On the Road: Security Check Programs Tend to Create an Elite Class - On the Road


THE Transportation Security Administration plans to widen the pool of travelers who qualify for PreCheck, its 14-month-old expedited security program that allows selected passengers to pass through special checkpoints without having to remove laptops from bags or take off their shoes, belts or outer coats.


That’s a welcome prospect for the roughly 40 percent whom the agency considers frequent fliers out of the annual 640 million domestic passengers — people who are screened “time and time again” at airports, according to John S. Pistole, the agency’s administrator. As such, these frequent travelers are presumably “known and trusted” fliers who make up a pool of potential members of so-called known-traveler security programs like PreCheck, he said.


A traveler qualifies for PreCheck only after passing a background check, and only the highest-frequency travelers are invited to take part by the five airlines currently participating.


But as the T.S.A. expands the program into the general population, some questions arise. For example, the agency is considering inviting private companies to help conduct those background checks, which would be done only on people who volunteer their information in order to enroll.


In a year-end report to agency employees, Mr. Pistole suggested that the checks could be conducted by companies “that we would contract with that would vet to our criteria and assess the exact things that we want to know about a person.”


Last week, the agency took a step in that direction, issuing a request for proposals from companies that might want to do the background checks to identify passengers who “present a low risk to the aviation transportation system” and who could enroll in an expanded PreCheck.


Every traveler I know who has participated in PreCheck likes the program enormously, even though there is no guarantee that a member is able to use a dedicated PreCheck lane on any given trip. That is because the T.S.A. has built in randomness as a security measure. PreCheck is now available at 35 airports, and the agency plans to expand the number of participating airports and airlines this year.


The potential for such programs to increase the possibility of racial profiling is well known. But another question concerns overall privacy. Assuming private businesses become involved, the security of passengers’ private data will be an issue — especially considering that the collected information may have commercial value beyond security purposes.


Another question is whether the government wants to create a class system for treating citizens differently at airport security. For example, I occasionally complain here about the way the airlines have instituted stark contrasts between the haves and have-nots in air travel, devising ever more complex ranks of privilege and status on the plane or at the boarding gate.


At the security checkpoint, it arguably makes sense to de-emphasize what Mr. Pistole calls the “one size fits all” approach and rely more on intelligence-based risk assessment. But what about the have-nots, the majority of travelers who pose no risk but who are not “known” well enough to qualify for special treatment?


Last week, the American Civil Liberties Union expressed reservations about the T.S.A.’s idea of “allowing private companies to carry out risk analysis” to determine which Americans might qualify as trusted travelers.


Jay Stanley, an A.C.L.U senior policy analyst, described concerns about a system that would rely on a commercial “data broker” to collect background information and essentially assign a passing score to qualified participants. Aside from the implications for those who may fail a background check for any reason, what about the majority of air travelers, who simply don’t apply, or who don’t travel enough to qualify for consideration?


Mr. Stanley said that he has no serious issue with the current PreCheck program because its scope is limited. But as it expands more into the general population, he said, “I’m uncomfortable with the logic of this kind of program, and where it will take us in the end,” as government and possibly private businesses share more and more data on travelers.


In its request for proposals, the T.S.A. enumerates strict standards for privacy protections in “safeguarding the personal information from loss or disclosure.”


Incidentally, here’s a disclosure of my own. I recently enrolled in another known-traveler program, Global Entry, which is run by the Customs and Border Protection agency and provides expedited re-entry into the country for members who have passed a background check, submitted to a personal interview and fingerprinting and paid $100 for five years. Global Entry also automatically bumps its members into the PreCheck program — and that was a prime incentive for me to join.


Which makes me one of the “haves” in security, I suppose. My hubris is tempered, however, by my decidedly have-not status elsewhere, as I wait at the gate with my fellow humble have-nots and watch the privileged board ahead of us, rank by elite rank.


So are we indirectly creating a security underclass as we filter out trusted travelers for special treatment at the checkpoints?


“The notion that our own government is going to either directly or via an arms-length corporate relationship sort through the population and stamp some people with a trusted label and others with an untrusted label — that makes me uneasy,” Mr. Stanley said.


Me too, actually.



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India Ink: Woman Raped by Seven Men in Punjab, Police Say

NEW DELHI — A 29-year-old woman was raped over the weekend by a bus driver, a conductor and five other men in the northern Indian state of Punjab, the police said Sunday, in an episode that recalls the recent attack in Delhi that has caused widespread outrage.

The woman in the Punjab attack boarded a bus on Friday bound for Gurdaspur to visit her in-laws, the Gurdaspur police chief, Raj Jit Singh, said in a telephone interview. When she got off the bus, the driver offered her a ride on his motorcycle, perhaps to her in-laws’ village, the police said. Instead, he took her to a nearby village, where he and six other men, including the bus conductor, raped her repeatedly through the night.

The next morning, the driver dropped her at her in-laws’ home, where the woman told family members of the rape and then reported it to the police, Mr. Singh said.

Six men, including the bus driver and conductor, have been arrested, he said. All of the men are in their 20s.

Gurmesh Singh, the deputy police superintendent for the region, said it was unclear how the bus driver persuaded the woman to go with him. She was in a state of distress during the bus ride, Mr. Singh said, and originally refused to get off the bus when it reached its destination.

The Press Trust of India, a news agency, reported that the bus driver did not stop when requested.

The gang rape of a woman on a bus in New Delhi on Dec. 16, and her death from injuries sustained during the attack, has led to widespread protests and calls for increased policing and tougher laws against sexual assault in India.

The evidence against five of the men arrested in the New Delhi rape is being heard this month in a special fast-track court created for sexual assault cases.

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Facebook search leads to Iowa man, sister reunion






DAVENPORT, Iowa (AP) — An Iowa man has been reunited with his sister 65 years after the siblings were separated in foster care thanks to a 7-year-old friend who searched Facebook.


Sixty-six-year-old Clifford Boyson of Davenport met his 70-year-old sister, Betty Billadeau, in person on Saturday. Billadeau drove up from her home in Florissant, Mo., with her daughter and granddaughter for the reunion.






Boyson and Billadeau both tried to find each other for years without success.


Then 7-year-old Eddie Hanzelin, who is the son of Boyson‘s landlord, got involved.


Eddie managed to find Billadeau by searching Facebook with her maiden name. He recognized the family resemblance when he saw her picture.


Near the end of their tearful reunion Boyson and Billadeau presented Eddie with a $ 125 check in appreciation of his detective work.


Social Media News Headlines – Yahoo! News





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Vereen's 2 TDs lead Pats to 17-13 halftime lead


FOXBOROUGH, Mass. (AP) — Shane Vereen scored two touchdowns, Wes Welker had 120 yards receiving and the New England Patriots overcame a 94-yard return by Danieal Manning on the opening kickoff to take a 17-13 lead over the Houston Texans at halftime of their AFC divisional playoff game Sunday.


Shayne Graham kicked a 55-yard field goal on the final play of the half after a short punt by Zoltan Mesko gave the Texans the ball at their 38-yard line.


The Patriots got little help from running back Danny Woodhead and tight end Rob Gronkowski, who left with injuries.


Woodhead hurt his thumb after carrying the ball on the Patriots' first offensive play and Gronkowski went to the locker room with an arm injury midway through the period. Gronkowski was playing his second game since breaking his left forearm


Vereen scored on a 1-yard run with 1:28 left in the first quarter after Graham opened the scoring with a 27-yard field goal.


Stephen Gostkowski gave the Patriots (12-4) a 10-3 lead with a 31-yard field goal on the first series of the second quarter. They went ahead 17-3 as Tom Brady threw to a wide-open Vereen, who easily ran into the end zone for an 8-yard touchdown reception.


But the Texans (13-4) made it 17-10 with 1:15 left in the half on a 1-yard run by Arian Foster, who gained all 47 yards on the drive on five rushes. Manning had set them up with another big kickoff return. He ran 35 yards before being horse-collared by Gostkowski, who was called for a 15-yard penalty.


Manning's first kickoff return set up Graham's opening field goal just 1:03 into the game.


That early score was in stark contrast to Houston's first game against New England, a 42-14 loss in which the Texans trailed 21-0 at halftime.


The Patriots punted on their first two possessions before taking charge.


After a poor punt by Donnie Jones gave them the ball at their 35, Stevan Ridley rushed 14 yards on the first play, then lost 2 on the next. Brady then connected on three straight passes: 13 yards to Ridley, 25 to Vereen and 14 to Aaron Hernandez.


Vereen ran in from the 1-yard line on the next play.


After Gostkowski's field goal, Jones punted again for Houston and New England started at its 20. With a second-and-3 at the Patriots 39, Brady hit Welker for a 47-yard completion down the left sideline. It was Welker's 59th postseason catch, a New England club record.


On the next play, Vereen drifted out to the left with no Texan nearby and scored 3:38 before intermission.


The Patriots had early troubles on offense, punting on their first two possessions. Brady was sacked once, with NFL sacks leader J.J. Watt and Brooks Reed sharing credit for it.


In the first meeting with the Texans, Brady threw touchdown passes on the Patriots' first three possessions.


The winner of Sunday's game will host the Baltimore Ravens in the AFC championship game next Sunday.


New England's victory over Houston in Foxborough on Dec. 10 began the Texans' stretch of three losses in their last four regular-season games that cost them a playoff bye and home-field advantage.


But Houston beat the Cincinnati Bengals 19-13 in a wild-card game to advance to Sunday's rematch, the first playoff meeting between the Texans and Patriots.


AFC East champion New England had a first-round bye and is the top remaining AFC seed after the No. 1 Denver Broncos lost to the No. 4 Ravens 38-35 in double overtime on Saturday.


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City Room: Cuomo Declares Public Health Emergency Over Flu Outbreak

With the nation in the grip of a severe influenza outbreak that has seen deaths reach epidemic levels, New York State declared a public health emergency on Saturday, making access to vaccines more easily available.

There have been nearly 20,000 cases of flu reported across the state so far this season, officials said. Last season, 4,400 positive laboratory tests were reported.

“We are experiencing the worst flu season since at least 2009, and influenza activity in New York State is widespread, with cases reported in all 57 counties and all five boroughs of New York City,” Gov. Andrew M. Cuomo said in a statement.

Under the order, pharmacists will be allowed to administer flu vaccinations to patients between 6 months and 18 years old, temporarily suspending a state law that prohibits pharmacists from administering immunizations to children.

While children and older people tend to be the most likely to become seriously ill from the flu, Mr. Cuomo urged all New Yorkers to get vaccinated.

On Friday, the Centers for Disease Control and Prevention in Atlanta said that deaths from the flu had reached epidemic levels, with at least 20 children having died nationwide. Officials cautioned that deaths from pneumonia and the flu typically reach epidemic levels for a week or two every year. The severity of the outbreak will be determined by how long the death toll remains high or if it climbs higher.

There was some evidence that caseloads may be peaking, federal officials said on Friday.

In New York City, public health officials announced on Thursday that flu-related illnesses had reached epidemic levels, and they joined the chorus of authorities urging people to get vaccinated.

“It’s a bad year,” the city’s health commissioner, Dr. Thomas A. Farley, told reporters on Thursday. “We’ve got lots of flu, it’s mainly type AH3N2, which tends to be a little more severe. So we’re seeing plenty of cases of flu and plenty of people sick with flu. Our message for any people who are listening to this is it’s still not too late to get your flu shot.”

There has been a spike in the number of people going to emergency rooms over the past two weeks with flulike symptoms – including fever, fatigue and coughing – Dr. Farley said.

Mayor Michael R. Bloomberg and Mr. Cuomo made a public display of getting shots this past week.

In a briefing with reporters on Friday, officials from the C.D.C. said that this year’s vaccine was effective in 62 percent of cases.

As officials have stepped up their efforts encouraging vaccinations, there have been scattered reports of shortages. But officials said plenty of the vaccine was available.

According to the C.D.C., makers of the flu vaccine produced about 135 million doses for this year. As of early this month, 128 million doses had been distributed. While that would not be enough for every American, only 37 percent of the population get a flu shot each year.

Federal health officials said they would be happy if that number rose to 50 percent, which would mean that there would be more than enough vaccine for anyone who wanted to be immunized.

Two other diseases – norovirus and whooping cough – are also widespread this winter and are contributing to the number of people getting sick.

The flu can resemble a cold, though the symptoms come on more rapidly and are more severe.

A version of this article appeared in print on 01/13/2013, on page A21 of the NewYork edition with the headline: New York Declares Health Emergency.
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Disruptions: U.S. Agency Warns of Java Software Problem

6:53 p.m. | Updated The Department of Homeland Security has warned users to disable Java software on their computers, citing a security hole that allows hackers to take control of their machines.

“Java 7 Update 10 and earlier contain an unspecified vulnerability that can allow a remote, unauthenticated attacker to execute arbitrary code on a vulnerable system,” the agency said in an alert issued last week. “This and previous Java vulnerabilities have been widely targeted by attackers, and new Java vulnerabilities are likely to be discovered.”

A European security researcher who blogs under the name Kafeine first discovered the vulnerability and posted it to his blog Thursday. The homeland security agency said that it had confirmed that Microsoft Windows, Apple’s Mac OS X and Linux platforms were all affected and that it was “unaware of a practical solution to this problem.” On Thursday evening, the agency recommended that users disable Java in their Web browsers.

On Sunday, Oracle, Java’s developer, released a patch for the security hole. Apple stopped shipping its computers with Java enabled last year, largely because of security concerns, but said it was remotely disabling the Java 7 plug-in on Macs where it had already been installed. Windows and Linux users can disable Java by following this guide on java.com.

Oracle did not return a request for comment on Sunday.

Java, a widely used programming language that runs on more than 850 million personal computers, has been the source of security problems before. Last April, hackers exploited a Java vulnerability to infect more than half a million Apple computers with a vicious form of malware in what was the largest-scale attack on the OS X operating system to date.

A month later, the Shadowserver Foundation, a nonprofit group that tracks cyber threats, discovered that hackers had used a Java security hole to infect visitors to several foreign policy Web sites, including the Web sites of the International Institute for Counter-Terrorism, Amnesty International Hong Kong and the Cambodian Ministry of Foreign Affairs.

The exploit was particularly disconcerting because it let attackers download a malicious program onto its victims’ machines without prompting. Users did not even have to click on a malicious link for their computers to be infected. The program simply downloaded itself.

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Plenty of Theories, and Enemies, in Killing of 3 Kurds in Paris


Joel Saget/Agence France-Presse — Getty Images


The brother of Sakine Cansiz (on poster), one of three Kurdish activists found shot on Thursday, said his family was convinced that it was a professional assassination.







PARIS — With her signature long hennaed hair, fiery resolve and olive-green military fatigues, Sakine Cansiz was a feminist, guerrilla fighter and former political prisoner as adept at wielding a machine gun as organizing political protests from a jail cell.




One day after she and two other Kurdish activists were killed in the heart of Paris, speculation abounded regarding Ms. Cansiz, 55, and whether she had been the main target.


One of her brothers, Metin Cansiz, and activists interviewed Friday said her main role in recent years was to raise money and provide political support for the separatist group she helped found, the Kurdistan Workers’ Party, or P.K.K. Ms. Cansiz may also still have been involved in providing arms for the rebels.


Echoing many analysts, Mr. Cansiz said the family was convinced that his sister had been the victim of a professional assassination. It was aimed, he said, at disrupting recently started peace talks that seek to end decades of bloody conflict between the Turkish government and the P.K.K., which is considered a terrorist organization by the United States and the European Union.


Ms. Cansiz was a close ally of a crucial player in the talks with Turkey, the P.K.K.’s imprisoned leader, Abdullah Ocalan.


“My sister supported the peace process, and she paid with her life,” Mr. Cansiz said as family members and hundreds of mourners gathered at a Kurdish cultural center not far from the locked, unlabeled office where Ms. Cansiz and the other two women, Fidan Dogan and Leyla Soylemez, were found fatally shot early Thursday. “Whoever did this wanted to kill the process.” 


Many Kurdish rebels said they believed that Turkish nationalists were behind the killings. But there were competing suspicions. Some rebels speculated that Iran  sponsored the attack as a way to destabilize Turkey, which has taken a stand against an Iranian ally, President Bashar al-Assad of Syria.


Turkey’s prime minister, Recep Tayyip Erdogan, said Friday that he believed that the killings bore the signs of an internal feud. In any case, the contours of Ms. Cansiz’s shortened life suggest that she would have had plenty of enemies.


Born to an Alevi family of eight brothers and sisters, Ms. Cansiz became politically active in her early 20s, her brother said. What she saw as the impoverishment and repression of the Kurdish community led her and a small group of revolutionaries to found the P.K.K. at a teahouse near Diyarbakir, in Turkey’s predominantly Kurdish southeast.


In 1980, after a coup in Turkey, she was arrested and imprisoned until 1991, enduring torture, according to Rusen Werdi, a Kurdish lawyer in Paris.


Her brother, who was imprisoned with her, recalled that she was one of the only prisoners to stand up to the authorities. Activists recalled that she spit in the face of the notorious prison director.


In interviews on Friday, activists said  Ms. Cansiz continued to organize demonstrations from behind bars. They said she had initially been attracted by the Marxist ideology of the Kurdish rights movement, which allowed women to escape from the tribal structures of Kurdish society and to take up arms alongside men.


Vahap Coskun, an expert on Kurdish movements at Dicle University in Diyarbakir, said that from its inception, the P.K.K. saw that Kurdish women could provide a powerful base for political organization and on the battlefield. Of the group’s 5,500 members, he said, about a quarter are women. In the mid-1990s, some joined suicide bombing attacks aimed at military and civilian targets, sometimes deflecting suspicion by dressing as though pregnant.


After Ms. Cansiz was released from prison, her brother said, she received military training, organized clandestine meetings, traveled to P.K.K. mountain outposts in southeastern Turkey and went underground to Germany to raise funds.


Ms. Cansiz spent time in Syria, where Mr. Ocalan was based, at the group’s training camp in Lebanon’s Bekaa region and in northern Iraq, Mr. Coskun said. She was eventually sent to Western Europe to work in logistics and fund-raising after the P.K.K. incurred losses in fighting with Turkish security forces, he said.


The German authorities questioned her in 2007 but turned down a Turkish request for her extradition, her friends and colleagues said. She then moved to Paris, and believed that she was under frequent surveillance, they said.


Her brother said that the two had recently celebrated the new year in Rotterdam, the Netherlands, and that Ms. Cansiz had betrayed no concerns about her safety. “She was never afraid,” he said. “She was happy.”


Sebnem Arsu contributed reporting from Istanbul.



This article has been revised to reflect the following correction:

Correction: January 12, 2013

An earlier version of this article misidentified the background of Sakine Cansiz. She was an Alevi, not an Alawite. Among their differences, the Alevis are spread throughout Turkey, while most Alawites in Turkey are concentrated along the country’s border with Syria.



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December video game retail sales drop 22 percent






NEW YORK (AP) — U.S. retail sales of video games and gaming systems fell 22 percent in December, capping a year of declining sales for the industry.


Research firm NPD Group said Thursday that overall sales fell to $ 3.21 billion from $ 4.1 billion in December 2011. NPD estimates that sales of new game hardware, software and accessories account for about half of what consumers spend on gaming.






Sales of video games themselves, excluding PC titles, tumbled 26 percent to $ 1.54 billion. Sales of hardware — gaming systems such as the Xbox 360 and the Wii U — fell 20 percent to $ 1.07 billion.


“Call of Duty: Black Ops II” from Activision Blizzard Inc. was December’s top game.


For all of 2012, total game sales dropped 22 percent to $ 13.26 billion.


Gaming News Headlines – Yahoo! News





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Broncos, Ravens tied at 21 after 1st half


DENVER (AP) — Torrey Smith breezed past Champ Bailey for two long touchdowns as the Baltimore Ravens' quick-strike ability allowed them to keep up with the AFC's top-seeded Denver Broncos and head into halftime tied at 21 Saturday.


Smith had just two catches in the first half, but they covered 91 yards and both went for scores.


He sped past Bailey for a 59-yard TD in the first quarter and then beat him down the sideline for a 32-yard TD catch 36 seconds left before the break that capped a three-play, 58-yard drive that began after Matt Prater botched a 52-yard field goal attempt that would have given Denver a double-digit lead.


Smith beat Bailey several other times only to see Joe Flacco overthrow him, and Denver defensive coordinator Jack Del Rio was sure to reconsider his scheme not giving Bailey any safety help over the top so they could stay in and counter Baltimore's tough tight ends.


Running back Knowshon Moreno's first touchdown catch of the season, a 13-yard grab from Peyton Manning in tight coverage by linebacker Dannell Ellerbe, had given the Broncos a 21-14 lead.


The Ravens rebounded from Trindon Holliday's 90-yard punt return touchdown, the longest in NFL playoff history, to score two TDs in a 42-second span in the first quarter.


The 13-degree temperature at kickoffs made this the coldest playoff game ever played in Denver. The wind chill was 2. The only colder game played in Denver was against San Diego on Dec. 10, 1972, when the temperature was 9 degrees.


Manning, the league's only four-time MVP, was 0-3 in previous playoff games below 40 degrees, all while playing for the Indianapolis Colts, who released him last year after a series of neck operations.


Manning had a stellar bounce-back season in Denver, throwing for 4,659 yards and a team-record 37 TDs.


Wearing gloves on both hands for the first time in his career — the one on the right hand as much a concession to the altered feel of his grip following the four neck surgeries as it was for the wintry weather, Manning threw a 15-yard TD toss to Brandon Stokley to tie it at 14.


Holliday got the scoring started when he fielded Sam Koch's punt, broke one tackle and raced down the Ravens' sideline, avoiding the punter as he galloped into the end zone. The previous longest TD on a punt return in a playoff game was Jermaine Lewis' 88-yarder for Baltimore in 2001.


Jacoby Jones botched the ensuing kickoff return, losing the handle on the ball as he brought it out before smothering it at the 6.


After a key pass interference call on Tony Carter allowed the Ravens to get out from the shadow of their end zone, Baltimore tied it at 7 when Smith got behind Bailey and hauled in Flacco's 59-yard touchdown toss.


Forty-two seconds later, cornerback Corey Graham picked off a Manning pass that deflected off receiver Eric Decker and returned it 39 yards for the score — and the Broncos trailed for the first time since Dec. 2 against Tampa Bay.


The Broncos were trying to avoid becoming yet another No. 1 seed to lose in the divisional round. Since 2005, eight of the 14 top-seeded teams lost their first game in the playoffs, four in each conference.


___


Online: http://pro32.ap.org/poll and http://twitter.com/AP_NFL


___


Follow AP Pro Football Writer Arnie Stapleton on Twitter: http://twitter.com/arniestapleton


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‘Bodega Clinicas’ Draw Interest of Health Officials


HUNTINGTON PARK, Calif. — The “bodega clinicas” that line the bustling commercial streets of immigrant neighborhoods around Los Angeles are wedged between money order kiosks and pawnshops. These storefront offices, staffed with Spanish-speaking medical providers, treat ailments for cash: a doctor’s visit is $20 to $40; a cardiology exam is $120; and at one bustling clinic, a colonoscopy is advertised on an erasable board for $700.


County health officials describe the clinics as a parallel health care system, serving a vast number of uninsured Latino residents. Yet they say they have little understanding of who owns and operates them, how they are regulated and what quality of medical care they provide. Few of these low-rent corner clinics accept private insurance or participate in Medicaid managed care plans.


“Someone has to figure out if there’s a basic level of competence,” said Dr. Patrick Dowling, the chairman of the family medicine department at the David Geffen School of Medicine at the University of California, Los Angeles.


Not that researchers have not tried. Dr. Dowling, for one, has canvassed the clinics for years to document physician shortages as part of his research for the state. What he and others found was that the owners were reluctant to answer questions. Indeed, multiple attempts in recent weeks to interview owners and employees at a half-dozen of the clinics in Southern California proved fruitless.


What is certain, however, is that despite their name, many of these clinics are actually private doctor’s offices, not licensed clinics, which are required to report regularly to federal and state oversight bodies.


It is a distinction that deeply concerns Kimberly Wyard, the chief executive of the Northeast Valley Health Corporation, a nonprofit group that runs 13 accredited health clinics for low-income Southern Californians. “They are off the radar screen,” said Ms. Wyard of the bodega clinicas, “and it’s unclear what they’re doing.”


But with deadlines set by the federal Affordable Care Act quickly approaching, health officials in Los Angeles are vexed over whether to embrace the clinics and bring them — selectively and gingerly — into the network of tightly regulated public and nonprofit health centers that are driven more by mission than by profit to serve the uninsured.


Health officials see in the clinics an opportunity to fill persistent and profound gaps in the county’s strained safety net, including a chronic shortage of primary care physicians. By January 2014, up to two million uninsured Angelenos will need to enroll in Medicaid or buy insurance and find primary care.


And the clinics, public health officials point out, are already well established in the county’s poorest neighborhoods, where they are meeting the needs of Spanish-speaking residents. The clinics also could continue to serve a market that the Affordable Care Act does not touch: illegal immigrants who are prohibited from getting health insurance under the law.


Dr. Mark Ghaly, the deputy director of community health for the Los Angeles County Department of Health Services, said bodega clinicas — a term he seems to have coined — that agree to some scrutiny could be a good way of addressing the physician shortage in those neighborhoods.


“Where are we going to find those providers?” he said. “One logical place to consider looking is these clinics.”


Los Angeles is not the only city with a sizable Latino population where the clinics have become a part of the streetscape. Health care providers in Phoenix and Miami say there are clinics in many Latino neighborhoods.


But their presence in parts of the Los Angeles area can be striking, with dozens in certain areas. Visits to more than two dozen clinics in South Los Angeles and the San Fernando Valley found Latino women in brightly colored scrubs handing out cards and coupons that promised a range of services like pregnancy tests and endoscopies. Others advertised evening and weekend hours, and some were open around the clock.


Such all-hours access and upfront pricing are critical, Latino health experts say, to a population that often works around the clock for low wages.


Also important, officials say, is that new immigrants from Mexico and Central America are more accustomed to corner clinics, which are common in their home countries, than to the sprawling medical complexes or large community health centers found in the United States. And they can get the kind of medical treatments — including injections of hypertension drugs, intravenous vitamins and liberally dispensed antibiotics — that are frowned upon in traditional American medicine.


The waiting rooms at the clinics reflected the everyday maladies of peoples’ lives: a glassy-eyed child resting listlessly on his mother’s lap, a fit-looking young woman waiting with a bag of ice on her wrist, a pensive middle-aged man in work boots staring straight ahead.


For many ordinary complaints, the medical care at these clinics may be suitable, county health officials and medical experts say. But they say problems arise when an illness exceeds the boundaries of a physician’s skills or the patient’s ability to pay cash.


Dr. Raul Joaquin Bendana, who has been practicing general medicine in South Los Angeles for more than 20 years, said the clinics would refer patients to him when, for example, they had uncontrolled diabetes. “They refer to me because they don’t know how to handle the situation,” he said.


The clinic physicians by and large appear to have current medical licenses, a sample showed, but experts say they are unlikely to be board certified or have admitting privileges at area hospitals. That can mean that some clinics try to treat patients who face serious illness.


Olivia Cardenas, 40, a restaurant worker who lives in Woodland Hills, Calif., got a free Pap smear at a clinic that advertises “especialistas,” including in gynecology. The test came back abnormal, and the doctor told Ms. Cardenas that she had cervical cancer. “Come back in a week with $5,000 in cash, and I’ll operate on you,” Ms. Cardenas said the doctor told her. “Otherwise you could die.”


She declined to pay the $5,000. Instead, a family friend helped her apply for Medicaid, and she went to a hospital. The diagnosis, it turned out, was correct.


Health care experts say the clinics’ medical practices would come under greater scrutiny if they were brought closer into the fold.


But being connected would mean the clinics’ cash-only business model would need to change. Dr. Dowling said the lure of newly insured patients in 2014 might draw them in. “To the extent there are payments available,” he said, “the legitimate ones might step up to the plate.”


This article was produced in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.



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