Willis Whitfield, Clean Room Inventor, Dies at 92





The enemy was very small but it was everywhere. World peace, medical advancement, iTunes — all would eventually be threatened.




Half a century ago, as a rapidly changing world sought increasingly smaller mechanical and electrical components and more sanitary hospital conditions, one of the biggest obstacles to progress was air, and the dust and germs it contains.


Stray particles a few microns wide could compromise the integrity of a circuit board of a nuclear weapon. Unchecked bacteria could quickly infect a patient after a seemingly successful operation. Microprocessors, not yet in existence, would have been destroyed by dust. After all, an average cubic foot of air contained three million microscopic particles, and even the best efforts at vacuuming and wiping down a high-tech work space could only reduce the rate to one million.


Then, in 1962, Willis Whitfield invented the clean room.


“People said he was a fraud,” recalled Gilbert V. Herrera, the director of microsystems science and technology at Sandia National Laboratories in Albuquerque. “But he turned out to be right.”


Mr. Whitfield, who worked at Sandia from 1954 to 1984, died on Nov. 12 in Albuquerque. He was 92. The cause was prostate cancer, his wife, Belva, said.


His clean rooms blew air in from the ceiling and sucked it out from the floor. Filters scrubbed the air before it entered the room. Gravity helped particles exit. It might not seem like a complicated concept, but no one had tried it before. The process could completely replace the air in the room 10 times a minute.


Particle detectors in Mr. Whitfield’s clean rooms started showing numbers so low — a thousand times lower than other methods — that some people did not believe the readings, or Mr. Whitfield. He was questioned so much that he began understating the efficiency of his method to keep from shocking people.


“I think Whitfield’s wrong,” a scientist from Bell Labs finally said at a conference where Mr. Whitfield spoke. “It’s actually 10 times better than he’s saying.”


Willis James Whitfield was born in Rosedale, Okla., on Dec. 6, 1919. In addition to his wife, his survivors include his sons, James and Joe; a sister, Amy Blackburn; and a brother, Lawrence.


Mr. Whitfield became fascinated with electronics as a young man and received a two-year degree in the field after high school. He served in the Navy late in World War II, working with experimental electronic systems for aircraft. In 1952, he received a bachelor’s degree in physics and math from Hardin-Simmons University in Abilene, Tex.


By 1954 he was working at Sandia, which was involved in making parts for nuclear weapons and at the time was overseen by the Atomic Energy Commission. Mr. Whitfield’s duties soon included contamination control. By 1960, he had established his basic idea for the clean room.


“I thought about dust particles,” Mr. Whitfield told Time magazine in 1962. “Where are these rascals generated? Where do they go?”


The clean room was patented through Sandia, and the government shared it freely among manufacturers, hospitals and other industries.


Mr. Whitfield’s original clean room was only about six feet high, built as a small, self-contained unit. Some modern electronic devices, including the iPhone, are now built in China in huge clean rooms in structures that are more than a million square feet. Workers wear protective clothing, and other anticontamination methods have been added, but they still depend on Mr. Whitfield’s approach to suck up dust.


“Relative to these electronics, the particles are just massive boulders that would short out all of your electronics and make them not work,” Mr. Herrera said. “The core technology, just the cleaning part, hasn’t really changed a lot.”


Mrs. Whitfield said she was often been asked if her husband was a particularly fastidious man, and she always noted that he tended not to put his shoes away. He did live in a tidy house, though, and colleagues say he never tired of getting out a flashlight and shining it sideways across his coffee table to illuminate the prevalence of tiny dust particles that most people never notice.


Read More..

Willis Whitfield, Clean Room Inventor, Dies at 92





The enemy was very small but it was everywhere. World peace, medical advancement, iTunes — all would eventually be threatened.




Half a century ago, as a rapidly changing world sought increasingly smaller mechanical and electrical components and more sanitary hospital conditions, one of the biggest obstacles to progress was air, and the dust and germs it contains.


Stray particles a few microns wide could compromise the integrity of a circuit board of a nuclear weapon. Unchecked bacteria could quickly infect a patient after a seemingly successful operation. Microprocessors, not yet in existence, would have been destroyed by dust. After all, an average cubic foot of air contained three million microscopic particles, and even the best efforts at vacuuming and wiping down a high-tech work space could only reduce the rate to one million.


Then, in 1962, Willis Whitfield invented the clean room.


“People said he was a fraud,” recalled Gilbert V. Herrera, the director of microsystems science and technology at Sandia National Laboratories in Albuquerque. “But he turned out to be right.”


Mr. Whitfield, who worked at Sandia from 1954 to 1984, died on Nov. 12 in Albuquerque. He was 92. The cause was prostate cancer, his wife, Belva, said.


His clean rooms blew air in from the ceiling and sucked it out from the floor. Filters scrubbed the air before it entered the room. Gravity helped particles exit. It might not seem like a complicated concept, but no one had tried it before. The process could completely replace the air in the room 10 times a minute.


Particle detectors in Mr. Whitfield’s clean rooms started showing numbers so low — a thousand times lower than other methods — that some people did not believe the readings, or Mr. Whitfield. He was questioned so much that he began understating the efficiency of his method to keep from shocking people.


“I think Whitfield’s wrong,” a scientist from Bell Labs finally said at a conference where Mr. Whitfield spoke. “It’s actually 10 times better than he’s saying.”


Willis James Whitfield was born in Rosedale, Okla., on Dec. 6, 1919. In addition to his wife, his survivors include his sons, James and Joe; a sister, Amy Blackburn; and a brother, Lawrence.


Mr. Whitfield became fascinated with electronics as a young man and received a two-year degree in the field after high school. He served in the Navy late in World War II, working with experimental electronic systems for aircraft. In 1952, he received a bachelor’s degree in physics and math from Hardin-Simmons University in Abilene, Tex.


By 1954 he was working at Sandia, which was involved in making parts for nuclear weapons and at the time was overseen by the Atomic Energy Commission. Mr. Whitfield’s duties soon included contamination control. By 1960, he had established his basic idea for the clean room.


“I thought about dust particles,” Mr. Whitfield told Time magazine in 1962. “Where are these rascals generated? Where do they go?”


The clean room was patented through Sandia, and the government shared it freely among manufacturers, hospitals and other industries.


Mr. Whitfield’s original clean room was only about six feet high, built as a small, self-contained unit. Some modern electronic devices, including the iPhone, are now built in China in huge clean rooms in structures that are more than a million square feet. Workers wear protective clothing, and other anticontamination methods have been added, but they still depend on Mr. Whitfield’s approach to suck up dust.


“Relative to these electronics, the particles are just massive boulders that would short out all of your electronics and make them not work,” Mr. Herrera said. “The core technology, just the cleaning part, hasn’t really changed a lot.”


Mrs. Whitfield said she was often been asked if her husband was a particularly fastidious man, and she always noted that he tended not to put his shoes away. He did live in a tidy house, though, and colleagues say he never tired of getting out a flashlight and shining it sideways across his coffee table to illuminate the prevalence of tiny dust particles that most people never notice.


Read More..

Video Games: Little Inferno; Hitman; Assassin’s Creed III; Persona 4 Golden; Angry Birds Star Wars; My Little Pony


Ubisoft


Ratonhnhaké:ton is a half-British, half-Mohawk assassin in Revolutionary America.





Released on Nov. 18


Developed by Tomorrow Corporation


For PC, Mac, Linux and Wii U


Rated T for Teen (drug reference and crude humor)


Here’s an odd one. Little Inferno is an interactive fireplace. It’s an emotional, interactive fireplace with a story line and some notions about the dangers of amusing ourselves with distracting trifles.


At first this strange creation appears to be a simple puzzle game consisting of little more than a fireplace, a catalog of items to burn and 99 clues that challenge the player to burn these things in proper combinations. One clue is “Movie Night.” Burn the popcorn. Burn the TV. A weirder one is “Bike Pirate.” Burn the wooden bike. Burn the pirate.


As you play, an unseen character begins to send letters. They burn, too, but something seems off. The messages are alternately cheerful and sad, a wee bit wicked and increasingly desperate.


The purpose of the pyromaniac pastime becomes smoky with doubt. Why are we doing this? What are we missing? It’s odd enough to play a new video game that questions our decision to play video games. That it’s an interactive fireplace game that does this is all the stranger and more wonderful. It’s a yule log for our times.


HITMAN


Absolution


Released on Nov. 20


Developed by IO Interactive


Published by Square Enix


For PC, Xbox 360 and


PlayStation 3


Rated M for Mature (intense violence, partial nudity and strong language)


It’s a vile, dangerous world in Hitman: Absolution. Nearly everyone is in need of a good killing, and Agent 47, the depilated murder machine at the center of the long-running Hitman franchise, is just the man for the job.


Absolution is consistent with the setup of past Hitman games: At the start of a level, 47 is given an assassination target, and he must make his way through semi-open areas by any of a number of possible routes. The reactive artificial intelligence keeps things enjoyably unpredictable, and the best levels feel like a buffet of sadistic improvisation.


The story is pure B-movie hogwash. It’s mostly enjoyable in a certain exploitive way, but it often feels as if the writers were trying too hard.


When it gets cooking, Hitman: Absolution evokes the feeling of a deadly, measured dance. It’s a tango between you and the computer, with each party alternately taking the lead through arenas that shift and upset expectations.


ASSASSIN’S CREED III


Released on Oct. 30


Developed and published by Ubisoft


For PlayStation 3, Xbox 360, Wii U and PC


Rated M for Mature (blood, intense violence, sexual themes and strong language)


Assassin’s Creed III is really the fifth major Assassin’s Creed game. The numbering signifies that this new historical epic is a shift, as this Ubisoft series about the ancestral lives of a man named Desmond Miles leaps to its third era. Finished with the 12th-century crusades and 15th-century Renaissance Italy, Assassin’s Creed now lets us do interactive historical tourism in Boston, New York and the nearby woods of Revolutionary America.


Assassin’s Creed games are lavish action-adventure blockbusters. In this new one, we primarily play as a young, bitter, half-British, half-Mohawk greenhorn assassin named Ratonhnhaké:ton, who finds himself crossing paths and sometimes doing the bidding of Sam Adams, Paul Revere, George Washington and other real figures. Most of the bad guys are red coats with slow-firing muskets. We’re best with a tomahawk and a bow and arrow.


The new game involves a lot of climbing and killing across a sprawling landscape of bustling cities and gorgeous frontier. Add in a mix of awkwardly instituted horseback riding, homestead building, trading, trapping, hunting and, at the wheel of your own tall-masted warship, epic naval combat. There is much to do and witness in a ripped-from-the-history-books adventure that is refreshingly unwilling to ignore the unsavory aspects of America’s birth. A lengthy production cycle didn’t spare the game from a wealth of bugs that are only now being patched out.


The series’s low-key multiplayer games of competitive assassination return, but the star of this epic is something that might seem almost quaint: Assassin’s Creed III is easily the best tree-climbing simulator in history.


PERSONA 4 GOLDEN


Released on Nov. 20


Developed and published by Atlus


For PlayStation Vita


Rated M for Mature (violence, alcohol reference and partial nudity)


Persona 4 Golden is part turn-based role-playing game, part high school simulator and a rerelease of a celebrated PlayStation 2 game on the portable Vita.


These edited and condensed reviews are from the writers and editors of the gaming Web site Kotaku.com. Full reviews are at kotaku.com/nytselects.



Read More..

Changing of the Guard: How Crash Cover-Up Altered China’s Succession





BEIJING — “Thank you. I’m well. Don’t worry,” read the post on a Chinese social networking site. The brief comment, published in June, appeared to come from Ling Gu, the 23-year-old son of a high-powered aide to China’s president, and it helped quash reports that he had been killed in a Ferrari crash after a night of partying.




It only later emerged that the message was a sham, posted by someone under Mr. Ling’s alias — almost three months after his death.


The ploy was one of many in a tangled effort to suppress news of the Ferrari crash that killed Mr. Ling and critically injured two young female passengers, one of whom later died. The outlines of the affair surfaced months ago, but it is now becoming clearer that the crash and the botched cover-up had more momentous consequences, altering the course of the Chinese Communist Party’s once-in-a-decade leadership succession last month.


China’s departing president, Hu Jintao, entered the summer in an apparently strong position after the disgrace of Bo Xilai, previously a rising member of a rival political network who was brought down when his wife was accused of murdering a British businessman. But Mr. Hu suffered a debilitating reversal of his own when party elders — led by his predecessor, Jiang Zemin — confronted him with allegations that Ling Jihua, his closest protégé and political fixer, had engineered the cover-up of his son’s death.


According to current and former officials, party elites, and others, the exposure helped tip the balance of difficult negotiations, hastening Mr. Hu’s decline; spurring the ascent of China’s new leader, Xi Jinping; and playing into the hands of Mr. Jiang, whose associates dominate the new seven-man leadership at the expense of candidates from Mr. Hu’s clique.


The case also shows how the profligate lifestyles of leaders’ relatives and friends can weigh heavily in backstage power tussles, especially as party skulduggery plays out under the intensifying glare of media.


Numerous party insiders provided information regarding the episode, speaking on the condition of anonymity for fear of reprisals from the authorities. Officials have investigated the aftermath of the car wreck, they say, including looking into accusations that a state oil company paid hush money to the families of the two women.


Under Mr. Hu, Mr. Ling had directed the leadership’s administrative center, the General Office, but was relegated to a less influential post in September, ahead of schedule. Last month, he failed to advance to the 25-person Politburo and lost his seat on the influential party secretariat.


Mr. Hu, who stepped down as party chief, immediately yielded his post as chairman of the military, meaning he will not retain power as Mr. Jiang did. “Hu was weakened even before leaving office,” said a midranking official in the Organization Department, the party’s personnel office.


Mr. Ling’s future remains unsettled, with party insiders saying that his case presents an early test of whether Mr. Xi intends to follow through on public promises to fight high-level corruption.


“He can decide whether to go after Ling Jihua or not,” said Wu Guoguang, a former top-level party speechwriter, now a political scientist at the University of Victoria in British Columbia. “Either way, this is a big card in Xi Jinping’s hand.”


Mr. Ling, 56, built his career in the Communist Youth League. At an early age, he secured the patronage of Mr. Hu, who led the Youth League in the early 1980s and brought Mr. Ling to the General Office in 1995. “Hu didn’t come with a lot of friends, but Ling was someone he knew he could trust,” said the Organization Department official. “Officials said that if Ling called, it was like Hu calling.”


Mr. Ling played a central role in moving Youth League veterans into high offices and undermining Mr. Hu’s adversaries. Mr. Ling also wielded leverage over Internet censorship of leaders’ affairs, and sought to use it to benefit his patron.


“Negative publicity, including untruths, about Xi Jinping were not suppressed the way publicity about Hu Jintao was,” said one associate of party leaders.


As his influence grew, Mr. Ling tried to keep a low profile. About a decade ago, his wife closed a software company she owned and formed a nonprofit foundation that incubates young entrepreneurs. The couple sent their son, Ling Gu, to an elite Beijing high school under an alias, Wang Ziyun. “Ling Jihua told his family not to damage his career,” a former Youth League colleague said. “But it seems it can’t be stopped.”


Still living under an alias, Ling Gu graduated from Peking University last year with an international relations degree and began graduate studies in education. One of his instructors said his performance plunged later in his undergraduate years. “I think there were too many lures, too much seduction,” he said.


Before dawn on March 18, a black Ferrari Spider speeding along Fourth Ring Road in Beijing ricocheted off a wall, struck a railing and cracked in two. Mr. Ling was killed instantly, and the two young Tibetan women with him were hospitalized with severe injuries. One died months later, and the other is recovering, party insiders said.


Ian Johnson and Edward Wong contributed reporting.



Read More..

More Dads Buy the Toys, So Barbie, and Stores, Get Makeovers





Barbies are for girls and construction sets are for boys. Or are they?




For the first time in Barbie’s more than 50-year history, Mattel is introducing a Barbie construction set that underscores a huge shift in the marketplace. Fathers are doing more of the family shopping just as girls are being encouraged more than ever by hypervigilant parents to play with toys (as boys already do) that develop math and science skills early on.


It’s a combination that not only has Barbie building luxury mansions — they are pink, of course — but Lego promoting a line of pastel construction toys called Friends that is an early Christmas season hit. The Mega Bloks Barbie Build ’n Style line, available next week, has both girls — and their fathers — in mind.


“Once it’s in the home, dads would very much be able to join in this play that otherwise they might feel is not their territory,” said Dr. Maureen O’Brien, a psychologist who consulted on the new Barbie set.


Consumer surveys show that men are increasingly making the buying decisions for families, reflecting the growth in two-income households and those in which the women work and the men stay home. One-fifth of fathers with preschool-age children and working wives said they were the primary caretaker in 2010, according to the latest Census Bureau data. And 37.6 percent of working wives earned more than their husbands in 2011, up from 30.7 percent 10 years earlier.


“Kids are going to grow up with dads that give them baths and drive them to soccer and are cutting up oranges for team snacks,” said Liz Ross, president for North America of BPN, part of the IPG Mediabrands holding company, which recently completed a study on male consumers. “What will go away, albeit slowly, is the image or the perception of the befuddled dad.”


The change is having consequences beyond toys. Consumer products have traditionally been marketed to appeal to women, and stores have been designed for women’s sensibilities. Now, some brands and stores are catering directly to male decision-makers. Sears is reorganizing stores to put tools next to work wear, for instance, based on men’s preferences. Procter & Gamble is working on men’s grooming aisles at top retailers, a nod to the fact that women are no longer choosing shampoos or shaving creams for their husbands. With the selling point that it helps girls develop spatial reasoning, the Barbie set, a joint effort of Mattel and the toy company Mega Bloks, is also meant to pique fathers’ interest.


“Dad is a bigger influencer in terms of toy purchases over all, and this sets up well for that, because the construction category is something Dad grew up with and definitely has strong feelings and emotions about,” said Vic Bertrand, chief innovation officer of Mega Brands, Mega Bloks’ parent company.


Construction sets for girls are a speedy growth category, thanks to Lego’s introduction of its Friends line in January. Despite criticism that those sets were sexist — themes include a beauty shop and a fashion studio — Lego’s chief executive said in August that the company sold twice as many of the sets in the first half of the year as it had expected, and retailers like Amazon and Target have named them hot holiday toys.


Anne Marie Kehoe, vice president of toys for Walmart U.S., said that, with the Barbie addition, construction toys aimed at girls will represent about 20 percent of the toy construction category by the end of this year, while last year there were just a handful of products.


Research shows that playing with blocks, puzzles and construction toys helps children with spatial development, said Dr. Susan C. Levine, chairwoman of the psychology department at the University of Chicago and co-principal investigator at the National Science Foundation’s Spatial Intelligence and Learning Center. Even controlling for other skills such as verbal and numerical skills, she said, children with better spatial thinking are more likely to eventually go into mathematics, engineering, science and technology.


She said that a set aimed at girls could be beneficial, if only because it might increase girls’ likelihood of participating in construction activities.


Dr. O’Brien, the consultant on the new Barbie set, said adults had traditionally been “the limiting factor” in why girls have not played with those toys as often.


Recently, she said, there has been a shift in attitudes, as parents study research on development and spatial play. “For this particular product, one of the advantages is you can appeal to both moms and dads,” she said of the construction set.


During her research, Dr. O’Brien said, she watched a grandfather jump in to explain building principles to his granddaughter, who was playing with the Barbie. Still, the construction set is not exactly dump trucks and dirt. It remains “unapologetically all girl,” said Stephanie Cota, senior vice president of global marketing for Barbie, girls’ brands and games at Mattel.


The Mega Bloks building pieces are pink (Pantone 219, the signature Barbie color), and the construction choices are scenes like a fashion boutique, a mansion and an ice cream cart. Each set comes with a small Barbie figure that can be snapped into the scene.


Mattel, the world’s largest toy maker, still leans heavily on Barbie, one of its most popular and longest-running franchises. However, pressure to update Barbie has been high — Mattel has introduced Barbies with video cameras and digital cameras in recent years.


Yet sales of Barbie in North America through September fell 1 percent, even as sales of Mattel’s other girl brands, like Disney Princess dolls, rose 44 percent. Mega Brands makes just a fraction of what its larger rival Lego does, and had revenues of about $376 million last year.


The Barbie brand, which tends to raise feminists’ ire for its overly sexualized dolls, not to mention the 1992 version saying “Math class is tough,” has already taken some high-arched steps toward gender equality. A computer-engineer Barbie was introduced two years ago, for instance, with the support of the Society of Women Engineers.


This time, though, the introduction appears to be a response more to market changes than to critics.


Girls “don’t necessarily care about, ‘That’s a boy toy; that’s not for me,’ ” said Ms. Cota of Mattel. “Now, more so than ever, girls are looking at what’s fun, what they like.”


Read More..

With Some Hospitals Closed After Hurricane Sandy, Others Pick Up Slack





A month after Hurricane Sandy struck New York City, unexpectedly shutting down several hospitals, one Upper East Side medical center had so many more emergency room patients than usual that it was parking them in its lobby.




White and blue plastic screens had been set up between the front door and the elevator banks in the East 68th Street building of that hospital, NewYork-Presbyterian/Weill Cornell. The screens shielded 10 gurneys and an improvised nursing station from the view of people obliviously walking in and out of the soaring, light-filled atrium.


“It’s like a World War II ward,” Teri Daniels, who had been waiting a day and a half with a relative who needed to be admitted, said last week.


Since the storm, a number of New York City hospitals have been scrambling to deal with a sharp increase in patients, forcing them to add shifts of doctors and nurses on overtime, to convert offices and lobbies to use for patients’ care, and even, in one case, to go to a local furniture store to buy extra beds.


At Beth Israel Medical Center, 11 blocks south of the Bellevue Hospital Center emergency room, which was shuttered because of storm damage, the average number of visits to the E.R. per day has risen to record levels. Visits have increased by 24 percent this November compared with last, and the numbers show no sign of dropping. Hospital admissions have risen 12 percent compared with last November.


Most of the rise in volume is from patients who had never been to Beth Israel before. An emergency room doctor at the hospital described treating one patient who said he had been born at Bellevue and had never before gone anywhere else.


Emergency room visits have gone up 25 percent at NewYork-Presybterian/Weill Cornell, which in Bellevue’s absence is the closest high-level trauma center — treating stab wounds, gun wounds, people hit by cars and the like — in Manhattan from 68th Street south. Stretchers holding patients have been lined up like train cars around the nursing station and double-parked in front of stretcher bays.


In Brooklyn, some patients in Maimonides Medical Center’s emergency room who need to be admitted are waiting two or three days for a bed upstairs, instead of four or five hours. Almost every one of the additional 1,100 emergency patients this November compared with last November came from four ZIP codes affected by the storm and served by Coney Island Hospital, a public hospital that was closed because of storm damage.


The number of psychiatric emergency patients from those same ZIP codes has tripled, in a surge that began three days before the hurricane, perhaps fueled by anxiety, as well as by displacement from flooded adult homes or programs at Coney Island Hospital, doctors said.


The Maimonides psychiatric emergency room bought five captain’s beds — which do not have railings that can be used for suicide attempts — at a local furniture store, to accommodate extra patients. The regular emergency room had to buy 27 new stretchers after the hurricane, “and we probably need a few more,” the department’s chief, Dr. John Marshall, said.


The emergency room and inpatient operations of four hospitals remain closed because of flooding and storm damage. Besides Bellevue and Coney Island, NYU Langone Medical Center and the VA New York Harbor Healthcare System, both near Bellevue on the East Side of Manhattan, are closed.


While the surge in traffic to other hospitals has been a burden, it has also been a boon, bringing more revenue.


On the Upper East Side, the storm has helped Lenox Hill Hospital, which has a history of financial problems. It took two or three wards that had been turned into offices and converted them back to space for patients. Emergency room visits are up 10 percent, and surgery has been expanded to seven days a week from five.


“We usually operate at slightly over 300 beds, and now we’re at well over 550,” Carleigh Gustafson, director of emergency nursing, said.


Conversely, administrators at the shuttered hospitals, especially NYU Langone, a major teaching center, worry that their patients and doctors are being raided, with some never to return.


NYU’s salaried doctors are being paid through January, on the condition that they do not take another job. But at the same time, they need a place to practice, so NYU administrators have been arranging for them to work as far away as New Jersey until the hospital reopens. Lenox Hill alone has taken on close to 300 NYU doctors, about 600 nurses, and about 150 doctors in training, fellows and medical students.


Obstetricians and surgeons from the closed hospitals have been particularly disadvantaged, since they are dependent on hospitals to treat their patients. Many displaced surgeons have been reduced to treating only the most desperately ill, and operating on nights and weekends, when hospitals tend to be least well staffed.


“I think there’s no question that a lot of people have postponed anything that they can postpone that is elective,” said Dr. Andrew W. Brotman, senior vice president at NYU.


In mid-November, Dr. Michael L. Brodman, chairman of obstetrics at Mount Sinai Medical Center, sent out a memo saying his department had taken on 26 NYU physicians, as well as nurses and residents, but “clearly, that is too much for us to handle long term.”


Since then, 15 of the physicians have gone to New York Downtown Hospital, while Mount Sinai has retained 11 doctors and 26 nurses.


“We are guests in other people’s homes,” Dr. Brotman of NYU said, “and we are guests who have to some degree overstayed their welcome.”


Joanna Walters contributed reporting.



Read More..

With Some Hospitals Closed After Hurricane Sandy, Others Pick Up Slack





A month after Hurricane Sandy struck New York City, unexpectedly shutting down several hospitals, one Upper East Side medical center had so many more emergency room patients than usual that it was parking them in its lobby.




White and blue plastic screens had been set up between the front door and the elevator banks in the East 68th Street building of that hospital, NewYork-Presbyterian/Weill Cornell. The screens shielded 10 gurneys and an improvised nursing station from the view of people obliviously walking in and out of the soaring, light-filled atrium.


“It’s like a World War II ward,” Teri Daniels, who had been waiting a day and a half with a relative who needed to be admitted, said last week.


Since the storm, a number of New York City hospitals have been scrambling to deal with a sharp increase in patients, forcing them to add shifts of doctors and nurses on overtime, to convert offices and lobbies to use for patients’ care, and even, in one case, to go to a local furniture store to buy extra beds.


At Beth Israel Medical Center, 11 blocks south of the Bellevue Hospital Center emergency room, which was shuttered because of storm damage, the average number of visits to the E.R. per day has risen to record levels. Visits have increased by 24 percent this November compared with last, and the numbers show no sign of dropping. Hospital admissions have risen 12 percent compared with last November.


Most of the rise in volume is from patients who had never been to Beth Israel before. An emergency room doctor at the hospital described treating one patient who said he had been born at Bellevue and had never before gone anywhere else.


Emergency room visits have gone up 25 percent at NewYork-Presybterian/Weill Cornell, which in Bellevue’s absence is the closest high-level trauma center — treating stab wounds, gun wounds, people hit by cars and the like — in Manhattan from 68th Street south. Stretchers holding patients have been lined up like train cars around the nursing station and double-parked in front of stretcher bays.


In Brooklyn, some patients in Maimonides Medical Center’s emergency room who need to be admitted are waiting two or three days for a bed upstairs, instead of four or five hours. Almost every one of the additional 1,100 emergency patients this November compared with last November came from four ZIP codes affected by the storm and served by Coney Island Hospital, a public hospital that was closed because of storm damage.


The number of psychiatric emergency patients from those same ZIP codes has tripled, in a surge that began three days before the hurricane, perhaps fueled by anxiety, as well as by displacement from flooded adult homes or programs at Coney Island Hospital, doctors said.


The Maimonides psychiatric emergency room bought five captain’s beds — which do not have railings that can be used for suicide attempts — at a local furniture store, to accommodate extra patients. The regular emergency room had to buy 27 new stretchers after the hurricane, “and we probably need a few more,” the department’s chief, Dr. John Marshall, said.


The emergency room and inpatient operations of four hospitals remain closed because of flooding and storm damage. Besides Bellevue and Coney Island, NYU Langone Medical Center and the VA New York Harbor Healthcare System, both near Bellevue on the East Side of Manhattan, are closed.


While the surge in traffic to other hospitals has been a burden, it has also been a boon, bringing more revenue.


On the Upper East Side, the storm has helped Lenox Hill Hospital, which has a history of financial problems. It took two or three wards that had been turned into offices and converted them back to space for patients. Emergency room visits are up 10 percent, and surgery has been expanded to seven days a week from five.


“We usually operate at slightly over 300 beds, and now we’re at well over 550,” Carleigh Gustafson, director of emergency nursing, said.


Conversely, administrators at the shuttered hospitals, especially NYU Langone, a major teaching center, worry that their patients and doctors are being raided, with some never to return.


NYU’s salaried doctors are being paid through January, on the condition that they do not take another job. But at the same time, they need a place to practice, so NYU administrators have been arranging for them to work as far away as New Jersey until the hospital reopens. Lenox Hill alone has taken on close to 300 NYU doctors, about 600 nurses, and about 150 doctors in training, fellows and medical students.


Obstetricians and surgeons from the closed hospitals have been particularly disadvantaged, since they are dependent on hospitals to treat their patients. Many displaced surgeons have been reduced to treating only the most desperately ill, and operating on nights and weekends, when hospitals tend to be least well staffed.


“I think there’s no question that a lot of people have postponed anything that they can postpone that is elective,” said Dr. Andrew W. Brotman, senior vice president at NYU.


In mid-November, Dr. Michael L. Brodman, chairman of obstetrics at Mount Sinai Medical Center, sent out a memo saying his department had taken on 26 NYU physicians, as well as nurses and residents, but “clearly, that is too much for us to handle long term.”


Since then, 15 of the physicians have gone to New York Downtown Hospital, while Mount Sinai has retained 11 doctors and 26 nurses.


“We are guests in other people’s homes,” Dr. Brotman of NYU said, “and we are guests who have to some degree overstayed their welcome.”


Joanna Walters contributed reporting.



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Software Programs Help Doctors Diagnose, but Can’t Replace Them





SAN FRANCISCO — The man on stage had his audience of 600 mesmerized. Over the course of 45 minutes, the tension grew. Finally, the moment of truth arrived, and the room was silent with anticipation.




At last he spoke. “Lymphoma with secondary hemophagocytic syndrome,” he said. The crowd erupted in applause.


Professionals in every field revere their superstars, and in medicine the best diagnosticians are held in particularly high esteem. Dr. Gurpreet Dhaliwal, 39, a self-effacing associate professor of clinical medicine at the University of California, San Francisco, is considered one of the most skillful clinical diagnosticians in practice today.


The case Dr. Dhaliwal was presented, at a medical  conference last year, began with information that could have described hundreds of diseases: the patient had intermittent fevers, joint pain, and weight and appetite loss.


To observe him at work is like watching Steven Spielberg tackle a script or Rory McIlroy a golf course. He was given new information bit by bit — lab, imaging and biopsy results. Over the course of the session, he drew on an encyclopedic familiarity with thousands of syndromes. He deftly dismissed red herrings while picking up on clues that others might ignore, gradually homing in on the accurate diagnosis.


Just how special is Dr. Dhaliwal’s talent? More to the point, what can he do that a computer cannot? Will a computer ever successfully stand in for a skill that is based not simply on a vast fund of knowledge but also on more intangible factors like intuition?


The history of computer-assisted diagnostics is long and rich. In the 1970s, researchers at the University of Pittsburgh developed software to diagnose complex problems in general internal medicine; the project eventually resulted in a commercial program called Quick Medical Reference. Since the 1980s, Massachusetts General Hospital has been developing and refining DXplain, a program that provides a ranked list of clinical diagnoses from a set of symptoms and laboratory data.


And I.B.M., on the heels of its triumph last year with Watson, the Jeopardy-playing computer, is working on Watson for Healthcare.


In some ways, Dr. Dhaliwal’s diagnostic method is similar to that of another I.B.M. project: the Deep Blue chess program, which in 1996 trounced Garry Kasparov, the world’s best player at the time, to claim an unambiguous victory in the computer’s relentless march into the human domain.


Although lacking consciousness and a human’s intuition, Deep Blue had millions of moves memorized and could analyze as many each second. Dr. Dhaliwal does the diagnostic equivalent, though at human speed.


Since medical school, he has been an insatiable reader of case reports in medical journals, and case conferences from other hospitals. At work he occasionally uses a diagnostic checklist program called Isabel, just to make certain he hasn’t forgotten something. But the program has yet to offer a diagnosis that Dr. Dhaliwal missed.


Dr. Dhaliwal regularly receives cases from physicians who are stumped by a set of symptoms. At medical conferences, he is presented with one vexingly difficult case and is given 45 minutes to solve it. It is a medical high-wire act; doctors in the audience squirm as the set of facts gets more obscure and all the diagnoses they were considering are ruled out. After absorbing and processing scores of details, Dr. Dhaliwal must commit to a diagnosis. More often than not, he is right.


When working on a difficult case in front of an audience, Dr. Dhaliwal puts his entire thought process on display, with the goal of “elevating the stature of thinking,” he said. He believes this is becoming more important because physicians are being assessed on whether they gave the right medicine to a patient, or remembered to order a certain test.


Without such emphasis, physicians and training programs might forget the importance of having smart, thoughtful doctors. “Because in medicine,” Dr. Dhaliwal said, “thinking is our most important procedure.”


He added: “Getting better at diagnosis isn’t about figuring out if someone has one rare disease versus another. Getting better at diagnosis is as important to patient quality and safety as reducing medication errors, or eliminating wrong site surgery.”


Clinical Precision


Dr. Dhaliwal does half his clinical work on the wards of the San Francisco V. A. Medical Center, and the other half in its emergency department, where he often puzzles through multiple mysteries at a time.


One recent afternoon in the E.R., he was treating a 66-year-old man who was mentally unstable and uncooperative. He complained of hip pain, but routine lab work revealed that his kidneys weren’t working and his potassium was rising to a dangerous level, putting him in danger of an arrhythmia that could kill him — perhaps within hours. An ultrasound showed that his bladder was blocked.


There was work to be done: drain the bladder, correct the potassium level. It would have been easy to dismiss the hip pain as a distraction; it didn’t easily fit the picture. But Dr. Dhaliwal’s instinct is to hew to the ancient rule that physicians should try to come to a unifying diagnosis. In the end, everything — including the hip pain — was traced to metastatic prostate cancer.


“Things can shift very quickly in the emergency room,” Dr. Dhaliwal said. “One challenge of this, whether you use a computer or your brain, is deciding what’s signal and what’s noise.” Much of the time, it is his intuition that helps figure out which is which.


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Syrian Government Beset by Battles and Diplomatic Setbacks


Narciso Contreras/Associated Press


A kitchen in a residence in Aleppo, Syria, damaged Sunday in fighting between Free Syrian Army fighters and government forces.







BEIRUT, Lebanon — Fierce fighting on the battlefield and setbacks on the diplomatic front increased pressure on the embattled Syrian government on Monday as fresh signs emerged of a worsening battle for control of the capital.




A senior Turkish official said that Russia had agreed on Monday to a new diplomatic approach that would seek ways to persuade President Bashar al-Assad to relinquish power, a possible weakening in Russia’s steadfast support for the government. Fighting raged around Damascus, the Syrian capital, and its airport, disrupting commercial flights for a fourth straight day.


A prominent Foreign Ministry spokesman was said to have left the country amid reports of his defection, and both President Obama and Secretary of State Hillary Rodham Clinton issued warnings that any use of chemical weapons by a desperate government would be met with a strong international response. A Western diplomat confirmed that there were grave concerns in United States intelligence circles that Syrian leaders could resort to the use of the weapons as their position deteriorates.


The Syrian Foreign Ministry, repeating earlier statements, told state television that the government “would not use chemical weapons, if it had them, against its own people under any circumstances.”


The United Nations said it was withdrawing nonessential international staff from Syria, and the European Union said it was reducing activities in Damascus “to a minimum,” as security forces pummeled the suburbs with artillery and airstrikes in a struggle to seal off the city from its restive outskirts and control the airport road. A senior Russian official spoke for the first time in detail about the possibility of evacuating Russian citizens.


Mr. Assad has held on longer than many had predicted at the start of the 21-month uprising. He still has a strong military advantage and undiminished support from his closest ally, Iran. Military analysts doubt the rebels are capable of taking Damascus by force, and one fighter interviewed on Monday said the government counteroffensive was inflicting heavy losses. There were still no firm indications from Russia that it was ready to join Turkey and Western nations in insisting on Mr. Assad’s immediate departure.


But the latest grim developments follow a week of events that suggested the Assad government was being forced to fight harder to keep its grip on power. Rebels threatened its vital control of the skies, using surface-to-air missiles to down a fighter plane and other aircraft. The opposition also gained control of strategic military bases and their arsenals, and forced the government to shut down the Damascus airport periodically. The Internet was off for two days.


A Russian political analyst with contacts at the Foreign Ministry said that “people sent by the Russian leadership” who had contact with Mr. Assad two weeks ago described a man who has lost all hope of victory or escape.


“His mood is that he will be killed anyway,” Fyodor Lukyanov, editor of a Russian foreign affairs journal and the head of an influential policy group, said in an interview in Moscow, adding that only an “extremely bold” diplomatic proposal could possibly convince Mr. Assad that he could leave power and survive.


“If he will try to go, to leave, to exit, he will be killed by his own people,” Mr. Lukyanov said, speculating that security forces dominated by Mr. Assad’s minority Alawite sect would not let him depart and leave them to face revenge. “If he stays, he will be killed by his opponents. He is in a trap. It is not about Russia or anybody else. It is about his physical survival.”


Many observers — United Nations personnel in Syria, Arab diplomats and opposition activists — stress that it is difficult to reliably assess the state of the government. But taken together, the day’s events suggested that the government’s position was declining more sharply than it had in months and that an international scramble to find a solution to the crisis was intensifying.


Nabil al-Araby, the head of the Arab League, said on Monday that the government could fall at “any time,” Agence France-Presse reported.


“I think there will be something soon,” he said. “Facts on the ground indicate very clearly now that the Syrian opposition is gaining, politically and militarily.”


The Arab League has long called for Mr. Assad to step down. But Russia, Mr. Assad’s most powerful ally, has held out the possibility of his staying in power during a transition, so the Russian government’s apparent shift of emphasis carried more weight.


Anne Barnard reported from Beirut, Lebanon, and Ellen Barry from Moscow. Reporting was contributed by Sebnem Arsu in Istanbul, Peter Baker in Washington, Hwaida Saad, Neil MacFarquhar and Hania Mourtada in Beirut and Christine Hauser in New York.



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Texas Business Incentives Highest in Nation


DALLAS — The Preston Hollow neighborhood has been home to many of Texas’ rich and powerful — George and Laura Bush, Mark Cuban, T. Boone Pickens, Ross Perot. So it is hardly surprising that a recent political fund-raiser was held there on the back terrace of a 20,000-square-foot home overlooking lush gardens with life-size bronze statues of the host’s daughters.


The guest of honor was Gov. Rick Perry, but the man behind the event was not one of the enclave’s boldface names. He was a tax consultant named G. Brint Ryan.


Mr. Ryan’s specialty is helping clients like ExxonMobil and Neiman Marcus secure state and local tax breaks and other business incentives. It is a good line of work in Texas.


Under Mr. Perry, Texas gives out more of the incentives than any other state, around $19 billion a year, an examination by The New York Times has found. Texas justifies its largess by pointing out that it is home to half of all the private sector jobs created over the last decade nationwide. As the invitation to the fund-raiser boasted: “Texas leads the nation in job creation.”


Yet the raw numbers mask a more complicated reality behind the flood of incentives, the examination shows, and raise questions about who benefits more, the businesses or the people of Texas.


Along with the huge job growth, the state has the third-highest proportion of hourly jobs paying at or below minimum wage. And despite its low level of unemployment, Texas has the 11th-highest poverty rate among states.


“While economic development is the mantra of most officials, there’s a question of when does economic development end and corporate welfare begin,” said Dale Craymer, the president of the Texas Taxpayers and Research Association, a group supported by business that favors incentives programs.


In a state that markets itself as “wide open for business,” the lines are often blurred between decision makers and beneficiaries, according to interviews with dozens of state and local officials and corporate representatives. The government in many instances is relying on businesses and consultants like Mr. Ryan for suggestions on what incentives to grant and which companies should receive them, as well as on other factors that directly affect public spending and budgets, the interviews show.


Mr. Ryan does not claim to be neutral on where the money should go. “It’s widely known that I represent a lot of taxpayers,” he said in an interview. “I have client relationships with people who hopefully, if they invest in Texas, they’ll receive incentives.”


Granting corporate incentives has become standard operating procedure for state and local governments across the country. The Times investigation found that the governments collectively give incentives worth at least $80 billion a year.


The free flow of tax breaks and subsidies in Texas makes it particularly fertile ground to examine these economic development deals and the fundamental trade-off behind them: the more states give to businesses, the less they have available in the short term to spend on basic services, a calculation made more stark by the recession.


To help balance its budget last year, Texas cut public education spending by $5.4 billion — a significant decrease considering that it already ranked 11th from the bottom among all states in per-pupil financing, according to recent data from the Census Bureau. Yet highly profitable companies like Dow Chemical and Texas Instruments continue to enjoy hefty discounts on their school tax bills through one of the state’s economic development programs.


In the Manor school district, which comprises the town and part of Austin, Samsung has been awarded more than $231 million in incentives from state and local officials. But the recent budget cuts have left the district with crowded classes and fewer programs.


Mr. Perry, who took office at the end of 2000, has been a longtime proponent of lowering taxes. He said in an interview that companies could put the money to better use than the government and would spend it in ways that would create jobs and help Texans.


“Facebook, eBay, Apple — all of those within the last two years have announced major expansions in Texas,” Mr. Perry said. “They’re coming because it is given, it is covenant, in these boardrooms across America, that our tax structure, regulatory climate and legal environment are very positive to those businesses.”


He acknowledged that the state’s job growth was not erasing persistent poverty, saying that “we are going to have people that fall through the cracks.” He said creating jobs was the best way to help Texans, who “don’t want government assistance when they can do it themselves.”


But relying on companies does not always turn out well. When Amazon set up a distribution center outside Dallas, it received incentives from the state. Six years later, when the company got into a tax dispute with the state, it shut the warehouse, which employed as many as 2,000 people during its peak season.


Nationwide, a whole industry of consultants has grown up around state efforts to lure companies with incentives. Companies like Ernst & Young, Deloitte and Automatic Data Processing, a payroll company, have divisions dedicated to helping companies search for the best deals.


Mr. Ryan’s Dallas-based firm, Ryan LLC, operates in 27 states and seven countries and represents numerous Fortune 500 companies. Texas alone is a big source of business for Mr. Ryan, who has won tax refunds of more than $20 million each for ExxonMobil and Raytheon. This year, he sought similar amounts for Verizon, Freescale Semiconductor and several other companies, according to state documents obtained through an open records request.


At the same time, Mr. Ryan has become one of the state’s most generous political donors. He co-founded a political action committee last year that supported Mr. Perry’s bid for the Republican presidential nomination and donated $250,000.


Even as business leaders press local governments to give out more incentives, they warn against requiring too much in return.


In Travis County, which includes Austin, commissioners recently passed new rules for companies that receive tax abatements. One requires paying employees $11 an hour, an amount the county considers to be a living wage.


The rules had been contested by the business community. “The more stipulations you put into an agreement, the more complicated it becomes and the less competitive we become,” Gary Farmer, a local business leader who runs an insurance company, told the county commissioners at a hearing. “We’re concerned about including a living wage into the policy, as we believe that could have a chilling effect on certain companies.”


The Money Starts Flowing


When Mr. Perry became governor in 2000, Texas was not a major player in the incentives game. He quickly got his first taste during a bidding war among states when Boeing was hunting for a new location for its headquarters.


Texas ultimately lost to Illinois, which awarded Boeing $52.5 million in incentives, but the episode was a turning point. “We came back in here after we lost that,” Mr. Perry said, “and we analyzed our economic development efforts, and that’s when we started making some changes.”


Mr. Perry got the money flowing through two new cash funds created to recruit businesses. One, the Texas Enterprise Fund, awarded more than $410 million over eight years, according to the governor’s office, and the recipients said they would create more than 54,000 jobs. The fund requires companies that do not meet their job targets to return incentive money.


The state has also embraced a popular program that establishes enterprise zones where companies can receive refunds on some taxes they pay in exchange for moving there. The exemption has added up to big money for retailers like Walmart. Not coincidentally, the company has opened stores in similar enterprise zones across the country.


Walmart owed some of its other tax savings to Mr. Ryan, who counted the retailer among his earliest clients in the 1990s. Once an accounting firm, Ryan LLC transformed itself in recent years into a powerhouse focused on corporate tax breaks.


Mr. Ryan is a familiar presence at the state comptroller’s office in Austin, which must sign off on many tax breaks. He is known there for his laser focus and forceful negotiating skills. “It’s gloves-off, full-frontal assault,” said a former official, who requested anonymity because of state confidentiality rules.


Mr. Ryan agrees that he is aggressive, saying that “guys like me are all that stand between the government fleecing taxpayers.” He has at times filed lawsuits over tax rules he does not like, including one against the head of the Internal Revenue Service and Treasury Secretary Timothy F. Geithner.


In one of his most lucrative deals, Mr. Ryan in 2006 helped Texas Instruments win tens of millions of dollars in tax refunds, according to the comptroller’s office. Ryan LLC often gets to keep around 30 percent of its clients’ awards, according to former employees.


That same year, Mr. Ryan was a top donor to the campaign of the comptroller at the time, Carole Keeton Strayhorn, personally giving $250,000, according to campaign finance records. Over the course of Ms. Strayhorn’s tenure, Mr. Ryan, his employees and his company’s PAC would donate nearly $3 million, including when the comptroller ran for governor, the records show. He and his employees have made campaign contributions to the current comptroller, Susan Combs, totaling more than $600,000.


Ms. Strayhorn declined to comment, and a representative for Ms. Combs said the donations did not affect her decisions.


Since 2000, Mr. Ryan and his wife, Amanda, have contributed over $4 million to a variety of state officials and political causes, including the governor. Mr. Perry declined to comment on Mr. Ryan, but at a local event in 2010 he called him “the type of visionary that every community wants to have,” according to The Abilene Reporter-News.


Mr. Ryan said that he gave to candidates in many states and that his donations brought extra scrutiny, not favorable treatment.


Others see it differently. “When you give money to a state regulator who you appear before, there are potential conflicts of interest,” said Craig McDonald, the executive director of Texans for Public Justice, a liberal watchdog group. “And Texas law is way too weak in allowing those conflicts to exist.”


Mr. Ryan set his own sights on public office in 2009, running for the Dallas City Council on a platform that pushed cutting public spending. Simultaneously, Mr. Ryan was pursuing state aid for his own company, applying for an enterprise zone designation for his business.


Mr. Ryan lost the race but won the incentive. “In these tough economic times, our city officials must use every tool available to ensure job growth and expand the tax base,” he said of the award in a news release.


Mr. Perry has made corporate recruitment a hallmark of his administration. The governor frequently makes trips to cities like Chicago, New York and San Francisco to lure prospective businesses.


During a visit to San Diego in June, he proudly told local officials that about a third of the companies moving to Texas were from California, said Ruben Barrales, the chief executive of the San Diego Regional Chamber of Commerce.


“Governor Perry is here quite a bit,” Mr. Barrales said. “He meets with companies. He’s letting people know if they’re interested in further growth, Texas will greet them with open arms. He’s not very shy about it.”


Asked if he had qualms about taking jobs from other states, Mr. Perry said, “Competition is what drives this country.”


A nonprofit group called TexasOne recommends potential businesses to the governor and then pays for his travel and other expenses during the recruiting trips. The group is financed by large corporations like Shell and AT&T, as well as by consultants like Ryan LLC.


The governor’s office allocates the awards, which state records show amount to millions of dollars each year. In the enterprise zone program, 82 of the 222 awards granted from March 2008 to June 2012 went to companies represented by Mr. Ryan’s firm, according to public records provided by the governor’s office. The list included General Motors, Tyson Foods and the German chemical giant BASF.


Until recently, the cash incentives were overseen in Mr. Perry’s office by a top aide, Roberto De Hoyos. In September, Mr. De Hoyos took a new job — at Ryan LLC.


Companies Gain, Schools Lose


Lines of new students show up each August at the public schools in Manor. The town is mostly rural, with fields of hay and cattle in every direction. Some of the students’ families came to double up with relatives or friends, others were pushed outward by Austin’s gentrification.


Downtown Manor consists of a couple of blocks lined with spots like Ramos Cocina and a smoke-filled convenience store. There are few doctors and no real place to buy groceries.


About six miles away, a fabrication plant for the South Korean company Samsung looms over one of Manor’s elementary schools, a symbol of corporate interests juxtaposed with a pillar of public spending. The complex, which makes memory chips for smartphones and other products, includes some of the largest buildings in the area: one covers 1.6 million square feet, or about nine football fields.


Since Mr. Perry took office, companies have seen a drop in their school property taxes because of a special incentives program, as well as an across-the-board cut in the school tax rate. The recession has made the squeeze all the more difficult for schools.


In the Manor district, spending shrank by about $540 per student this year, according to the Equity Center, an advocacy group for Texas schools. The cuts came even as school enrollment has nearly tripled since 2000.


The cracks in financing were on display this summer, as families filled a school cafeteria to register for a prekindergarten program with shortened days. For parents like Tommy and Melissa Sifuentes, the cutback means they have to leave work early or hire a baby sitter. “It’s harder,” said Ms. Sifuentes, who is still grateful that her son will learn socialization skills at school.


About 80 percent of Manor’s students are low-income, according to the E3 Alliance, a nonprofit group in Austin that focuses on education. For about a third of the 8,000 students, English is a second language.


In 2005, Manor’s school board gave Samsung eight years of tax abatements worth $112 million as part of the company’s incentives package for its fabrication plant. Under the special incentives program, known as Chapter 313, school boards approve tax abatements for companies. The state then reimburses the district for the amounts they give up.


In many districts, the awards were granted after little review. Robert Schneider, a member of Austin’s school board, said the district was nonchalant when it gave an abatement to Hewlett-Packard in 2006.


“The board took it as ‘we don’t lose in this deal,’ because we knew we were going to get reimbursed by the state,” Mr. Schneider said. “I can tell you there wasn’t any analysis done that said, ‘Ten, 15 years from now, they will be here and we’ll get such and such out of it.’ ”


School boards statewide have approved abatements worth at least $1.9 billion through the program, according to the comptroller’s office. Although the districts are not paying for the abatements themselves, budget experts point out that the reimbursements come from the state’s general fund, which like most state treasuries is running low.


In Texas, tax revenues for schools took a direct hit when Mr. Perry created a commission in 2005 to evaluate the state’s tax system. The State Supreme Court was questioning districts’ property tax rates and warned of a school shutdown if legislators did not intervene. The tax rates had been criticized for years by businesses and residents, but some districts countered that they could not afford to cut them without additional state financing.


Mr. Perry turned to John Sharp, a Democrat and former comptroller, to lead the commission. At the time, Mr. Sharp worked for Ryan LLC. The commission called for districts to cut school property taxes by around one-third. To make up for some of the lost revenue, it recommended adding a business tax, as well as increasing some sales taxes.


“I did what I thought was the best for the state of Texas,” said Mr. Sharp, adding that his position at Ryan LLC did not affect his decisions. “We saved the state of Texas from complete collapse of the school system, and I’m very proud of that.” Mr. Sharp left Ryan last year to become the chancellor of Texas A&M University.


In 2006, the Legislature largely adopted the commission’s proposals and required the state to give districts billions of dollars to allow time for the business tax to make up the difference.


Some six years later, things have not worked out as planned.


The business tax has not yielded anywhere near what Mr. Sharp’s panel projected, and the state has cut its aid to the districts by $5.4 billion. A spokeswoman for Mr. Perry noted that one of the state’s cash incentive funds was also cut back.


Leslie Whitworth, who oversees the curriculum in Manor, said that the district was doing its best to make do with less, but that “it wears on people, the constant crisis, the constant increases in students and constant pressure on budgets.”


Among other things, the cuts have meant overcrowding across Texas: the number of classrooms over the state’s student limit nearly quadrupled last year.


Some companies recognize the trade-off. Daimler, the German maker of the Mercedes-Benz, accepts incentives in the United States but tries to avoid ones that come out of school budgets, said David Trebing, who manages the company’s relationship with local governments. “We want to make sure they have enough money for their schools,” Mr. Trebing said. “Our workers send their kids there.”


Even members of the Austin Technology Council, which includes Samsung, identified an educated work force as among their biggest concerns for the area, according to a recent survey.


Of the $231 million in incentives Samsung received, it donated $1 million back to Manor for a scholarship fund. The company also mentors district students.


Catherine Morse, Samsung Austin’s general counsel, said the abatements from the Manor school board were crucial because of the company’s expensive machinery. Samsung also received $10.8 million from Mr. Perry’s cash fund, but Ms. Morse said the money had not swung the decision. “It was more like it showed respect,” she said.


Ms. Morse noted that Samsung was still the county’s largest taxpayer and that locating the facility in Texas had been a tough sell inside the company. “It was very unpopular to take jobs out of South Korea,” she said.


Samsung said it had created 2,500 jobs on its payroll and 2,000 more for contract employees. Ms. Morse said that 495 of those on its payroll lived in the Manor school district. The company is currently seeking additional incentives for a $4 billion retooling of its facility, though it is not expected to add many jobs.


Amazon Plays Hardball


Tarik Carlton gathered with other workers in February 2011 to hear the bad news: Amazon was shutting its distribution center in Irving, where he loaded trucks for $12.75 an hour.


Business had been strong, but the online retailer did not want to pay a $269 million tax bill from the state comptroller. A standoff with the state ensued, and Amazon laid off the workers. “They didn’t have our interests in heart, truth be told,” Mr. Carlton said.


Amazon opened the distribution facility in 2005 in Irving, near Dallas-Fort Worth International Airport, and local officials awarded the company tax breaks on its inventory.


Positions at the warehouse included product pickers, dock crews and truck loaders. The employees were typically on the young side, and some had served in the military. The warehouse churned through workers because many could not meet the quota of products they were supposed to move each day, according to Frankie Lloyd, who helped Amazon find temporary workers to fill many of the jobs.


“It’s all about what you can do physically,” Ms. Lloyd said. “Like manufacturing, but without the great pay.”


The distribution business grew as manufacturing moved overseas and online shopping boomed. It is big in the Dallas area because two main train lines run here from Long Beach, Calif., where goods arrive from Asia.


The work is highly physical. One Amazon worker wore a step counter that logged five miles during one shift, according to Mr. Carlton, who only recently found a new job. He was among 12 former Amazon workers, including two warehouse managers, who agreed to be interviewed.


There was no air-conditioning in the warehouse, and Mr. Carlton and others said the temperature could reach 115 degrees. They said it was difficult to take breaks given the production quotas.


The pay was typically $11 to $15 an hour, Ms. Lloyd said. Amazon gave out small shares of stock and some bonuses, but the amounts were minimal, she said.


Amazon said it had been working to upgrade its warehouses, which it calls fulfillment centers. The company has installed air-conditioning in all its centers over the past year, said Dave Clark, the vice president for global customer fulfillment.


Mr. Clark said workers always received breaks, and sometimes free ice cream when the facilities did not have air-conditioning. He said the quotas were akin to “expectations that go along with every job, mine included.”


“I really do think these jobs get a bad rap,” Mr. Clark said. “They’re great jobs. They’re safe jobs.”


Mr. Carlton said he had no idea the company was being partly subsidized. “If you give them money, I think more should be expected,” he said, adding that Amazon should have been required to hire more people to handle the heavy workload.


John Bonnot, the director of business recruitment for the Irving Chamber of Commerce, said the city did not impose wage or benefit requirements on companies that received incentives. Irving had required that Amazon create only 10 jobs to receive the tax break.


Mr. Bonnot said Amazon “would have nothing but praise” for the original assistance from the state and the city, which outsources its economic development to the local chamber.


Things began to slide downhill in late 2010 when the state comptroller, Ms. Combs, demanded that Amazon pay the $269 million sales tax bill. The retailer had never charged its Texas customers the tax, giving it an advantage over on-the-ground competitors.


The company hired three powerful advocates with ties to the governor, according to state lobbyist disclosure records. One, Luis Saenz, had been the director of Mr. Perry’s political operation. Days after the warehouse closed, Mr. Perry said he disagreed with the comptroller’s decision to demand the taxes.


As it was battling with the comptroller, Amazon began negotiating with the Legislature, which was debating whether online businesses should be required to charge sales tax. The company told lawmakers that it would create up to 6,000 jobs in exchange for delaying sales tax collections, similar to a compromise it had struck in states like South Carolina and Tennessee.


The lawmaker with the most power in the decision was John Otto, a Republican member of the Texas House of Representatives. Like all Texas legislators, Mr. Otto’s government job is part time. He also works at Ryan LLC — a job that is not disclosed on his legislative Web site.


Mr. Otto drafted legislation that said online retailers like Amazon would not have to charge sales tax as long as it did not have distribution facilities in Texas. By then, the company had already shut the Irving warehouse.


Mr. Otto and Mr. Saenz declined to comment about the legislation. Amazon would not comment on its negotiations with Texas.


In July, Amazon began collecting sales tax from customers in Texas after the comptroller agreed to release the company from most of its $269 million bill. The company has also promised to open new distribution facilities and hire 2,500 workers. Amazon will owe the state a $1 million penalty if it fails to deliver.


The math on the new deal angers former Amazon workers, especially those who are still unemployed. For Texas to give up more than $250 million in tax revenues in exchange for 2,500 jobs amounts to about $100,000 per job. Most distribution workers are paid $20,000 to $30,000 a year. The rest benefits the company’s bottom line, which generally increases executive bonuses and shareholder returns.


King White, a consultant who helps Amazon choose locations, would not comment on the online retailer but said that companies in general had come to view incentives as entitlements. “Everybody thinks they deserve something,” Mr. White said. “ ‘If I’m creating jobs, what’s in it for me?’ ”


The deal on the sales tax did not require Amazon to reopen the Irving facility. That touched off the latest state competition to win over Amazon.


Last month, the city of Schertz beat out neighboring San Antonio for one of Amazon’s warehouses. The company is currently in negotiations with Coppell, outside of Dallas, about an additional center. Like Schertz, Coppell has offered Amazon a deal to keep a part of the sales tax it collects there, among other incentives.


If Amazon accepts, it will be located near Irving and many of its former workers. Sharon Sylvas, 47, had moved from Kansas seven years ago to help Amazon set up the Irving facility. She lives nearby in a one-bedroom apartment with her partner, daughter and two grandchildren.


After Amazon closed, she was out of a job for over a year. With limited options, Ms. Sylvas took a temporary position in October at another company’s distribution center. It is a tougher job than the one at Amazon, and it pays less. For $11 an hour, Ms. Sylvas moves heavy inventory and other items.


She said that if Amazon returned to the area, she would work there again, despite the rigors of warehouse jobs. “It’s real miserable,” Ms. Sylvas said. “But you do it to make a living.”


Both Player and Referee


For the past few months, a commission created by the Texas Legislature has been taking a broad look at the state’s economic development efforts. It will report back in January with recommendations. Four members of the commission are specifically focused on evaluating the state’s cash grants and the school tax abatement programs. This means that companies in Texas have a lot at stake in the panel’s work.


So does at least one of the commissioners: G. Brint Ryan.


He was appointed to the commission by the state’s lieutenant governor, David Dewhurst, who has received more than $150,000 in campaign donations from Mr. Ryan.


At a meeting in mid-September, the panel invited business representatives to testify. Among them was Ms. Morse, the general counsel at Samsung Austin, who urged the commission to continue the school property tax program that benefits her company in the Manor district.


During Ms. Morse’s testimony, it went unmentioned that Samsung is a Ryan client. Ryan LLC had helped the company gain designation as an enterprise zone in 2010, enabling it to receive sales tax refunds from the state on many of its purchases, according to documents obtained by The Times under a public records request.


Mr. Ryan said the commission had never asked him whom he represents.


No representatives from Texas schools spoke at the hearing. But Mr. Ryan said in an interview that school financing and poverty could best be addressed by emphasizing economic activity. He noted his own humble beginnings. “Frankly, I never got one single government handout,” he said.


Over the years, of course, Mr. Ryan has profited by helping many companies obtain checks from the government. In at least one instance, he was more eager to get the money than his client was.


The client, a computer chip maker called Advanced Micro Devices, had hired Mr. Ryan’s firm to review its books. But when the firm found what it believed would be a way to save more than $30 million in taxes, the chip maker decided it was not worth pursing. Ryan LLC responded by suing its client, saying AMD owed it to the firm to seek the money. Ryan LLC would have received a cut of the savings.


AMD declined to comment on the case, which was settled last year. But in a deposition contained in the court filings, a representative of the chip maker described numerous e-mails and phone calls by Mr. Ryan, who was trying to persuade the company to file for the refunds.


“It’s continuing evidence that they’ve placed their interest above our own and continued to press this issue,” the representative said. The company said Ryan LLC’s behavior “bordered on harassment.”


At one point, Mr. Ryan wrote to the chip maker’s chief financial officer. “At stake is tens of millions of dollars in tax recovery and future tax savings on an issue I have WON for other fabs in Texas,” he said, referring to fabrication facilities.


The company’s choice not to seek the tax break, Mr. Ryan said in a deposition, was an “irrational and unreasonable decision.”

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