bank froze the account, which Katherine and her mother shared. It was then that Katherine realized she had been the victim of a scam. The money transferred into her account turned out to have been stolen, and she was responsible for repaying it.


Katherine went to detectives immediately with more than 20 pages of evidentiary e-mails, but found that she was unable to file a complaint.


“They told me it wasn’t enough,” she said. “These things happen all the time.”


They lost almost $2,000.


Ms. Morales lives on a fixed income. She receives just over $700 a month from Social Security and $200 month in food stamps. The rent for the apartment she shares with her daughter in the Throgs Neck neighborhood of the Bronx is $230, and Ms. Morales has a monthly combined phone and cable bill of $140. Ms. Morales has a son, but he is unable to help the family.


Falling behind on her bills, Ms. Morales turned once again to JASA for help paying a combined phone and cable bill of nearly $200, a grant the agency drew from the Neediest Cases Fund.


“It was terrible, because my intention was to help my mom,” said Katherine, who has since found a part-time job at a vitamin shop.


Ms. Morales has been feeling much better, but she is nervous about an appointment with her hepatitis C specialist in January.


“I’m taking things one day at a time, but I’m looking forward to someone taking care of me,” she said. “I want to live a little bit longer, but not that long.”


“Why are you putting a time limit on it?” Katherine said, jokingly. “Seventy’s the new 20!” she added, nudging her mother in the side. “Remember, the doctor said you wouldn’t live past your late 50s, but you did.”


Read More..

The Neediest Cases: The Daughter of a Sick Woman Falls Prey to a Craigslist Scam





Sitting side by side on their living room sofa, Patricia Morales and her daughter, Katherine, could be any mother-daughter duo. Both have dark hair, dark eyes and welcoming, infectious smiles.







Librado Romero/The New York Times

Patricia Morales, 62, at home in the Bronx. Her treatment for ailments like rheumatoid arthritis and hepatitis C led to depression.




The Neediest CasesFor the past 100 years, The New York Times Neediest Cases Fund has provided direct assistance to children, families and the elderly in New York. To celebrate the 101st campaign, an article will appear daily through Jan. 25. Each profile will illustrate the difference that even a modest amount of money can make in easing the struggles of the poor.


Last year donors contributed $7,003,854, which was distributed to those in need through seven New York charities.








2012-13 Campaign


Previously recorded:

$3,375,394



Recorded Wednesday:

182,251



*Total:

$3,557,645



Last year to date:

$3,320,812




*Includes $709,856 contributed to the Hurricane Sandy relief efforts.


The Youngest Donors


If your child or family is using creative techniques to raise money for this year’s campaign, we want to hear from you. Drop us a line on Facebook or talk to us on Twitter.





But the ties that bind them go beyond their genes, beyond the bodies they were born with.


“It’s called a neck ring. It’s a silver curved barbell, one inch,” Katherine, 20, said as she swept aside her shoulder-length black hair to show the piercing in the back of her neck, a show of solidarity with her mother. She had it done when she was 16. “I wanted to know what it felt like for my mom.”


Her mother then turned around and outlined with her finger two lengthy scars that run down her back.


“I’ve had a lot of physical problems,” Ms. Morales, 62, said. Shaking her head at her daughter’s piercing, she added, “I’ve had rods put in my upper and lower spine, but I could never do that.”


The rods were surgically planted to treat herniated discs, the result of having a cruel combination of osteoporosis, hepatitis C, fibromyalgia and rheumatoid arthritis. Ms. Morales contracted hepatitis C from a blood transfusion she received in 1972 after the birth of her only son, she said.


“I didn’t even know about it until 10 years ago,” she said. “My liver blood count was a little high.”


Since the diagnosis, Ms. Morales, a former schoolteacher, has ridden the arduous highs and lows common to patients with hepatitis C. Her treatments for the disease, which debilitates the liver over time, have included pills and injections that can cause depression. Ms. Morales, a single parent, found an unforgiving salve in alcohol.


“I was depressed; I was totally drunk,” she said. “I didn’t want to live anymore.”


Then, about a year ago, she reached a turning point when visiting her hepatitis C specialist.


“I was 210 pounds,” she said. “The doctor said: ‘You have to stop drinking. You have to lose weight.’ ”


To help combat the depression, her doctor referred her to Jewish Association Serving the Aging, a beneficiary agency of UJA-Federation of New York, one of the organizations supported by The New York Times Neediest Cases Fund. She began weekly counseling sessions with a social worker and started taking an antidepressant medication. The federation drew about $600 from the fund in May so that Ms. Morales could buy a mattress.


“I had a horrible bed,” she said. “I felt like I was sleeping on rocks, and with rods in my back, I was waking up every hour.”


After several months of therapy and starting a diet, Ms. Morales was on her way to losing 60 pounds. Today, she weighs 148.


Light was starting to show itself again when the family took an unexpected financial hit this summer. While taking time off from attending Hostos Community College, Katherine Morales looked for work on Craigslist.


“I saw my mom, and I realized I needed to get a job,” Katherine said shyly. “This guy asked me to be his personal assistant, and he asked me to wire money.”


Offering $400 a week, the man requested help transferring almost $2,000 from what he said was his wife’s account. He transferred the money to Katherine’s account, asking her to wire it to a bank account in Malaysia.


Shortly after she wired the money, the bank froze the account, which Katherine and her mother shared. It was then that Katherine realized she had been the victim of a scam. The money transferred into her account turned out to have been stolen, and she was responsible for repaying it.


Katherine went to detectives immediately with more than 20 pages of evidentiary e-mails, but found that she was unable to file a complaint.


“They told me it wasn’t enough,” she said. “These things happen all the time.”


They lost almost $2,000.


Ms. Morales lives on a fixed income. She receives just over $700 a month from Social Security and $200 month in food stamps. The rent for the apartment she shares with her daughter in the Throgs Neck neighborhood of the Bronx is $230, and Ms. Morales has a monthly combined phone and cable bill of $140. Ms. Morales has a son, but he is unable to help the family.


Falling behind on her bills, Ms. Morales turned once again to JASA for help paying a combined phone and cable bill of nearly $200, a grant the agency drew from the Neediest Cases Fund.


“It was terrible, because my intention was to help my mom,” said Katherine, who has since found a part-time job at a vitamin shop.


Ms. Morales has been feeling much better, but she is nervous about an appointment with her hepatitis C specialist in January.


“I’m taking things one day at a time, but I’m looking forward to someone taking care of me,” she said. “I want to live a little bit longer, but not that long.”


“Why are you putting a time limit on it?” Katherine said, jokingly. “Seventy’s the new 20!” she added, nudging her mother in the side. “Remember, the doctor said you wouldn’t live past your late 50s, but you did.”


Read More..

As Shoppers Hop From Tablet to PC to Phone, Retailers Try to Adapt


Jim Wilson/The New York Times


Shoppers often visit ModCloth, a Web site that sells women’s clothes, on their phones but return on a different kind of device to buy something, said Sarah Rose, a vice president at ModCloth.







Ryan O’Neil, a Connecticut government employee, was in the market to buy a digital weather station this month. His wife researched options on their iPad, but even though she found the lowest-price option there, Mr. O’Neil made the purchase on his laptop.




“I do use the iPad to browse sites,” Mr. O’Neil said, but when it comes time to close the deal, he finds it easier to do on a computer.


Many online retailers had visions of holiday shoppers lounging beneath the Christmas tree with their mobile devices in hand, making purchases. The size of the average order on tablets, particularly iPads, tends to be bigger than on PCs. So retailers poured money and marketing into mobile Web sites and apps with rich images and, they thought, easy checkout.


But while visits to e-commerce sites and apps on tablets and phones have nearly doubled since last year, consumers like Mr. O’Neil are more frequently using multiple devices to shop. In many cases, they are more comfortable making the final purchase on a computer, with its bigger screen and keyboard. So retailers are trying to figure out how to appeal to a shopper who may use a cellphone to research products, a tablet to browse the options and a computer to buy.


“I’ve been yelling at customers for two years, saying, ‘Mobile, mobile, mobile,’ ” said Jason Spero, director of mobile sales and strategy at Google. “But the funny thing is, now we’re going to say: ‘Don’t put mobile in a silo. It’s also about the desktop.’ ”


The challenges are daunting, though. It is technically difficult to track consumers as they hop from phone to computer to tablet and back again. This means customers who, say, fill shopping carts on their tablets have to do all the work again on their PCs or other devices. The biggest obstacle, retailers say, is that the tools used to track shoppers on computers — cookies, or bundles of data stored in Web browsers — don’t transfer across devices.


Instead, retailers are figuring out how to sync the experience in other ways, like prompting shoppers to log in on each device. And being able to track people across devices gives retailers more insight into how they shop.


The retailers’ efforts are backed by research. While one-quarter of the visits to e-commerce sites occur on mobile devices, only around 15 percent of purchases do, according to data from I.B.M. According to Google, 85 percent of online shoppers start searching on one device — most often a mobile phone — and make a purchase on another.


At eBags, customers are shopping on their tablets in the evening and returning on their work computers the next day. But eBags has not yet synced the shoppers across devices, so customers must build their shopping carts from scratch if they switch devices.


“That is a blind spot with a lot of sites,” said Peter Cobb, co-founder of eBags. “It is a requirement moving forward.”


At eBay, one-third of the purchases involve mobile devices at some point, even if the final purchase is made on a computer.


At eBay, once shoppers log in on a device, they do not need to log in again. Their information, like shipping and credit card details and saved items, syncs across all their devices. If an eBay shopper is interested in a certain handbag, and saves that search on a computer, eBay will send alerts to her cellphone when a new handbag arrives or an auction is about to end.


“They might discover an item on a phone or tablet, do a saved-search push alert later on some other screen and eventually close on the Web site,” said Steve Yankovich, who runs eBay Mobile. “People are buying and shopping and consuming potentially every waking moment of the day.”


ModCloth, an e-commerce site for women’s clothes, said that while a quarter of its visits come from mobile devices, people are not yet buying there in the same proportion, though they are becoming more comfortable with checking out on those devices.


“She’s visiting us more on the phone, but she’s actually transacting somewhere else,” said Sarah Rose, vice president of product at ModCloth.


For example, a shopper will skim through new arrivals on her phone while on the bus and add items to her wish list, then visit that evening on her tablet to make a purchase, Ms. Rose said.


Read More..

As Constitution Nears Approval, Egypt’s Factions Face New Fight


Tara Todras-Whitehill for The New York Times


Egyptian women walk into a polling station. Millions went to the polls to pass judgment on an Islamist-backed constitution, whose passage would represent an important milestone in Egypt’s chaotic two-year transition to democracy. More Photos »







CAIRO — An Islamist-backed constitution appeared headed for approval on Saturday, propelling Egypt’s deeply divided political factions into a new phase in the battle over the country’s future.




As millions went to the polls for the final round of a referendum, all sides predicted that the charter would win approval, marking an important milestone in Egypt’s chaotic two-year transition to democracy.


But the hastily drafted document leaves unresolved many questions about the character of that democracy, including the Islamists’ commitment to individual freedoms and their opposition’s willingness to accept the results of the political process without recourse to violent street protests.


The charter’s path to the referendum has also pushed Egypt to the brink of civil strife, exposing the alienation of the Christian minority, the political opposition’s refusal to negotiate, and the Muslim Brotherhood’s willingness to rely on authoritarian tactics.


How those tensions are managed and the new constitution is put in effect will determine whether Egypt returns to stability or plunges further into discord, and much of the region is watching the outcome of that definitive Arab Spring revolt.


Neither supporters nor opponents of the charter said they expected an immediate end to the partisan feuding that has torn at the country in the month before the vote. The Islamists allied with President Mohamed Morsi said they intended to rebuild trust by using the new charter as a tool to battle remnants of former President Hosni Mubarak’s government. Old laws and prosecutors, the Islamists say, are protecting loyalists and holdovers while they obstruct change from within the bureaucracy and conspire with the opposition to stir up unrest. Leaders of the anti-Islamist opposition, however, said they hoped to carry the momentum of their struggle against the constitution into the parliamentary elections set to be held two months from now. They accused the Islamists of using the specter of a struggle against remnants of Mr. Mubarak’s government as a pretext to demonize the opposition and take over the machinery of the state.


“If we accept the legitimacy of working within the system, they have to agree that the opposition is legitimate,” said Amr Moussa, a former foreign minister under Mr. Mubarak and a presidential candidate who has re-emerged as an opposition leader during the constitutional debate. “The ancien régime is finished. They are imagining things. They are imagining that if you say no to the constitution, as I have done, then you are part of a conspiracy to topple them.”


Both sides of the ideological divide appeared to dig in.


“A crack has emerged in Egypt; there’s a gap, there’s blood and deaths, there’s extremism,” said Ahmed Maher, who helped jump-start the revolution as a leader of the secular April 6 Youth Group and then served as a delegate in the constituent assembly that wrote a draft of the charter. “Something has happened between Egyptians that would make the results bad no matter what the outcome” of the constitutional vote, he said, predicting further clashes before the parliamentary elections.


Adding to the uncertainty about what may come next, Mr. Morsi’s vice president, Mahmoud Mekki, resigned Saturday. The draft constitution would eliminate his position, And Mr. Mekki, a former judge, said that he had originally submitted his resignation in early November before a series of crises postponed it.


“The nature of political work does not suit my nature as a judge,” he said.


The turnout for Saturday’s voting appeared to be low, as it was last week. At one polling place in the dense Mohandiseen district near Cairo, the station was empty in the middle of the day. The low turnout may have reflected a lack of enthusiasm or perhaps a consensus among Egyptians that after last week, the charter’s approval was a foregone conclusion.


Read More..

About New York: One Boy’s Death Moves State to Action to Prevent Others





Prompted by the death of a 12-year-old Queens boy in April, New York health officials are poised to make their state the first in the nation to require that hospitals aggressively look for sepsis in patients so treatment can begin sooner. Under the regulations, which are now being drafted, the hospitals will also have to publicly report the results of their efforts.




The action by New York has elated sepsis researchers and experts, including members of a national panel who this month formally recommended that the federal government adopt standards similar to what the state is planning.


Though little known, sepsis, an abnormal and self-destructive immune response to infection or illness, is a leading cause of death in hospitals. It often progresses to severely low blood pressure, shock and organ failure.


Over the last decade, a global consortium of doctors, researchers, hospitals and advocates has developed guidelines on early identification and treatment of sepsis that it says have led to significant drops in mortality rates. But first hints of the problem, like a high pulse rate and fever, often are hard for clinicians to tell apart from routine miseries that go along with the flu or cold.


“First and foremost, they need to suspect sepsis,” Dr. Mitchell M. Levy, a professor at Brown University School of Medicine and a lead author of a paper on the latest sepsis treatment guidelines to be published simultaneously next month in the United States in a journal, Critical Care Medicine, and in Europe in Intensive Care Medicine.


“It’s the most common killer in intensive care units,” Dr. Levy said. “It kills more people than breast cancer, lung cancer and stroke combined.”


If started early enough, the treatment, which includes antibiotics and fluids, can help people escape from the drastic vortex of sepsis, according to findings by researchers working with the Surviving Sepsis Campaign, the global consortium. The tactics led to a reduction of “relative risk mortality by 40 percent,” Dr. Levy said.


Although studies of 30,000 patients show that the guidelines save lives, “the problem is that many hospitals are not adhering to them,” said Dr. Clifford S. Deutschman, director of the sepsis research program at the Perelman School of Medicine at the University of Pennsylvania and the president of the Society of Critical Care Medicine.


About 300 hospitals participate in the study, and the consortium has a goal of having 10,000. “The case is irrefutable: if you take these sepsis measures, and you build a program to help clinicians and hospitals suspect sepsis and identify it early, that will mean more people will survive,” Dr. Levy said.


At a symposium in October, the New York health commissioner, Dr. Nirav R. Shah, said that he would require state hospitals to adopt best practices for early identification and treatment of sepsis. Gov. Andrew M. Cuomo intends to make it a major initiative in 2013, said Josh Vlasto, a spokesman for the governor. “The state is taking unprecedented measures to prevent and effectively treat sepsis in health care facilities across the state and is looking at a wide range of additional measures to better protect patients,” Mr. Vlasto said.


In April, Rory Staunton, a sixth grader from Queens, died of severe septic shock after he became infected, apparently through a cut he suffered while playing basketball. The severity of his illness was not recognized when he was treated in the emergency room at NYU Langone Medical Center. He was sent home with a diagnosis of an ordinary bellyache. Hours later, alarming laboratory results became available that suggested he was critically ill, but neither he nor his family was contacted. For an About New York column in The New York Times, Rory’s parents, Ciaran and Orlaith Staunton, publicly discussed their son’s final days. Their revelations prompted doctors and hospitals across the country to seek new approaches to heading off medical errors.


In addition, Commissioner Shah in New York convened a symposium on sepsis, which included presentations from medical experts and Rory’s parents.


At the end of the meeting, Dr. Shah said that he had listened to all the statistics on the prevalence of the illness, and that one had stuck in his memory: “Twenty-five percent,” he said — the portion of the Staunton family lost to sepsis.


He said he would issue new regulations requiring hospitals to use best practices in identifying and treating sepsis, actions that, he said, he was taking “in honor of Rory Staunton.”


The governor’s spokesman, Mr. Vlasto, said that “the Staunton family’s advocacy has been essential to creating a strong public will for action.”


Dr. Levy said New York’s actions were “bold, pioneering and grounded in good scientific evidence,” adding, “The commissioner has taken the first step even before the federal government.”


Dr. Deutschman said that initiatives like those in New York were needed to overcome resistance among doctors. “You’re talking about a profession that has always prided itself on its autonomy,” he said. “They don’t like to be told that they’re wrong about something.”


The availability of proven therapies should move treatment of sepsis into a new era, experts say, comparing it to how heart attacks were handled not long ago. People arriving in emergency rooms with chest pains were basically put to bed because not much could be done for them, said Dr. Kevin J. Tracey, the president of the Feinstein Institute for Medical Research at North Shore-Long Island Jewish Health System. Dr. Tracey, a neurosurgeon, has made major discoveries about the relationship between the nervous system and the runaway immune responses of sepsis.


If physicians and nurses were trained to watch for sepsis, as they now routinely do for heart attacks, many of its most dire problems could be headed off before they got out of control, he said. The Stauntons have awakened doctors and nurses to the possibility of danger camouflaged as a stomach bug.


“We are with sepsis where we were with heart attack in the early 1980s,” Dr. Tracey said.


“If you don’t think of it as a possibility, this story can happen again and again. This case could change the world.”


E-mail: dwyer@nytimes.com


Twitter: @jimdwyernyt



Read More..

About New York: One Boy’s Death Moves State to Action to Prevent Others





Prompted by the death of a 12-year-old Queens boy in April, New York health officials are poised to make their state the first in the nation to require that hospitals aggressively look for sepsis in patients so treatment can begin sooner. Under the regulations, which are now being drafted, the hospitals will also have to publicly report the results of their efforts.




The action by New York has elated sepsis researchers and experts, including members of a national panel who this month formally recommended that the federal government adopt standards similar to what the state is planning.


Though little known, sepsis, an abnormal and self-destructive immune response to infection or illness, is a leading cause of death in hospitals. It often progresses to severely low blood pressure, shock and organ failure.


Over the last decade, a global consortium of doctors, researchers, hospitals and advocates has developed guidelines on early identification and treatment of sepsis that it says have led to significant drops in mortality rates. But first hints of the problem, like a high pulse rate and fever, often are hard for clinicians to tell apart from routine miseries that go along with the flu or cold.


“First and foremost, they need to suspect sepsis,” Dr. Mitchell M. Levy, a professor at Brown University School of Medicine and a lead author of a paper on the latest sepsis treatment guidelines to be published simultaneously next month in the United States in a journal, Critical Care Medicine, and in Europe in Intensive Care Medicine.


“It’s the most common killer in intensive care units,” Dr. Levy said. “It kills more people than breast cancer, lung cancer and stroke combined.”


If started early enough, the treatment, which includes antibiotics and fluids, can help people escape from the drastic vortex of sepsis, according to findings by researchers working with the Surviving Sepsis Campaign, the global consortium. The tactics led to a reduction of “relative risk mortality by 40 percent,” Dr. Levy said.


Although studies of 30,000 patients show that the guidelines save lives, “the problem is that many hospitals are not adhering to them,” said Dr. Clifford S. Deutschman, director of the sepsis research program at the Perelman School of Medicine at the University of Pennsylvania and the president of the Society of Critical Care Medicine.


About 300 hospitals participate in the study, and the consortium has a goal of having 10,000. “The case is irrefutable: if you take these sepsis measures, and you build a program to help clinicians and hospitals suspect sepsis and identify it early, that will mean more people will survive,” Dr. Levy said.


At a symposium in October, the New York health commissioner, Dr. Nirav R. Shah, said that he would require state hospitals to adopt best practices for early identification and treatment of sepsis. Gov. Andrew M. Cuomo intends to make it a major initiative in 2013, said Josh Vlasto, a spokesman for the governor. “The state is taking unprecedented measures to prevent and effectively treat sepsis in health care facilities across the state and is looking at a wide range of additional measures to better protect patients,” Mr. Vlasto said.


In April, Rory Staunton, a sixth grader from Queens, died of severe septic shock after he became infected, apparently through a cut he suffered while playing basketball. The severity of his illness was not recognized when he was treated in the emergency room at NYU Langone Medical Center. He was sent home with a diagnosis of an ordinary bellyache. Hours later, alarming laboratory results became available that suggested he was critically ill, but neither he nor his family was contacted. For an About New York column in The New York Times, Rory’s parents, Ciaran and Orlaith Staunton, publicly discussed their son’s final days. Their revelations prompted doctors and hospitals across the country to seek new approaches to heading off medical errors.


In addition, Commissioner Shah in New York convened a symposium on sepsis, which included presentations from medical experts and Rory’s parents.


At the end of the meeting, Dr. Shah said that he had listened to all the statistics on the prevalence of the illness, and that one had stuck in his memory: “Twenty-five percent,” he said — the portion of the Staunton family lost to sepsis.


He said he would issue new regulations requiring hospitals to use best practices in identifying and treating sepsis, actions that, he said, he was taking “in honor of Rory Staunton.”


The governor’s spokesman, Mr. Vlasto, said that “the Staunton family’s advocacy has been essential to creating a strong public will for action.”


Dr. Levy said New York’s actions were “bold, pioneering and grounded in good scientific evidence,” adding, “The commissioner has taken the first step even before the federal government.”


Dr. Deutschman said that initiatives like those in New York were needed to overcome resistance among doctors. “You’re talking about a profession that has always prided itself on its autonomy,” he said. “They don’t like to be told that they’re wrong about something.”


The availability of proven therapies should move treatment of sepsis into a new era, experts say, comparing it to how heart attacks were handled not long ago. People arriving in emergency rooms with chest pains were basically put to bed because not much could be done for them, said Dr. Kevin J. Tracey, the president of the Feinstein Institute for Medical Research at North Shore-Long Island Jewish Health System. Dr. Tracey, a neurosurgeon, has made major discoveries about the relationship between the nervous system and the runaway immune responses of sepsis.


If physicians and nurses were trained to watch for sepsis, as they now routinely do for heart attacks, many of its most dire problems could be headed off before they got out of control, he said. The Stauntons have awakened doctors and nurses to the possibility of danger camouflaged as a stomach bug.


“We are with sepsis where we were with heart attack in the early 1980s,” Dr. Tracey said.


“If you don’t think of it as a possibility, this story can happen again and again. This case could change the world.”


E-mail: dwyer@nytimes.com


Twitter: @jimdwyernyt



Read More..

Obama Nominates Kerry for Secretary of State





WASHINGTON — President Obama nominated Senator John Kerry of Massachusetts as secretary of state, choosing an elder of the Democratic Party’s foreign policy establishment and a crucial political ally in the Senate to succeed Hillary Rodham Clinton.




“In a sense, John’s entire life has prepared him for this role,” Mr. Obama said, making the widely expected announcement at the White House. “He’s not going to need a lot of on-the-job training.”


With Mr. Kerry standing at his side, the president praised Mr. Kerry’s combat service in the Vietnam War and his three decades in the Senate, which Mr. Obama said had placed him at the heart of “every major foreign policy debate for the past 30 years.”


Mr. Kerry, the president said, had also earned the respect of his Senate colleagues and expressed confidence that he would be quickly confirmed. In recent weeks, Senator John McCain, the Arizona Republican, has jokingly referred to his colleague as “Mr. Secretary.”


Mr. Obama’s first choice for the job, Susan E. Rice, the ambassador to the United Nations, asked Mr. Obama to withdraw her name last week after Mr. McCain and other Republicans threatened to block her nomination because of statements she made after the lethal attack on the American mission in Benghazi, Libya.


In addition to Mr. Kerry’s foreign-policy credentials, Mr. Obama noted that he had supported the president’s political career at key moments — not least, he said, by inviting a “young Illinois state senator to address the Democratic National Convention in 2004.”


Mr. Kerry, 69, was his party’s presidential candidate in that election, losing to George W. Bush. He is chairman of the Senate Foreign Relations Committee and has carried out several diplomatic missions for the Obama administration, helping to persuade President Hamid Karzai of Afghanistan to agree to a runoff election in 2009. Early in the administration, he also tried to engage President Bashar al-Assad of Syria, who has waged a brutal crackdown on his own people as he fights to cling to power.


During the last campaign he also played the role of Mitt Romney in Mr. Obama’s debate preparations.


“Nothing brings two people closer together than two weeks of debate prep,” the president joked. “John, I’m looking forward to working with you rather than debating you.”


Mr. Kerry has long coveted the job of secretary of state.


Mrs. Clinton, who is recovering from the effects of a concussion, did not appear at the White House announcement.


“Hillary wanted very much to be here today, but she continues to recuperate,” the president said. “I had a chance to talk to her earlier today, and she is in good spirits and could not be more excited about the announcement that I’m making.”


Mr. Obama still has to fill two other key openings in his national security team, finding replacements for Secretary of Defense Leon E. Panetta, who intends to resign; and David H. Petraeus, director of the Central Intelligence Agency, who resigned in November because of an extramarital affair.


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U.N. Suspends Polio Campaign in Pakistan After Killings of Workers


B.K. Bangash/Associated Press


A Pakistani woman administered polio vaccine to an infant on Wednesday in the slums of Islamabad. Militants have killed nine polio workers this week.







LAHORE, Pakistan — The front-line heroes of Pakistan’s war on polio are its volunteers: young women who tread fearlessly from door to door, in slums and highland villages, administering precious drops of vaccine to children in places where their immunization campaign is often viewed with suspicion.




Now, those workers have become quarry. After militants stalked and killed eight of them over the course of a three-day, nationwide vaccination drive, the United Nations suspended its anti-polio work in Pakistan on Wednesday, and one of Pakistan’s most crucial public health campaigns has been plunged into crisis.


The World Health Organization and Unicef ordered their staff members off the streets, while government officials reported that some polio volunteers — especially women — were afraid to show up for work.


At the ground level, it is those female health workers who are essential, allowed privileged entrance into private homes to meet and help children in situations denied to men because of conservative rural culture. “They are on the front line; they are the backbone,” said Imtiaz Ali Shah, a polio coordinator in Peshawar.


The killings started in the port city of Karachi on Monday, the first day of a vaccination drive aimed at the worst affected areas, with the shooting of a male health worker. On Tuesday four female polio workers were killed, all gunned down by men on motorcycles in what appeared to be closely coordinated attacks.


The hit jobs then moved to Peshawar, the capital of Khyber-Pakhtunkhwa Province, which, along with the adjoining tribal belt, constitutes Pakistan’s main reservoir of new polio infections. The first victim there was one of two sisters who had volunteered as polio vaccinators. Men on motorcycles shadowed them as they walked from house to house. Once the sisters entered a quiet street, the gunmen opened fire. One of the sisters, Farzana, died instantly; the other was uninjured.


On Wednesday, a man working on the polio campaign was shot dead as he made a chalk mark on the door of a house in a suburb of Peshawar. Later, a female health supervisor in Charsadda, 15 miles to the north, was shot dead in a car she shared with her cousin.


Yet again, Pakistani militants are making a point of attacking women who stand for something larger. In October, it was Malala Yousafzai, a schoolgirl advocate for education who was gunned down by a Pakistani Taliban attacker in the Swat Valley. She was grievously wounded, and the militants vowed they would try again until they had killed her. The result was a tidal wave of public anger that clearly unsettled the Pakistani Taliban.


In singling out the core workers in one of Pakistan’s most crucial public health initiatives, militants seem to have resolved to harden their stance against immunization drives, and declared anew that they consider women to be legitimate targets. Until this week, vaccinators had never been targeted with such violence in such numbers.


Government officials in Peshawar said that they believe a Taliban faction in Mohmand, a tribal area near Peshawar, was behind at least some of the shootings. Still, the Pakistani Taliban have been uncharacteristically silent about the attacks, with no official claims of responsibility. In staying quiet, the militants may be trying to blunt any public backlash like the huge demonstrations over the attack on Ms. Yousafzai.


Female polio workers here make for easy targets. They wear no uniform but are readily recognizable, with clipboards and refrigerated vaccine boxes, walking door to door. They work in pairs — including at least one woman — and are paid just over $2.50 a day. Most days one team can vaccinate 150 to 200 children.


Faced with suspicious or recalcitrant parents, their only weapon is reassurance: a gentle pat on the hand, a shared cup of tea, an offer to seek religious assurances from a pro-vaccine cleric. “The whole program is dependent on them,” said Mr. Shah, in Peshawar. “If they do good work, and talk well to the parents, then they will vaccinate the children.”


That has happened with increasing frequency in Pakistan over the past year. A concerted immunization drive, involving up to 225,000 vaccination workers, drove the number of newly infected polio victims down to 52. Several high-profile groups shouldered the program forward — at the global level, donors like the Bill and Melinda Gates Foundation, the United Nations and Rotary International; and at the national level, President Asif Ali Zardari and his daughter Aseefa, who have made polio eradication a “personal mission.”


On a global scale, setbacks are not unusual in polio vaccination campaigns, which, by dint of their massive scale and need to reach deep inside conservative societies, end up grappling with more than just medical challenges. In other campaigns in Africa and South Asia, vaccinators have grappled with natural disaster, virulent opposition from conservative clerics and sudden outbreaks of mysterious strains of the disease.


Declan Walsh reported from Lahore, and Donald G. McNeil Jr. from New York. Ismail Khan contributed reporting from Peshawar, Pakistan.



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U.N. Suspends Polio Campaign in Pakistan After Killings of Workers


B.K. Bangash/Associated Press


A Pakistani woman administered polio vaccine to an infant on Wednesday in the slums of Islamabad. Militants have killed nine polio workers this week.







LAHORE, Pakistan — The front-line heroes of Pakistan’s war on polio are its volunteers: young women who tread fearlessly from door to door, in slums and highland villages, administering precious drops of vaccine to children in places where their immunization campaign is often viewed with suspicion.




Now, those workers have become quarry. After militants stalked and killed eight of them over the course of a three-day, nationwide vaccination drive, the United Nations suspended its anti-polio work in Pakistan on Wednesday, and one of Pakistan’s most crucial public health campaigns has been plunged into crisis.


The World Health Organization and Unicef ordered their staff members off the streets, while government officials reported that some polio volunteers — especially women — were afraid to show up for work.


At the ground level, it is those female health workers who are essential, allowed privileged entrance into private homes to meet and help children in situations denied to men because of conservative rural culture. “They are on the front line; they are the backbone,” said Imtiaz Ali Shah, a polio coordinator in Peshawar.


The killings started in the port city of Karachi on Monday, the first day of a vaccination drive aimed at the worst affected areas, with the shooting of a male health worker. On Tuesday four female polio workers were killed, all gunned down by men on motorcycles in what appeared to be closely coordinated attacks.


The hit jobs then moved to Peshawar, the capital of Khyber-Pakhtunkhwa Province, which, along with the adjoining tribal belt, constitutes Pakistan’s main reservoir of new polio infections. The first victim there was one of two sisters who had volunteered as polio vaccinators. Men on motorcycles shadowed them as they walked from house to house. Once the sisters entered a quiet street, the gunmen opened fire. One of the sisters, Farzana, died instantly; the other was uninjured.


On Wednesday, a man working on the polio campaign was shot dead as he made a chalk mark on the door of a house in a suburb of Peshawar. Later, a female health supervisor in Charsadda, 15 miles to the north, was shot dead in a car she shared with her cousin.


Yet again, Pakistani militants are making a point of attacking women who stand for something larger. In October, it was Malala Yousafzai, a schoolgirl advocate for education who was gunned down by a Pakistani Taliban attacker in the Swat Valley. She was grievously wounded, and the militants vowed they would try again until they had killed her. The result was a tidal wave of public anger that clearly unsettled the Pakistani Taliban.


In singling out the core workers in one of Pakistan’s most crucial public health initiatives, militants seem to have resolved to harden their stance against immunization drives, and declared anew that they consider women to be legitimate targets. Until this week, vaccinators had never been targeted with such violence in such numbers.


Government officials in Peshawar said that they believe a Taliban faction in Mohmand, a tribal area near Peshawar, was behind at least some of the shootings. Still, the Pakistani Taliban have been uncharacteristically silent about the attacks, with no official claims of responsibility. In staying quiet, the militants may be trying to blunt any public backlash like the huge demonstrations over the attack on Ms. Yousafzai.


Female polio workers here make for easy targets. They wear no uniform but are readily recognizable, with clipboards and refrigerated vaccine boxes, walking door to door. They work in pairs — including at least one woman — and are paid just over $2.50 a day. Most days one team can vaccinate 150 to 200 children.


Faced with suspicious or recalcitrant parents, their only weapon is reassurance: a gentle pat on the hand, a shared cup of tea, an offer to seek religious assurances from a pro-vaccine cleric. “The whole program is dependent on them,” said Mr. Shah, in Peshawar. “If they do good work, and talk well to the parents, then they will vaccinate the children.”


That has happened with increasing frequency in Pakistan over the past year. A concerted immunization drive, involving up to 225,000 vaccination workers, drove the number of newly infected polio victims down to 52. Several high-profile groups shouldered the program forward — at the global level, donors like the Bill and Melinda Gates Foundation, the United Nations and Rotary International; and at the national level, President Asif Ali Zardari and his daughter Aseefa, who have made polio eradication a “personal mission.”


On a global scale, setbacks are not unusual in polio vaccination campaigns, which, by dint of their massive scale and need to reach deep inside conservative societies, end up grappling with more than just medical challenges. In other campaigns in Africa and South Asia, vaccinators have grappled with natural disaster, virulent opposition from conservative clerics and sudden outbreaks of mysterious strains of the disease.


Declan Walsh reported from Lahore, and Donald G. McNeil Jr. from New York. Ismail Khan contributed reporting from Peshawar, Pakistan.



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F.T.C. Pushes Antitrust Inquiry Against Google Into January


WASHINGTON — Google was prepared to start the holidays early this week, by settling its antitrust dispute with federal regulators without a harsh punishment.


But in shelving its inquiry until January, the Federal Trade Commission has put stronger penalties back on the bargaining table, people briefed on the investigation who were not authorized to speak publicly about it said Wednesday.


For two years, the F.T.C. has been looking into whether Google abuses its market power by favoring its own services over rivals in search results. Google and the agency had been planning to sign a settlement this week that would have said Google would change some of its behavior but that would not have been subject to court action.


The agency may now demand a consent decree — a formal order detailing anticompetitive behavior and an agreement that if the company does the same thing again, it could be fined and subject to court sanctions. Google has instead offered voluntary concessions.


But the people briefed, and others close to the negotiations, said the agency was unlikely to take a second look at one of the major issues — Google’s dominance in specialized search, like travel and local reviews — because the legal hurdles remain high.


Google has long said that it does not believe it has broken antitrust laws and that the agency’s case against it is weak. Jill Hazelbaker, a Google spokeswoman, said that it continued to cooperate with the F.T.C. but declined to comment further.


Cecelia Prewett, an F.T.C. spokeswoman, declined to comment.


Competitors of Google called for the agency to use the additional time to take harsher legal action against Google. Failing to do so would hurt consumers in many ways, including by allowing Google too much control over private data, said Pamela Jones Harbour, a former F.T.C. commissioner and a lawyer representing Microsoft.


Supporters of Google said its case had already been made.


“If in 19 months they did not offer the kind of evidence and facts to support a case or conclude the behavior was such that it was posing legal difficulties, then frankly another couple weeks isn’t going to make a difference,” said Ed Black, chief executive of the Computer and Communications Industry Association, of which Google is a member.


Regulators’ decision to delay resolution of the case offered a glimpse of the tense negotiations and a series of missteps that have bedeviled the negotiations.


As details of a possible settlement appeared in news reports over the last week, Google’s competitors began arguing that a settlement without court-enforced sanctions was meaningless.


At the F.T.C., people close to the agency said, commissioners grew irked that they were being portrayed as spineless. In a parallel investigation, European regulators were said to be wringing a more stringent agreement from Google.


But it was unclear that Jon D. Leibowitz, the F.T.C. chairman, could get the two votes necessary to approve a tougher case against Google.


The five commissioners had yet to vote on possible sanctions. Julie Brill, a Democrat commissioner, supported strong antitrust action, while Edith Ramirez, the commission’s other Democrat, has resisted the strictest sanctions, said the people who have been briefed on the inquiry.


J. Thomas Rosch, a Republican, questioned whether the agency had the evidence to bring a case on search manipulation, but also expressed skepticism at a settlement that did not involve a consent decree, the people briefed said. Maureen K. Ohlhausen, the other Republican commissioner, opposed the government’s interference in private enterprise, they said.


Each of the commissioners and an F.T.C. spokeswoman declined to respond to queries about their views on the settlement.


Throughout the deliberations, both sides have complained about leaks to the news media of details of private meetings and settlement terms.


Edward Wyatt reported from Washington and Claire Cain Miller from San Francisco.



This article has been revised to reflect the following correction:

Correction: December 20, 2012

An earlier version of this article misspelled the surname of the chairman of the Federal Trade Commission. He is Jon Leibowitz, not Liebowitz.



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At Benghazi Hearing, State Dept. Concedes Errors





WASHINGTON — State Department officials promised on Thursday to carry out quickly the recommendations of a review board to beef up security for the foreign service and urged Congress to provide more money to protect American diplomats.







Brendan Hoffman for The New York Times

Senator John Kerry, center, the chair of the Senate Foreign Relations Committee, opened a hearing Thursday on the attack on Sept. 11 in Benghazi, Libya.








Brendan Hoffman for The New York Times

William J. Burns, deputy secretary of State, left, and Thomas R. Nides a deputy secretary of State for Management and Resources, testified on the attacks.






The promises came during a Senate hearing into the handling of diplomatic security in Benghazi, Libya, before a deadly attack on a diplomatic outpost there that led to the deaths of four Americans, including the American ambassador.


“We have to do better,” Deputy Secretary of State William J. Burns said in prepared testimony to the Foreign Relations Committee. On Tuesday, one department official resigned and three others were relieved of their duties after a scathing report was released by an inquiry panel led by Thomas R. Pickering, a retired diplomat.


In an opening statement, Senator John Kerry of Massachusetts, the committee’s chairman, said that Congress “also bears some responsibility” to provide adequate financing for diplomatic security. He noted that the board’s report called for spending $2.3 billion a year in the coming decade to protect American Embassies and offices abroad.


Mr. Kerry and Mr. Burns said it was important to find ways for diplomats to get out among the people, even in dangerous countries.


“We do not want to concertina-wire America off from the world,” Mr. Kerry said.


Mr. Burns said that “diplomacy, by its very nature, must sometimes be practiced in dangerous places.”


“Chris Stevens understood that as well as anyone,” he said, referring to the ambassador to Libya who was killed along with the three others in the Sept. 11 attack. “Chris also knew that every chief of mission has the responsibility to ensure the best possible security and support for our people.”


Mr. Burns and Thomas R. Nides, another deputy secretary of state, told the committee in prepared testimony that the department had “already begun to fix” the “serious, systemic problems” identified in the Pickering report. The two men testified in place of Secretary of State Hillary Rodham Clinton, who is recovering from a concussion.


Mr. Nides said the department accepted “every one” of the report’s 29 specific recommendations. He mentioned, for example, the addition of hundreds of Marines to protect foreign missions. His office is leading an effort to put them into effect “quickly and completely — and to pursue steps above and beyond the board’s report,” he said.


Dozens of specific actions are already under way, several will be completed within weeks, and all will be in motion “by the time the next secretary of state takes office,” he said.


Mr. Kerry is the leading candidate to be replace Mrs. Clinton as secretary of state, after the withdrawal from consideration of Susan E. Rice, the ambassador to the United Nations, after criticisms of statements she made following the attack on the Benghazi outpost.


Senator Bob Corker, Republican of Tennessee, was skeptical about claims of progress, saying that rarely are the recommendations of review boards like the Pickering panel fully implemented.


“The culture of the State Department is one that needs to be reformed,” he said.


But Senator Bob Menendez, a Democrat of New Jersey, said one reason for weak security was that Congress had not provided as much money as the administration has sought and the Pickering panel recommended.


Pleas for more money come as Congress and the administration face broad spending cuts next year, whether or not a resolution is reached soon in the continuing fiscal impasse.


This article has been revised to reflect the following correction:

Correction: December 20, 2012

An earlier version of this article misstated the number of State Department officials who resigned after the release of a report investigating the attacks in Benghazi, Libya. One official resigned, not three.



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U.N. Seeks New Aid for Syria Crisis and Predicts 1 Million Refugees by Mid-2013





GENEVA — The United Nations appealed on Wednesday for $1.5 billion in new aid to handle the steadily worsening humanitarian crisis created by spiraling violence in Syria and predicted that the number of refugees fleeing the conflict would double to more than 1 million in the next six months.




The increased estimate was least the fourth time the United Nations had revised its projections upward on refugees in the nearly two-year-old uprising against the Syrian president, Bashar al-Assad, which has turned into a civil war that has left at least 40,000 people dead and has threatened to destabilize the Middle East.


The revised figures came as Syrian antigovernment activists and state media in Syria reported new mayhem convulsing the capital, Damascus, and other areas, and as Lebanese officials reported that Syria’s interior minister, Mohamed al-Shaar, was in Beirut for emergency medical treatment of injuries suffered in a Dec. 12 bomb attack by insurgents in Damascus. There was no confirmation from the Syrian government, which had denied earlier reports that Mr. Shaar had been wounded in that attack.


Meeting representatives of donor governments here in Geneva, United Nations agencies said they were seeking $1 billion to assist Syrian refugees in five neighboring countries and a further $519 million to provide emergency aid to four million people inside Syria over the same period — roughly 20 percent of the country’s population.


The Syrian crisis was also a dominant theme of a year-end news conference at the United Nations by Ban Ki-moon, the secretary general, who said that he planned to convene a donor conference next year to raise additional aid money. Mr. Ban also thanked all the neighboring countries in the region that had absorbed Syrian refugees and he called upon Israel publicly for the first time to accept them as well. There was no immediate comment from Israel, which remains in a technical state of war with Syria.


Mr. Ban reiterated his plea for an end to the violence in Syria and said “we’re doing our best to provide necessary humanitarian assistance. We are raising our voices, appealing to the international community.”


Panos Moumtzis, the United Nations regional coordinator for Syrian refugees, said in a statement from Geneva that the enormity of the crisis “requires urgent support from governments, businesses and private individuals. Unless these funds come quickly we will not be able to fully respond to the lifesaving needs of civilians who flee Syria every hour of the day — many in a truly desperate condition.”


More than 525,000 Syrians have now registered as refugees, the United Nations refugee agency reported, roughly double the number it had recorded in early September. These include approximately 160,000 in Lebanon, 150,000 in Jordan, 140,000 in Turkey and more than 65,000 in Iraq. The agency also included Egypt for the first time as a sanctuary for fleeing Syrians, reporting more than 10,000 had registered there.


The refugee agency now expects the number to double again within the next six months, Mr. Moumtzis said.


He based that forecast on present trends in the conflict, with 2,000 to 3,000 Syrians crossing into neighboring countries every day. Under a worst-case outcome, in which the conflict results in a massive exodus of civilians, the number of refugees could rise to 1.85 million, he said.


As it is, “the violence in Syria is raging across the country, there are nearly no more safe areas where people can flee,” Radhouane Nouicer, the coordinator of United Nations humanitarian aid based in Damascus, told journalists in Geneva, citing daily shelling and bombings in the suburbs of the capital.


The needs of Syria’s increasingly desperate population, facing winter cold and shortages of basics like food, were much greater than the aid sought by the United Nations, Mr. Nouicer said, but the appeal was “realistic assessment of what we can achieve” in the complex and dangerous conditions prevailing in the country.


Among the immediate concerns is the fate of around half a million Palestinian refugees in Syria, a legacy of the Arab-Israeli conflict, mostly living in Damascus. An aerial assault by Syrian forces on Sunday against Yarmouk, a vast Palestinian neighborhood in the south of the capital that had been home to about 450,000 people, had caused many to flee. More than 2,200 crossed into Lebanon, according to a Lebanese security official, while others sought protection with relatives living elsewhere in Syria. But the whereabouts of many Yarmouk inhabitants as of Wednesday was unclear.


“We don’t know where they are, it’s a humanitarian crisis that still playing itself out,” said Martha Myers, director of relief and social services for the United Nations Relief and Works Agency, which administers aid to Palestinian refugees.


In Syria, the state-run SANA news agency reported that military forces had attacked insurgent positions in and around Damascus, Idlib, Hama and Dara, and had seized weapons and “eliminated a number of terrorists,” the government’s generic term for Mr. Assad’s armed opponents.


The Syrian Observatory for Human Rights, a group based in Britain with a network of contacts in Syria, said much of the fighting on Wednesday was in districts adjoining the Yarmouk neighborhood, which insurgents have sought to occupy as part of their stated intention to seize control of the central part of the capital.


The observatory also reported that at least 11 people, most of them rebel fighters, had been killed in a car bombing in the contested northern Syrian city of Aleppo.


Nick Cumming-Bruce reported from Geneva, and Rick Gladstone from New York. Hania Mourtada and Hwaida Saad contributed reporting from Beirut, Lebanon.



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Some Gun Retailers Make Changes After Newtown Shootings



Dick’s Sporting Goods, a chain with more than 500 stores, said in a statement that “during this time of national mourning” it was stopping gun sales, and withdrawing them from display, at its store closest to Newtown. The company said it was also temporarily ceasing sales of modern sporting rifles nationwide.


 And Walmart.com removed its information page on the Bushmaster .223, a semiautomatic rifle said to be used by the gunman, Adam Lanza, in the Newtown killings.


Walmart, the nation’s largest retailer, said it removed the information page on Bushmaster “in light of the tragic events.” However, it said it had made no changes to its sales policies on guns and ammunition.


 A spokesman for Wal-Mart, David Tovar, said that the company remained “dedicated to the safe and responsible sale of firearms in areas of the country where they are sold,” and that the company “had not made any changes to the assortment of guns we sell in select stores.”


Walmart had recently been increasing its emphasis on gun sales, after a five-year period where it had backed away from them.


In 2006, the company stopped selling guns in most of its American stores, saying there was little customer demand for the items.


 But in 2011, it reversed that decision, saying it wanted to appeal to hunting enthusiasts, and began selling guns at more than half of its stores.


Mr. Tovar said that the company was a member of Mayors Against Illegal Guns. As part of that, the company takes video recordings of gun sales, conducts background checks on employees selling guns and takes other steps to help keep guns away from criminals.


 Still, Jared Lee Loughner, who shot Representative Gabrielle Giffords and other Arizona residents last year, bought ammunition for a Glock gun at a Walmart the morning of the shooting.


Walmart.com’s removal of the Bushmaster .223 information page was first reported by The Nation.


A spokesman for Cabela’s, another large chain that sells guns, did not immediately return requests for comment on Tuesday. An information page at Cabela’s featured the Bushmaster .223 on Tuesday.


Bass Pro Shops’ site showed information about other guns on Tuesday but no Bushmaster-brand guns; last month, though, it offered a Black Friday special on a Bushmaster M4 Patrolman for $949.99. A spokesman said in an e-mail that the company had made no changes to its Web site.  


A Dick’s Sporting Goods spokesman did not immediately return a request for comment on Tuesday.


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World Briefing | Science and Health: Lack of Funds Could Weaken Malaria Fight, Report Says





The world has made great progress against malaria in the last decade, but the fight is stalling for lack of funds, the World Health Organization’s annual report on malaria concluded on Monday. The amount spent on the disease by all countries rose to $1.8 billion last year, compared with $100 million in 2000, and, as a result, about one million children’s lives were probably spared over that time, the report said. But it would take $5 billion a year to get nets, insecticide spraying, diagnostic kits, effective drugs and hospital treatment to everyone needing them, and donor contributions, especially to the Global Fund to Fight AIDS, Tuberculosis and Malaria, have been nearly flat since 2010. Last year, the number of new nets purchased fell sharply, to 66 million from 145 million two years ago. Since nets wear out in three years and children are always being born, large numbers of infants and toddlers will soon be unprotected if more money does not come in, the report warned. The W.H.O. estimated that there were 219 million malaria cases in the world in 2010, with 660,00 deaths.


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World Briefing | Science and Health: Lack of Funds Could Weaken Malaria Fight, Report Says





The world has made great progress against malaria in the last decade, but the fight is stalling for lack of funds, the World Health Organization’s annual report on malaria concluded on Monday. The amount spent on the disease by all countries rose to $1.8 billion last year, compared with $100 million in 2000, and, as a result, about one million children’s lives were probably spared over that time, the report said. But it would take $5 billion a year to get nets, insecticide spraying, diagnostic kits, effective drugs and hospital treatment to everyone needing them, and donor contributions, especially to the Global Fund to Fight AIDS, Tuberculosis and Malaria, have been nearly flat since 2010. Last year, the number of new nets purchased fell sharply, to 66 million from 145 million two years ago. Since nets wear out in three years and children are always being born, large numbers of infants and toddlers will soon be unprotected if more money does not come in, the report warned. The W.H.O. estimated that there were 219 million malaria cases in the world in 2010, with 660,00 deaths.


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As Europe Presses Google on Antitrust, U.S. Backs Away


BRUSSELS — Google seems on its way to coming through a major antitrust investigation in the United States essentially unscathed. But the outlook is not as bright for Google here, as the European Union’s top antitrust regulator prepares to meet on Tuesday with Eric E. Schmidt, Google’s executive chairman.


In the United States, the Federal Trade Commission appears to be ready to back off what had been the centerpiece of its antitrust pursuit of Google: the complaint that the company’s dominant search engine favors the company’s commerce and other services in search queries, thwarting competition.


Yet in a statement last spring, Joaquín Almunia, the competition commissioner of the European Union, placed the contentions about search bias at the top of his list of concerns about Google. And in a private meeting this month, Mr. Almunia told Jon Leibowitz, chairman of the F.T.C., that European antitrust officials remain focused on that issue, according to two people told of the meeting, who asked not to be identified because they were not authorized to speak about it.


Mr. Almunia’s tougher bargaining stance, antitrust experts say, is not merely a personal preference.


European antitrust doctrine, they say, applies a somewhat different standard than United States law does. In America, dominant companies are given great leeway, if their conduct can be justified in the name of efficiency, thus consumer benefit. Google has consistently maintained that it offers a neutral, best-for-the-customer result.


In Europe, antitrust experts say, the law prohibits the “abuse of a dominant position,” with the victims of the supposed abuse often being competitors. “The Europeans tend to use competition law to level the playing field more than is the case in the United States,” said Herbert Hovenkamp, an antitrust expert and law professor at the University of Iowa. (Mr. Hovenkamp advised Google on one project, but no longer has any financial connection to the company.)


The European rationale, legal experts say, is that shielding competitors to some degree preserves competition and enhances consumer welfare in the long run.


“Europe has a stronger hand to play with Google because of its standards,” said Keith N. Hylton, a professor at the Boston University School of Law.


The European antitrust regulators, like their American counterparts, have been in negotiations with Google for several months. The F.T.C. is expected to announce its decision within days, while the European timetable seems not as tight and is likely to go into next year.


The investigations in the United States and Europe really started with accusations of search bias. Rivals complain that the search giant gives more prominent placement and display for its online shopping and travel services, for example, than to competitors. The potential antitrust concern is that such specialized, or “vertical,” search services — like Yelp or Nextag — are partial substitutes for Google’s search engine because they also allow people to find information.


In his public statement in May, Mr. Almunia identified four areas of concern in Europe’s antitrust investigation of Google. The first concern he cited was search bias.


“Google displays links to its own vertical search services differently than it does for links to competitors,” Mr. Almunia said in a statement then. “We are concerned that this may result in preferential treatment compared to those of competing services, which may be hurt as a consequence.”


His other three concerns are ones that Google is preparing to address with a set of voluntary commitments in the United States, according to two people briefed on Google’s talks with the F.T.C., who declined to give their names because they were not authorized to speak about them.


Google, according to the people, has agreed to refrain from copying summaries of product and restaurant reviews from other Web sites and including them in Google search results, a practice known as screen scraping.


James Kanter reported from Brussels and Steve Lohr from New York. Claire Cain Miller contributed reporting from San Francisco.



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How Wal-Mart Used Payoffs to Get Its Way in Mexico



SAN JUAN TEOTIHUACÁN, Mexico — Wal-Mart longed to build in Elda Pineda’s alfalfa field. It was an ideal location, just off this town’s bustling main entrance and barely a mile from its ancient pyramids, which draw tourists from around the world. With its usual precision, Wal-Mart calculated it would attract 250 customers an hour if only it could put a store in Mrs. Pineda’s field.


One major obstacle stood in Wal-Mart’s way.


After years of study, the town’s elected leaders had just approved a new zoning map. The leaders wanted to limit growth near the pyramids, and they considered the town’s main entrance too congested already. As a result, the 2003 zoning map prohibited commercial development on Mrs. Pineda’s field, seemingly dooming Wal-Mart’s hopes.


But 30 miles away in Mexico City, at the headquarters of Wal-Mart de Mexico, executives were not about to be thwarted by an unfavorable zoning decision. Instead, records and interviews show, they decided to undo the damage with one well-placed $52,000 bribe.


The plan was simple. The zoning map would not become law until it was published in a government newspaper. So Wal-Mart de Mexico arranged to bribe an official to change the map before it was sent to the newspaper, records and interviews show. Sure enough, when the map was published, the zoning for Mrs. Pineda’s field was redrawn to allow Wal-Mart’s store.


Problem solved.


Wal-Mart de Mexico broke ground months later, provoking fierce opposition. Protesters decried the very idea of a Wal-Mart so close to a cultural treasure. They contended the town’s traditional public markets would be decimated, its traffic mess made worse. Months of hunger strikes and sit-ins consumed Mexico’s news media. Yet for all the scrutiny, the story of the altered map remained a secret. The store opened for Christmas 2004, affirming Wal-Mart’s emerging dominance in Mexico.


The secret held even after a former Wal-Mart de Mexico lawyer contacted Wal-Mart executives in Bentonville, Ark., and told them how Wal-Mart de Mexico routinely resorted to bribery, citing the altered map as but one example. His detailed account — he had been in charge of getting building permits throughout Mexico — raised alarms at the highest levels of Wal-Mart and prompted an internal investigation.


But as The New York Times revealed in April, Wal-Mart’s leaders shut down the investigation in 2006. They did so even though their investigators had found a wealth of evidence supporting the lawyer’s allegations. The decision meant authorities were not notified. It also meant basic questions about the nature, extent and impact of Wal-Mart de Mexico’s conduct were never asked, much less answered.


The Times has now picked up where Wal-Mart’s internal investigation was cut off, traveling to dozens of towns and cities in Mexico, gathering tens of thousands of documents related to Wal-Mart de Mexico permits, and interviewing scores of government officials and Wal-Mart employees, including 15 hours of interviews with the former lawyer, Sergio Cicero Zapata.


The Times’s examination reveals that Wal-Mart de Mexico was not the reluctant victim of a corrupt culture that insisted on bribes as the cost of doing business. Nor did it pay bribes merely to speed up routine approvals. Rather, Wal-Mart de Mexico was an aggressive and creative corrupter, offering large payoffs to get what the law otherwise prohibited. It used bribes to subvert democratic governance — public votes, open debates, transparent procedures. It used bribes to circumvent regulatory safeguards that protect Mexican citizens from unsafe construction. It used bribes to outflank rivals.


Through confidential Wal-Mart documents, The Times identified 19 store sites across Mexico that were the target of Wal-Mart de Mexico’s bribes. The Times then matched information about specific bribes against permit records for each site. Clear patterns emerged. Over and over, for example, the dates of bribe payments coincided with dates when critical permits were issued. Again and again, the strictly forbidden became miraculously attainable.


Thanks to eight bribe payments totaling $341,000, for example, Wal-Mart built a Sam’s Club in one of Mexico City’s most densely populated neighborhoods, near the Basílica de Guadalupe, without a construction license, or an environmental permit, or an urban impact assessment, or even a traffic permit. Thanks to nine bribe payments totaling $765,000, Wal-Mart built a vast refrigerated distribution center in an environmentally fragile flood basin north of Mexico City, in an area where electricity was so scarce that many smaller developers were turned away.


But there is no better example of Wal-Mart de Mexico’s methods than its conquest of Mrs. Pineda’s alfalfa field. In Teotihuacán, The Times found that Wal-Mart de Mexico executives approved at least four different bribe payments — more than $200,000 in all — to build just a medium-size supermarket. Without those payoffs, records and interviews show, Wal-Mart almost surely would not have been allowed to build in Mrs. Pineda’s field.


The Teotihuacán case also raises new questions about the way Wal-Mart’s leaders in the United States responded to evidence of widespread corruption in their largest foreign subsidiary.


Wal-Mart’s leadership was well aware of the protests here in 2004. (The controversy was covered by several news outlets in the United States, including The Times.) From the start, protest leaders insisted that corruption surely played a role in the store’s permits. Although woefully short on specifics, their complaints prompted multiple investigations by Mexican authorities. One of those investigations was still under way when Wal-Mart’s top executives first learned of Mr. Cicero’s account of bribes in Teotihuacán (pronounced Tay-o-tea-wah-KHAN).


But Wal-Mart’s leaders did not tell Mexican authorities about his allegations, not even after their own investigators concluded there was “reasonable suspicion” to believe laws had been violated, records and interviews show. Unaware of this new evidence, Mexican investigators said they could find no wrongdoing in Teotihuacán.


Wal-Mart has been under growing scrutiny since The Times disclosed its corruption problems in Mexico, where it is the largest private employer, with 221,000 people working in 2,275 stores, supermarkets and restaurants.


In the United States, the Justice Department and the Securities and Exchange Commission are investigating possible violations of the Foreign Corrupt Practices Act, the federal law that makes it a crime for American corporations or their subsidiaries to bribe foreign officials. Mexican authorities and Congressional Democrats have also begun investigations, and Wal-Mart has been hit by shareholder lawsuits from several major pension funds.


Wal-Mart declined to discuss its conduct in Teotihuacán while it is continuing its own investigation. The company has hired hundreds of lawyers, investigators and forensic accountants who are examining all 27 of its foreign markets. It has already found potentially serious wrongdoing, including indications of bribery in China, Brazil and India. Several top executives in Mexico and India have been suspended or forced to resign in recent months.


Wal-Mart has also tightened oversight of its internal investigations. It has created high-level positions to help root out corruption. It is spending millions on anticorruption training and background checks of the lawyers and lobbyists who represent Wal-Mart before foreign governments. The company has spent more than $100 million on investigative costs this year.


“We are committed to having a strong and effective global anticorruption program everywhere we operate and taking appropriate action for any instance of noncompliance,” said David W. Tovar, a Wal-Mart spokesman.


In Mexico, a major focus of Wal-Mart’s investigation is none other than the boxy, brown supermarket in Mrs. Pineda’s alfalfa field.


Eight years later, it remains the most controversial Wal-Mart in Mexico, a powerful symbol of globalism’s impact on Mexican culture and commerce.


As it turns out, the store also took on symbolic importance within Wal-Mart de Mexico, Mr. Cicero said in an interview. Executives, he said, came to believe that by outmuscling protesters and building in the shadow of a revered national treasure, they would send a message to the entire country: If we can build here, we can build anywhere.


City of the Gods


In ancient times, Teotihuacán was a sprawling metropolis of perhaps 150,000 people. The “city of the gods,” as the Aztecs called it, rose up around a vast temple complex and two great pyramids, the Sun and the Moon. The ancient city is long gone, buried under farm fields, small pueblos and the detritus of bygone civilizations. But the temple complex and pyramids remain, which is why Teotihuacán is so central to Mexico’s cultural patrimony.


Teotihuacán’s leaders naturally wanted to protect this legacy as they began work on a new zoning plan in 2001. To keep the town attractive as a tourist destination, they decided to limit development in the “archaeological zone,” a buffer of protected land that encircles the pyramids. At the same time, they wanted a plan that would lure more tourists into the town’s central square.


“People complained tourists didn’t go into town,” said Víctor Ortiz, a partner in the consulting firm the town hired to draw up its new zoning plan.


By early 2003, just as Mr. Ortiz’s firm was finishing its work, Wal-Mart de Mexico had settled on Teotihuacán as a ripe target for expansion. Its population, nearly 50,000, was growing fast, and its commerce was dominated by small neighborhood shops and a traditional public market in the central square — exactly the type of competition Wal-Mart de Mexico had vanquished in town after town.


Mr. Cicero, a trim, sharp-featured man, recalled how Mrs. Pineda’s alfalfa field jumped out as Wal-Mart’s real estate executives scoured aerial photographs of Teotihuacán. By putting one of Wal-Mart’s Bodega Aurrera supermarkets at the town’s main entrance, they could create a choke point that would effectively place the town off limits to competitors. There was also space to add other types of Wal-Mart stores — restaurants or department stores — down the road. “We would be slamming the gate on the whole town,” he said.


But Wal-Mart officials got a cold reception when they began to inquire about permits at Teotihuacán’s municipal offices. Saúl Martínez, an employee in the urban development office, recalled telling Wal-Mart’s representatives that a supermarket could not be built in Mrs. Pineda’s field, because the field was zoned for housing. Wal-Mart would need a zoning change. But a supermarket, he told them, was sure to generate strong opposition because of the traffic chaos it would create.


“Go look for something else,” he recalled telling Wal-Mart.


At first, Mr. Cicero’s team thought it had found a perfectly legal solution to the zoning problem. Only a narrow strip of land separated Mrs. Pineda’s field from Hidalgo Avenue, the main road into town. If Wal-Mart could build an entrance across that strip, zoning rules would let it rely on Hidalgo Avenue’s zoning, which allowed commercial development. But Wal-Mart could not get a right of way, despite months of trying.


By then, the municipality was rushing to complete its new zoning plan. Officials were already holding public meetings to present the plan and solicit feedback. A final vote was scheduled for Aug. 6, 2003.


The Times obtained four different copies of the new zoning map as it existed on the eve of the vote. All four, including two found in the town’s urban development office, confirm that housing was the only kind of development allowed on Mrs. Pineda’s field. There is no record of Wal-Mart seeking a last-minute change, and nine officials closely involved in drafting the plan all said in separate interviews that they were certain Wal-Mart made no such request.


“I would remember,” said Humberto Peña, then the mayor of Teotihuacán. “And if they would have asked that, my answer would have been no.”


After two years of painstaking work, Mr. Peña and the municipal council unanimously approved Teotihuacán’s new zoning plan on Aug. 6


The next day Mr. Peña sent the new map to the state’s Office of Urban and Regional Planning, a bureaucratic outpost of roughly a dozen employees in Toluca, the State of Mexico’s capital. The office’s main job was to verify that local zoning plans fit the state’s development goals. It also handled the critical final step — arranging publication of completed plans in the state’s official newspaper, the Government’s Gazette.


An Altered Map


If the council’s vote seemingly dashed Wal-Mart’s hopes for Teotihuacán, Wal-Mart de Mexico’s executives certainly acted as if they knew something the rest of the world did not.


On Aug. 12, records show, they asked Wal-Mart’s leadership in the United States to approve their plan to spend about $8 million on a Bodega Aurrera in Mrs. Pineda’s field. The request was approved by Wal-Mart’s international real estate committee, made up of 20 or so top executives, including S. Robson Walton, the company’s chairman.


The committee’s approval, records show, was contingent on obtaining “zoning for commercial use.”


By law, the state Office of Urban and Regional Planning could not make zoning changes on maps it reviewed. If there were problems, it was supposed to send the map back to the town for revisions. Teotihuacán’s plan, however, was quickly approved and then sent to the Government’s Gazette on Aug. 20.


It typically took the Gazette a few weeks to publish a new zoning plan. Only then did it become law. But even before Teotihuacán’s map was published, Wal-Mart de Mexico did two very curious things: First, it began an expensive soil mechanics study of Mrs. Pineda’s field, which it would later lease. Second, it submitted an application to the Business Attention Commission, a state agency that helps developers get permits.


The application and the soil study would have been a foolish waste of time and money, assuming the soon-to-be-published map matched what the Teotihuacán council approved on Aug. 6. It made perfect sense, though, for a company that had reason to believe the map would be published with a single strategically situated change.


The Times found evidence of that change on a computer disc stored in a shoe box inside the Office of Urban and Regional Planning. The disc, created by a senior official in the office, held a copy of Teotihuacán’s zoning map as it existed on Aug. 20, the day it was sent to the Government’s Gazette.


On the map, the zoning on Mrs. Pineda’s field had been changed to allow a commercial center.


“One thing I am sure of — this was altered,” Alejandro Heredia, a partner in the consulting firm that created Teotihuacán’s zoning map, said when he was shown that Aug. 20 map.


“It was surgical work,” he said, adding, “It would be quite a gift to someone who wanted to do something here.”


It was a safe bet that a single small change would not be noticed by Teotihuacán’s municipal council. Because of term limits, the entire council left office after the Aug. 6 vote. A new mayor, Guillermo Rodríguez, was sworn in with a new council on Aug. 17. In interviews, Mr. Rodríguez and members of the new council said they had no idea Wal-Mart had its eye on Mrs. Pineda’s field when they took office.


“They must have had to bribe somebody in order to make the illegal legal,” Mr. Rodríguez said when he was shown both the Aug. 20 map and the map approved on Aug. 6.


“Whatever happened here must be explained,” Jesús Aguiluz, a former high-ranking state official whose domain included the Office of Urban and Regional Planning, said when he was shown both maps. Only one person, he said, could explain what happened — Víctor Manuel Frieventh, then the director of the urban planning office.


“He was in charge totally,” Mr. Aguiluz said.


In interviews with The Times, people who worked in Mr. Frieventh’s office recalled a steady parade of favor-seekers — housing developers, wealthy landowners, politically wired businessmen — all hoping Mr. Frieventh would use his influence to shape zoning plans to favor their interests. Wal-Mart de Mexico, they said, was part of the parade.


During a two-hour interview with The Times, Mr. Frieventh jovially described how his predecessors had taken bribes to shift zoning boundaries. But he insisted he never met with anyone from Wal-Mart, and said he had nothing to do with the change to Teotihuacán’s map.


“It’s very strange,” he said, looking intently at the altered map.


The formal order to publish Teotihuacán’s new zoning plan was received by the Government’s Gazette on Sept. 11, 2003. The next day, internal Wal-Mart de Mexico records show, Mr. Cicero authorized five bribe payments totaling $221,000. According to the internal records, the bribes were for obtaining zoning changes to build five supermarkets. One of the payments, for $52,000, was for the Bodega Aurrera in Teotihuacán, Mr. Cicero said in an interview.


Wal-Mart de Mexico officials did not themselves pay bribes. Records and interviews show that payoffs were made by outside lawyers, trusted fixers dispatched by Mr. Cicero to deliver envelopes of cash without leaving any trace of their existence. Wal-Mart de Mexico’s written policies said these fixers could be entrusted with up to $280,000 to “expedite” a single permit. The bribe payments covered the payoffs themselves, a commission for the fixer and taxes. For some permits, it was left to the fixers to figure out who needed to be bribed. In this case, Mr. Cicero said, Mr. Frieventh was the intended recipient.


Mr. Frieventh, the son of a shoe-store owner, earned a government salary of less than $30,000 in 2003. However modest his pay, he was in the midst of amassing an impressive real estate portfolio. From 2001 to 2004, property records show, he bought up most of a city block in Toluca. The land costs alone were nearly 65 percent of his government pay during those years.


Asked if he had ever accepted anything of value from a Wal-Mart representative, Mr. Frieventh shook his head, chuckled and extended a hand, palm up. “Bring him to me so he can pay me, no? Have him bring it to me.”


Even with the right zoning, Wal-Mart still needed at least a dozen different permits to begin construction. But to apply for them, Mr. Cicero’s team first had to get a zoning certificate, which verified that a plot’s zoning was consistent with the proposed development.


Zoning certificates did not come from Mr. Frieventh’s office. They were issued by the state Office of Urban Operations, and Wal-Mart’s request went to Lidia Gómez, a career civil servant known as a stickler for rules. Ms. Gómez rejected Wal-Mart’s request. Wal-Mart tried again a few months later, and again Ms. Gómez said no, saying that even with Teotihuacán’s new map, a Bodega Aurrera would still run afoul of a rarely enforced federal guideline. Wal-Mart was dead in the water.


With help from Mr. Frieventh, Mr. Cicero’s team found a way around Ms. Gómez, and the law. Mr. Frieventh had no legal authority to overrule Ms. Gómez. But at Wal-Mart’s request, records show, Mr. Frieventh wrote a letter on government letterhead on March 9, 2004, that directly contradicted Ms. Gómez’s rulings. Citing the altered map, he wrote that Wal-Mart’s supermarket was indeed compatible with the zoning for Mrs. Pineda’s field.


Mr. Frieventh said he did not recall the letter, or why he wrote it. But Wal-Mart de Mexico immediately put the letter to work. It began applying for other permits, each time submitting the letter as if it were a valid zoning certificate.


One of its first applications was to the state agency that regulates roads.


There were obvious reasons for traffic regulators to balk at Wal-Mart’s permit request. Traffic, of course, was one of Teotihuacán’s biggest headaches, and a supermarket at the main entrance would only make matters worse. But there was a far bigger complication. The town had recently approved a long-term plan to ease congestion. The plan called for building a bypass road through Mrs. Pineda’s alfalfa field.


According to internal Wal-Mart records, Mr. Cicero authorized a $25,900 bribe for the permit, which was issued in less than two weeks. The paperwork approving it did not even mention the bypass road.


A Helpful Mayor


Teotihuacán’s municipal council had just finished its regular meeting on June 11, 2004, when the mayor, Guillermo Rodríguez, made an unusual request. He asked the council members to stick around and meet privately with some people from Wal-Mart. Instructions were given to turn off the video camera used to record public meetings. But the video operator disregarded the instructions, and the camera continued to roll.


“They are going to explain what they want to do here,” the mayor told his colleagues.


To build in Mrs. Pineda’s field, Wal-Mart now needed a construction license from Teotihuacán. Construction licenses were issued by Hugo Hernández, the town’s director of urban development. Yet Mr. Hernández had thus far declined to give Wal-Mart a license because it still lacked several approvals — an environmental permit, for example.


But Wal-Mart de Mexico had found a friend in Mayor Rodríguez, who now, in private, explained to the council why it was essential to act with speed and flexibility to help Wal-Mart build, regardless of the inevitable opposition.


“They say that if we don’t solve this quickly, they will leave,” he told the council members. Wal-Mart, he revealed, had raised the possibility of a donation. “They asked me, ‘What are you going to ask from us?’ I said, ‘Pay your taxes, reach an agreement, help the community.’ ”


Then he summoned Wal-Mart’s team, led by Jorge Resendiz, one of Mr. Cicero’s deputies.


Mr. Resendiz got to the point. In exchange for bringing jobs and low prices to Teotihuacán, Wal-Mart wanted something extraordinary. It wanted the council members to let Wal-Mart start construction even though it did not have all the required permits. And it wanted them to do it then and there, in private, without public hearings. Wal-Mart was in a rush to open for Christmas shopping. “Time is precious for us,” he said. “If we don’t start this unit in the coming days, we will have a delay.”


Mr. Rodríguez assured Mr. Resendiz that the council would give its approval the next week.


The mayor’s aggressive activism was out of character. In interviews, former aides and colleagues described Mr. Rodríguez as “insecure,” “easily manipulated” and “passive.” He was frequently absent during working hours. “My persistent thought was that I was disappointed by him,” said Mr. Peña, the former mayor who had been Mr. Rodríguez’s political mentor.


But according to Mr. Cicero, there was nothing accidental about Mr. Rodríguez’s enthusiasm. Wal-Mart de Mexico, he said, bribed Mr. Rodríguez to secure his support and that of his allies on the town council. The decision to bribe Mr. Rodríguez, he said, was blessed by Wal-Mart de Mexico’s leaders.


“I didn’t receive any money from Wal-Mart — no money,” Mr. Rodríguez insisted during two lengthy interviews with The Times.


But he struggled to explain why he began to spend tens of thousands of dollars in June 2004, the same month he emerged as Wal-Mart’s champion.


The spending is described in financial disclosure reports Mr. Rodríguez prepared himself under oath. The reports, obtained by The Times, show that he spent $30,300 to begin building a ranch on a hill overlooking the pyramids. He spent $1,800 more on a used Dodge pickup. He paid cash in both transactions.


As mayor, Mr. Rodríguez was paid $47,000 a year. His wife made $23,000 more working for the municipality. His spending spree in June nearly equaled their entire pay for the first half of 2004.


Even more remarkable was what happened six months later. Mr. Rodríguez swore in his disclosure reports that he had no savings as of Dec. 31, 2004. Yet on Jan. 1, 2005, he and his wife spent $47,700 in cash on improvements to their ranch, his reports show.


Before becoming mayor, Mr. Rodríguez had been the town comptroller, responsible for making sure municipal officials completed their financial disclosure reports correctly. Yet in the interviews, Mr. Rodríguez claimed over and over that the amounts he reported were “mistakes” or “approximate figures” or “generalized.”


He tried to be precise, he explained. “I now see it wasn’t so.”


But he did not dispute the overall spending pattern. From June 2004 to June 2005, he acknowledged, he spent “approximately” $114,000 building and furnishing his ranch, all in cash.


Wal-Mart’s investigators would ask Mr. Cicero how much Wal-Mart de Mexico had paid to bribe the mayor. About $114,000, he said.


Teotihuacán’s council members met again on June 18, 2004, a week after Mr. Rodríguez first introduced them to Wal-Mart. It was just after 7 a.m. and Mr. Resendiz took a seat up front. Item 7 on the agenda was Wal-Mart.


It was the first and only public airing of Wal-Mart’s plans. The council members spent 15 minutes discussing one of the largest construction projects in the town’s modern history.


Mr. Rodríguez announced they were there to give a “favorable or unfavorable opinion” of Wal-Mart’s supermarket. When a council member pointed out that Wal-Mart had not even submitted a formal written request, the mayor waved away the problem. “That’s a detail we omitted,” he said.


Mr. Hernández, the town’s urban development director, noted that Wal-Mart still did not have several permits it needed before the town could issue a construction license. He urged the council to stick to the rules.


Mr. Resendiz objected, saying Wal-Mart did not have time to spare.


The mayor pushed for a vote, suggesting that all they were doing was indicating general support while Wal-Mart rounded up its missing permits. He gave no indication that the vote constituted a final approval.


In interviews, council members said they viewed Wal-Mart’s proposal through the prism of lingering resentments toward their public markets. Residents had long complained about vendors inflating prices and rigging scales. They liked the way Wal-Mart challenged the old irritants of the Mexican shopping experience — stores that do not list prices; stores with no parking; stores with musty display cases.


The vote was unanimous for Wal-Mart. Days later, construction began.


Getting By the Guardians


The appearance of heavy excavation equipment in Mrs. Pineda’s field quickly aroused suspicion around town. The suspicions stemmed from Teotihuacán’s fraught relationship with the National Institute of Anthropology and History, or INAH, the official guardian of Mexico’s cultural treasures.


Because of the pyramids, INAH (pronounced EE-nah) is a major presence in Teotihuacán. Its approval is required to build anything inside the protected archaeological zone. Its officials patrol town looking for signs of illegal construction, and it is not hard to find stories about zealous inspectors stopping a homeowner from extending a kitchen a few feet.


It was also well known that INAH required excavations to be done with picks and shovels to minimize damage if digging uncovered ancient ruins. So the sight of bulldozers and backhoes stood out, especially when a sign went up announcing that a Bodega Aurrera was coming. Why, residents asked, should Wal-Mart get special treatment?


Among those who noticed was Sergio Gómez, an archaeologist and researcher for INAH. Mr. Gómez knew that before the agency issued a permit, it first had to officially “liberate” the plot by verifying that construction would not destroy valuable archaeological remains. That meant conducting a formal archaeological survey, with grid lines and exploration holes.


For any developer, a survey was risky. If significant remains were discovered, it could kill the project, or at least force lengthy delays. Yet Mr. Gómez had not seen any sign of a survey, an odd thing since a survey like this should have occupied a team of INAH researchers and laborers for a good six months. This, too, was a red flag.


Mr. Gómez was concerned enough to follow trucks from the site one day. When they dumped their loads, he could see fragments of pottery and other evidence of ancient remains. “I didn’t need to scratch the ground to see it,” he said in an interview.


Iván Hernández noticed, too. He was one of five INAH archaeologists who did surveys to liberate land for construction in the protected zone. He knew every major project in town, but nothing of this one.


Residents were also calling INAH to complain. The calls went to Juan Carlos Sabais, the agency’s top lawyer in Teotihuacán. He would have been the one to review the permit paperwork and prepare the official liberation letter for this plot. “We didn’t have a clue,” he recalled. “People were saying this was Wal-Mart, and we didn’t know a thing.”


Mr. Sabais led a party of INAH officials to the site to find out what was going on. They passed through a small crowd of angry residents. It was July 16, and construction was already well under way. There were several large excavations, one as deep as 16 feet, records show. Workers claimed they had an INAH permit, just not on site as the law required. Mr. Sabais ordered them to stop construction.“The crowd started clapping,” he said.


By the time Mr. Sabais returned to his office, senior INAH officials were calling from Mexico City demanding to know why he had halted construction. Only then, he said, did he discover that Wal-Mart had somehow managed to get a permit without a survey, or a liberation letter.


This bureaucratic miracle, Mr. Cicero would explain to Wal-Mart investigators and The Times, was made possible by another payoff. As Mr. Cicero described it, senior INAH officials had asked for an “official donation” of up to $45,000 and a “personal gift” of up to $36,000 in exchange for a permit.


Wal-Mart’s permit was signed by Mirabel Miró, then the agency’s top official in the State of Mexico. According to Ms. Miró, it was Wal-Mart de Mexico that made an improper offer of money. Her chief architect, she said, told her that Wal-Mart had approached him with an offer of a sizable “donation.” He wanted to accept, she said.


“I told him, ‘I don’t want a dime, not as a donation, not as anything, because it may be interpreted as something else,’ ” she said.


Sergio Raúl Arroyo, the director general of INAH, recalled in an interview that Ms. Miró had told him about Wal-Mart’s offer. He could not recall any other instance of a company offering a donation while it was seeking a permit. “That would have been totally irregular,” he said. “It was obvious we had to be very careful with these people.”


“I told Miró to accept no donations,” he added. “Not even a pair of scissors.”


And yet in June 2004, three weeks after Ms. Miró signed the permit, Mr. Resendiz spoke about a payment to INAH during his private meeting with Teotihuacán’s council. “INAH itself is asking us for a considerable contribution,” Mr. Resendiz said.


“We are going to formalize the contribution next Monday,” he added. “But it is a fact.”


Mr. Resendiz, who has been placed on administrative leave pending Wal-Mart’s investigation, declined to comment. Every INAH official interviewed, including Ms. Miró’s chief architect, Carlos Madrigal, denied accepting money from Wal-Mart.


But Mr. Sabais, the agency’s top lawyer in Teotihuacán, knew nothing about official donations or personal gifts on the day he stopped construction. All he knew was that he was being summoned to INAH’s headquarters in Mexico City. Over several tense meetings, he recalled, his bosses confronted their embarrassing predicament: INAH had halted construction even though Wal-Mart had the required permit. Yet the agency had given Wal-Mart that permit without first conducting a survey and liberating the land.


Fearing a public relations debacle, senior INAH officials concocted a trail of backdated documents to hide its blunders, Mr. Sabais said. He pointed to an INAH report dated April 2, 2004, seven weeks before the agency issued its permit. The report suggested Wal-Mart’s plot had been liberated after a 1984 survey. “This document,” Mr. Sabais said, “was made later to justify what had not been done.”


INAH officials would later tell multiple government inquiries that Wal-Mart’s plot had been liberated because of this 1984 survey.


The Times tracked down the 1984 survey. It had nothing to do with the land where Wal-Mart was building. The survey was done on a different plot several hundred yards away. The archaeologists who supervised and evaluated the survey were appalled to learn that it had been used to justify INAH’s permit for Wal-Mart. “This is a fraud,” Ana María Jarquín, one of the archaeologists, said in an interview.


In interviews last week, top INAH officials acknowledged for the first time that Wal-Mart’s plot had neither been surveyed nor liberated, either in 1984 or any other time, before construction began. They also made one other startling admission. The agency has long maintained no ancient remains were destroyed during construction. But Verónica Ortega, INAH’s top archaeologist in Teotihuacán, acknowledged it was indeed possible ancient remains were destroyed during the excavation before Mr. Sabais halted construction.


“I am not able to affirm categorically that no soil went out,” she said.


The work shutdown ordered by Mr. Sabais did not last long. Four days later, INAH allowed Wal-Mart to resume construction. The agency did take one precaution: it began an extensive survey, digging dozens of exploration wells alongside Wal-Mart’s crews.


A Gathering Protest


By now a loose protest movement had begun to form. Its leaders all had deep roots here. Lorenzo Trujillo owned produce stands in the public market. Emmanuel D’Herrera, a teacher and poet, had celebrated his son’s birth by tucking the boy’s umbilical cord in a crack atop the Moon pyramid. Emma Ortega was a spiritual healer who cared for patients a stone’s throw from the pyramid. “You feel that it’s part of you, and you are part of it,” she said.


The protesters immediately suspected something “dirty” had taken place, Ms. Ortega recalled. The first clue came on Aug. 1, 2004, when she and other protest leaders met with Mayor Rodríguez. By now the supermarket’s walls were being erected. They asked the mayor to show them the construction permit. The mayor, nervous and evasive, admitted Wal-Mart did not actually have one.


“So we were like, ‘Why are they there working?’ ” Ms. Ortega said. They asked the mayor to halt work and hold hearings. The mayor said he would think about it. Two days later, he issued Wal-Mart a construction license.


He signed it himself.


In response, the protesters demanded his resignation and filed the first of several legal challenges. Then they blockaded the construction site.


As word of the blockade spread, bells rang from a chapel in Purificación, the neighborhood where Wal-Mart was building. It was the alarm used to summon neighbors in an emergency. Residents marched toward the blockade.


“We thought they were there to support us,” Ms. Ortega recalled. “No. They were there to attack us.” The crowd descended on the small band of protesters, pushing and yelling insults until the blockade was broken.


What Ms. Ortega did not know was that Wal-Mart had already bought the support of Purificación’s neighborhood leaders. In interviews, several of those leaders recalled being invited to Mr. Rodríguez’s office to meet with the company’s representatives. The Wal-Mart people, the leaders said, offered money to expand their cemetery, pave a road and build a handball court. They offered paint and computers for Purificación’s school. They offered money to build a new office for the neighborhood leaders.


But the money came with strings: if there were any protests, they were expected to be visibly and loudly supportive of Wal-Mart.


Protest leaders began to get anonymous phone calls urging them to back off. In news conferences, the mayor dismissed them as a tiny minority of gadflies and self-interested local merchants. He insisted the town overwhelmingly favored Wal-Mart’s arrival, and as proof of his incorruptibility, he boasted of how he had rejected Wal-Mart de Mexico’s offer of a $55,000 donation to the municipal treasury.


But the tide turned as INAH’s archaeologists began to find evidence that Wal-Mart was building on ancient ruins after all. They found the remains of a wall dating to approximately 1300 and enough clay pottery to fill several sacks. Then they found an altar, a plaza and nine graves. Once again, construction was temporarily halted so their findings could be cataloged, photographed and analyzed. The discoveries instantly transformed the skirmish over Mrs. Pineda’s field into national news.


Student groups, unions and peasant leaders soon joined the protests. Opponents of other Wal-Marts in Mexico offered support. Influential politicians began to express concern. Prominent artists and intellectuals signed an open letter asking Mexico’s president to stop the project. Many were cultural traditionalists, united by a fear that Wal-Mart was inexorably drawing Mexico’s people away from the intimacy of neighborhood life, toward a bland, impersonal “gringo lifestyle” of frozen pizzas, video games and credit card debt.


The support emboldened the protesters. When the mayor held a news conference, they interrupted and openly accused him of taking bribes. They blockaded INAH’s headquarters and marched on Wal-Mart de Mexico’s corporate offices in Mexico City. “All we have found are closed doors and an ocean of corruption around the authorizations for this Wal-Mart,” Mr. D’Herrera told reporters with typical flourish.


Their allegations of corruption seeped into the news coverage in Mexico and the United States. In September 2004, an article in The Times included this passage: “How Wal-Mart got permission to build a superstore on farmland supposedly protected under Mexican law as an archaeological site has vexed the merchants here, who freely accuse the town, the state and the federal Institute of Anthropology and History of corruption.”


Open for Business


Back in Bentonville, Wal-Mart’s international real estate committee was aware of the growing attention from the news media, former members said in interviews. Some committee members cringed at the ugly optics of Wal-Mart literally bulldozing Mexico’s cultural heritage. “I kept waiting for someone to say, ‘Let’s just move sites,’ ” recalled one member, who, like others on the committee, asked not to be identified because of the continuing inquiry.


But top Wal-Mart de Mexico executives assured the committee that the situation was under control. They portrayed the protesters as a fringe group — “like they were from Occupy Wall Street,” another person recalled.


Despite multiple news accounts of possible bribes, Wal-Mart’s leaders in the United States took no steps to investigate Wal-Mart de Mexico, records and interviews show.


Mr. Tovar, the Wal-Mart spokesman, said that while executives in the United States were aware of the furor in Teotihuacán they did not know about the corruption allegations. “None of the associates we have interviewed, including people responsible for real estate projects in Mexico during this time period, recall any mention of bribery allegations related to this store,” he said.


In Mexico, government officials were looking for a way to quell the controversy. Mr. Arroyo, INAH’s director general, urged Wal-Mart de Mexico to build elsewhere. The state’s urban development ministry quietly searched for alternate sites outside the archaeological zone. Then, on Oct. 2, Mexico’s newspapers reported a major announcement: Arturo Montiel, the state’s governor, was looking for another site “that is better for all.”


With its supermarket more than half built, Wal-Mart de Mexico was not eager to accommodate the governor. The company raced to complete construction and mounted a public relations offensive. Executives argued that Wal-Mart de Mexico had scrupulously fulfilled every legal requirement: the zoning was correct, as confirmed by the map in the Government’s Gazette; necessary approvals had been duly obtained from INAH, traffic authorities and other agencies; the mayor himself had signed the construction license.


Not even a week after Mr. Montiel’s announcement, his top deputy told reporters there was, alas, no way to stop Wal-Mart. “We would be violating the law since they can tell us they complied with all that is required,” he explained.


The supermarket opened on Nov. 4, 2004. A year later, Mr. Cicero met with Wal-Mart’s lawyers and told his story for the first time. His allegations were shared with several of the same executives who were on the international real estate committee, records show. If the protesters’ vague allegations of corruption had been easy to dismiss, now they were coming from the person responsible for obtaining Wal-Mart de Mexico’s permits in Teotihuacán.


More important, Mr. Cicero’s allegations emerged as a comptroller for the State of Mexico was wrapping up a lengthy investigation into whether officials had acted unlawfully in granting permits to Wal-Mart de Mexico.


But Wal-Mart did not share Mr. Cicero’s allegations with any authorities in Mexico. “This is one of the areas we are reviewing as part of our ongoing investigation,” Mr. Tovar said.


When the comptroller’s office subsequently announced it had found no wrongdoing, it chided protesters for failing to present any specific proof.


The comptroller had been the protesters’ last hope. Most moved on, resigned to the idea that their struggle had been for nothing. But not Mr. D’Herrera. He continued to visit government archives, seeking access to Wal-Mart’s permit records. He kept appealing to public officials for help. “I shall continue my hunger strike until Wal-Mart leaves or until I die,” he wrote in a letter to Vicente Fox, Mexico’s president at the time.


Despite the passage of time, Mr. D’Herrera never wavered in his conviction that Wal-Mart must have paid bribes. He was appalled by the store’s impact on Teotihuacán, and infuriated that so few seemed to care. It did not go unnoticed when protest leaders were spotted shopping contentedly in the Bodega Aurrera, where people can buy everything from tortillas to tires, almost always at a substantial discount from local shops.


Friends and relatives urged Mr. D’Herrera to let it go, but he refused. “He became obsessed,” Ms. Ortega said. Mr. D’Herrera finally snapped. On May 16, 2009, he entered the Bodega Aurrera and placed a crude homemade bomb in a shopping cart. According to prosecutors, the bomb consisted of a small juice can containing gunpowder and nails. Mr. D’Herrera pushed the cart into the store’s home section, looked around to make sure the aisle was empty, and then lit a fuse poking from the can. His intent, he later wrote, was to kill himself and damage the store to draw public attention back to Wal-Mart. But all the blast did was knock him down and damage $68 worth of merchandise.


As he awaited trial from a prison cell, he continued his hopeless campaign. He wrote more letters to politicians. He asked his wife to publish his diatribes against Wal-Mart on an obscure poetry blog. Yet he clearly recognized the precariousness of his circumstances. He was thin and severely diabetic. His teeth were falling out. In early 2010, he asked a cellmate to deliver a letter to his wife in case he died in prison. A few months later, he had a brain hemorrhage and slipped into a coma. Death quickly followed. He was 62.


In his final letter to his wife, Mr. D’Herrera tried to explain why he had battled so long at such grievous cost.


“I am not leaving material patrimony for you and our son,” he wrote. “I’m leaving you a moral and political legacy, dying as I am for a cause, in defense of the Mexican culture.”


Josh Haner and James C. McKinley Jr. contributed reporting.



This article has been revised to reflect the following correction:

Correction: December 18, 2012

An earlier version of this article misspelled the surname on one occasion of the former director of urban planning. He is Víctor Manuel Frieventh, not Freiventh.



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