South L.A. frustrated by delays in building new King hospital

Earlier this year, Joane Austin rushed her elderly mother to the emergency room for fear she was having a heart attack.

Austin normally would have made the short trip to Martin Luther King Jr./Drew Medical Center, the landmark hospital in South Los Angeles. But King/Drew has been closed for five years, so Austin drove several miles to the emergency room at Centinela Hospital Medical Center in Inglewood.

"I prayed all the lights would stay green," she said. "It was scary."

Once they arrived, doctors determined that Austin's mother needed emergency surgery to remove scar tissue around her intestines.

For years, King/Drew provided emergency, trauma and inpatient care to residents from throughout South Los Angeles. After a series of medical errors resulted in patient deaths, Los Angeles County closed it in 2007. County officials promised the community a better, safer new medical center in a few years.

But the opening has been repeatedly delayed, and the community is still waiting. Originally, officials hoped to have the new facility ready by 2010. Then it was pushed to 2012. Now, officials say they plan to have construction completed next year and the hospital opening its doors in 2014.

Without a nearby hospital, patients have had to travel to such places as Bellflower, Inglewood and Long Beach for emergency room and inpatient care.

Several local hospitals — California Hospital Medical Center, L.A. County/USC Medical Center and Harbor-UCLA Medical Center — received an influx of former King patients after the closure. The closest hospital, St. Francis Medical Center in Lynwood, reported an increase of 20% to 30% in emergency room visits since King/Drew closed, though other factors also may have contributed to the rise.

Getting to other hospitals has presented a challenge for many in the low-income neighborhood, said William Hobson, president and chief executive of the Watts Healthcare Corp. "Just the fact that it is a long way away may discourage them from going," he said.

The closure of King/Drew, which was born out of the Watts riots and opened in 1972, created a healthcare gap in a community where rates of chronic disease are high and vast swaths of the population lack insurance, said David Carlisle, president of the adjacent Charles R. Drew University of Medicine and Science. South Los Angeles has a shortage of doctors, inpatient beds and outpatient services, according to both experts and research.

Despite King/Drew's many medical lapses, which earned it the nickname "Killer King," many in the community remained fiercely loyal to the hospital and the services it provided.

Studies examining the impact of King/Drew's closure found that it led to delays in care for elderly blacks and Latinos and a dramatic increase in patient admissions at other trauma centers. Physicians throughout the county also reported more overcrowding in other emergency rooms and said they saw sicker patients who didn't know where to go or couldn't afford transportation elsewhere.

"It is fearful to think about how many lives may have been saved had this thing been opened by now," said Lark Galloway-Gilliam, executive director of the advocacy group Community Health Councils. "It shouldn't take five years to build a facility."

Patrick Wooten, 49, went to St. Francis when he had a dislocated kneecap a few years ago. Wooten, who is uninsured, said he received good care at the private hospital but then got a $3,200 bill. Wooten said he is frustrated that the new King hospital still hasn't opened and won't until 2014. "What you do until then, God only knows," he said. "Hopefully we can wait it out."

Last year, Sandira Gonzalez, 29, took her 5-year-old son to the Martin Luther King urgent care center when he had a fever. But when the center closed for the night, her son had to be taken by ambulance to Harbor-UCLA near Torrance, where he was treated for an infection.

Community members and advocates said they are disappointed by the long wait, caused by a combination of bureaucratic delays and the complexity of the project. But when it does open, they said, they are hopeful that it will be a better, and safer, hospital.

The county is building the hospital and will help support it financially but will not be responsible for day-to-day operations. Instead, an independent, nonprofit organization will run the facility, to be known as Martin Luther King Jr. Community Hospital, and the University of California will help staff it and ensure the quality of patient care. Construction is progressing, but the grand opening may still be nearly two years away.

"It will be a significantly different kind of institution, with the right kind of accountability," said Robert K. Ross, president and chief executive of the California Endowment. "Now we just need the institution to open up on budget and on time."

Los Angeles County Supervisor Mark Ridley-Thomas said it takes time to create a state-of-the-art hospital — and a whole medical complex — that could become a model for others around the nation. "A lot of eyes are on this," he said. "We want to do this well and we want to do it right.... Nothing else is acceptable."

The nonprofit's board recognizes how critical the facility is to the area, said board President Manny Abascal. "Every day this hospital is not open, people are suffering," he said. At the same time, he added, the board is committed to ensuring that the new hospital is a high-quality institution. "If you open it … and there are some of the same problems you had before, then it's going to be devastating," he said.

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The Cow Jumped Over the Moon (1957)

In June 1957, launch of the civilian U.S. Vanguard scientific satellite (image at top of post) was thought imminent. That month, Krafft Ehricke and George Gamow wrote in Scientific American magazine that, after Vanguard reached low-Earth orbit, the moon, 238,000 miles away, would be “the next interesting target in space.” They estimated that, with “luck and sufficient effort,” a U.S. automated probe could reach the moon by 1963.

Ehricke and Gamow proposed a design for such a probe, which they inelegantly dubbed “Cow” in tribute to the moon-jumping nursery rhyme character. Cow would have a mass of between 400 and 800 pounds. A 100-foot-tall, 120-ton rocket would boost it to a speed of 23,827 miles per hour on a path toward the moon. If the Earth existed in isolation, Cow would then enter an elliptical orbit around the Earth taking it 280,000 miles out into space – that is, about 45,000 miles beyond the moon. The gravitational attraction of the moon and Sun meant, however, that Cow would follow a “distorted” path to a point 1281 miles from the moon 75.6 hours after launch. The probe would then swing around the moon, collecting data all the while, and fall back to Earth.

Cow would strike Earth’s atmosphere moving at 25,000 miles per hour 157 hours after launch. Though high-speed reentry would drive Cow’s skin temperature to 5000° C, Ehricke and Gamow maintained that “preventing the capsule from burning up by means of insulation and a cooling system” would not be “technically prohibitive.” This would enable recovery of high-quality photographic film images and other recorded data.

Ehricke and Gamow then proposed an explosive follow-on mission that would employ two probes launched on a “Cow-type” trajectory. The lead probe would drop an atomic bomb on the moon, blasting a debris cloud far into space; then, through “a miracle of electronic guidance,” the trailing probe would “dive into the cloud, collect some of the spray and emerge from its dive by means of an auxiliary jet.” It would then fall to Earth bearing its precious cargo of lunar material. This was one of a host of U.S. and Soviet proposals to explode nuclear weapons on the lunar surface put forward in the late 1950s/early 1960s, none of which reached fruition.

On 4 October 1957, the Soviet Union launched the first Earth satellite. Though the Soviets had announced two years previously that they aimed to launch a satellite, few in the West had taken them seriously. A second satellite, Sputnik 2, reached orbit with the dog Laika on board on November 3, 1957.

The first Vanguard launch attempt, designated TV3, ended in a nationally televised launch pad explosion on 6 December 1957, heaping humiliation upon humiliation. President Dwight Eisenhower, eager to calm American anxiety about Soviet technological prowess, decided not to rely solely on Vanguard. He authorized the U.S. Army rocket team under Wernher von Braun to prepare to launch a satellite as work toward the next Vanguard launch attempt proceeded. Citing technical difficulties (a fault in the Vanguard rocket’s second-stage engine), the Vanguard TV-3BU mission stood down on January 26, 1958, clearing the way for an Army Juno I rocket to launch Explorer 1, the first U.S. Earth satellite, on 31 January 1958.

The first Vanguard satellite to reach orbit left Earth on March 17, 1958. The 3.2-pound satellite, which ceased operating in 1964, remains in Earth orbit. Sputnik 1, Sputnik 2, and Explorer 1 have long since reentered the atmosphere and been destroyed, making Vanguard 1 the oldest artificial object orbiting Earth.

In August 1958, the U.S. and U.S.S.R. began to launch probes toward the moon. The Soviet Luna 2 probe became the first human-made object to strike the moon (13 September 1959) and Luna 3 imaged the moon’s hidden Farside (6 October 1959). No spacecraft would follow Ehricke and Gamow’s Cow-type trajectory until the Soviet Zond 5 (an unmanned test of a manned circumlunar spacecraft) in September 1967, and none would return samples of lunar surface material until the first manned moon landing (Apollo 11, 16-24 July 1969).

Reference:

A Rocket Around the Moon, K. Ehricke and G. Gamow, Scientific American, Volume 196, Number 6, June 1957, pp. 47-53.

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Dr. Dre ranks as Forbes’ highest-paid musician, at $100 million

LOS ANGELES (Reuters) – You may be singing “Call Me Maybe” or dancing “Gangnam Style” to this year’s music, but it was veteran hip-hop artist Dr. Dre who topped Forbes‘ list of the 25 highest-paid musicians in 2012, released on Thursday.

California native Dre, 47, became one of the leading names in hip-hop and rap in the early 1990s and has worked with artists including Eminem and Snoop Dogg.

Along with his extensive back catalog, Dre‘s lucrative headphones business, Beats by Dre, helped him gross $ 100 million in pre-tax earnings according to Forbes.

The list’s top 10 was dominated by veteran musicians, with Pink Floyd‘s bassist and singer Roger Waters coming in at No. 2 with earnings of $ 88 million from his lucrative The Wall Live tour, and British singer Elton John at No. 3 with $ 80 million.

Last year’s highest-paid musicians U2 landed at No. 4 this year with combined earnings of $ 78 million from their three-year 360 tour. 1990s British boy band Take That, who reformed in 2005, rounded out the top five with $ 69 million, earned from an eight-date tour at London’s Wembley Stadium, which became the highest-grossing single stadium tour to date.

Forbes compiles its annual highest-paid musicians list by estimating artists’ earnings from music sales, live shows, endorsements and merchandising. Earlier this year, Dutch DJ Tiesto was named the highest-paid DJ in the fast-growing electronic dance music industry.

The only two artists under 30 to break the top 10 were country-pop darling Taylor Swift, 22, who tied with ex-Beatle Paul McCartney at No. 8 with earnings of $ 57 million, and Canadian pop star Justin Bieber, 18, who tied with country star Toby Keith at No. 10 with earnings of $ 55 million.

Pop star and “X Factor” judge Britney Spears entered the list at No. 7 with earnings of $ 58 million, cementing her comeback after a turbulent few years. Her earnings encompass her multi-million dollar “X Factor” deal, music sales and endorsements.

Spears led eight female artists in the top 25 list, including R&B star Rihanna at No. 12 with $ 53 million, coming ahead of Lady Gaga at No. 13 with $ 52 million. Grammy-winning British singer Adele notched No. 22 on the list, tied with Kanye West, with earnings of $ 35 million following a record year for her album “21.”

Music’s power couple, singer Beyonce and rapper Jay-Z, came in at No. 18 and No. 20, respectively, with earnings of $ 40 million and $ 38 million.

(Reporting By Piya Sinha-Roy; editing by Jill Serjeant and Leslie Adler)

Music News Headlines – Yahoo! News

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Doctors Who Work for Hospitals Face a New Bottom Line

For decades, doctors in picturesque Boise, Idaho, were part of a tight-knit community, freely referring patients to the specialists or hospitals of their choice and exchanging information about the latest medical treatments.

But that began to change a few years ago, when the city’s largest hospital, St. Luke’s Health System, began rapidly buying physician practices all over town, from general practitioners to cardiologists to orthopedic surgeons.

Today, Boise is a medical battleground.

A little over half of the 1,400 doctors in southwestern Idaho are employed by St. Luke’s or its smaller competitor, St. Alphonsus Regional Medical Center.

Many of the independent doctors complain that both hospitals, but especially St. Luke’s, have too much power over every aspect of the medical pipeline, dictating which tests and procedures to perform, how much to charge and which patients to admit.

In interviews, they said their referrals from doctors now employed by St. Luke’s had dropped sharply, while patients, in many cases, were paying more there for the same level of treatment.

Boise’s experience reflects a growing national trend toward consolidation. Across the country, doctors who sold their practices and signed on as employees have similar criticisms. In lawsuits and interviews, they describe growing pressure to meet the financial goals of their new employers — often by performing unnecessary tests and procedures or by admitting patients who do not need a hospital stay.

In Boise, just a few weeks ago, even the hospitals were at war. St. Alphonsus went to court seeking an injunction to stop St. Luke’s from buying another physician practice group, arguing that the hospital’s dominance in the market was enabling it to drive up prices and to demand exclusive or preferential agreements with insurers. The price of a colonoscopy has quadrupled in some instances, and in other cases St. Luke’s charges nearly three times as much for laboratory work as nearby facilities, according to the St. Alphonsus complaint.

Federal and state officials have also joined the fray. In one of a handful of similar cases, the Federal Trade Commission and the Idaho attorney general are investigating whether St. Luke’s has become too powerful in Boise, using its newfound leverage to stifle competition.

Dr. David C. Pate, chief executive of St. Luke’s, denied the assertions by St. Alphonsus that the hospital’s acquisitions had limited patient choice or always resulted in higher prices. In some cases, Dr. Pate said, services that had been underpriced were raised to reflect market value. St. Luke’s, he argued, is simply embracing the new model of health care, which he predicted would lead over the long term to lower overall costs as fewer unnecessary tests and procedures were performed.

Regulators expressed some skepticism about the results, for patients, of rapid consolidation, although the trend is still too new to know for sure. “We’re seeing a lot more consolidation than we did 10 years ago,” said Jeffrey Perry, an assistant director in the F.T.C.’s Bureau of Competition. “Historically, what we’ve seen with the consolidation in the health care industry is that prices go up, but quality does not improve.”

A Drive to Consolidate

An array of new economic realities, from reduced Medicare reimbursements to higher technology costs, is driving consolidation in health care and transforming the practice of medicine in Boise and other communities large and small. In one manifestation of the trend, hospitals, private equity firms and even health insurance companies are acquiring physician practices at a rapid rate.

Today, about 39 percent of doctors nationwide are independent, down from 57 percent in 2000, according to estimates by Accenture, a consulting firm.

Many policy experts praise the shift away from independent practices as a way of making health care less fragmented and expensive. Systems that employ doctors, modeled after well-known organizations like Kaiser Permanente, are better able to coordinate patient care and to find ways to deliver improved services at lower costs, these advocates say. Indeed, consolidation is encouraged by some aspects of the Obama administration’s health care law.

“If you’re going to be paid for value, for performance, you’ve got to perform together,” said Dr. Ricardo Martinez, chief medical officer for North Highland, an Atlanta-based consultant that works with hospitals.

The recent trend is reminiscent of the consolidation that swept the industry in the 1990s in response to the creation of health maintenance organizations, or H.M.O.’s — but there is one major difference. Then, hospitals had difficulty managing the practices, contending that doctors did not work as hard when they were employees as they had as private operators. Now, hospitals are writing contracts more in their own favor.

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Online Retailers Rush to Adjust Prices in Real Time

The day before Thanksgiving, Amazon was offering a discounted price of $49.96 on a popular Xbox game, the same price as Walmart and 3 cents lower than Target.

Then the holiday pricing shuffle began.

Amazon dropped its price on the game, Dance Central 3, to $24.99 on Thanksgiving Day, matching Best Buy’s “doorbuster” special, and went to $15 once Walmart stores offered the game at that lower price. Amazon then brought the price up, down, down again, up and up again — in all, seven price changes in seven days.

The unluckiest buyer paid more than triple the price that the luckiest buyer paid.

Retail price wars online have entered a new era of speed and precision, creating a confusing landscape for shoppers in which prices leap and plummet on short notice. In the old days, merchants sent employees into competitors’ stores to check on pricing, and days later “sale” signs reflected new markdowns. Now, sophisticated computer programs accomplish the same goal online within hours, and even minutes.

The battle was fierce over the holiday weekend. At the request of The New York Times, the pricing firm Dynamite Data tracked prices at three major online retailers — Walmart.com, Amazon.com and Target.com — starting the week before Thanksgiving and going through Tuesday, after most heavy promotions ended.

The data shows that retailers paid close attention to competitors’ online prices and in-store specials, battling to undercut one another by as little as 2 cents and forcing each other into out-of-stock positions as they pushed prices down. Retailers fight to have the lowest prices to increase sales volume, aid in search-result prominence and help burnish a thrifty reputation.

“There was definitely some gamesmanship going on,” said Diana Schulz, chief executive of Dynamite Data, which tracks online retail pricing, stock status, ratings and other information for clients like Samsung and Abt Electronics.

While Amazon has long tinkered with prices, its competitors are now fighting back. In the last year, Walmart invested heavily in pricing tools, a Walmart eCommerce spokesman, Dan Toporek, said. Dynamite Data said there had been a marked increase in how much Walmart played with prices, and smaller retailers, including GameStop, Best Buy and Toys “R” Us, were now also adjusting some prices at least daily.

The goal is to attract shoppers with competitively priced products that show up on Web searches, but there is risk, too: some consumers tire of price whiplash.

“People are starting to realize, ‘I can’t trust the price I’m getting, because it might change,’ ” a pricing consultant, Rafi Mohammed, said. Shoppers have few ways to gain an advantage — ordering the same product at different prices requires expensive return shipments — but Mr. Mohammed said retailers had an opportunity to soothe consumers by offering refunds for price adjustments.

The parrying could be seen with a Nintendo game, Mario Kart DS.

A week before Thanksgiving, the retailers’ prices varied, with Amazon selling it at $29.17, Walmart at $40.88, and Target at $33.99, according to Dynamite Data. Through Thanksgiving, as Target kept the price stable, Walmart changed prices six times, and Amazon five. On Thanksgiving itself, Walmart marked down the price to its advertised $29.96, which Amazon matched.

Ms. Schulz said sophisticated retailers set algorithms to change prices in response to competitors. “Retailers pipe a bunch of information in electronically, like internal information — cost, availability of inventory, sales goals,” along with competitors’ prices, she said.

The software also lets retailers establish rules on the pricing of certain products: always price Furbys 5 percent below Kmart, for example, or make sure some goods are priced at an average of Amazon’s and Walmart’s prices. Generally, pricing managers also manually adjust prices.

Mr. Toporek said Walmart.com used a combination of computer tools and human adjustments. On popular items, like Walmart’s best sellers, the site tries to “maintain low prices on the items people want the most,” meaning it usually responds to competitors’ price changes.

Mr. Toporek said, however, that the site also tried not to jostle shoppers.

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Away from Egypt's protests, the worries mount

CAIRO — Amid thimbles, pins and strands of silver thread, the tailor twitched his pencil-perfect mustache in disgust and said the country where he learned to sew and raised six children was edging into darkness.

"I'm worried," said Sayed Abdelwahab, leaning on a worn counter in a shop where he has mended suits for decades. "I have employees with three and four kids. I'm responsible for them. My customers are mostly foreigners, but they're leaving the country. My business is down 50%. Did you see what happened to the stock market?"

"It's Morsi," said his friend Awad Abdelhafez, a porter, referring to Egyptian President Mohamed Morsi. "He's taken all the power.... Who's responsible for those dying in this violence?"

Such was the talk Thursday on a shaded street in a Cairo neighborhood far from the protest banners in Tahrir Square and the political intrigue over a new constitution. After nearly two years marked by endless clashes and skies tinged with tear gas, the true Egypt is slipping deeper into its worries.

The ragged semblance of democracy that emerged from the 2011 uprising against Hosni Mubarak is dominated by Morsi and his Muslim Brotherhood. The opposition can fill the streets with demonstrators and slogans but so far lacks the momentum to unseat Islamists in the fight for the nation's character.

But on this street, where butcher knives flash quick and women sell dusty oranges stacked in pyramids, such thoughts seem strange abstractions. But then, so does the recent revelation by Morsi to Time magazine that he found the movie "Planet of the Apes" to be politically instructive. Heads shake in weary unison.

"I'm so worried and depressed I can't follow things anymore," said Dina Mohamed, a call center operator. "Morsi's been ruling us for four months but he's mixing the wrong ingredients. I'm scared we're facing a hunger revolution. The poor will rise up for bread, not politics or culture, but for their own lives."

This in a nation where the average annual income is reported to be about $4,000. More than 40% of the population lives on $2 a day. The revolution has not improved these statistics, and to many Egyptians, that is its central failing. All the promises that have echoed from mosques, political rallies and television studios have drifted past them like smoke.

The deeper worry is about prolonged civil strife between Islamists and secularists over how deeply Islam will be embedded in public life. This is the fierce debate that the country knew for generations had to come. But now that it has suddenly arrived, the sides have hardened to the point where even Mubarak loyalists have joined their onetime foes, the leftists, to take on Morsi and other Islamists.

"I respect Morsi very much," said Mahmoud Hashem, stepping out from behind the counter of a juice shop. He wears a beard and, as is customary for conservative Muslims, does not look an unveiled woman in the eye. "We elected him. He needs to make decisions as a president, and whether they're right or wrong we have to stand by him. We chose him for four years. He must be given a chance."

But then, step into the tailor's shop, a box of a place with mannequins in the window wearing half-finished jackets, pins in shoulders, strips of fabric whirling on the floor. Abdelwahab has been here since 1966. He started in the trade even before that, when he was 13, after his parents died and he quit school "because I had to look after myself."

That was a few years after Gamal Abdel Nasser, a charismatic army officer, led the 1952 revolution that won Egypt its independence, eventually leading to President Anwar Sadat's peace treaty with Israel, the rise of Mubarak and, Abdelwahab scoffed, the era of Morsi.

"It was good under Nasser and Sadat," he said. "It was good under Mubarak for the first 20 years, but the last 10, when he gave his son more power and started privatization, things started going bad."

Now?

"Worst time of all," he said. "The country is falling apart. We're going to hell."

Abdelhafez, the porter, nodded.

A man sewing upstairs, yelled down, "Half of us are slaves!"

"The people in Tahrir Square will never be slaves," said Abdelwahab. "They are fighting."

The men talked, voices rising and falling in an afternoon cool with the coming winter. Would the military step in again like it did immediately after Mubarak's fall? Would the stock market rebound? Would those killing the protesters be prosecuted? Why is it that every time U.S. Secretary of State Hillary Rodham Clinton visits Cairo, as she did last week to help seal a cease-fire between Israel and Hamas, something bad happens shortly after? (The porter's eyebrows danced at the question.) Why isn't the Muslim Brotherhood open to different views, different ways of seeing things?

So many discussions. But there was work to do, even if many of Abdelwahab's clients had left the country and there were only a few bags of ruffled shirts needing a needle and thread, a steam and a pressing.

This weekend, the Brotherhood has promised a huge rally in Cairo to support Morsi and pressure the protesters in Tahrir.

The porter and the tailor glanced at each other.

"We are entering a dangerous weekend," said Abdelhafez, who left his friend's shop and crossed the street, passing a man yelling into his cellphone. "The Islamists want to pass this constitution!" the man said. "They want to make this country their own!"

jeffrey.fleishman@latimes.com

Special correspondent Reem Abdellatif contributed to this report.

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A Google-a-Day Puzzle for Nov. 30

Our good friends at Google run a daily puzzle challenge and asked us to help get them out to the geeky masses. Each day’s puzzle will task your googling skills a little more, leading you to Google mastery. Each morning at 12:01 a.m. Eastern time you’ll see a new puzzle posted here.

SPOILER WARNING:
We leave the comments on so people can work together to find the answer. As such, if you want to figure it out all by yourself, DON’T READ THE COMMENTS!

Also, with the knowledge that because others may publish their answers before you do, if you want to be able to search for information without accidentally seeing the answer somewhere, you can use the Google-a-Day site’s search tool, which will automatically filter out published answers, to give you a spoiler-free experience.

And now, without further ado, we give you…

TODAY’S PUZZLE:

Note: Ad-blocking software may prevent display of the puzzle widget.

Ken is a husband and father from the San Francisco Bay Area, where he works as a civil engineer. He also wrote the NYT bestselling book "Geek Dad: Awesomely Geeky Projects for Dads and Kids to Share."

Read more by Ken Denmead

Follow @fitzwillie and @wiredgeekdad on Twitter.

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Attorneys say Halle Berry, ex settle dispute

LOS ANGELES (AP) — Attorneys for Halle Berry and her ex-boyfriend have settled court issues that arose after a Thanksgiving Day fight at the actress’ home.

The fisticuffs involved Berry’s ex-boyfriend Gabriel Aubry and her fiance, actor Olivier Martinez. Aubry was arrested after the fight, which left him with a black eye, a broken rib and other injuries.

Aubry obtained a temporary restraining order against Martinez. The model and Berry have been battling over custody of their 4-year-old daughter for months and have appeared twice in a family law court since the fight.

Blair Berk, an attorney for Berry, and Shawn Holley, who represents Aubry, released a statement after Thursday’s hearing that said the two sides had reached an amicable agreement.

No details were released, and the attorneys declined to answer questions.

Entertainment News Headlines – Yahoo! News

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Man Indicted in New Hampshire in Hepatitis Infections

A traveling medical technician who is believed to have infected at least 39 people with hepatitis C through his use of stolen hospital drugs and syringes was indicted late Wednesday in New Hampshire on 14 new charges.

The technician, David Kwiatkowski, known as the “serial infector,” was arrested in July and charged with tampering with a consumer product and illegally obtaining drugs, primarily fentanyl, a powerful anesthetic that is about 80 times more potent than morphine.

After a lengthy investigation that ranged over several states, he was indicted Wednesday by a federal grand jury in Concord, N.H., and charged with seven counts of tampering with a consumer product and seven counts of illegally obtaining drugs.

If convicted on the pending charges, Mr. Kwiatkowski, 33, faces up to 10 years in prison for each count of tampering with a consumer product and up to four years in prison for each count of obtaining controlled substances by fraud. Each offense is also punishable by a fine of $250,000.

Mr. Kwiatkowski had pleaded not guilty to the original charges and remains in federal custody in New Hampshire.

In announcing the indictment, John P. Kacavas, the United States attorney in New Hampshire, said that Mr. Kwiatkowski “used the stolen syringes to inject himself, causing them to become tainted with his infected blood, before filling them with saline and then replacing them for use in the medical procedure.”

He continued, “Consequently, instead of receiving the prescribed dose of fentanyl, patients instead received saline tainted by Kwiatkowski’s infected blood.”

The problem was discovered after several patients in the cardiac catheterization lab at Exeter Hospital, where Mr. Kwiatkowski worked, tested positive for a specific strain of hepatitis C, a chronic disease that can lead to cancer and is a major reason for liver transplants. Mr. Kwiatkowski tested positive for the same strain, leading to the testing of thousands of patients in New Hampshire this summer.

The outbreak was one of the largest in recent history. The investigation has been complicated because Mr. Kwiatkowski worked at 18 hospitals in seven other states (Arizona, Georgia, Kansas, Maryland, Michigan, New York and Pennsylvania) over the last decade. He was fired from at least two hospitals but was hired subsequently by four others.

Since Mr. Kwiatkowski’s arrest, thousands of patients in the other states have been tested for hepatitis C. More than 30 patients in New Hampshire, about a half-dozen in Kansas and one in Maryland have tested positive for the same strain.

A report in August by the federal Centers for Medicare and Medicaid Services said that syringes at Exeter Hospital were left unattended on medication carts by nurses in the cardiac catheterization lab.

Hospital officials have said that they received reports of concerns about Mr. Kwiatkowski but not that he was diverting drugs. A statement on the hospital’s Web site said: “We understand that this has been a difficult time for our patients and the community. Our focus remains on all of our patients and while this situation has shaken the community, we will continue to do everything we can to restore the community’s confidence by providing excellent care to the hundreds of patients who receive care within our health system each day.”

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Fast-Food Workers in New York City Rally for Higher Wages

Michael Nagle for The New York Times

A rally at a McDonald’s near Times Square on Thursday. Organizers said 200 fast-food workers went on strike in New York City.

The biggest wave of job actions in the history of America’s fast-food industry began at 6:30 a.m. on Thursday at a McDonald’s at Madison Avenue and 40th Street, with several dozen protesters chanting: “Hey, hey, what do you say? We demand fair pay.”

That demonstration kicked off a day of walkouts and rallies at dozens of Burger King, Taco Bell, Wendy’s, McDonald’s and other fast-food restaurants in New York City, organizers said. They said 14 of the 17 employees scheduled to work the morning shift at the McDonald’s on Madison Avenue did not — part of what they said were 200 fast-food workers who went on strike in the city.

Raymond Lopez, 21, an aspiring actor who has worked at the McDonald’s for two and a half years, showed up at the daybreak protest on his day off. “In this job, having a union would really be a dream come true,” said Mr. Lopez, who said his pay of $8.75 an hour left him feeling undercompensated. “It really is living in poverty.”

Workplace experts said it was by far the largest series of job actions at fast-food restaurants ever — part of an ambitious plan that seeks to unionize workers and increase wages at fast-food restaurants across the city.

The unionization drive, called Fast Food Forward, is sponsored by community and civil rights groups — including New York Communities for Change, United NY.org and the Black Institute — as well as the Service Employees International Union. The campaign has deployed 40 organizers since January to rally fast-food workers behind unionization, saying the goal is to raise wages to $15 an hour.

Rick Cisneros, the franchisee who operates the McDonald’s at 40th and Madison, said: “I value my employees. I welcome an open dialogue while always encouraging them to express any concerns or to provide feedback so I can continue to be an even better employer.”

Several mayoral candidates — including Christine C. Quinn, the City Council speaker; Bill de Blasio, the public advocate; John C. Liu, the comptroller; and William C. Thompson Jr., a former comptroller — were quick to voice support for the workers. As those candidates vie for the Democratic nomination, they are furiously jockeying for union support.

Mary Kay Henry, the service employees’ president, said the fast-food companies could easily afford to pay their employees more. “People who work for the richest corporations in America should be able to afford at least the basic necessities to support their families,” she said.

Labor leaders say they see an uptick in activism among low-wage workers — including last week’s Walmart protests — as workers grow increasingly frustrated about pay stagnating at $8 or $9 an hour, translating into $16,000 or $18,000 a year for a full-time worker.

Pamela Waldron, who has worked at the KFC in Pennsylvania Station for eight years, complained that she earned just $7.75 an hour and was assigned just 20 hours a week, meaning income of about $8,000 a year. She was picketing outside a Burger King on 34th Street, as several dozen workers and their supporters chanted, “How can we survive on seven twenty-five” — $7.25 an hour is the federal and New York State minimum wage.

“I’m protesting for better pay,” Ms. Waldron, 26, said. “I have two kids under 6, and I don’t earn enough to buy food for them.”

Miguel Piedra, a Burger King spokesman, said its restaurants provide entry-level jobs for millions of Americans, train and invest in workers, and “offer compensation and benefits that are consistent with the quick-service restaurant industry.”

Fast Food Forward said it had filed six complaints with the National Labor Relations Board, asserting that various restaurant managers had threatened to fire workers for striking or supporting a union or had improperly interrogated workers about backing the effort.

The protest on Thursday culminated in a rally with hundreds of fast-food workers and their supporters outside the McDonald’s on 42nd Street west of Times Square. They chanted, “Hey, hey, ho, ho, seven-twenty-five has got to go.”

Inside the McDonald’s on Madison Avenue on Thursday morning, a few workers made funny faces as their friends demonstrated outside. A few patrons, quaffing coffee and gobbling sausage McMuffins, eyeballed the protesters with concern through the restaurant windows.

Jocelyn Horner, 35, a graduate student, said she supported the protesters. “If anybody deserves to unionize, it’s fast-food workers,” she said.

A cashier whose name tag read “Milady” said she chose not to participate in the demonstration.

“At least I have a job,” she said.

Randy Leonard and Nate Schweber contributed reporting.

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