Robert L. Citron dies at 87; central figure in O.C. bankruptcy

Robert L. Citron, the Orange County treasurer whose bad bets on exotic Wall Street investments resulted in what at the time was the largest municipal bankruptcy in U.S. history, died Wednesday. He was 87.

Citron died at St. Joseph Hospital in Orange of complications from a heart attack, said his wife, Terry Citron.

Until the 1994 financial collapse, Citron was a low-key bureaucrat who won praise from Orange County supervisors for earning much higher yields from the county's complex array of investments than many other government agencies. His investment pools attracted funds from governments around the country as well as from schools, cities and public agencies.

The county declared bankruptcy Dec. 6, 1994, buffeted by losses that, when the final count was tallied, amounted to $1.64 billion. The county was forced to postpone repayments on bonds it had sold, ruining its credit rating, but eventually repaid its creditors in full. The bankruptcy sent shock waves through Wall Street and the municipal bond markets. It also made national headlines, with some asking how such a prosperous county could become insolvent.

A grand jury investigation would later find that the treasurer who over the years won so much praise for his investment skills relied upon a mail order astrologer and a psychic for interest rate predictions as the county's treasury began to falter.

Citron pleaded guilty to six felony counts, including filing false statements to participants in the Orange County Treasury Investment Pool. His lawyer, David Wiechert, submitted medical testimony indicating that Citron was in the early stages of dementia.

Citron was sentenced to work in the county jail, sorting inmates' requests for personal items by day before returning to his home in Santa Ana. He never spent a night behind bars but worked for months in the jail's commissary. He remained on probation until 2002.

In a 1997 interview with The Times, Citron insisted that he was duped into making rashly imprudent investments by Merrill Lynch. He became a key witness in Orange County's $2-billion lawsuit against the investment giant. The suit said that Citron was a "pigeon" for greedy brokers at the investment house.

Merrill Lynch maintained that the bankruptcy was Citron's fault. It later settled the case with the county, paying $400 million.

A third-generation Californian, Citron was born in Los Angeles on April 14, 1925, according to public records, and grew up in Burbank. Because he had asthma as a child, his family moved out to the town of Hemet in the foothills of the San Jacinto Mountains. His father, Jesse, was a doctor who earned a measure of fame for being liquor-loving W.C. Fields' doctor and weaning him off Scotch.

Citron rose through the ranks of the county's treasury department to become county treasurer-tax collector, a post he held for 24 years. He was one of the few Democrats to hold countywide elected office in a region dominated by Republicans. He lived in Santa Ana, just a few miles from work, and was famous for his long hours. In a 1994 interview, his wife told The Times that the weekends were hardest for her husband because he could not go to work.

"He can barely stand the weekend at home," she said. "He can't wait to get back. I think he'd go crazy without that job."

The bankruptcy tarnished Citron's name as well as the county's. County government slashed hundreds of jobs and cut budgets. Orange County's repayment plan siphoned money from four county departments every year, affecting projects big and small.

Citron's assistant, Matthew Raabe, was convicted of fraud and misappropriation and served 41 days in jail before the verdict was overturned. Taxpayers spent $1 million on his defense. The county's financial director, Ronald S. Rubino, was tried on fraud and misappropriation charges, but a jury deadlocked in favor of acquittal. He pleaded no contest to one record-keeping violation under a deal that allowed his record to be erased after a year. County Supervisors Roger R. Stanton and William G. Steiner were indicted by a grand jury on grounds of failing to safeguard public funds. The indictment was later dismissed by an appeals court ruling that said failing to do their jobs wasn't a crime.

Citron is survived by his wife of 57 years.

scott.reckard@latimes.com

Times staff writers Shelby Grad and Robert J. Lopez contributed to this report.

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Facing the French, Mali Rebels Dig In and Blend In

Joe Penney/Reuters

As France fortified its ground forces in Mali, French soldiers refueled armored personnel carriers, newly arrived from Ivory Coast, at a Bamako air base on Tuesday.

BAMAKO, Mali — In the face of fierce, all-night bombardment by the French military, Mali’s Islamist insurgents have hunkered down to fight again.

Barging into some of the mud-brick houses in the battle zone and ejecting residents, they have sought to implant themselves in the local population and add to the huge challenges facing the French military campaign to loosen their grip on Mali.

“They are in the town, almost everywhere in the town,” said Bekaye Diarra, who owns the pharmacy in Diabaly, which experienced French bombing on Tuesday but remained under the control of the insurgents. “They are installing themselves.”

Benco Ba, a parliamentary deputy there, described residents in fear of the conflict that had descended on them. “The jihadists are going right into people’s families,” he said. “They have completely occupied the town. They are dispersed. It’s fear.”

Six days into the French military campaign, it was becoming clear that airstrikes alone will probably not be enough to root out these battle-hardened fighters, who know well the harsh grassland and desert terrain of Mali.

French Defense Minister Jean-Yves Le Drian, speaking as French ground forces deployed in the north, said on Wednesday that the campaign would be long, Reuters reported.

“We’re in a better position than last week, but the combat continues and it will be long, I imagine,” he said on RTL radio. “Today the ground forces are in the process of deploying,” he said. “Now the French forces are reaching the north,” Reuters said.

Adm. Edouard Guillaud, the French chief of staff, was quoted by The Associated Press as saying that ground operations began overnight. “Now we’re on the ground,” Admiral Guillaud said. “We will be in direct combat within hours.”

Containing the rebels’ southern advance toward Bamako, the capital, is proving more challenging than anticipated, French military officials have acknowledged. And with the Malian Army in disarray and no outside African force yet assembled, displacing the rebels from the country altogether appears to be an elusive, long-term challenge.

The jihadists are “dug in” at Diabaly, Mr. Le Drian said Tuesday at a news conference. From that strategic town, they “threaten the south,” he said, adding: “We face a well-armed and determined adversary.”

Mr. Le Drian also acknowledged that the Malian Army had not managed to retake the town of Konna, whose seizure by the rebels a week ago provoked the French intervention. “We will continue the strikes to diminish their potential,” the minister said.

Using advanced attack planes and sophisticated military helicopters, the French campaign has forced the Islamists from important northern towns like Gao and Douentza. But residents there say that while the insurgents suffered losses, many of them had simply gone into the nearby bush.

“Bombing will weaken them, and it will stop their advance,” said Djallil Lounnas, an expert on the region at the University of Montreal who has written widely on Al Qaeda in the Islamic Maghreb, one of the main extremist groups in northern Mali. “But as soon as the bombing stops, they’ll come back.”

Since the French started bombing, he said, “the situation has changed slightly, but not fundamentally.”

Other analysts said that while forcing the insurgents from the cities was achievable, eliminating them altogether would require considerable additional effort.

“You can’t launch a war of extermination against a very tenacious and mobile adversary,” said Col. Michel Goya of the French Military Academy’s Strategic Research Institute. “We are in a classic counterinsurrectionary situation. They are well armed, but the weapons are not sophisticated. A couple of thousand men, very mobile.”

And they have been preparing for battle for months.

One resident of Gao who accompanied Islamist fighters to a desert hide-out in recent months described a vast system of underground caves big enough to drive cars into, said Corinne Dufka, a senior researcher at Human Rights Watch.

Adam Nossiter reported from Bamako, and Eric Schmitt from Washington. Steven Erlanger and Scott Sayare contributed reporting from Paris, and Elisabeth Bumiller from Madrid.

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Apple scoops PBS on “Downton Abbey” episodes, but PBS is cool with it

NEW YORK (TheWrap.com) – Apple is making the entire third season of “Downton Abbey” available on iTunes before every episode airs on PBS – and that’s just fine with PBS.

Fans who buy a season pass on iTunes beginning January 29 will get to see three episodes before they air on PBS. The Season 3 finale airs February 17.

But PBS CEO Paula Kerger isn’t worried that viewers will watch the show online, then tune out PBS. In fact, she says, Apple isn’t the only place Americans can see “Downton” before they can see it on her network.

“You can also buy the DVD sets. They’re being shipped at the end of January, and the DVD sets and Apple are going up at the same time,” Kerger told TheWrap. “I think that for people who are really passionate and want to have it, it’s a great thing.”

Kerger says she hopes more viewers will discover “Downton” on whatever format they like best – and then watch it on PBS next season.

“At the end of the day, my interest is just in seeing it get to the widest possible audience, and there are people that would pick it up on Apple that may not pick it up anywhere else,” she said.

The first episode of the third season premiered to a record 7.9 million viewers earlier this month. Many of those viewers, no doubt, caught up on the previous seasons online or through DVD viewing.

“Downton” airs in the U.K. in the fall but on PBS in January, which means PBS viewers must shield themselves from spoilers. That has led to some grumbling from American fans.

But Kerger said airing the show in January allows the show to get more attention domestically than it might otherwise receive in the crowded fall season.

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It's a Boy for Elton John

Mom & Babies
Celebrity Baby Blog

01/15/2013 at 10:00 PM ET

George Pimentel/WireImage

Elton John is a father again!

The musician and David Furnish welcomed their second child, son Elijah Joseph Daniel Furnish-John, via surrogate on Friday, Jan. 11 in Los Angeles, the couple confirm to HELLO.

Born at 6:40 p.m., Elijah weighed in at 8 lbs., 4 oz.

John and Furnish, who married in 2005, are already parents to son Zachary Jackson Levon, 2.

“Both of us have longed to have children, but the reality that we now have two sons is almost unbelievable. The birth of our second son completes our family in a most precious and perfect way,” the couple say in a statement.

“It is difficult to fully express how we are feeling at this time; we are just overwhelmed with happiness and excitement.”

John, 65, has been open about his desire to expand their family.

“I know when he goes to school there’s going to be an awful lot of pressure, and I know he’s going to have people saying, ‘You don’t have a mummy,’” says the singer-songwriter of his decision to have another baby.

“It’s going to happen. We talked about it before we had him. I want someone to be at his side and back him up. We shall see.”

– Sarah Michaud

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Risk to all ages: 100 kids die of flu each year

NEW YORK (AP) — How bad is this flu season, exactly? Look to the children.

Twenty flu-related deaths have been reported in kids so far this winter, one of the worst tolls this early in the year since the government started keeping track in 2004.

But while such a tally is tragic, that does not mean this year will turn out to be unusually bad. Roughly 100 children die in an average flu season, and it's not yet clear the nation will reach that total.

The deaths this year have included a 6-year-old girl in Maine, a 15-year Michigan student who loved robotics, and 6-foot-4 Texas high school senior Max Schwolert, who grew sick in Wisconsin while visiting his grandparents for the holidays.

"He was kind of a gentle giant" whose death has had a huge impact on his hometown of Flower Mound, said Phil Schwolert, the Texas boy's uncle.

Health officials only started tracking pediatric flu deaths nine years ago, after media reports called attention to children's deaths. That was in 2003-04 when the primary flu germ was the same dangerous flu bug as the one dominating this year. It also was an earlier than normal flu season.

The government ultimately received reports of 153 flu-related deaths in children, from 40 states, and most of them had occurred by the beginning of January. But the reporting was scattershot. So in October 2004, the government started requiring all states to report flu-related deaths in kids.

Other things changed, most notably a broad expansion of who should get flu shots. During the terrible 2003-04 season, flu shots were only advised for children ages 6 months to 2 years.

That didn't help 4-year-old Amanda Kanowitz, who one day in late February 2004 came home from preschool with a cough and died less than three days later. Amanda was found dead in her bed that terrible Monday morning, by her mother.

"The worst day of our lives," said her father, Richard Kanowitz, a Manhattan attorney who went on to found a vaccine-promoting group called Families Fighting Flu.

The Centers for Disease Control and Prevention gradually expanded its flu shot guidance, and by 2008 all kids 6 months and older were urged to get the vaccine. As a result, the vaccination rate for kids grew from under 10 percent back then to around 40 percent today.

Flu vaccine is also much more plentiful. Roughly 130 million doses have been distributed this season, compared to 83 million back then. Public education seems to be better, too, Kanowitz observed.

The last unusually bad flu season for children, was 2009-10 — the year of the new swine flu, which hit young people especially hard. As of early January 2010, 236 flu-related deaths of kids had been reported since the previous August.

It's been difficult to compare the current flu season to those of other winters because this one started about a month earlier than usual.

Look at it this way: The nation is currently about five weeks into flu season, as measured by the first time flu case reports cross above a certain threshold. Two years ago, the nation wasn't five weeks into its flu season until early February, and at that point there were 30 pediatric flu deaths — or 10 more than have been reported at about the same point this year. That suggests that when the dust settles, this season may not be as bad as the one only two years ago.

But for some families, it will be remembered as the worst ever.

In Maine, 6-year-old Avery Lane — a first-grader in Benton who had recently received student-of-the-week honors — died in December following a case of the flu, according to press reports. She was Maine's first pediatric flu death in about two years, a Maine health official said.

In Michigan, 15-year-old Joshua Polehna died two weeks ago after suffering flu-like symptoms. The Lake Fenton High School student was the state's fourth pediatric flu death this year, according to published reports.

And in Texas, the town of Flower Mound mourned Schwolert, a healthy, lanky 17-year-old who loved to golf and taught Sunday school at the church where his father was a youth pastor.

Late last month, he and his family drove 16 hours to spend the holidays with his grandparents in Amery, Wis., a small town near the Minnesota state line. Max felt fluish on Christmas Eve, seemed better the next morning but grew worse that night. The family decided to postpone the drive home and took him to a local hospital. He was transferred to a medical center in St. Paul, Minn., where he died on Dec. 29.

He'd been accepted to Oklahoma State University before the Christmas trip. And an acceptance letter from the University of Minnesota arrived in Texas while Max was sick in Minnesota, his uncle said.

Nearly 1,400 people attended a memorial service for Max two weeks ago in Texas.

"He exuded care and love for other people," Phil Schwolert said.

"The bottom line is take care of your kids, be close to your kids," he said.

On average, an estimated 24,000 Americans die each flu season, according to the Centers for Disease Control and Prevention. People who are elderly and with certain chronic health conditions are generally at greatest risk from flu and its complications.

The current vaccine is about 60 percent effective, and is considered the best protection available. Max Schwolert had not been vaccinated, nor had the majority of the other pediatric deaths.

Even if kids are vaccinated, parents should be watchful for unusually severe symptoms, said Lyn Finelli of the CDC.

"If they have influenza-like illness and are lethargic, or not eating, or look punky — or if a parent's intuition is the kid doesn't look right and they're alarmed — they need to call the doctor and take them to the doctor," she advised.

___

CDC advice on kids: http://www.cdc.gov/flu/protect/children.htm

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With laughter and tears, fans bid farewell to Huell Howser

Everyone thought they knew what Huell Howser would have said if he'd been standing outside Griffith Observatory just before sunset Tuesday afternoon.

If he'd climbed the observatory steps in a short-sleeved button down, khakis and work boots and taken in the hundreds who had come to celebrate him, a crowd stretching in glorious honeyed light beyond the Astronomers Monument and into the overflowing parking lot.

If he'd known that his fans had started arriving about 9 a.m. for a public memorial due to start at 3:30 p.m., that among them were teenagers and nonagenarians, some of whom had driven for hours — from the far-flung California cities and small towns he'd visited, from the mountains and deserts he loved.

If he had seen Lynne Green, 90, of Woodland Hills holding court in high style in the first row of folding white seats, wearing a jaunty red hat decorated with a red feather and telling everyone she met about how, after she'd signed up at 80 for Buddy Powell's commercial acting class for seniors, Howser came to do a show on the class and "made me one of his featured speakers."

It was so easy to picture Howser there, plunging happily into that crowd, microphone in hand, stopping to squeeze the shoulders of people bundled in winter coats, scarves wrapped around their heads, and warming them up in his Tennessee drawl with a loud "Howdy!" or a "How y'all doin'?"

L.A. City Councilman Tom LaBonge arranged the memorial for Howser, who died last week at 67, and who became a California household name in three decades of exploring the state's people and places in his homespun television shows.

Similarly exuberant and smitten with the state, LaBonge and Howser were longtime friends. But even those in the gathering who knew Howser only from watching TV spoke of him as if he were family. Some teared up as they affectionately swapped stories about him with the strangers they found themselves standing next to in the crowd. They talked about how his shows had sent them out, in search of the obscure monuments and the hole-in-the-wall diners and the odd festivals he'd told them about.

"He always found something cute to say, no matter what. I had a big crush on him," confessed Joy Fisher, 78, of Mid-Wilshire.

Teresa Cerna, 65, of West Hollywood said she had a crush on him too, for "his personality — so warm — and his accent." She said that she'd raced to make it to the observatory from Newport Beach, where she works in a private home as a cook, and that she'd once waited outside Pink's for 2 1/2 hours to get Howser's autograph.

Gloria and Beverly Pink, dressed in pink, took a break from their family's famed 73-year-old hot dog stand to attend, carrying with them the sign for their $5.80 "Huell Dawg" — two hot dogs in one bun, with mustard, chili, cheese and onions. The bright yellow sign, which they pulled off the wall for the occasion, fittingly is in the shape of California.

Howser was so humble, the ladies Pink said, that he wouldn't cut in line when he visited, even though everyone knew who he was and vied to offer him the chance.

Tuesday's gathering featured a lineup of speeches, from the director of the observatory, the executive director of the Los Angeles Conservancy, pop culture historian Charles Phoenix and others. As the sun began sinking just before 5 p.m., an LAPD helicopter circled in a salute.

Then Howser's voice suddenly boomed from the speakers, singing "California, Here I Come." LaBonge asked everyone to sing along, and they did. As the song played again and again, people joined him, singing and dancing on the observatory steps.

It was heartfelt. It was hokey. It felt just right.

Everyone thought they knew what Howser would have said if he'd seen it.

"Oh my gosh!" they could practically hear him. "That's amaaaaaazing!"

And on this day, it would have been an understatement.

nita.lelyveld@latimes.com

Follow City Beat @latimescitybeat on Twitter and at Los Angeles Times City Beat on Facebook.

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India Ink: Indian Court Issues Warrant for Porsche C.E.O.'s Arrest

An Indian court has issued a warrant of arrest for Matthias Mueller, the chief executive officer and chairman of Porsche AG, the iconic German carmaker, and eight other executives from the company.

The bailable warrants come as a result of a court case filed by Precision Cars India, a former importer of Porsche cars based in New Delhi.

Precision Cars has been an importer for Porsche vehicles in India since 2003. However, when Porsche appointed Volkswagen Group Sales India as their sole importer in April 2012, they allegedly failed to inform Precision Cars, which Precision executives said left them no choice but to file a lawsuit.

“All along we have been making bona-fide efforts to sort out the issues with Porsche, but they are acting in an illegal and unjust manner and have not been giving any support in resolving the issues so we were not left any choice but pursue the matter legally and await justice,” Precision Cars India said in a statement.

The bailable arrest warrants, issued by the Court of the Additional Chief Metropolitan Magistrate No.3 in Jaipur, were issued on the basis of several charges including extortion, cheating, dishonestly inducing delivery of property, criminal breach of trust and criminal conspiracy filed against Porsche AG by Precision Cars India.

Mr. Mueller, who was contacted at the auto show in the United States, said lawyers were investigating the issue and that he had no further comment.

Because accused executives are originally from Germany and the United Arab Emirates, the Central Bureau of Investigation has written to the Interpol in a letter dated November 8, 2012 asking that, “necessary action in the matter” be taken up with the concerned countries.

From January 2011 to March 2012, Precision Cars sold an average of 35 cars per month. During Porsche India’s first month of working with Volkswagen in India, in October 2012, the company sold 117 cars, followed by 51 cars in November.

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Can We Trust CNET Again After a Scandal This Shady?

CNET, one of the Internet’s first and most influential authorities on gadgets and tech news, watched its editorial integrity spiral out of control Monday, with staffers quitting and editors left to explain themselves in the wake of explosive new charges over its annual Consumer Electronics Show awards — a scandal, it would appear, that goes all the way to the top of its corporate umbrella, and could shake the entire ecosystem of online tech journalism.

RELATED: CBS Puts CNET in an Ethically Questionable Spot at CES

Contrary to an already controversial move first reported last Friday, CNET parent company CBS didn’t just asked the site to remove Dish’s Slingbox Hopper from consideration for its Best of CES Awards amidst a lawsuit between CBS and Dish; the removal came after executives learned the gadget would take the top award, and that request came down from CBS CEO Leslie Moonves himself, sources tell The Verge’s Joshua Topolsky. Now, CNET’s corporate responsibilities appear to have made the long trusted site bend at will and, despite desperate pushback from some of its writers and editors, it appears CNET may have moved to cover up the series of events that led to the removal of the award.

RELATED: Following Time and CNN, The Washington Post Suspends Zakaria

For CNET, all of this looks very bad. How can readers trust the site for its famously unbiased reviews and industry news coverage if a media-conglomerate overlord is insisting that some things just “can’t exist”? The events that have unfolded since the scandal broke wide open haven’t exactly restored anyone’s faith. Greg Sandoval, a seven-year veteran of the site, announced his resignation Monday morning on Twitter, citing a lack of “editorial independence” from CBS as his motivation. In a separate tweet, he called CNET’s dishonesty about its parent company‘s involvement with Dish “unacceptable.” Since, both CNET and CBS have released not-too-convincing statements. 

RELATED: Does The Times’ Public Editor Regret Its Adventures in Social-Media Babysitting?

Following the Verge report and Sandoval’s resignation, CNET Editor in Chief Lindsay Turrentine explained how CNET editors did everything in their power to fend off corporate insistence on its editorial decisions, but found the power of a pending deal between two bigger media companies too intimidating. So the editors gave in, and waited. “We were in an impossible situation as journalists,” Turrentine wrote, adding that she thought about resigning. “I decided that the best thing for my team was to get through the day as best we could and to fight the fight from the other side.” 

RELATED: What Kind of David Brooks Hater Are You?

Speaking for many a media and tech pundit, Reuters’s Megan McCarthy questioned the front side of the internal debate: 

CNET’s editor-in-chief’s explains why she caved to CBS. Why didn’t she just refuse to award the Best in Show? : news.cnet.com/8301-30677_3-5…

— Megan McCarthy (@Megan) January 14, 2013

For her part, Turrentine seems to have one major regret: “I wish I could have overridden the decision not to reveal that Dish had won the vote in the trailer.” That doesn’t exactly scream editorial independence, as The Verge’s Sean Hollister pointed out on Twitter.

CNET doesn’t get it either. “I wish I could have overridden the decision not to reveal” is NOT editorial independence. cnet.co/VWBv5o

— Sean Hollister (@StarFire2258) January 14, 2013

Turrentinge went on to say that if she had to face this “dilemma” again, she would not quit. Meaning, if this turns into more than a one-time incident, she wouldn’t have a problem bending to CBS again? 

RELATED: Did Cops Target Journalist’s Wife’s Spa with Prostitution Raid as Payback?

CBS’s statement to The Verge hasn’t calmed the critics, either. “In terms of covering actual news, CNET maintains 100% editorial independence, and always will. We look forward to the site building on its reputation of good journalism in the years to come,” reads the CBS reply. But when you’re dealing with angry tech readers, their nerdfest of the year, and the corporate responsibilities  therein, 100 percent of trust is tough to build back.

While CNET struggles to emerge from this mess, the situation appears to be threatening the entire ecosystem of the technology press, which has a history of reinventing its standards on bias in product reviews. A number of gadget and tech-news sites fall under larger corporate umbrellas: AOL owns Engadget; NewsCorp owns The Wall Street Journal and its influential tech coverage; BuzzFeed FWD has to answer to its investors, who put money in all sorts of tech ventures; IAC invests in companies like Aereo but owns The Daily Beast. Turns out this wasn’t just a family feud — the CNET and CBS scandal at CES could set a precedent for years to come.

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Bachelor Sean Lowe: My Girl Must Love Dogs

For any of the 25 women looking to win over this season's Bachelor, Sean Lowe, here's a tip straight from the source: "The girl I'm dating must be into my dogs," he tells PEOPLE.

The proud pet parent to two pooches, a boxer named Lola and a chocolate Labrador named Ellie, Lowe says, "For so long it's just been me and my two dogs, and I'm certainly not going to replace them with any woman."

Having had both animals for the past six years, the hunk has developed a special bond with the duo – though he admits his quest for love has forced him to make some changes.

"For many years, my dogs would sleep in the bed with me," he says. "I'm a big guy and I've got two good-sized dogs, so it's a full bed. Then I just realized one day, 'Alright, if I get married and a woman's going to join me in the bed, there's not going to be enough room.' I had to break the dogs of the habit of sleeping in the bed."

Luckily for Lowe, the pair have taken to their new accommodations easily.

"They're very intelligent dogs; they pick up on things really quickly," he says. "They learn pretty fast."

To hear more from Sean Lowe – including how his dogs help him navigate the dating world – check out the video above.

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Hospitals crack down on workers refusing flu shots

CHICAGO (AP) — Patients can refuse a flu shot. Should doctors and nurses have that right, too? That is the thorny question surfacing as U.S. hospitals increasingly crack down on employees who won't get flu shots, with some workers losing their jobs over their refusal.

"Where does it say that I am no longer a patient if I'm a nurse," wondered Carrie Calhoun, a longtime critical care nurse in suburban Chicago who was fired last month after she refused a flu shot.

Hospitals' get-tougher measures coincide with an earlier-than-usual flu season hitting harder than in recent mild seasons. Flu is widespread in most states, and at least 20 children have died.

Most doctors and nurses do get flu shots. But in the past two months, at least 15 nurses and other hospital staffers in four states have been fired for refusing, and several others have resigned, according to affected workers, hospital authorities and published reports.

In Rhode Island, one of three states with tough penalties behind a mandatory vaccine policy for health care workers, more than 1,000 workers recently signed a petition opposing the policy, according to a labor union that has filed suit to end the regulation.

Why would people whose job is to protect sick patients refuse a flu shot? The reasons vary: allergies to flu vaccine, which are rare; religious objections; and skepticism about whether vaccinating health workers will prevent flu in patients.

Dr. Carolyn Bridges, associate director for adult immunization at the federal Centers for Disease Control and Prevention, says the strongest evidence is from studies in nursing homes, linking flu vaccination among health care workers with fewer patient deaths from all causes.

"We would all like to see stronger data," she said. But other evidence shows flu vaccination "significantly decreases" flu cases, she said. "It should work the same in a health care worker versus somebody out in the community."

Cancer nurse Joyce Gingerich is among the skeptics and says her decision to avoid the shot is mostly "a personal thing." She's among seven employees at IU Health Goshen Hospital in northern Indiana who were recently fired for refusing flu shots. Gingerich said she gets other vaccinations but thinks it should be a choice. She opposes "the injustice of being forced to put something in my body."

Medical ethicist Art Caplan says health care workers' ethical obligation to protect patients trumps their individual rights.

"If you don't want to do it, you shouldn't work in that environment," said Caplan, medical ethics chief at New York University's Langone Medical Center. "Patients should demand that their health care provider gets flu shots — and they should ask them."

For some people, flu causes only mild symptoms. But it can also lead to pneumonia, and there are thousands of hospitalizations and deaths each year. The number of deaths has varied in recent decades from about 3,000 to 49,000.

A survey by CDC researchers found that in 2011, more than 400 U.S. hospitals required flu vaccinations for their employees and 29 hospitals fired unvaccinated employees.

At Calhoun's hospital, Alexian Brothers Medical Center in Elk Grove Village, Ill., unvaccinated workers granted exemptions must wear masks and tell patients, "I'm wearing the mask for your safety," Calhoun says. She says that's discriminatory and may make patients want to avoid "the dirty nurse" with the mask.

The hospital justified its vaccination policy in an email, citing the CDC's warning that this year's flu outbreak was "expected to be among the worst in a decade" and noted that Illinois has already been hit especially hard. The mandatory vaccine policy "is consistent with our health system's mission to provide the safest environment possible."

The government recommends flu shots for nearly everyone, starting at age 6 months. Vaccination rates among the general public are generally lower than among health care workers.

According to the most recent federal data, about 63 percent of U.S. health care workers had flu shots as of November. That's up from previous years, but the government wants 90 percent coverage of health care workers by 2020.

The highest rate, about 88 percent, was among pharmacists, followed by doctors at 84 percent, and nurses, 82 percent. Fewer than half of nursing assistants and aides are vaccinated, Bridges said.

Some hospitals have achieved 90 percent but many fall short. A government health advisory panel has urged those below 90 percent to consider a mandatory program.

Also, the accreditation body over hospitals requires them to offer flu vaccines to workers, and those failing to do that and improve vaccination rates could lose accreditation.

Starting this year, the government's Centers for Medicare & Medicaid Services is requiring hospitals to report employees' flu vaccination rates as a means to boost the rates, the CDC's Bridges said. Eventually the data will be posted on the agency's "Hospital Compare" website.

Several leading doctor groups support mandatory flu shots for workers. And the American Medical Association in November endorsed mandatory shots for those with direct patient contact in nursing homes; elderly patients are particularly vulnerable to flu-related complications. The American Nurses Association supports mandates if they're adopted at the state level and affect all hospitals, but also says exceptions should be allowed for medical or religious reasons.

Mandates for vaccinating health care workers against other diseases, including measles, mumps and hepatitis, are widely accepted. But some workers have less faith that flu shots work — partly because there are several types of flu virus that often differ each season and manufacturers must reformulate vaccines to try and match the circulating strains.

While not 100 percent effective, this year's vaccine is a good match, the CDC's Bridges said.

Several states have laws or regulations requiring flu vaccination for health care workers but only three — Arkansas, Maine and Rhode Island — spell out penalties for those who refuse, according to Alexandra Stewart, a George Washington University expert in immunization policy and co-author of a study appearing this month in the journal Vaccine.

Rhode Island's regulation, enacted in December, may be the toughest and is being challenged in court by a health workers union. The rule allows exemptions for religious or medical reasons, but requires unvaccinated workers in contact with patients to wear face masks during flu season. Employees who refuse the masks can be fined $100 and may face a complaint or reprimand for unprofessional conduct that could result in losing their professional license.

Some Rhode Island hospitals post signs announcing that workers wearing masks have not received flu shots. Opponents say the masks violate their health privacy.

"We really strongly support the goal of increasing vaccination rates among health care workers and among the population as a whole," but it should be voluntary, said SEIU Healthcare Employees Union spokesman Chas Walker.

Supporters of health care worker mandates note that to protect public health, courts have endorsed forced vaccination laws affecting the general population during disease outbreaks, and have upheld vaccination requirements for schoolchildren.

Cases involving flu vaccine mandates for health workers have had less success. A 2009 New York state regulation mandating health care worker vaccinations for swine flu and seasonal flu was challenged in court but was later rescinded because of a vaccine shortage. And labor unions have challenged individual hospital mandates enacted without collective bargaining; an appeals court upheld that argument in 2007 in a widely cited case involving Virginia Mason Hospital in Seattle.

Calhoun, the Illinois nurse, says she is unsure of her options.

"Most of the hospitals in my area are all implementing these policies," she said. "This conflict could end the career I have dedicated myself to."

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Online:

R.I. union lawsuit against mandatory vaccines: http://www.seiu1199ne.org/files/2013/01/FluLawsuitRI.pdf

CDC: http://www.cdc.gov

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AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner

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