Wall Street flat, losses trimmed after data

PARIS, March 1 (Reuters) - Alex Ferguson's philosophy is behind the longevity of Manchester United's homegrown players, says Paris St Germain midfielder David Beckham. The former England captain and United player is still active at 37, having joined PSG on a five-month loan at the end of January. Former team mate Phil Neville, 36, plays at Everton and the 39-year-old Ryan Giggs, who started his youth career at Manchester City but ended it at United, is still at Old Trafford after signing his first professional contract there in 1990. ...

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Rachel McAdams Finds Unlikely Suitor at Toronto Raptors Game

By Tim Nudd

02/28/2013 at 11:15 AM EST

Rachel McAdams and the Toronto Raptors's velociraptor mascot

IPHOTO

Rachel McAdams's last boyfriend was a little older than her. Now it looks like she's keeping company with someone from the Cretaceous Period.

The actress, 34, who recently split with her beau of two years, actor Michael Sheen, was courted by the Toronto Raptors's velociraptor mascot on Monday night.

He presented the Midnight in Paris actress with flowers and a stuffed dinosaur as the Toronto public-address announcer introduced the London, Ontario, native to the crowd, who cheered wildly.

McAdams, sporting newly red locks, seemed charmingly embarrassed by the whole episode, but took it in stride, grinning her famous smile as she accepted the presents.

As NBA mascots go, the Raptor would be a prize catch for any Hollywood actress. Described as "165 lbs. of pure solid fur," he's been voted the most popular NBA mascot in each of the past three seasons.

He also "enjoys making people laugh, whether with him or at him, usually at him," according to his bio.

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Medicare paid $5.1B for poor nursing home care

SAN FRANCISCO (AP) — Medicare paid billions in taxpayer dollars to nursing homes nationwide that were not meeting basic requirements to look after their residents, government investigators have found.

The report, released Thursday by the Department of Health and Human Services' inspector general, said Medicare paid about $5.1 billion for patients to stay in skilled nursing facilities that failed to meet federal quality of care rules in 2009, in some cases resulting in dangerous and neglectful conditions.

One out of every three times patients wound up in nursing homes that year, they landed in facilities that failed to follow basic care requirements laid out by the federal agency that administers Medicare, investigators estimated.

By law, nursing homes need to write up care plans specially tailored for each resident, so doctors, nurses, therapists and all other caregivers are on the same page about how to help residents reach the highest possible levels of physical, mental and psychological well-being.

Not only are residents often going without the crucial help they need, but the government could be spending taxpayer money on facilities that could endanger people's health, the report concluded. The findings come as concerns about health care quality and cost are garnering heightened attention as the Obama administration implements the nation's sweeping health care overhaul.

"These findings raise concerns about what Medicare is paying for," the report said.

Investigators estimate that in one out of five stays, patients' health problems weren't addressed in the care plans, falling far short of government directives. For example, one home made no plans to monitor a patient's use of two anti-psychotic drugs and one depression medication, even though the drugs could have serious side effects.

In other cases, residents got therapy they didn't need, which the report said was in the nursing homes' financial interest because they would be reimbursed at a higher rate by Medicare.

In one example, a patient kept getting physical and occupational therapy even though the care plan said all the health goals had been met, the report said.

The Office of Inspector General's report was based on medical records from 190 patient visits to nursing homes in 42 states that lasted at least three weeks, which investigators said gave them a statistically valid sample of Medicare beneficiaries' experiences in skilled nursing facilities.

That sample represents about 1.1 million patient visits to nursing homes nationwide in 2009, the most recent year for which data was available, according to the review.

Overall, the review raises questions about whether the system is allowing homes to get paid for poor quality services that may be harming residents, investigators said, and recommended that the Centers for Medicare & Medicaid Services tie payments to homes' abilities to meet basic care requirements. The report also recommended that the agency strengthen its regulations and ramp up its oversight. The review did not name individual homes, nor did it estimate the number of patients who had been mistreated, but instead looked at the overall number of stays in which problems arose.

In response, the agency agreed that it should consider tying Medicare reimbursements to homes' provision of good care. CMS also said in written comments that it is reviewing its own regulations to improve enforcement at the homes.

"Medicare has made significant changes to the way we pay providers thanks to the health care law, to reward better quality care," Medicare spokesman Brian Cook said in a statement to AP. "We are taking steps to make sure these facilities have the resources to improve the quality of their care, and make sure Medicare is paying for the quality of care that beneficiaries are entitled to."

CMS hires state-level agencies to survey the homes and make sure they are complying with federal law, and can require correction plans, deny payment or end a contract with a home if major deficiencies come to light. The agency also said it would follow up on potential enforcement at the homes featured in the report.

Greg Crist, a Washington-based spokeswoman for the American Health Care Association, which represents the largest share of skilled nursing facilities nationwide, said overall nursing home operators are well regulated and follow federal guidelines but added that he could not fully comment on the report's conclusions without having had the chance to read it.

"Our members begin every treatment with the individual's personal health needs at the forefront. This is a hands-on process, involving doctors and even family members in an effort to enhance the health outcome of the patient," Crist said.

Virginia Fichera, who has relatives in two nursing homes in New York, said she would welcome a greater push for accountability at skilled nursing facilities.

"Once you're in a nursing home, if things don't go right, you're really a prisoner," said Fichera, a retired professor in Sterling, NY. "As a concerned relative, you just want to know the care is good, and if there are problems, why they are happening and when they'll be fixed."

Once residents are ready to go back home or transfer to another facility, federal law also requires that the homes write special plans to make sure patients are safely discharged.

Investigators found the homes didn't always do what was needed to ensure a smooth transition.

In nearly one-third of cases, facilities also did not provide enough information when the patient moved to another setting, the report found.

___

On the Web:

The OIG report: http://1.usa.gov/VaztQm

The Medicare nursing home database: http://www.medicare.gov/NursingHomeCompare/search.aspx?bhcp=1&AspxAutoDetectCookieSupport=1

___

Follow Garance Burke on Twitter at —http://twitter.com/garanceburke.

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Wall Street advances, on track for third day of gains

NEW YORK (Reuters) - U.S. stocks edged higher on Thursday, pointing to a third straight day of gains in the wake of some strong economic data, though a further advance may be limited with major averages near multi-year highs.

While some data released Thursday were rosy, a read on economic growth was weaker than expected, and analysts said a pullback may be in store a day after major equity indexes posted their biggest daily advance since early January.

Over the past two sessions, the S&P 500 has gained 1.9 percent, rising back above the closely watched level of 1,500. The Dow Jones industrial average moved within striking distance of an all-time high.

"The market is looking choppy, and I think investors should use this as an opportunity to sell into strength," said Matt McCormick, a money manager at Cincinnati-based Bahl & Gaynor. "This seems like an environment where someone should be conservative instead of aggressive."

The U.S. economy grew 0.1 percent in the fourth quarter, a weaker pace than expected, although a slightly better performance in exports and fewer imports led the government to scratch an earlier estimate of an economic contraction.

Separately, the number of Americans filing new claims for unemployment benefits fell more than expected last week, while the February Chicago Purchasing Managers Index unexpectedly rose to an 11-month high.

While equity markets suffered steep losses earlier in the week on concerns over European debt, they have since recovered, with the gains fueled by strong data and recent comments by Federal Reserve Chairman Ben Bernanke that showed continued support for the Fed's economic stimulus policy.

"Growth is still anemic and there are still issues with Europe. People seem to be ignoring the signs that would otherwise give them cause for concern," said McCormick, who helps oversee $8.2 billion in assets.

The Dow Jones industrial average <.dji> was up 27.27 points, or 0.19 percent, at 14,102.64. The Standard & Poor's 500 Index <.spx> was up 5.13 points, or 0.34 percent, at 1,521.12. The Nasdaq Composite Index <.ixic> was up 13.75 points, or 0.43 percent, at 3,176.01.

The benchmark S&P 500 has gained 1.4 percent in February, the Dow is up 1.7 percent and the Nasdaq has added 1 percent.

J.C. Penney Co Inc slumped 18 percent to $17.32 as the S&P's biggest decliner after the department store reported a steep drop in sales on Wednesday. Groupon Inc also slumped on weak revenue, with the stock off 25 percent at $4.50.

Mylan Inc jumped 6.5 percent to $30.45 on the Nasdaq after the generic drugmaker posted a 25 percent rise in fourth-quarter profit.

Investors were keeping an eye on the debate in Washington over sequestration - U.S. government budget cuts that will take effect starting on Friday if lawmakers fail to reach an agreement on spending and taxes. President Barack Obama and Republican congressional leaders arranged to hold last-ditch talks to prevent the cuts, but expectations were low that any deal would be produced.

With 93 percent of the S&P 500 companies having reported results so far, 69.5 percent have beaten profit expectations, compared with a 62 percent average since 1994 and 65 percent over the past four quarters, according to Thomson Reuters data.

Fourth-quarter earnings for S&P 500 companies are estimated to have risen 6.2 percent, according to the data, above a 1.9 percent forecast at the start of the earnings season.

(Editing by Bernadette Baum)

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Iran upbeat on nuclear talks, West wary

ALMATY (Reuters) - Iran gave an upbeat assessment of two days of nuclear talks with world powers that ended on Wednesday, but Western officials said Tehran must start taking concrete steps to ease mounting concerns about its atomic activity.

The first negotiations between Iran and six world powers in eight months ended without a breakthrough in Almaty, but they agreed to meet again at expert level in Istanbul next month and resume political discussions in the Kazakh city on April 5.

Israel, assumed to be the Middle East's only nuclear-armed power, is watching the talks closely. It has strongly hinted it might attack Iran if diplomacy and sanctions fail to stop it from acquiring nuclear weapons. Iran denies any such aim.

Iran's foreign minister said he was optimistic an agreement could be reached with the powers - the United States, France, Russia, Britain, Germany and China - on the country's disputed nuclear program.

"Very confident," Ali Akbar Salehi told Reuters when asked on the sidelines of a U.N. conference in Vienna how confident he was of a positive outcome.

The six powers offered at the February 26-27 Almaty meeting to lift some sanctions if Iran scaled back nuclear activity that the West fears could be used to build a bomb.

Tehran, which says its program is entirely peaceful, did not agree to do so and the sides did not appear any closer to a deal to resolve a decade-old dispute that could lead to another war in the Middle East if diplomacy fails.

But Iran still said the talks were a positive step in which the six powers tried to "get closer to our viewpoint".

Western officials had made clear they did not expect major progress in Almaty, aware that the closeness of Iran's presidential election in June is raising political tensions in Tehran and makes significant concessions unlikely.

"I hope the Iranian side is looking positively on the proposal we put forward," said European Union foreign policy chief Catherine Ashton, who led the talks on behalf of the powers. "We have to see what happens next."

The United States did not expect a breakthrough and "the result was clearly in line with those expectations," a senior U.S. official said.

The meeting was "useful" as the two sides agreed dates and venues for follow-up talks but there was a need for progress on confidence building measures, the official added.

UNDERGROUND NUCLEAR SITE

The West's immediate priority is that Iran halts higher-grade uranium enrichment and closes an underground facility, Fordow, where this work is carried out. The material is a relatively short technical step from bomb-grade uranium.

"What we care about at the end is concrete results," the U.S. official said.

One diplomat in Almaty said the Iranians appeared to be suggesting at the negotiations that they were opening new avenues, but that it was not clear if this was really the case.

Both sides said experts would meet for talks in the Turkish city of Istanbul on March 18 and that political negotiators would return to Almaty on April 5-6.

Russian negotiator Sergei Ryabkov confirmed that the powers had offered to ease sanctions on Iran if it stops enriching uranium to 20 percent fissile purity - a short technical step from weapons grade - at the Fordow underground site where it carries out its most controversial uranium enrichment work.

Western officials said the offer of sanctions relief included a resumption of trade in gold and precious metals.

One diplomat said that lifting an embargo on imports of Iranian petrochemical products to Europe, if Iran responded, was also on the table. But a U.S. official said the world powers had not offered to suspend oil or financial sanctions.

The sanctions are hurting Iran's economy and its chief nuclear negotiator, Saeed Jalili, suggested Iran could discuss its production of higher-grade nuclear fuel, although he appeared to rule out shutting Fordow.

In comments in Persian translated into English, Jalili told a news conference Fordow was under the supervision of the U.N. nuclear watchdog and there was no justification for closing it.

MOOD "MORE OPTIMISTIC"

Asked about the production of 20-percent enriched fuel, he reiterated Iran's position that it needed this for a research reactor and had a right to produce it.

Iran says its enrichment program is aimed solely at fuelling nuclear power plants so that it can export more oil, and that Israel's assumed nuclear arsenal is the main threat to peace in the region.

But Jalili did indicate that Iran might be prepared to talk about the issue, saying: "This can be discussed in the negotiations ... in view of confidence building."

Iran has also previously suggested that 20-percent enrichment was up for negotiation if it received the fuel from abroad instead. It also wants sanctions lifted.

"While an agreement to meet again may not impress skeptics of diplomacy, an important development did occur," said Trita Parsi, an expert on Iran. "The parties began searching for a solution by offering positive measures in order to secure concessions from the other side.

Another expert, Dina Esfandiary of the International Institute for Strategic Studies, said: "I note that the mood is more optimistic and that's great, but a deal still hasn't been reached and in my view its unlikely to be reached before the Iranian elections have come and gone."

(Additional reporting Fredrik Dahl in Almaaty, Georgina Prodhan in Vienna, Zahra Hosseinian in Zurich, Gabriela Baczynska in Moscow, Dan Williams in Jerusalem and Marcus George in Dubai; Writing by Timothy Heritage and Fredrik Dahl; Editing by Jon Hemming)

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Meet the Biggest Star in Music Right Now: A Goat!

By Cara Lynn Shultz

02/27/2013 at 11:15 AM EST

The biggest duet partner for music's biggest stars right now? A goat.

We're not kidding.

If your coworker bleating with joy, he or she has probably stumbled upon a new meme, which mashes up pop hits with an old clip of a goat screaming as if it were a human. (Some might argue that the goat improves the songs, but we'll leave that discussion to the comments section.) So far, Taylor Swift's "I Knew You Were Trouble," Justin Bieber's "Baby" and Katy Perry's "Firework" have all gotten the wooly treatment.

Put on your headphones (our goat pal is loud), throw your hooves in the air, and wave them like you just don't care to some of our favorites – before this goat gets a record deal!

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Vt. lye victim gets new face at Boston hospital

BOSTON (AP) — A Vermont woman whose face was disfigured in a lye attack has received a face transplant.

Doctors at Boston's Brigham and Women's Hospital say 44-year-old Carmen Blandin Tarleton underwent the surgery earlier this month.

A team worked 15 hours to transplant the facial skin, including the neck, nose, lips, facial muscles, arteries and nerves.

The 44-year-old Tarleton, of Thetford, Vt., was attacked by her former husband in 2007. He doused her with industrial strength lye. She suffered chemical burns over 80 percent of her body. The mother of two wrote a book about her experience that describes her recovery.

It was the fifth face transplant at the Boston hospital.

Physicians are planning to discuss the case Wednesday at the hospital.

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Wall Street rises on Bernanke, Italian bond auction

NEW YORK (Reuters) - Wall Street rose on Wednesday as Federal Reserve Chairman Ben Bernanke reaffirmed his support of the Fed's stimulus policy, the latest U.S. earnings showed strength and an Italian bond auction drew ample demand, reassuring investors.

In his second day before a congressional committee, Bernanke repeated testimony in which he defended the Fed's policy of buying bonds to keep interest rates low in order to promote growth and bring down the unemployment rate.

Bernanke's similar remarks on Tuesday helped the market rebound from its worst decline since November. The S&P 500 <.spx> is now back above 1,500, a closely watched level that has been technical support until recently.

"Bernanke comments will keep liquidity in place in the market and every dip now is being viewed as an opportunity to get in," said Dan Veru, chief investment officer at Palisade Capital Management.

Financial markets had been worried about the possibility the Fed would end its bond buying earlier than expected after Fed meeting minutes showed some policymakers favored changes.

Also supporting the market, European stocks and the euro rose on relief that Italy was able to sell bonds despite jitters about the country's political instability.

The Dow Jones industrial average <.dji> rose 96.77 points, or 0.70 percent, at 13,996.90. The Standard & Poor's 500 Index <.spx> gained 11.93 points, or 0.80 percent, at 1,508.87. The Nasdaq Composite Index <.ixic> advanced 30.75 points, or 0.98 percent, at 3,160.39.

The benchmark S&P 500, up 6 percent for the year, was within reach of record highs a week ago, before the minutes from the Fed's January meeting were released. Since then, the index has shed 1 percent as the minutes raised questions about whether the Fed may slow or halt its economy-stimulating measures soon.

In earnings news, discount retailer Target Corp appeared poised for a solid showing in the first quarter and forecast a higher profit for the full year after a weak performance in the key holiday season. The stock was off 1.5 percent at $63.07.

Dollar Tree Inc reported a higher quarterly profit as shoppers spent more and the chain controlled costs. The stock jumped 10 percent to $45.00.

Shares of Boyd Gaming jumped 2 percent to $6.63 after New Jersey Governor Chris Christie signed a revised online gaming bill.

A closely watched proxy for business spending plans jumped 6.3 percent in January, the biggest gain since December 2011, data on durable goods orders showed on Wednesday.

Another report showed an index of pending home sales increased 4.5 percent to its highest level since April 2010 - just before the expiration of the home-buyer tax credit.

(Editing by Bernadette Baum)

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Seth MacFarlane's TV Guide Critic Reacts to Oscar Mention

02/26/2013 at 11:30 AM EST

Seth MacFarlane (far left) and William Shatner, with Stephen Battaglio (inset)

Zuma; Inset: Getty

So, how does it feel to have your name dropped before a billion people?

Surprising, says TV Guide columnist Stephen Battaglio, who was part of the lively opening exchange between Oscar host Seth MacFarlane and intruder from the future William Shatner.

In a spoof (and a screen grab), the Star Trek captain showed the Family Guy guy what would be his upcoming review from Battglio.

"I didn't know it was coming," Battaglio writes on TV Guide's website. "I was watching the show at home with my wife. Staring at the byline, it took a few seconds to absorb."

And once it did, he says, "every electronic device in our apartment was ringing, buzzing, pinging or vibrating."

For the writer's full reaction, click here.
– Stephen M. Silverman

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C. Everett Koop, 'rock star' surgeon general, dies

NEW YORK (AP) — Dr. C. Everett Koop has long been regarded as the nation's doctor— even though it has been nearly a quarter-century since he was surgeon general.

Koop, who died Monday at his home in Hanover, N.H., at age 96, was by far the best known and most influential person to carry that title. Koop, a 6-foot-1 evangelical Presbyterian with a biblical prophet's beard, donned a public health uniform in the early 1980s and became an enduring, science-based national spokesman on health issues.

He served for eight years during the Reagan administration and was a breed apart from his political bosses. He thundered about the evils of tobacco companies during a multiyear campaign to drive down smoking rates, and he became the government's spokesman on AIDS when it was still considered a "gay disease" by much of the public.

"He really changed the national conversation, and he showed real courage in pursuing the duties of his job," said Chris Collins, a vice president of amfAR, the Foundation for AIDS Research.

Even before that, he had been a leading figure in medicine. He was one of the first U.S. doctors to specialize in pediatric surgery at a time when children with complicated conditions were often simply written off as untreatable. In the 1950s, he drew national headlines for innovative surgeries such as separating conjoined twins.

His medical heroics are well noted, but he may be better remembered for transforming from a pariah in the eyes of the public health community into a remarkable servant who elevated the influence of the surgeon general — if only temporarily.

"He set the bar high for all who followed in his footsteps," said Dr. Richard Carmona, who served as surgeon general a decade later under President George W. Bush.

Koop's religious beliefs grew after the 1968 death of his son David in a mountain-climbing accident, and he became an outspoken opponent of abortion. His activism is what brought him to the attention of the administration of President Ronald Reagan, who decided to nominate him for surgeon general in 1981. Though once a position with real power, surgeon generals had been stripped of most of their responsibilities in the 1960s.

By the time Koop got the job, the position was kind of a glorified health educator.

But Koop ran with it. One of his early steps involved the admiral's uniform that is bestowed to the surgeon general but that Koop's predecessors had worn only on ceremonial occasions. In his first year in the post, Koop stopped wearing his trademark bowties and suit jackets and instead began wearing the uniform, seeing it as a way to raise the visual prestige of the office.

In those military suits, he surprised the officials who had appointed him by setting aside his religious beliefs and feelings about abortion and instead waging a series of science-based public health crusades.

He was arguably most effective on smoking. He issued a series of reports that detailed the dangers of tobacco smoke, and in speeches began calling for a smoke-free society by the year 2000. He didn't get his wish, but smoking rates did drop from 38 percent to 27 percent while he was in office — a huge decline.

Koop led other groundbreaking initiatives, but perhaps none is better remembered than his work on AIDS.

The disease was first identified in 1981, before Koop was officially in office, and it changed U.S. society. It destroyed the body's immune system and led to ghastly death, but initially was identified in gay men, and many people thought of it as something most heterosexuals didn't have to worry about.

U.S. scientists worked hard to identify the virus and work on ways to fight it, but the government's health education and policy efforts moved far more slowly. Reagan for years was silent on the issue. Following mounting criticism, Reagan in 1986 asked Koop to prepare a report on AIDS for the American public.

His report, released later that year, stressed that AIDS was a threat to all Americans and called for wider use of condoms and more comprehensive sex education, as early as the third grade. He went on to speak frankly about AIDS in an HBO special and engineered the mailing of an educational pamphlet on AIDS to more than 100 million U.S. households in 1988.

Koop personally opposed homosexuality and believed sex should be saved for marriage. But he insisted that Americans, especially young people, must not die because they were deprived of explicit information about how HIV was transmitted.

Koop's speeches and empathetic approach made him a hero to a wide swath of America, including public health workers, gay activists and journalists. Some called him a "scientific Bruce Springsteen." AIDS activists chanted "Koop, Koop" at his appearances and booed other officials.

"I was walking down the street with him one time" about five years ago, recalled Dr. George Wohlreich, director of the College of Physicians of Philadelphia, a medical society with which Koop had longstanding ties. "People were yelling out, 'There goes Dr. Koop!' You'd have thought he was a rock star."

Koop angered conservatives by refusing to issue a report requested by the Reagan White House, saying he could not find enough scientific evidence to determine whether abortion has harmful psychological effects on women.

He got static from some staff at the White House for his actions, but Reagan himself never tried to silence Koop. At a congressional hearing in 2007, Koop spoke about political pressure on the surgeon general post. He said Reagan was pressed to fire him every day.

After his death was reported Monday, the tributes poured forth, including a statement from New York Mayor Michael Bloomberg, who has made smoking restrictions a hallmark of his tenure.

"The nation has lost a visionary public health leader today with the passing of former Surgeon General C. Everett Koop, who was born and raised in Brooklyn," Bloomberg said. "Outspoken on the dangers of smoking, his leadership led to stronger warning labels on cigarettes and increased awareness about second-hand smoke, creating an environment that helped millions of Americans to stop smoking — and setting the stage for the dramatic changes in smoking laws that have occurred over the past decade."

Dr. Anthony Fauci of the National Institutes of Health taught Koop what was known about AIDS during quiet after-hours talks in the early 1980s and became a close friend.

"A less strong person would have bent under the pressure," Fauci said. "He was driven by what's the right thing to do."

Carmona, a surgeon general years later, said Koop was a mentor who preached the importance of staying true to the science in speeches and reports — even when it made certain politicians uncomfortable.

"We remember him for the example he set for all of us," Carmona said.

Koop's nomination originally was met with staunch opposition. Women's groups and liberal politicians complained Reagan had selected him only because of his conservative views, especially his staunch opposition to abortion.

Foes noted that Koop traveled the country in 1979 and 1980 giving speeches that predicted a progression "from liberalized abortion to infanticide to passive euthanasia to active euthanasia, indeed to the very beginnings of the political climate that led to Auschwitz, Dachau and Belsen."

But Koop, a devout Presbyterian, was confirmed as surgeon general after he told a Senate panel he would not use the post to promote his religious ideology. He kept his word and eventually won wide respect with his blend of old-fashioned values, pragmatism and empathy.

Koop was modest about his accomplishments, saying before leaving office in 1989, "My only influence was through moral suasion."

The office declined after that. Few of his successors had his speaking ability or stage presence. Fewer still were able to secure the support of key political bosses and overcome the meddling of everyone else. The office gradually lost prestige and visibility, and now has come to a point where most people can't name the current surgeon general. (It's Dr. Regina Benjamin.)

Even after leaving office, Koop continued to promote public health causes, from preventing childhood accidents to better training for doctors.

"I will use the written word, the spoken word and whatever I can in the electronic media to deliver health messages to this country as long as people will listen," he promised.

In 1996, he rapped Republican presidential hopeful Bob Dole for suggesting that tobacco was not invariably addictive, saying Dole's comments "either exposed his abysmal lack of knowledge of nicotine addiction or his blind support of the tobacco industry."

He maintained his personal opposition to abortion. After he left office, he told medical students it violated their Hippocratic oath. In 2009, he wrote to Senate Majority Leader Harry Reid, urging that health care legislation include a provision to ensure doctors and medical students would not be forced to perform abortions. The letter briefly set off a security scare because it was hand delivered.

Koop served as chairman of the National Safe Kids Campaign and as an adviser to President Bill Clinton's health care reform plan.

Worried that medicine had lost old-fashioned caring and personal relationships between doctors and patients, Koop opened an institute at Dartmouth College in New Hampshire to teach medical students basic values and ethics. He also was a part-owner of a short-lived venture, drkoop.com, to provide consumer health care information via the Internet.

Koop was the only son of a Manhattan banker and the nephew of a doctor. He said by age 5 he knew he wanted to be a surgeon and at age 13 he practiced his skills on neighborhood cats. He attended Dartmouth, where he received the nickname Chick, short for "chicken Koop." It stuck for life.

He received his medical degree at Cornell Medical College, choosing pediatric surgery because so few surgeons practiced it. In 1938, he married Elizabeth Flanagan, the daughter of a Connecticut doctor. They had four children. Koop's wife died in 2007, and he married Cora Hogue in 2010.

He was appointed surgeon-in-chief at Children's Hospital in Philadelphia and served as a professor at the University of Pennsylvania School of Medicine. He pioneered surgery on newborns and successfully separated three sets of conjoined twins. He won national acclaim by reconstructing the chest of a baby born with the heart outside the body.

Although raised as a Baptist, he was drawn to a Presbyterian church near the hospital, where he developed an abiding faith. He began praying at the bedside of his young patients — ignoring the snickers of some of his colleagues.

___

Contributing to this report were Associated Press writers Wilson Ring in Montpelier, Vt.; Jeff McMillan in Philadelphia; and AP Medical Writer Lauran Neergaard in Washington.

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