Petraeus’s Lower C.I.A. Profile Leaves Benghazi Void

WASHINGTON — In 14 months as C.I.A. director, David H. Petraeus has shunned the spotlight he once courted as America’s most famous general. His low-profile style has won the loyalty of the White House, easing old tensions with President Obama, and he has overcome some of the skepticism he faced from the agency’s work force, which is always wary of the military brass.

Brendan Smialowski/Getty Images

The low-profile style of David H. Petraeus, right, has won the loyalty of the White House, easing old tensions with President Obama.

Win Mcnamee/Getty Images

C.I.A. director, David H. Petraeus, right, appeared before the Senate Select Committee on Intelligence in Washington in January.

But since an attack killed four Americans seven weeks ago in Benghazi, Libya, his deliberately low profile, and the C.I.A.’s penchant for secrecy, have left a void that has been filled by a news media and Congressional furor over whether it could have been prevented. Rather than acknowledge the C.I.A.’s presence in Benghazi, Mr. Petraeus and other agency officials fought a losing battle to keep it secret, even as the events there became a point of contention in the presidential campaign.

Finally, on Thursday, with Mr. Petraeus away on a visit to the Middle East, pressure from critics prompted intelligence officials to give their own account of the chaotic night when two security officers died along with the American ambassador, J. Christopher Stevens, and another diplomat. The officials acknowledged for the first time that the security officers, both former members of the Navy SEALs, worked on contract for the C.I.A., which occupied one of the buildings that were attacked.

The Benghazi crisis is the biggest challenge so far in the first civilian job held by Mr. Petraeus, who retired from the Army and dropped the “General” when he went to the C.I.A. He gets mostly high marks from government colleagues and outside experts for his overall performance. But the transition has meant learning a markedly different culture, at an agency famously resistant to outsiders.

“I think he’s a brilliant man, but he’s also a four-star general,” said Senator Dianne Feinstein, the chairwoman of the Senate Intelligence Committee. “Four-stars are saluted, not questioned. He’s now running an agency where everything is questioned, whether you’re a four-star or a senator. It’s a culture change.”

Mr. Petraeus, who turns 60 next week, has had to learn that C.I.A. officers will not automatically defer to his judgments, as military subordinates often did. “The attitude at the agency is, ‘You may be the director, but I’m the Thailand analyst,’ ” said one C.I.A. veteran.

Long a media star as the most prominent military leader of his generation, Mr. Petraeus abruptly abandoned that style at the C.I.A. Operating amid widespread complaints about leaks of classified information, he has stopped giving interviews, speaks to Congress in closed sessions and travels the globe to consult with foreign spy services with little news media notice.

“He thinks he has to be very discreet and let others in the government do the talking,” said Michael E. O’Hanlon, a Brookings Institution scholar who is a friend of Mr. Petraeus’s and a member of the C.I.A.’s advisory board.

Mr. Petraeus’s no-news, no-nonsense style stands out especially starkly against that of his effusive predecessor, Leon E. Panetta, who is now the defense secretary.

Mr. Panetta, a gregarious politician by profession, was unusually open with Congress and sometimes with the public — to a fault, some might say, when he spoke candidly after leaving the C.I.A. about a Pakistani doctor’s role in helping hunt for Osama bin Laden, or about the agency’s drone operations.

Mr. Petraeus’s discretion and relentless work ethic have had a positive side for him: old tensions with Mr. Obama, which grew out of differing views on the wars in Iraq and Afghanistan, appear to be gone. Mr. Petraeus is at the White House several times a week, attending National Security Council sessions and meeting weekly with James R. Clapper Jr., the director of national intelligence, and Thomas E. Donilon, Mr. Obama’s national security adviser. Mr. Donilon said recently that the C.I.A. director “has done an exceptional job,” bringing “deep experience, intellectual rigor and enthusiasm” to his work.

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Second Illness Infects Meningitis Sufferers

Just when they might have thought they were in the clear, people recovering from meningitis in an outbreak caused by a contaminated steroid drug have been struck by a second illness.

The new problem, called an epidural abscess, is an infection near the spine at the site where the drug — contaminated by a fungus — was injected to treat back or neck pain. The abscesses are a localized infection, different from meningitis, which affects the membranes covering the brain and spinal cord. But in some cases, an untreated abscess can cause meningitis. The abscesses have formed even while patients were taking powerful antifungal medicines, putting them back in the hospital for more treatment, often with surgery.

The problem has just begun to emerge, so far mostly in Michigan, which has had more people sickened by the drug — 112 out of 404 nationwide — than any other state.

“We’re hearing about it in Michigan and other locations as well,” said Dr. Tom M. Chiller, the deputy chief of the mycotic diseases branch of the Centers for Disease Control and Prevention. “We don’t have a good handle on how many people are coming back.”

He added, “We are just learning about this and trying to assess how best to manage these patients. They’re very complicated.”

In the last few days, about a third of the 53 patients treated for meningitis at St. Joseph Mercy Hospital in Ann Arbor, Mich., have returned with abscesses, said Dr. Lakshmi K. Halasyamani, the chief medical officer.

“This is a significant shift in the presentation of this fungal infection, and quite concerning,” she said. “An epidural abscess is very serious. It’s not something we expected.”

She and other experts said they were especially puzzled that the infections could occur even though patients were taking drugs that, at least in tests, appeared to work against the fungus causing the infection, a type of black mold called Exserohilum.

The main symptom is severe pain near the injection site. But the abscesses are internal, with no visible signs on the skin, so it takes an M.R.I. scan to make the diagnosis. Some patients have more than one abscess. In some cases, the infection can be drained or cleaned out by a neurosurgeon.

But sometimes fungal strands and abnormal tissue are wrapped around nerves and cannot be surgically removed, said Dr. Carol A. Kauffman, an expert on fungal diseases at the University of Michigan. In such cases, all doctors can do is give a combination of antifungal drugs and hope for the best. They have very little experience with this type of infection.

Some patients have had epidural abscesses without meningitis; St. Joseph Mercy Hospital has had 34 such cases.

A spokesman for the health department in Tennessee, which has had 78 meningitis cases, said that a few cases of epidural abscess had also occurred there, and that the state was trying to assess the extent of the problem.

Dr. Chiller said doctors were also reporting that some patients exposed to the tainted drug had arachnoiditis, a nerve inflammation near the spine that can cause intense pain, bladder problems and numbness.

“Unfortunately, we know from the rare cases of fungal meningitis that occur, that you can have complicated courses for this disease, and it requires prolonged therapy and can have some devastating consequences,” he said.

The meningitis outbreak, first recognized in late September, is one of the worst public health disasters ever caused by a contaminated drug. So far, 29 people have died, often from strokes caused by the infection. The case count is continuing to rise. The drug was a steroid, methylprednisolone acetate, made by the New England Compounding Center in Framingham, Mass. Three contaminated lots of the drug, more than 17,000 vials, were shipped around the country, and about 14,000 people were injected with the drug, mostly for neck and back pain. But some received injections for arthritic joints and have developed joint infections.

Inspections of the compounding center have revealed extensive contamination. It has been shut down, as has another Massachusetts company, Ameridose, with some of the same owners. Both companies have had their products recalled.

Compounding pharmacies, which mix their own drugs, have had little regulation from either states or the federal government, and several others have been shut down recently after inspections found sanitation problems.

Read More..

Second Illness Infects Meningitis Sufferers

Just when they might have thought they were in the clear, people recovering from meningitis in an outbreak caused by a contaminated steroid drug have been struck by a second illness.

The new problem, called an epidural abscess, is an infection near the spine at the site where the drug — contaminated by a fungus — was injected to treat back or neck pain. The abscesses are a localized infection, different from meningitis, which affects the membranes covering the brain and spinal cord. But in some cases, an untreated abscess can cause meningitis. The abscesses have formed even while patients were taking powerful antifungal medicines, putting them back in the hospital for more treatment, often with surgery.

The problem has just begun to emerge, so far mostly in Michigan, which has had more people sickened by the drug — 112 out of 404 nationwide — than any other state.

“We’re hearing about it in Michigan and other locations as well,” said Dr. Tom M. Chiller, the deputy chief of the mycotic diseases branch of the Centers for Disease Control and Prevention. “We don’t have a good handle on how many people are coming back.”

He added, “We are just learning about this and trying to assess how best to manage these patients. They’re very complicated.”

In the last few days, about a third of the 53 patients treated for meningitis at St. Joseph Mercy Hospital in Ann Arbor, Mich., have returned with abscesses, said Dr. Lakshmi K. Halasyamani, the chief medical officer.

“This is a significant shift in the presentation of this fungal infection, and quite concerning,” she said. “An epidural abscess is very serious. It’s not something we expected.”

She and other experts said they were especially puzzled that the infections could occur even though patients were taking drugs that, at least in tests, appeared to work against the fungus causing the infection, a type of black mold called Exserohilum.

The main symptom is severe pain near the injection site. But the abscesses are internal, with no visible signs on the skin, so it takes an M.R.I. scan to make the diagnosis. Some patients have more than one abscess. In some cases, the infection can be drained or cleaned out by a neurosurgeon.

But sometimes fungal strands and abnormal tissue are wrapped around nerves and cannot be surgically removed, said Dr. Carol A. Kauffman, an expert on fungal diseases at the University of Michigan. In such cases, all doctors can do is give a combination of antifungal drugs and hope for the best. They have very little experience with this type of infection.

Some patients have had epidural abscesses without meningitis; St. Joseph Mercy Hospital has had 34 such cases.

A spokesman for the health department in Tennessee, which has had 78 meningitis cases, said that a few cases of epidural abscess had also occurred there, and that the state was trying to assess the extent of the problem.

Dr. Chiller said doctors were also reporting that some patients exposed to the tainted drug had arachnoiditis, a nerve inflammation near the spine that can cause intense pain, bladder problems and numbness.

“Unfortunately, we know from the rare cases of fungal meningitis that occur, that you can have complicated courses for this disease, and it requires prolonged therapy and can have some devastating consequences,” he said.

The meningitis outbreak, first recognized in late September, is one of the worst public health disasters ever caused by a contaminated drug. So far, 29 people have died, often from strokes caused by the infection. The case count is continuing to rise. The drug was a steroid, methylprednisolone acetate, made by the New England Compounding Center in Framingham, Mass. Three contaminated lots of the drug, more than 17,000 vials, were shipped around the country, and about 14,000 people were injected with the drug, mostly for neck and back pain. But some received injections for arthritic joints and have developed joint infections.

Inspections of the compounding center have revealed extensive contamination. It has been shut down, as has another Massachusetts company, Ameridose, with some of the same owners. Both companies have had their products recalled.

Compounding pharmacies, which mix their own drugs, have had little regulation from either states or the federal government, and several others have been shut down recently after inspections found sanitation problems.

Read More..

For Hourly Workers After the Storm, No Work, No Pay

Chantal Sainvilus, a home health aide in Brooklyn who makes $10 an hour, does not get paid if she does not show up. So it is no wonder that she joined the thousands of people taking extreme measures to get to work this week, even, in her case, hiking over the Williamsburg Bridge.

While salaried employees worked if they could, often from home after Hurricane Sandy, many of the poorest New Yorkers faced the prospect of losing days, even a crucial week, of pay on top of the economic ground they have lost since the recession.

Low-wage workers, more likely to be paid hourly and work at the whim of their employers, have fared worse in the recovery than those at the top of the income scale — in New York City the bottom 20 percent lost $463 in annual income from 2010 to 2011, in contrast to a gain of almost $2,000 for the top quintile. And there are an increasing number of part-time and hourly workers, the type that safety net programs like unemployment are not designed to serve. Since 2009, when the recovery began, 86 percent of the jobs added nationally have been hourly. Over all, about 60 percent of the nation’s jobs are hourly.

Even as the sluggish economy has accentuated this divide, Hurricane Sandy has acted as a further wedge, threatening to take a far greater toll on the have-littles who live from paycheck to paycheck.

“There’s a lot of people in our society that are living in a very precarious situation in terms of low wages or very insecure work,” said Arne L. Kalleberg, a sociologist at the University of North Carolina at Chapel Hill and author of “Good Jobs, Bad Jobs.” “That’s why it’s important to have a safety net that’s based on the idea of people working insecure jobs like this.”

On Friday, Gov. Andrew M. Cuomo announced that New York City and four suburban counties were eligible for disaster unemployment relief, which covers a broader spectrum of workers than regular unemployment benefits, including the self-employed like taxi drivers and street vendors as well as those who were unable to get to work.

New Jersey has also declared people in 10 counties eligible for disaster unemployment assistance. In Connecticut, residents of four counties and the Mashantucket Pequot Indian Reservation are eligible.

A New York Department of Labor spokesman emphasized that workers who lost wages should call to apply because the program is flexible and many eligibility issues would be determined on a case-by-case basis.

But the program might not help people whose commute simply lasted longer or cost more, like Ibezim Oki, a cabdriver who spent $50 on a cab to get from his Brooklyn home to Manhattan on Friday, rather than risk long bus delays, and “now I don’t know how long I’m going to have to wait for gas.”

The commute alone represented a hardship for workers whose jobs require a physical presence, while neighborhood coffee shops in the boroughs and suburbs overflowed with those who needed nothing more than a laptop and Wi-Fi to stay connected to work.

Ms. Sainvilus estimated that on Thursday, she had traveled eight hours to work for five, making her effective pay less than $4 an hour.

Others could not work because their place of business was closed. At a food distribution center in Chelsea, Mike Samuel, 55, a delivery man for a florist, was feeling the pain of five days of lost income. “We don’t work, we don’t get no tips, we don’t get no pay,” he said.

Muta Prather said the chemical company where he works in Newark was flooded, causing him to miss three days of work. He worked part of the day on Thursday helping to clean up, but worried about how he would pay for damage to his own roof.

“It hurts, you know,” said Mr. Prather, who is 49 and lives in West Orange, N.J. “I looked up at my roof, and it’s going to cost me like seven grand. I don’t make that kind of money.”

But at a playground in the Clinton Hill section of Brooklyn, Damien Carney stood with his baby daughter strapped to his chest and his toddler on a nearby swing, enjoying a surprise week off. For Mr. Carney, a salaried portfolio manager for a wine distributor that was closed because it had no power, the storm was amounting to something like a paid vacation with time for cooking and rearranging the living room. “They basically said, ‘Don’t worry about it,’ ” Mr. Carney said of his employers.

Federal labor laws include more protections for salaried workers than hourly workers when a disaster hits. Employers must continue to pay salaries if the worksite is closed for less than a week, even though they are allowed to require employees to use vacation or paid leave for the duration of the closure. Hourly workers, on the other hand, do not have to be paid if the worksite closes. If the workplace is open but salaried workers cannot get there, their pay may be reduced.

Of course, policies vary from workplace to workplace, and some hourly workers were luckier than others. Cassandra Williams, 54, waiting for the bus from Brooklyn to Manhattan with her 6-year-old granddaughter, said the family for whom she keeps house would pay her full wages despite her missing three days of work. Tinash Makots, a 24-year-old salesman at the Nike store in Midtown Manhattan, said he would be paid for the days missed as well.

One nanny in the bus line said she would be paid her regular wages, while another said she would not be compensated for hours missed.

A financial district worker who would identify himself only as William S. said he did not strictly need to go into Manhattan to do his job, but felt that he should make an appearance after one of his staff members showed up every day at 6 a.m. and another paid $40 a day to get to a distant office in Queens.

But Anthony Howell, a 42-year-old hair stylist in Chelsea, said he hadn’t worked all week because his salon, like his high-rise apartment, has no electricity.

“That’s the brutal part,” he said. “The hair industry is like that. You don’t do the work, you don’t get the money.”

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Sony, Sharp and Panasonic Report Significant Losses

TOKYO — After years of bets gone wrong and lost opportunities, three of Japan’s consumer electronics giants are showing some signs of faltering.

In the most dire warning, Sharp forecast on Thursday a 450 billion yen ($5.6 billion) full-year loss and warned that it had “material doubts” about its ability to survive.

On the same day, Panasonic’s shares lost a fifth of their value in Tokyo after the company forecast a 765 billion yen ($9.6 billion) annual net loss from write-downs in its solar-power, battery and mobile handset businesses.

And Sony, perhaps the best positioned of the companies, posted a net loss of 15.5 billion yen ($194 million) for the quarter on Thursday and warned of falling sales in almost every product it sells.

“We have a lot of great technology which we want to tap to revive and generate profit, but the company does not have that vitality,” Takashi Okuda, Sharp’s chief executive, told reporters after the company posted a net loss of 249 billion yen ($3.1 billion) for the three months to September. The loss was far larger than expected.

In a statement, the company said it had a “serious negative operating cash flow” which raised “serious doubts” about its ability to continue as a going concern, and said it was taking steps, including pay cuts, voluntary redundancies and asset sales, to generate cash flow.

While Sharp is in the most serious trouble, the three companies’ woes are similar at the core.

All three make good quality, even cutting-edge products — but so do their overseas competitors, usually at lower prices. None of the three have managed to generate the brand pizazz of Apple, or the marketing muscle of Samsung Electronics. In addition, a stubbornly strong yen continues to sap their competitiveness, while Japan’s territorial dispute with China has hurt sales there.

The scale of the losses is the result of specific missteps, from huge investments in the wrong technologies to a reluctance to exit loss-making businesses. A manufacturing bubble here in the mid-2000s — fed partly by an unusually weak currency and Americans flush with cash from rising home prices — masked continued weaknesses in their business models and spurred the companies to take big bets that backfired.

When the global financial crisis brought that boom to an end in 2008, the three were saddled with excess capacity, bloated work forces and investments that they could hardly hope to recoup. And their refusal to make a big enough departure from the ways of their glory years is now making a comeback difficult.

“Many investors are longing for reforms that will let all of the pus out,” Yuji Fujimori, technology analyst at Barclays Capital in Tokyo, said in a recent note to clients.

Sharp’s stumble, in many ways, has been the most humbling. It was the biggest beneficiary of the manufacturing bubble: from 2000 to 2007, its profits jumped 150 percent. Sharp’s high-end Aquos liquid-crystal display televisions — which it manufactured at state-of-the-art factories in Kameyama, in western Japan — were a runaway hit in the nascent flat-panel market. The spinoff Aquos cellphone topped Japanese sales rankings. Sharp’s solar batteries also sold briskly, helped by a bubble in green technologies.

The company’s success during this period seemed to validate Japan’s penchant for manufacturing their most important products in-house. In advertisements, Sharp showed off its cutting-edge factories.

But even before the financial crisis, analysts were warning of an impending crash in prices of flat-panel televisions, which were fast becoming commodities that cheap upstarts could emulate. In 2008, the iPhone made its debut in Japan, the end of an era for Japanese-style cellphones. Chinese upstarts were starting to flood global markets with cheap solar panels and batteries. In consumer electronics, outsourced manufacturing became the norm.

Still, Sharp did not change course. It built a new factory in Sakai, Japan, which could make 6 million large LCD panels a year — more than the size of the global market at the time. Sharp missed the smartphone wave, and its cellphone sales in Japan halved from 2007 to 2012. And in late 2011, the solar bubble burst, driving many solar power companies into bankruptcy and Sharp’s solar batteries business into the red. The unit has not turned a profit since.

Now, the Kameyama factories no longer make televisions but panels for Apple’s iPhones and iPads.

Panasonic, for its part, also bet heavily on plasma televisions in 2003, pouring some 600 billion yen into a series of factories in Amagasaki, not far from Sharp’s own plant. It also bet on solar panels and rechargeable batteries, buying Sanyo in 2009.

But with plasma now a fading technology and solar power struggling, Panasonic is saddled with major losses. Last year, it announced that a factory in Amagasaki was closing, less than two years after it opened.

Kazuhiro Tsuga, who took the helm at Panasonic this year, was blunt in describing his company’s predicament. “We are among the losers in consumer electronics," he told a news conference on Wednesday. He now promises to shift the company away from money-losing televisions and gadgets.

Of the three, Sony now seems the most prescient. Its executives have preached the power of networks and content since the 1990s, building up a vast catalog of music and movies to lure users to their devices. Sony has also moved to slash costs and jobs and sell off some unprofitable businesses, refocusing the company on digital cameras and imaging technology, video games and mobile devices. This quarter, the sale of its chemical products business, which made materials for LCDs and optical discs, helped alleviate losses. Sony is now making a push into the medical field with an investment in the endoscope maker Olympus.

Internal squabbling has quashed its efforts to marry its hardware and software, however, and it refuses to abandon one of its biggest money-losers, its television business, which has bled red ink for eight consecutive years.

“We intend to hunker down and build a profitable business,” Masaru Kato, Sony’s chief financial officer, told a news conference Thursday. “And where we can, we will chase new markets.”

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At Bellevue, a Desperate Fight to Ensure the Patients’ Safety

Uli Seit for The New York Times

Ralston Davis had a triple heart bypass operation at Bellevue, but when the hospital lost power, he walked down 10 flights of stairs and was moved to another medical center.

From the moment the water lapped above street level in Lower Manhattan, the doctors and nurses of Bellevue Hospital Center began a desperate struggle to keep patients safe. By 9 p.m. Monday, the hospital was on backup power, and an hour later, the basement was flooded.

Officials rushed to move the most critically ill patients closer to an emergency generator. After midnight, doctors heard shouts in the hallway. The basement fuel pumps had stopped working, and medical residents, nurses and administrators formed a bucket brigade to ferry fuel up 13 flights to the main backup generators.

By Tuesday, the elevator shafts at Bellevue, the country’s oldest public hospital, had flooded, so all 32 elevators stopped working. There was limited compressed air to run ventilators, so oxygen tanks were placed next to the beds of patients who needed them. Water faucets went dry, food ran low, and buckets of water had to be carried up to flush toilets.

Some doctors began urging evacuations, and on Tuesday, at least two dozen ambulances lined up around the block to pick up many of the 725 patients housed there. People carried babies down flights of stairs. The National Guard was called in to help. On Thursday afternoon, the last two patients were waiting to be taken out.

The evacuation went quickly only because Bellevue had planned for such a possibility before Hurricane Irene hit last year, several doctors said. But the city, which had evacuated two nearby hospitals before that storm, decided not to clear out Bellevue. In the wake of Hurricane Sandy, the consequences of bad calls, bad luck and equipment failures cascaded through the region’s health care system, as sleep-deprived health care workers and patients were confronted by a new kind of disarray.

A patient recovering from a triple bypass operation at Bellevue walked down 10 flights of stairs to a waiting ambulance, one of the dozens provided through the Federal Emergency Management Agency to speed patients across the metropolitan region.

Mount Sinai Medical Center, already dealing with the 2 a.m. arrival of a dozen psychiatric patients who spoke only Chinese, was struggling to identify the relatives of brain-injured traffic victims from Bellevue who arrived three hours later with only rudimentary medical records.

Maimonides Medical Center in Brooklyn was straining to meet a rising need for emergency dialysis for hundreds of people shut out of storm-crippled private dialysis centers. Patients who would normally get three hours of dialysis were getting only two, to ensure the maximum number of people received at least a minimal amount of care.

“The catastrophe is growing by the minute,” said Eileen Tynion, a Maimonides spokeswoman. “Here we thought we’d reached a quiet point after the storm.”

Every hospital maintains an elaborate disaster plan, but after Hurricane Sandy, the fact that many health care facilities are in low-lying areas proved to be something of an Achilles’ heel. Bellevue became the third hospital in the city to evacuate after the storm’s landfall, after NYU Langone Medical Center, just north of Bellevue, and Coney Island Hospital, another public hospital.

New York Downtown Hospital, the only hospital south of 14th Street in Manhattan, and the Veterans Affairs Hospital, just below Bellevue, had evacuated before the storm.

Hospital executives were reluctant to criticize their colleagues or city officials. But the sequence of events left them with many questions.

“All hospitals are required to do disaster planning and disaster drills,” Pamela Brier, the chief executive of Maimonides, noted. “All hospitals are required as a condition of being accredited, to have generators, backup generators.”

City health department and emergency officials have been particularly fervent about citywide disaster drills, she added, but “as prepared as we think we are we’ve never had a mock disaster drill where we carried patients downstairs. I’m shocked that we didn’t do that. Now we’re going to.”

The city’s health commissioner, Dr. Thomas Farley, defended the decision not to require evacuations of Bellevue, Coney Island and NYU Langone hospitals before the storm, which he said had been made in consultation with the state health commissioner, Dr. Nirav Shah.

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Live Coverage: Burdens of Storm’s Damage Ease Slightly

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State-by-State Guide

A look at the devastation caused in the aftermath of Hurricane Sandy from North Carolina to New England.

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