Kenya hospital imprisons new mothers with no money

NAIROBI, Kenya (AP) — The director of the Pumwani Maternity Hospital, located in a hardscrabble neighborhood of downtown Nairobi, freely acknowledges what he's accused of: detaining mothers who can't pay their bills. Lazarus Omondi says it's the only way he can keep his medical center running.

Two mothers who live in a mud-wall and tin-roof slum a short walk from the maternity hospital, which is affiliated with the Nairobi City Council, told The Associated Press that Pumwani wouldn't let them leave after delivering their babies. The bills the mothers couldn't afford were $60 and $160. Guards would beat mothers with sticks who tried to leave without paying, one of the women said.

Now, a New York-based group has filed a lawsuit on the women's behalf in hopes of forcing Pumwani to stop the practice, a practice Omondi is candid about.

"We hold you and squeeze you until we get what we can get. We must be self-sufficient," Omondi said in an interview in his hospital office. "The hospital must get money to pay electricity, to pay water. We must pay our doctors and our workers."

"They stay there until they pay. They must pay," he said of the 350 mothers who give birth each week on average. "If you don't pay the hospital will collapse."

The Center for Reproductive Rights, which filed the suit this month in the High Court of Kenya, says detaining women for not paying is illegal. Pumwani is associated with the Nairobi City Council, one reason it might be able to get away with such practices, and the patients are among Nairobi's poorest with hardly anyone to stand up for them.

Maimouna Awuor was an impoverished mother of four when she was to give birth to her fifth in October 2010. Like many who live in Nairobi's slums, Awuor performs odd jobs in the hopes of earning enough money to feed her kids that day. Awuor, who is named in the lawsuit, says she had saved $12 and hoped to go to a lower-cost clinic but was turned away and sent to Pumwani. After giving birth, she couldn't pay the $60 bill, and was held with what she believes was about 60 other women and their infants.

"We were sleeping three to a bed, sometimes four," she said. "They abuse you, they call you names," she said of the hospital staff.

She said saw some women tried to flee but they were beaten by the guards and turned back. While her husband worked at a faraway refugee camp, Awuor's 9-year-old daughter took care of her siblings. A friend helped feed them, she said, while the children stayed in the family's 50-square-foot shack, where rent is $18 a month. She says she was released after 20 days after Nairobi's mayor paid her bill. Politicians in Kenya in general are expected to give out money and get a budget to do so.

A second mother named in the lawsuit, Margaret Anyoso, says she was locked up in Pumwani for six days in 2010 because she could not pay her $160 bill. Her pregnancy was complicated by a punctured bladder and heavy bleeding.

"I did not see my child until the sixth day after the surgery. The hospital staff were keeping her away from me and it was only when I caused a scene that they brought her to me," said Anyoso, a vegetable seller and a single mother with five children who makes $5 on a good day.

Anyoso said she didn't have clothes for her child so she wrapped her in a blood-stained blouse. She was released after relatives paid the bill.

One woman says she was detained for nine months and was released only after going on a hunger strike. The Center for Reproductive Rights says other hospitals also detain non-paying patients.

Judy Okal, the acting Africa director for the Center for Reproductive Rights, said her group filed the lawsuit so all Kenyan women, regardless of socio-economic status, are able to receive health care without fear of imprisonment. The hospital, the attorney general, the City Council of Nairobi and two government ministries are named in the suit.

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Associated Press reporter Tom Odula contributed to this report.

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A make-or-break moment for 'fiscal cliff' negotiations

WASHINGTON (AP) — Amid partisan bluster, top members of Congress and President Barack Obama were holding out slim hopes for a limited fiscal deal before the new year. But even as congressional leaders prepared to convene at the White House, there were no signs that legislation palatable to both sides was taking shape.

The Friday afternoon meeting among congressional leaders and the president — their first since Nov. 16 — stood as a make-or-break moment for negotiations to avoid across-the-board first of the year tax increases and deep spending cuts.

Obama called for the meeting as top lawmakers alternately cast blame on each other while portraying themselves as open to a reasonable last-minute bargain.

Senate Democratic Leader Harry Reid all but conceded that any effort at this late date was a long shot. "I don't know timewise how it can happen now," he said.

For Obama, the 11th-hour scramble represented a test of how he would balance the strength derived from his re-election with his avowed commitment to compromise. Despite early talk of a grand bargain between Obama and House Speaker John Boehner that would reduce deficits by more than $2 trillion, the expectations were now far less ambitious.

Although there were no guarantees of a deal, Republicans and Democrats said privately that any agreement would likely include an extension of middle-class tax cuts with increased rates at upper incomes, an Obama priority that was central to his re-election campaign. The deal would also likely put off the scheduled spending cuts. Such a year-end bill could also include an extension of expiring unemployment benefits, a reprieve for doctors who face a cut in Medicare payments and possibly a short-term measure to prevent dairy prices from soaring, officials said.

To get there, Obama and Reid would have to propose a package that Senate Republican Leader Mitch McConnell would agree not to block with procedural steps that require 60 votes to overcome.

Sen. Chuck Schumer of New York said he still thinks a deal could be struck.

The Democrat told NBC's "Today" show Friday that he believes the "odds are better than people think."

Schumer said he based his optimism on indications that McConnell has gotten "actively engaged" in the talks.

Appearing on the same show, Republican Sen. John Thune noted the meeting scheduled later Friday at the White House, saying "it's encouraging that people are talking."

But Sen. Bob Corker, R-Tenn., predicted that "the worst-case scenario" could emerge from Friday's talks.

"We will kick the can down the road," he said on "CBS This Morning."

"We'll do some small deal and we'll create another fiscal cliff to deal with the fiscal cliff," he said. Corker complained that there has been "a total lack of courage, lack of leadership," in Washington.

Speaking on the Senate floor Thursday, McConnell cautioned: "Republicans aren't about to write a blank check for anything the Democrats put forward just because we find ourselves at the edge of the cliff."

Nevertheless, he said he told Obama in a phone call late Wednesday that "we're all happy to look at whatever he proposes."

If a deal were to pass the Senate, Boehner would have to agree to take it to the floor in the Republican-controlled House.

Boehner discussed the fiscal cliff with Republican members in a conference call Thursday and advised them that the House would convene Sunday evening. Rep. Tom Cole, R-Okla., an ally of the speaker, said Boehner told the lawmakers that "he didn't really intend to put on the floor something that would pass with all the Democratic votes and few of the Republican votes."

But Cole did not rule out Republican support for some increase in tax rates, noting that Boehner had amassed about 200 Republican votes for a plan last week to raise rates on Americans earning $1 million or more. Boehner ultimately did not put the plan to a House floor vote in the face of opposition from Republican conservatives and a unified Democratic caucus.

"The ultimate question is whether the Republican leaders in the House and Senate are going to push us over the cliff by blocking plans to extend tax cuts for the middle class," White House communications director Dan Pfeiffer said. "Ironically, in order to protect tax breaks for millionaires, they will be responsible for the largest tax increase in history."

Boehner, McConnell, Reid and House Democratic Leader Nancy Pelosi are all scheduled to attend Friday's White House meeting with Obama. Vice President Joe Biden will also participate in the meeting, the White House said.

Despite the urgency to act, the rhetoric Thursday was quarrelsome and personal.

The House of Representatives is "being operated with a dictatorship of the speaker," Reid said on the Senate floor. He attributed Boehner's reluctance to put a version of Senate bill that raised tax rates on incomes above $250,000 for couples to fears he could lose his re-election as speaker next week.

"Harry Reid should talk less and legislate more if he wants to avert the fiscal cliff," countered Brendan Buck, a spokesman for Boehner.

If a deal is not possible, it should become evident at Friday's White House meeting. If that occurs, Obama and the leaders would leave the resolution to the next Congress to address in January.

Such a delay could unnerve the stock market, which performed erratically Thursday amid the developments in Washington. Economists say that if the tax increases are allowed to hit most Americans and if the spending cuts aren't scaled back, the recovering but fragile economy could sustain a traumatizing shock.

But a sentiment is taking hold that despite a black eye to its image, Congress could weather the fiscal cliff without significant economic consequences if it acts decisively next month.

"Going over is likely because at this point both sides probably see a better deal on the other side of the cliff," Jared Bernstein, Biden's former economic adviser, wrote in a blog post Thursday.

By letting current tax cuts expire and rise, Bernstein and others say, Republicans would be voting to lower taxes next month, even if not for all taxpayers. Democrats — and Obama — would be in a stronger position to demand that taxpayers above the $250,000 threshold pay higher taxes, instead of the $400,000 threshold that Obama proposed in his latest offer to Boehner.

And the debate over spending cuts, including changes to politically sensitive entitlement programs such as Medicare, would have to start anew.

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Associated Press writers Alan Fram, Charles Babington and David Espo contributed to this report.

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Follow Jim Kuhnhenn on Twitter: http://twitter.com/jkuhnhenn

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India rape victim in Singapore; PM pledges action

NEW DELHI (AP) — Indian Prime Minister Manmohan Singh pledged Thursday to take action to protect the nation's women while the young victim of a gang rape on a New Delhi bus was flown to Singapore for treatment of severe internal injuries.

The Dec. 16 rape and brutal beating of the 23-year-old student triggered widespread protests, including a march on Thursday, demanding a government crackdown on the daily harassment Indian women face, ranging from groping to severe violence. Some protesters have called for the death penalty or castration for rapists, who under current laws face a maximum punishment of life imprisonment.

Rape victims rarely press charges because of social stigma and fear they will be accused of inviting the attack. Many women say they structure their lives around protecting themselves and their daughters from attack.

Singh's government set up two committees in response to the protests. One, looking into speeding up sexual assault trials, has already received 6,100 email suggestions. The second will examine what lapses might have contributed to the rape — which took place on a moving bus that passed through police checkpoints — and suggest measures to improve women's safety.

"Let me state categorically that the issue of safety and security of women is of the highest concern to our government," Singh said at a development meeting. He urged officials in India's states to pay special attention to the problem.

"There can be no meaningful development without the active participation of half the population, and this participation simply cannot take place if their security and safety is not assured," he said.

The rape victim arrived in Singapore on an air ambulance Thursday and was admitted to the intensive care unit of the Mount Elizabeth hospital, renowned for multi-organ transplant facilities.

On Thursday night she remained in "extremely critical condition" as a team of specialists worked to stabilize her, Dr. Kelvin Loh, the hospital's chief executive officer, said in a statement. Before arriving in Singapore, she had already undergone three abdominal surgeries and suffered cardiac arrest, he said.

India's Home Minister Sushilkumar Shinde said in a statement that the government, which is funding and overseeing the victim's treatment, had decided to send her abroad on the recommendation of her doctors.

"Despite the best efforts of our doctors, the victim continues to be critical and her fluctuating health remains a big cause of concern to all of us," he said.

Her family was also being sent to Singapore to be with her during her treatment, which could last weeks, he said.

Meanwhile, hundreds of protesters demanding safer public transportation for women and the resignation of Delhi's police commissioner tried to march to the major India Gate traffic circle in central Delhi before being stopped by police in riot gear manning barricades. Protesters carried signs reading, "Immediately end rape culture in India" and "Zero tolerance of violence against women."

Protests have shut down the center of the capital for days since the rape. Police quashed some of the demonstrations with tear gas, water cannons and baton charges.

One police officer died Tuesday after collapsing during a weekend protest. Police said an autopsy showed the officer had a heart attack that could have been caused by injuries suffered during violence at the protest. An Associated Press journalist at the scene said the officer was running toward the protesters with a group of police when he collapsed on the ground and began frothing at the mouth and shaking. Two protesters rushed to the officer to try to help him. Police charged eight people with murder in the death of the policeman.

Police said the rape victim was traveling on the evening of Dec. 16 with a male friend on a bus when they were attacked by six men who gang-raped her and beat the couple with iron rods before stripping them and dumping them on a road. All six suspects in the case have been arrested, police said.

Also Thursday, Ratanjit Singh, a junior minister in the home ministry, said the government would create a database of convicted rapists and publish it, along with their photos, on the ministry website to shame them, according to the Press Trust of India.

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Associated Press reporter Heather Tan contributed reporting from Singapore and Saurabh Das contributed from New Delhi.

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Follow Ravi Nessman at twitter at http://www.twitter.com/ravinessman

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Temple Run was downloaded more than 2.5 million times on Christmas Day

Title Post: Temple Run was downloaded more than 2.5 million times on Christmas Day
Rating:
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based on 99998 ratings.
5 user reviews.
Author: Fluser SeoLink
Thanks for visiting the blog, If any criticism and suggestions please leave a comment

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DC police investigating 'Meet the Press' incident

WASHINGTON (AP) — District of Columbia police say they are investigating an incident in which NBC News reporter David Gregory displayed what he described as a high-capacity ammunition magazine on "Meet the Press."

Police spokesman Tisha Gant said Wednesday the department is investigating whether Gregory may have violated D.C. firearms laws that ban the possession of high-capacity magazines. She declined to comment further.

While interviewing National Rifle Association CEO Wayne LaPierre on Sunday's program, Gregory held an object, apparently as a prop to make a point, and said it was a magazine that could hold 30 rounds.

High-capacity ammunition magazines are banned in the District of Columbia, regardless of whether they're attached to a firearm. "Meet the Press" is generally taped in Washington.

An email seeking comment from NBC was not immediately returned.

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Kenya hospital imprisons new mothers with no money

NAIROBI, Kenya (AP) — The director of the Pumwani Maternity Hospital, located in a hardscrabble neighborhood of downtown Nairobi, freely acknowledges that he detains mothers who can't pay their bills.

Lazarus Omondi says it's the only way he can keep his medical center running. Now, a New York-based group filed a lawsuit this month in hopes of forcing Pumwani to stop the practice.

Two mothers who live in a mud-wall and tin-roof slum near the maternity hospital said Pumwani wouldn't let them leave after delivering their babies. The bills the mothers couldn't afford were $60 and $160. Guards with sticks would beat mothers who tried to leave without paying, one of the women said.

Omondi says one solution to the problem would be a national health insurance program.

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Winter storm whips across Northeast

CONCORD, N.H. (AP) — A powerful winter storm brought snow to inland parts of the Northeast and driving rain and wind to areas along the coast Thursday, a day after it swept through the nation's middle, dumping a record snowfall in Arkansas and ruining holiday travel plans for thousands.

The storm, which was blamed for nine deaths, pushed through the Upper Ohio Valley and made its way into the Northeast Wednesday night. By Thursday morning, there was anywhere from a few inches of snow to a foot in some locations.

National Weather Service spokesman David Roth said the Northeast's heaviest snowfall would be in northern Pennsylvania, upstate New York and inland sections of several New England states before the storm ended Friday morning and headed to Canada.

The East Coast's largest cities — New York, Philadelphia and Boston — were seeing mostly high winds and rain Thursday morning. Other areas were getting a messy mix of rain and snow or just rain — enough to slow down commuters and those still heading home from visits with family.

Thousands of travelers were trying to make it home Thursday after the fierce storm stranded them at airports or relatives' homes around the region. Some inbound flights were delayed in Philadelphia and New York's LaGuardia, but the wet and windy weather wasn't leading to delays at other major East Coast airports.

A flight that landed safely in Pittsburgh during the storm Wednesday night got stuck in snow for about two hours on the tarmac.

The American Airlines flight arrived between 8 and 9 p.m., but then ran over a snow patch and got stuck.

Airport spokeswoman Joan Jenny told the Pittsburgh Post-Gazette workers tried for nearly two hours to tow the plane to the gate before deciding to bus passengers to the terminal.

Hundreds of flights were canceled or delayed on Wednesday and scores of motorists got stuck on icy roads or slid into drifts. Said John Kwiatkowski, an Indianapolis-based meteorologist with the weather service: "The way I've been describing it is as a low-end blizzard, but that's sort of like saying a small Tyrannosaurus rex."

The storm system spawned Gulf Coast region tornadoes on Christmas Day, startling people like Bob and Sherry Sims of Mobile, Alabama, who'd just finished dinner.

"We heard that very distinct sound, like a freight train," said Bob Sims. They headed for a center bathroom.

Power was still out at the Sims' home on Wednesday, but the house wasn't damaged and they used a generator to run heaters to stay warm. Some neighbors were less fortunate, their roofs peeled away and porches smashed by falling trees.

The storm also left freezing temperatures in its aftermath, and forecasters said parts of the Southeast from Virginia to Florida saw severe thunderstorms.

Schools on break and workers taking holiday vacations meant that many people could avoid messy commutes, but those who had to travel were urged to avoid it. Snow was blamed for scores of vehicle accidents as far east as Maryland, and about two dozen counties in Indiana and Ohio issued snow emergency travel alerts, urging people to go out on the roads only if necessary.

About 40 vehicles got bogged down trying to make it up a slick hill in central Indiana, and four state snowplows slid off roads as snow fell at the rate of 3 inches an hour in some places.

Officials in Ohio blamed the bad weather for a crash that killed an 18-year-old girl, who lost control of her car Wednesday afternoon and smashed into an oncoming snow plow on a highway northeast of Cincinnati.

A man and a woman in Evansville, Ind., were killed when the scooter they were riding went out of control on a snowy street Wednesday and they were hit by a pickup truck.

Two passengers in a car on a sleet-slickened Arkansas highway were killed Wednesday in a head-on collision, and two people, including a 76-year-old Milwaukee woman, were killed Tuesday on Oklahoma highways. Deaths from wind-toppled trees were reported in Texas and Louisiana.

The day after Christmas wasn't expected to be particularly busy for AAA, but its Cincinnati-area branch had its busiest Wednesday of the year. By mid-afternoon, nearly 400 members had been helped with tows, jump starts and other aid, with calls still coming in, spokesman Mike Mills said.

In Arkansas, some of the nearly 200,000 people who lost power could be without it for as long as a week because of snapped poles and wires after ice and 10 inches of snow coated power lines, said the state's largest utility, Entergy Arkansas.

Gov. Mike Beebe, who declared a statewide emergency, sent out National Guard teams, and Humvees transported medical workers and patients. Snow hadn't fallen in Little Rock on Christmas since 1926, but the capital ended Tuesday with 10.3 inches of it.

Other states also had scattered outages.

As the storm moved east, New England state highway departments were treating roads and getting ready to mobilize with snowfall forecasts of a foot or more.

Few truckers were stopping into a TravelCenters of America truck stop in Willington, Conn., near the Massachusetts border early Thursday. Usually 20 to 30 an hour stop in overnight, but high winds and slushy roads had cut that to two to three people an hour.

"A lot of people are staying off the road," said Louis Zalewa, 31, who works there selling gasoline and staffing the store. "I think people are being smart."

As usual, winter-sports enthusiasts welcomed the snow. At Smiling Hill Farm in Maine, Warren Knight was hoping for enough snow to allow the opening of trails.

"We watch the weather more carefully for cross-country skiing than we do for farming. And we're pretty diligent about farming. We're glued to the weather radio," said Knight, who described the weather at the 500-acre farm in Westbrook as being akin to the prizes in "Cracker Jacks — we don't know what we're going to get."

Behind the storm, Mississippi's governor declared states of emergency in eight counties with more than 25 people reported injured and 70 homes left damaged.

Cindy Williams stood near a home in McNeill, Miss., where its front had collapsed into a pile of wood and brick, a balcony and the porch ripped apart. Large oak trees were uprooted and winds sheared off treetops in a nearby grove. But she focused instead on the fact that all her family members had escaped harm.

"We are so thankful," she said. "God took care of us."

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Associated Press writers Rick Callahan and Charles Wilson in Indianapolis, Kelly P. Kissel in Little Rock, Ark.; Jim Van Anglen in Mobile, Ala.; Holbrook Mohr in Jackson, Miss.; Julie Carr Smyth and Mitch Stacy in Columbus, Ohio; Amanda Lee Myers in Cincinnati; David Dishneau in Hagerstown, Md.; and David Sharp in Portland, Maine, contributed to this report.

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New Japan PM: Saving economic crisis top mission

TOKYO (AP) — Japan's newly installed Prime Minister Shinzo Abe says his top mission is to avert economic and diplomatic crises.

Abe was elected as Japan's leader Wednesday. The rise of Abe, whose nationalist positions have in the past angered Japan's neighbors, brings back the conservative, pro-business Liberal Democratic Party that governed for most of the post-World War II era to power. The left-leaning government of the Democratic Party of Japan lasted three years.

Abe vowed to pull Japan out of deflation through bold economic measures, and said he would step up an alliance with the United States to stabilize Japan's diplomacy shaken by increasing territorial threats from its neighbors.

Abe, who was also prime minister in 2006-2007, led the LDP to victory in parliamentary elections Dec. 16.

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Ticket rush: Film fans hand Hollywood record cash

LOS ANGELES (AP) — The big deal for Hollywood is not the record $10.8 billion that studios took in domestically in 2012. It's the fact that the number of tickets sold went up for the first time in three years.

Thanks to inflation, revenue generally rises in Hollywood as admission prices climb each year. The real story is told in tickets, whose sales have been on a general decline for a decade, bottoming out in 2011 at 1.29 billion, their lowest level since 1995.

The industry rebounded this year, with ticket sales projected to rise 5.6 percent to 1.36 billion by Dec. 31, according to box-office tracker Hollywood.com. That's still well below the modern peak of 1.6 billion tickets sold in 2002, but in an age of cozy home theater setups and endless entertainment gadgets, studio executives consider it a triumph that they were able to put more butts in cinema seats this year than last.

"It is a victory, ultimately," said Don Harris, head of distribution at Paramount Pictures. "If we deliver the product as an industry that people want, they will want to get out there. Even though you can sit at home and watch something on your large screen in high-def, people want to get out."

Domestic revenue should finish up nearly 6 percent from 2011's $10.2 billion and top Hollywood's previous high of $10.6 billion set in 2009.

The year was led by a pair of superhero sagas, Disney's "The Avengers" with $623 million domestically and $1.5 billion worldwide and the Warner Bros. Batman finale "The Dark Knight Rises" with $448 million domestically and $1.1 billion worldwide. Sony's James Bond adventure "Skyfall" is closing in on the $1 billion mark globally, and the list of action and family-film blockbusters includes "The Hunger Games," ''The Twilight Saga: Breaking Dawn — Part Two," ''Ice Age: Continental Drift," ''Madagascar 3: Europe's Most Wanted," ''The Amazing Spider-Man" and "Brave."

Before television, movies were the biggest thing going, with ticket sales estimated as high as 4 billion a year domestically in the 1930s and '40s.

Movie-going eroded steadily through the 1970s as people stayed home with their small screens. The rise of videotape in the 1980s further cut into business, followed by DVDs in the '90s and big, cheap flat-screen TVs in recent years. Today's video games, mobile phones and other portable devices also offer easy options to tramping out to a movie theater.

It's all been a continual drain on cinema business, and cynics repeatedly predict the eventual demise of movie theaters. Yet Hollywood fights back with new technology of its own, from digital 3-D to booming surround-sound to the clarity of images projected at high-frame rates, which is being tested now with "The Lord of the Rings" prelude "The Hobbit: An Unexpected Journey," shown in select theaters at 48 frames a second, double the standard speed.

For all of the annoyances of theaters — parking, pricy concessions, sitting next to strangers texting on their iPhones — cinemas still offer the biggest and best way to see a movie.

"Every home has a kitchen, but you can't get into a good restaurant on Saturday night," said Dan Fellman, head of distribution for Warner Bros. "People want to escape. That's the nature of society. The adult population just is not going to sit home seven days a week, even though they have technology in their home that's certainly an improvement over what it was 10 years ago. People want to get out of the house, and no matter what they throw in the face of theatrical exhibition, it continues to perform at a strong level."

Even real-life violence at the movie theater didn't turn audiences away. Some moviegoers thought twice about heading to the cinema after a gunman killed 12 people and injured 58 at a screening of "The Dark Knight Rises" in Colorado last summer, but if there was any lull in attendance, it was slight and temporary. Ticket sales went on a tear for most of the fall.

While domestic revenues inch upward most years largely because of inflation, the real growth areas have been overseas, where more and more fans are eager for the next Hollywood blockbuster.

International business generally used to account for less than half of a studio film's overall receipts. Films now often do two or even three times as much business overseas as they do domestically. Some movies that were duds with U.S. audiences, such as "Battleship" and "John Carter," can wind up being $200 million hits with overseas crowds.

Whether finishing a good year or a bad one, Hollywood executives always look ahead to better days, insisting that the next crop of blockbusters will be bigger than ever. The same goes this time as studio bosses hype their 2013 lineup, which includes the latest "Iron Man," ''Star Trek," ''Hunger Games" and "Thor" installments, the Superman tale "Man of Steel" and the second chapter in "The Hobbit" trilogy.

Twelve months from now, they hope to be talking about another revenue record topping this year's $10.8 billion.

"I've been saying we're going to hit that $11 billion level for about three years now," said Paul Dergarabedian, a box-office analyst for Hollywood.com. "Next year I think is the year we actually do it."

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Online:

http://www.hollywood.com

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Predicting who's at risk for violence isn't easy

CHICAGO (AP) — It happened after Columbine, Virginia Tech, Aurora, Colo., and now Sandy Hook: People figure there surely were signs of impending violence. But experts say predicting who will be the next mass shooter is virtually impossible — partly because as commonplace as these calamities seem, they are relatively rare crimes.

Still, a combination of risk factors in troubled kids or adults including drug use and easy access to guns can increase the likelihood of violence, experts say.

But warning signs "only become crystal clear in the aftermath, said James Alan Fox, a Northeastern University criminology professor who has studied and written about mass killings.

"They're yellow flags. They only become red flags once the blood is spilled," he said.

Whether 20-year-old Adam Lanza, who used his mother's guns to kill her and then 20 children and six adults at their Connecticut school, made any hints about his plans isn't publicly known.

Fox said that sometimes, in the days, weeks or months preceding their crimes, mass murderers voice threats, or hints, either verbally or in writing, things like "'don't come to school tomorrow,'" or "'they're going to be sorry for mistreating me.'" Some prepare by target practicing, and plan their clothing "as well as their arsenal." (Police said Lanza went to shooting ranges with his mother in the past but not in the last six months.)

Although words might indicate a grudge, they don't necessarily mean violence will follow. And, of course, most who threaten never act, Fox said.

Even so, experts say threats of violence from troubled teens and young adults should be taken seriously and parents should attempt to get them a mental health evaluation and treatment if needed.

"In general, the police are unlikely to be able to do anything unless and until a crime has been committed," said Dr. Paul Appelbaum, a Columbia University professor of psychiatry, medicine and law. "Calling the police to confront a troubled teen has often led to tragedy."

The American Academy of Child & Adolescent Psychiatry says violent behavior should not be dismissed as "just a phase they're going through."

In a guidelines for families, the academy lists several risk factors for violence, including:

—Previous violent or aggressive behavior

—Being a victim of physical or sexual abuse

—Guns in the home

—Use of drugs or alcohol

—Brain damage from a head injury

Those with several of these risk factors should be evaluated by a mental health expert if they also show certain behaviors, including intense anger, frequent temper outbursts, extreme irritability or impulsiveness, the academy says. They may be more likely than others to become violent, although that doesn't mean they're at risk for the kind of violence that happened in Newtown, Conn.

Lanza, the Connecticut shooter, was socially withdrawn and awkward, and has been said to have had Asperger's disorder, a mild form of autism that has no clear connection with violence.

Autism experts and advocacy groups have complained that Asperger's is being unfairly blamed for the shootings, and say people with the disorder are much more likely to be victims of bullying and violence by others.

According to a research review published this year in Annals of General Psychiatry, most people with Asperger's who commit violent crimes have serious, often undiagnosed mental problems. That includes bipolar disorder, depression and personality disorders. It's not publicly known if Lanza had any of these, which in severe cases can include delusions and other psychotic symptoms.

Young adulthood is when psychotic illnesses typically emerge, and Appelbaum said there are several signs that a troubled teen or young adult might be heading in that direction: isolating themselves from friends and peers, spending long periods alone in their rooms, plummeting grades if they're still in school and expressing disturbing thoughts or fears that others are trying to hurt them.

Appelbaum said the most agonizing calls he gets are from parents whose children are descending into severe mental illness but who deny they are sick and refuse to go for treatment.

And in the case of adults, forcing them into treatment is difficult and dependent on laws that vary by state.

All states have laws that allow some form of court-ordered treatment, typically in a hospital for people considered a danger to themselves or others. Connecticut is among a handful with no option for court-ordered treatment in a less restrictive community setting, said Kristina Ragosta, an attorney with the Treatment Advocacy Center, a national group that advocates better access to mental health treatment.

Lanza's medical records haven't been publicly disclosed and authorities haven't said if it is known what type of treatment his family may have sought for him. Lanza killed himself at the school.

Jennifer Hoff of Mission Viejo, Calif. has a 19-year-old bipolar son who has had hallucinations, delusions and violent behavior for years. When he was younger and threatened to harm himself, she'd call 911 and leave the door unlocked for paramedics, who'd take him to a hospital for inpatient mental care.

Now that he's an adult, she said he has refused medication, left home, and authorities have indicated he can't be forced into treatment unless he harms himself — or commits a violent crime and is imprisoned. Hoff thinks prison is where he's headed — he's in jail, charged in an unarmed bank robbery.

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Online:

American Academy of Child & Adolescent Psychiatry: http://www.aacap.org

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AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner

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