Fewer health care options for illegal immigrants

ALAMO, Texas (AP) — For years, Sonia Limas would drag her daughters to the emergency room whenever they fell sick. As an illegal immigrant, she had no health insurance, and the only place she knew to seek treatment was the hospital — the most expensive setting for those covering the cost.

The family's options improved somewhat a decade ago with the expansion of community health clinics, which offered free or low-cost care with help from the federal government. But President Barack Obama's health care overhaul threatens to roll back some of those services if clinics and hospitals are overwhelmed with newly insured patients and can't afford to care for as many poor families.

To be clear, Obama's law was never intended to help Limas and an estimated 11 million illegal immigrants like her. Instead, it envisions that 32 million uninsured Americans will get access to coverage by 2019. Because that should mean fewer uninsured patients showing up at hospitals, the Obama program slashed the federal reimbursement for uncompensated care.

But in states with large illegal immigrant populations, the math may not work, especially if lawmakers don't expand Medicaid, the joint state-federal health program for the poor and disabled.

When the reform has been fully implemented, illegal immigrants will make up the nation's second-largest population of uninsured, or about 25 percent. The only larger group will be people who qualify for insurance but fail to enroll, according to a 2012 study by the Washington-based Urban Institute.

And since about two-thirds of illegal immigrants live in just eight states, those areas will have a disproportionate share of the uninsured to care for.

In communities "where the number of undocumented immigrants is greatest, the strain has reached the breaking point," Rich Umbdenstock, president of the American Hospital Association, wrote last year in a letter to Obama, asking him to keep in mind the uncompensated care hospitals gave to that group. "In response, many hospitals have had to curtail services, delay implementing services, or close beds."

The federal government has offered to expand Medicaid, but states must decide whether to take the deal. And in some of those eight states — including Texas, Florida and New Jersey — hospitals are scrambling to determine whether they will still have enough money to treat the remaining uninsured.

Without a Medicaid expansion, the influx of new patients and the looming cuts in federal funding could inflict "a double whammy" in Texas, said David Lopez, CEO of the Harris Health System in Houston, which spends 10 to 15 percent of its $1.2 billion annual budget to care for illegal immigrants.

Realistically, taxpayers are already paying for some of the treatment provided to illegal immigrants because hospitals are required by law to stabilize and treat any patients that arrive in an emergency room, regardless of their ability to pay. The money to cover the costs typically comes from federal, state and local taxes.

A solid accounting of money spent treating illegal immigrants is elusive because most hospitals do not ask for immigration status. But some states have tried.

California, which is home to the nation's largest population of illegal immigrants, spent an estimated $1.2 billion last year through Medicaid to care for 822,500 illegal immigrants.

The New Jersey Hospital Association in 2010 estimated that it cost between $600 million and $650 million annually to treat 550,000 illegal immigrants.

And in Texas, a 2010 analysis by the Health and Human Services Commission found that the agency had provided $96 million in benefits to illegal immigrants, up from $81 million two years earlier. The state's public hospital districts spent an additional $717 million in uncompensated care to treat that population.

If large states such as Florida and Texas make good on their intention to forgo federal money to expand Medicaid, the decision "basically eviscerates" the effects of the health care overhaul in those areas because of "who lives there and what they're eligible for," said Lisa Clemans-Cope, a senior researcher at the Urban Institute.

Seeking to curb expenses, hospitals might change what qualifies as an emergency or cap the number of uninsured patients they treat. And although it's believed states with the most illegal immigrants will face a smaller cut, they will still lose money.

The potential impacts of reform are a hot topic at MD Anderson Cancer Center in Houston. In addition to offering its own charity care, some MD Anderson oncologists volunteer at a county-funded clinic at Lyndon B. Johnson General Hospital that largely treats the uninsured.

"In a sense we've been in the worst-case scenario in Texas for a long time," said Lewis Foxhall, MD Anderson's vice president of health policy in Houston. "The large number of uninsured and the large low-income population creates a very difficult problem for us."

Community clinics are a key part of the reform plan and were supposed to take up some of the slack for hospitals. Clinics received $11 billion in new funding over five years so they could expand to help care for a swell of newly insured who might otherwise overwhelm doctors' offices. But in the first year, $600 million was cut from the centers' usual allocation, leaving many to use the money to fill gaps rather than expand.

There is concern that clinics could themselves be inundated with newly insured patients, forcing many illegal immigrants back to emergency rooms.

Limas, 44, moved to the border town of Alamo 13 years ago with her husband and three daughters. Now single, she supports the family by teaching a citizenship class in Spanish at the local community center and selling cookies and cakes she whips up in her trailer. Soon, she hopes to seek a work permit of her own.

For now, the clinic helps with basic health care needs. If necessary, Limas will return to the emergency room, where the attendants help her fill out paperwork to ensure the government covers the bills she cannot afford.

"They always attended to me," she said, "even though it's slow."

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Sherman can be followed on Twitter at https://twitter.com/chrisshermanAP .

Plushnick-Masti can be followed on Twitter at https://twitter.com/RamitMastiAP .

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'Good Evidence' on Massacre Motive

Police indicated today they have "some very good evidence" about the motive behind Adam Lanza's massacre at the Sandy Hook Elementary School and said that the sole person to survive being shot by Lanza will be "instrumental" in the probe.

Authorities also finished the grim task of identifying all of Lanza's 27 victims, which included 20 children. Families, who already feared the worst, were informed that their loved ones were dead early today.

All of the bodies have now been removed from the school and medical examiners are expected to provide a full list of victims later today.

With the tally of Lanza's carnage complete, authorities and the grieving people of Newtown, Conn., are left to wonder why he turned the elementary school in this quaint New England town into a slaughter house.

CLICK HERE for full coverage of the tragedy at the elementary school.

Emmanuel Dunand/AFP/Getty Images

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Connecticut State Police Lt. Paul Vance, who had compared the investigation to "peeling back the layers of an onion," said the investigation "did produce some very good evidence" about motive, but he would not go into further detail.

He indicated the evidence came from the shooting scene at the school as well as at the home where Lanza's mother, Nancy, was slain.

Also key will be the lone person shot by Lanza who wasn't killed. The female teacher has not been publicly identified.

"She is doing fine," Vance said at a news conference today. "She has been treated and she'll be instrumental in this investigation."

Evidence also emerged today that Lanza's rampage began in the office of school principal Dawn Hochsprung while the school intercom was on. It's not clear whether it was turned on to alert the school or whether it was on for morning announcements, but the principal's screams and the cries of children heard throughout the school gave teachers time to take precautions to protect their children.

Hochsprung was among those killed in the Friday morning killing spree.

READ: Connecticut Shooter Adam Lanza: 'Obviously Not Well'

Authorities have fanned out to New Jersey, Connecticut and Massachusetts to interview Lanza's relatives, ABC News has learned.

According to sources, Lanza shot his mother in the face, then left his house armed with at least two semi-automatic handguns, a Glock and a Sig Sauer, and a semi-automatic rifle. He was also wearing a bulletproof vest.

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Egyptians vote on divisive constitution

CAIRO/ALEXANDRIA (Reuters) - Egyptians queued in long lines on Saturday to vote on a constitution promoted by its Islamist backers as the way out of a political crisis and rejected by opponents as a recipe for further divisions in the Arab world's biggest nation.

Soldiers joined police to secure the referendum after deadly protests during the buildup. Street brawls erupted again on Friday in Alexandria, Egypt's second city, but voting proceeded quietly there, with no reports of violence elsewhere.

President Mohamed Mursi provoked angry demonstrations when he issued a decree last month expanding his powers and then fast-tracked the draft constitution through an assembly dominated by his Muslim Brotherhood group and its allies. At least eight people were killed in clashes last week outside the presidential palace.

His liberal, secular and Christian opponents says the constitution is too Islamist and tramples on minority rights. Mursi's supporters say the charter is needed if progress is to be made towards democracy nearly two years after the fall of military-backed strongman Hosni Mubarak.

"The sheikhs (preachers) told us to say 'yes' and I have read the constitution and I liked it," said Adel Imam, a 53-year-old queuing to vote in a Cairo suburb. "The country will move on."

Opposition politician and Nobel Peace Prize laureate Mohamed ElBaradei wrote on Twitter: "Adoption of (a) divisive draft constitution that violates universal values and freedoms is a sure way to institutionalize instability and turmoil."

Official results will not be announced until after a second round of voting next Saturday. But partial results and unofficial tallies are likely to emerge soon after the first round, giving some idea of the outcome.

In order to pass, the constitution must be approved by more than 50 percent of voters who cast ballots. A little more than half of Egypt's electorate of 51 million are eligible to vote in the first round in Cairo and other cities.

Rights groups reported some abuses, such as polling stations opening late, officials telling people to vote "yes", bribery and intimidation.

But Gamal Eid, head of the Arab Network for Human Rights Information, which is monitoring the vote, said nothing reported so far was serious enough to invalidate the referendum.

"Until now, there is no talk of vote rigging," said Eid.

TRANSITION

Christians, making up about 10 percent of Egypt's 83 million people and who have long grumbled of discrimination, were among those waiting at a polling station in Alexandria to oppose the basic law. They fear Islamists, long repressed by Mubarak, will restrict social and other freedoms.

"I voted 'no' to the constitution out of patriotic duty," said Michael Nour, a 45-year-old Christian teacher in Alexandria. "The constitution does not represent all Egyptians."

Howaida Abdel Azeem, a post office employee, said: "I said 'yes' because I want the destruction the country is living through to be over and the crisis to pass, and then we can fix things later."

Islamists are counting on their disciplined ranks of supporters and the many Egyptians who may fall into line in the hope of ending turmoil that has hammered the economy and sent Egypt's pound to eight-year lows against the dollar.

Mursi was among the early voters after polls opened at 8 a.m. (1:00 a.m. Eastern Time). He was shown on television casting his ballot shielded by a screen and then dipping his finger in ink - a measure to prevent people voting twice.

Turnout was high enough for voting on Saturday to be extended by four hours to 11 p.m. (4 p.m. Eastern Time). One senior official on the committee overseeing the referendum said Saturday's vote could continue on Sunday if crowds were too heavy to allow everyone to cast ballots in one day. Voting for Egyptians abroad that began on Wednesday has been extended to Monday, the state news agency reported.

After weeks of turbulence, there has been limited public campaigning. Opposition politicians and parties, beaten in two elections since Mubarak's overthrow, only announced on Wednesday that they backed a "no" vote instead of a boycott.

TWO DAYS

The second round will be held in other regions on December 22 because there are not enough judges willing to monitor all polling stations after some said they would boycott the vote.

Egyptians are being asked to accept or reject a constitution that must be in place before a parliamentary election can be held next year to replace an Islamist-led parliament dissolved in June. Many hope this will lead Egypt towards stability.

If the constitution is voted down, a new assembly will have to be formed to draft a revised version, a process that could take up to nine months.

The army has deployed about 120,000 troops and 6,000 tanks and armored vehicles to protect polling stations and other government buildings. While the military backed Mubarak and his predecessors, it has not intervened in the present crisis.

(Writing by Edmund Blair and Giles Elgood; Editing by Tom Pfeiffer)

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Hillary Clinton suffers concussion, recovering at home

WASHINGTON: Globe-trotting US Secretary of State Hillary Clinton hit her head and suffered a concussion while battling a nasty stomach bug, officials said on Saturday, forcing her to stay home for a second week.

"While suffering from a stomach virus, Secretary Clinton became dehydrated and fainted, sustaining a concussion," Clinton's top aide Philippe Reines said in a statement.

The news came just as Clinton, 65, had been expected to testify on Thursday to US lawmakers about the findings of a highly-anticipated investigation into September's militant attack on the US consulate in Benghazi, Libya.

The normally indefatigable Clinton, who in her four years as the top US diplomat has travelled almost a million miles visiting 112 countries, was "recovering" but plans to stay away from the office next week.

"She has been recovering at home and will continue to be monitored regularly by her doctors," Reines added.

At their recommendation, Clinton "will continue to work from home next week, staying in regular contact with Department and other officials."

There are also a slew of Christmas festivities planned at the State Department next week that Clinton had planned to host.

Clinton has already been out of the public eye for the past week, after she had to cancel a trip to North Africa when she contracted the stomach virus on her return from a five-day visit to Europe.

"The secretary's been really very ill. I mean, very. This stomach virus is a pretty vicious one," State Department spokeswoman Victoria Nuland said on Wednesday, adding the condition was not life-threatening.

The former first lady and wife of ex-president Bill Clinton is the most popular member of President Barack Obama's cabinet, with approval ratings of over 60 percent.

Even though she aims to step down as secretary of state early next year, Obama has not yet revealed his pick to replace her. Many believe that she will also take a second shot at being elected America's first woman president in the 2016 White House race.

This week she denied again she was planning to run in 2016, but said that although she is looking forward to a rest as she is exhausted after spending two decades in the public eye, her age would not play a factor in any decision.

"I am, thankfully, knock on wood, not only healthy, but have incredible stamina and energy," she told ABC.

She had been due to publicly testify on Thursday at open hearings in both the House and Senate on the outcome of the State Department investigation into the Benghazi assault in which the ambassador and three other Americans died.

State Department acting deputy spokesman Patrick Ventrell confirmed on Friday the report should be completed by early next week. Its findings are not binding, but "it's a chance for the department as a whole to look at our operations and look at what needs to be done to improve security," he said.

Clinton has said she takes full responsibility, repeatedly stressing that no one wants to find out what happened in Benghazi more than she does.

The September 11 attack became a political punchbag in the final, furious weeks of the 2012 presidential elections, and has already complicated Obama's calculations for his second term cabinet.

The report's findings are also likely to ignite another storm of protest, with Republicans already scenting blood.

Republicans have castigated the administration for failing to provide proper security, and for employing local Libyan security staff.

Republicans also allege the administration sought to cover up the links to Al-Qaeda by initially insisting the attack was sparked by a protest over an anti-Islam video, which had earlier triggered fury in Cairo.

The Republican onslaught cost US envoy to the United Nations, Susan Rice, her hopes of succeeding Clinton. Rice appeared on the Sunday talk shows just days after the assault to say that, according to the intelligence available, it arose from a "spontaneous" demonstration.

On Thursday, Rice asked Obama to withdraw her name from consideration to be the next top US diplomat, saying it would only lead to a protracted fight after several Republicans threatened to block her nomination.

Veteran Senator John Kerry, the chairman of the Senate Foreign Relations Committee, is now the odds-on favourite to replace Clinton at the helm of the State Department - an ambition he has long cherished.

- AFP/de

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Turban pride restores as Sikhs wins school turban ban case against France in UN

AMRITSAR: The UN Human Rights Committee (UNHRC) has ruled that France's ban on the wearing of "conspicuous" religious symbols in schools - introduced in a law adopted in March 2004 - violated a Sikh student's right to manifest his religion, protected by the International Covenant on Civil and Political Rights (ICCPR).

"The UNHRC has made our nine year wait for justice worthwhile, since the French law was passed against religious signs in public schools in 2004. The UNHRC has once again proved to be the beacon of light for the freedom of thought, conscience and religion by upholding that the Article 18 right under the ICCPR to manifest ones religion, cannot be overridden merely by pleading secularity without producing any evidence that the Sikh Turban would affect the right of other students or would affect order in the school," said Legal Director, United Sikhs, a Sikh NGO, Mejindarpal Kaur while talking to TOI over phone from Paris on Friday.

She said that in a decision that was sent out this week to the United Sikhs legal team, in relation to a complaint made by Bikramjit Singh in 2008, the Committee accepted that the wearing of a turban was regarded as a religious duty for a Sikh and was also tied in with his identity; and that France had not justified the prohibition on the wearing of the turban.

She further informed that the Committee accepted that the France was entitled to uphold the principle of secularism (laicite), a means by which a state party might seek to protect the religious freedom of all its population.

She informed that the Committee went on to express that France had "not furnished compelling evidence that by wearing his keski (small turban),Bikramjit would have posed a threat to the rights and freedoms of other pupils or to order at the school.Kaur informed that less than a year ago, the UNHRC had also concluded that France had violated the religious freedom of 76 year old Ranjit Singh when he was asked to remove his turban for his ID photograph. "A UN decision is still awaited for Shingara Singh, whose passport has not been renewed by France because he refused to remove his turban for his ID photograph" said she.

Quotes President of the Delhi Sikh Gurdwara Management Committee, Paramjit Singh Sarna said Bikramjit Singh is an Indian national and it should have been the responsibility of the Indian government to protect his religious freedom abroad so that he and other Sikhs were not banned from wearing the turban in French public schools:

"Religion and politics are two wheels that balance civil society. If one wheel comes off, society ceases to be stable. Laicite or secularity is the oil that ensures that the two wheels keep moving. Sikhs do not see laicite as the enemy. We see it as our friend to help us be good citizens. United Sikh's France Director Shingara Singh.

"Our stand for the turban will not only benefit France but the whole world Gurdial Singh of the Turban Action Committee of France, who has been defending campaign relentlessly.

The Turban is not a sign of oppression. It's a practice of freedom," said Mejinderpal Kaur quoting Bikramjit Singh, who after being expelled from school, completed his education privately and is now a project engineer with an engineering firm in Paris.

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APNewsBreak: Texas cancer probe draws NCI scrutiny

AUSTIN, Texas (AP) — The National Cancer Institute confirmed Friday that federal officials are taking a closer look at a troubled $3 billion cancer-fighting effort in Texas that is under a criminal investigation over a lucrative taxpayer-funded grant awarded by the state agency.

The Cancer Prevention and Research Institute of Texas has coveted status as an NCI-approved funding entity — an exclusive group headlined by the nation's most prominent cancer organizations. The list is fewer than two dozen and includes the American Cancer Society, Susan G. Komen for the Cure and federal entities like the Center for Disease Control and Prevention.

The designation is a federal seal-of-approval that signals high peer review standards and conflict of interest policies. Yearlong turmoil within the Texas institute, or CPRIT, reached a new peak this week when the agency's beleaguered chief executive asked to resign and prosecutors opened cases following an $11 million grant to a private company that was revealed to have bypassed an independent review.

NCI spokeswoman Aleea Farrakh Khan told The Associated Press that officials are "evaluating recent events" at CPRIT. She said officials have not made decisions or contacted the agency directly.

Members of CPRIT's governing board did not immediately return an email seeking comment.

NCI designation is not required for CPRIT to continue running the nation's second-largest pot of cancer research dollars, Khan said. But jeopardizing that status — and especially losing it — would be a severe blow to CPRIT's reputation, which already has been battered by sweeping resignations, internal accusations of politics trumping science and now a criminal investigation.

A recent internal audit at CPRIT discovered an $11 million funding request from Dallas-based Peloton Therapeutics was approved without the agency ever scrutinizing the proposal's merits. The revelation came only months after two Nobel laureates and other top scientists left the agency in protest over a $20 million grant some accused of being rushed to approval without a proper peer review.

While CPRIT is funded by taxpayers, donors to cancer nonprofits might look to an NCI designation for assurance that their money is in good hands.

"It says, 'If I'm donating money to this agency, if NCI is approving them, that means NCI says it's handling its money well,'" Khan said.

Khan added that CPRIT's inclusion on the list does not mean all of its funding mechanisms are NCI-approved.

An entire page of CPRIT's website is devoted to boasting its NCI designation. The agency says the status is important because it means cancer centers in Texas seeking its own NCI designation — so as to reassure patients or bolster recruitment — can include CPRIT research dollars in their calculations to maintain levels needed to be NCI approved.

"This enhances Texas' ability to leverage additional federal funding for cancer research and raises Texas' profile as a center for cancer research," according to the website.

Executive Director Bill Gimson submitted his resignation letter Tuesday but offered to stay on through January. He has described Peloton's improper funding as an honest mistake and said no one associated with CPRIT stood to personally profit from the company's award.

Prosecutors have not made any specific criminal allegations. Launching separate investigations into CPRIT are the Texas attorney general's office and the Travis County district attorney's public integrity unit, which investigates criminal misconduct within state government.

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Follow Paul J. Weber on Twitter: www.twitter.com/pauljweber

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At Least 27, Mostly Kids, Killed at Grade School

More than two dozen people, mostly elementary school children, were shot and killed at a Newtown, Conn., elementary school this morning, federal and state sources tell ABC News.

The massacre involved two gunmen and prompted the town of Newtown to lock down all its schools and draw SWAT teams to the school, authorities said today.

One shooter is dead and a manhunt is on for a second gunman. Police are searching cars. One shooter was described as a 24-year-old armed man with four weapons and wearing a bullet-proof vest, sources told ABC News.

It's unclear how many people have been shot, but 25 people, mostly children, are dead, multiple federal and state sources tell ABC News. That number could rise, officials said.

President Obama was briefed on the shooting by FBI Director Robert Mueller.

It is the worst shooting in a U.S. elementary school in recent memory and exceeds the carnage at the 1999 Columbine High School
shooting in which 13 died and 24 were injured.

The Newtown shooting comes three days after masked gunman Jacob Roberts opened fire in a busy Oregon mall, killing two before turning the gun on himself.

Today's shooting occurred at the Sandy Hook Elementary School, which includes 450 students in grades K-4. The town is located about 12 miles east of Danbury.

Shannon Hicks/The Newtown Bee

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State Police received the first 911 call at 9:41 a.m. and immediately began sending emergency units from the western part of the state. Initial 911 calls stated that multiple students were trapped in a classroom, possibly with a gunman, according to a Connecticut State Police source.

A photo from the scene shows a line of distressed children being led out of the school.

LIVE UPDATES: Newtown, Conn., School Shooting

Three patients have been taken to Danbury Hospital, which is also on lockdown, according to the hospital's Facebook page.

"Out of abundance of caution and not because of any direct threat Danbury Hospital is under lockdown," the statement said. "This allows us simply to focus on the important work at hand."

CLICK HERE for more photos from the scene.

Newtown Public School District secretary of superintendent Kathy June said in a statement that the district's schools were locked down because of the report of a shooting. "The district is taking preventive measures by putting all schools in lockdown until we ensure the safety of all students and staff," she said.

State police sent SWAT team units to Newtown.

All public and private schools in the town are on lockdown.

"We have increased our police presence at all Danbury Public Schools due to the events in Newtown. Pray for the victims," Newtown Mayor Boughton tweeted.

State emergency management officials said ambulances and other units were also en route and staging near the school.

A message on the school district website says that all afternoon kindergarten is cancelled today and there will be no midday bus runs.

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U.S., rebels urge gloomy Moscow to help oust Assad

BEIRUT (Reuters) - Syria's rebel leadership and the United States seized on Russian pessimism over President Bashar al-Assad's future to urge Moscow to help push its ally into ceding power and end the battles closing in around his capital.

"We want to commend the Russian government for finally waking up to the reality and acknowledging that the regime's days are numbered," the U.S. State Department spokeswoman said after a senior Kremlin envoy conceded publicly on Thursday that Assad's opponents could win the 20-month-old civil war.

"The question now is, will the Russian government join those of us in the international community who are working with the opposition to try to have a smooth democratic transition?" U.S. spokeswoman Victoria Nuland added in Washington.

In Marrakech, where his new coalition won recognition from other international powers as the legitimate leadership of Syria, rebel political leader Mouaz al-Khatib said he believed Russia, ally and arms supplier to the Assad dynasty since Soviet times, was looking for ways out of its support for a lost cause.

"I believe that the Russians have woken up and are sensing that they have implicated themselves with this regime, but they don't know how to get out," al-Khatib told Reuters. He held them "particularly responsible" for helping Assad with arms but said Moscow need not "lose everything" in Syria if it changed tack.

Under President Vladimir Putin, wary since last year's Libyan war of what Russia sees as a Western drive to use the United Nations to overthrow national leaders it dislikes, Russia has blocked U.N. efforts to squeeze Assad, who has also had strong support from his long-time sponsor Iran.

But Mikhail Bogdanov, a deputy foreign minister and the Kremlin's special envoy for Middle East affairs, was quoted as saying in Moscow: "One must look the facts in the face."

"Unfortunately, the victory of the Syrian opposition cannot be ruled out." The Syrian government, he said, was "losing control of more and more territory" and Moscow was preparing to evacuate Russian citizens if necessary.

Nuland said Bogdanov's comments demonstrated that Moscow now "sees the writing on the wall" on Syria and said Russia should now rally behind U.N. efforts to prevent a wider bloodbath.

"They can withdraw any residual support for the Assad regime, whether it is material support (or) financial support," she said. "They can also help us to identify people who might be willing, inside of Syria, to work on a transitional structure."

DIPLOMACY

International envoy Lakhdar Brahimi, who has met Russian and U.S. officials twice in the past week, is seeking a solution based on an agreement reached in Geneva in June that called for the creation of a transitional government in Syria.

But Russia has repeated warnings that recognition of al-Khatib's coalition, notably by the United States, is undermining diplomacy, and rejected U.S. contentions that the Geneva agreement sent a clear message that Assad should step down.

Nuland said the Brahimi meetings could lay the framework for a political structure to follow Assad:

"We've said all along to the Russians that we are concerned that the longer that this goes on, and the longer it takes us to get to an alternative political path for Syria, the only path is going to be the military one and that is just going to bring more violence.

"We all ought to be working together."

Bogdanov, whose government has suggested that Assad himself should be allowed to see through a transition he has promised, suggested the rebels and their allies were set on a military solution and he gave little hint of detente with Washington.

"The fighting will become even more intense and (Syria) will lose tens of thousands and, perhaps, hundreds of thousands of civilians," Bogdanov was quoted as saying. "If such a price for the removal of the president seems acceptable to you, what can we do? We, of course, consider it absolutely unacceptable."

The head of NATO, Anders Fogh Rasmussen, said elsewhere: "I think the regime in Damascus is approaching collapse."

A U.S. official said: "Assad probably still believes that Syria is his and illusions can die hard. But Assad and those closest to him have got to be feeling the psychological strain of fighting a long war that is not going their way."

DAMASCUS BATTLES

But Al-Khatib, who played down Western concerns of sectarian Sunni Islamists in rebel ranks, warned that the fighting was far from over, even as it has begun to rattle the heart of Assad's power in Damascus. On Wednesday, a car bomb killed at least 16 people in a nearby town which is home to many military families.

"The noose is tightening around the regime," al-Khatib said.

"(But) the regime still has power. People think that the regime is finished, but it still has power left, but it is demoralized and however long it lasted its end is clear."

Day and night, Damascenes can hear the thunderous sound of bombardment aimed at rebel-held and contested neighborhoods.

The city's streets have now turned into a labyrinth of checkpoints and road blocks, with several major roads permanently closed off to traffic by concrete barriers.

"We escape from one place and trouble follows," said one grandmother, Um Hassan, as she described to Reuters her family's flight from one neighborhood to another as fighting seeps into the capital. "I don't know where we can keep running to."

Nonetheless, al-Khatib played down demands for their allies to provide heavier weaponry - a request long resisted by governments wary of anti-aircraft missiles and other hardware reaching Islamist rebels who might turn them against the West.

"The Syrian people ... no longer need international forces to protect them," he said, not specifying whether he meant a no-fly zone, arms supplies or other military support.

The opposition chief said he was willing to listen to proposals for Assad to escape with his life - "The best thing is that he steps down and stops drinking the blood of the Syrian people" - and outlined three scenarios for a change of power:

Al-Khatib ruled out the Russian proposal suggesting Assad hand over power to a transitional government while remaining president, saying it was "disgraceful for a slaughtered nation to accept to have a killer and criminal at its head".

The British-based Syrian Observatory said war planes bombed rebel-held eastern suburbs of Damascus on Thursday and artillery was hitting Daraya and Moadamiyeh, southwestern areas near the centre where rebels have been fighting for a foothold.

Syria has relied on war planes and helicopters to bombard rebel districts but Damascus denied accusations by U.S. and NATO officials that it had fired Scud missiles in recent days. The foreign ministry said the long-range missiles were not used against "terrorist groups," a term it uses for the rebels.

At least 40,000 people have been killed in Syria's uprising, which started in March 2011 with street protests which were met with gunfire by Assad's security forces, and which spiraled into the most enduring and destructive of the Arab revolts.

(Additional reporting by Steve Gutterman in Moscow and Andrew Quinn in Washington; Writing by Alastair Macdonald; Editing by Michael Roddy) For an interactive look at the uprising in Syria, please click on http://link.reuters.com/rut37s

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Deadly shooting erupts at US elementary school

NEW YORK: At least 27 people were killed, including 18 children, in a shooting Friday at a Connecticut elementary school, US media reported.

Connecticut State Police spokesman Paul Vance would not give details, but confirmed "there was a shooting."

CBS News cited law enforcement sources as saying that 27 people were killed, including 18 children. A White House spokesman said that President Barack Obama had been informed of the shooting and was following events.

Local media quoted unconfirmed reports that a gunman had died at the Sandy Hook Elementary School in Newtown, Connecticut, northeast of New York City.

Police swarmed into the leafy neighborhood after the shooting, while other area schools were put under lock-down, police and local media said.

Reports also said that at least one teacher was wounded, while The Newtown Bee newspaper said that a child was carried out of the school with apparently serious injuries.

A photo on the Bee's website showed officers leading more than a dozen clearly frightened small children across a parking lot. Another image showed officers gathering in the quiet street nearby.

On the Newtown Public School District website, an alert was posted warning that "afternoon kindergarten is cancelled today" and that there would be no lunch-hour bus runs.

Authorities were to give a press conference on the emergency at 1:00 pm (1800 GMT).

Deadly shootings are a regular occurrence in US public places, often ending only when the gunman is shot or kills himself.

On Tuesday, a man with a semi-automatic rifle raked an Oregon shopping mall, killing two people, then taking his own life.

In the most notorious recent incident, in July this year, a 24-year-old, James Holmes, allegedly killed 12 people and wounded 58 others when he opened fire in a midnight screening of the latest Batman movie in Aurora, Colorado.

Last month, gunman Jared Loughner was jailed for life for killing six people in Tucson, Arizona, in January 2011 in an attack targeting congresswoman Gabrielle Giffords, who was shot in the head at point-blank range but survived.

However, despite the tragedies support for tougher gun ownership laws is mixed, with many Americans opposing restrictions of what they consider to be a constitutional right to keep powerful firearms at home.

-AFP/ac

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Killing of fishermen: Italy summons Indian ambassador

ROME: Italy has summoned India's ambassador to insist that India's Supreme Court issue a decision soon concerning two Italian naval guards detained since February for the deaths of two Indian fishermen mistaken for pirates.

Italy maintains the shooting occurred in international waters and that as a result, Rome should have jurisdiction.

India claims the ship was in Indian territorial waters. The Indian Supreme Court is to decide on Italy's petition to try the sailors at home.

In a statement Thursday, the foreign ministry said it was "profoundly bewildered" why the court hasn't ruled even though arguments ended three months ago. It asked for a decision before Christmas.

The sailors were providing security on a cargo ship when they allegedly shot the fishermen. The dispute has strained diplomatic relations.

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