Tax Deal Done - but How Can Obama Sign It?

Jan 2, 2013 6:29pm

AP Photo/Charles Dharapak

Congress officially delivered the bill to avert the fiscal cliff to the White House this afternoon, House Speaker John Boehner’s office told ABC News.

Now the question is when will the President sign it?

The bill, passed late on New Year’s Day, expires tomorrow at 11:59 a.m. when the current session of Congress concludes. If President Obama doesn’t sign it by then, constitutionally the bill is dead.

But this evening, eighteen hours before the deadline, the President is on a golf course in Hawaii.  And the bill is in Washington at the White House.

Administration officials won’t say what they will do despite repeated inquiries from ABC News.

There seem to be two options:  1) An Air Force jet can deliver the bill to Hawaii (better leave quickly!) in time for the President to sign it before 11:59 Eastern Standard Time; or, 2) The White House can use a presidential “auto-pen.”

The simple mechanical device uses a template of the presidential signature to scrawl it on paper if activated by the White House at Obama’s direction.

But would an auto-pen – usually used to sign insignificant correspondence and photographs – pass constitutional muster?  We don’t know.  The question has never been tested by the courts.

A 2005 legal study commissioned by former President George W. Bush determined that use of the autopen is constitutional but acknowledged the possibility that its use could be challenged.  Bush never used the autopen, officials from his administration told ABC.

President Obama is only believed to have used the autopen once to sign a piece of major legislation — the 2011 extension of the Patriot Act — which reached his desk while he was on a diplomatic trip to Europe. Officials invoked national security concerns to justify the move.

Use of the autopen has been controversial.  Conservative groups alleged last summer that Obama used an autopen to sign condolence letters to the families of Navy SEALs killed in a Chinook crash in Afghanistan — a charge the White House disputed flatly as false.

In 2004, then-Secretary of Defense Donald Rumsfeld was criticized for using an autopen to sign condolence letters to the families of fallen troops.

And in 1992 then-Vice President Dan Quayle even got into some hot water over his use of the autopen on official correspondence during an appearance on “This Week with David Brinkley.” More HERE.

ABC News’ Ann Compton and Devin Dwyer contributed reporting.

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At least 61 crushed to death in Ivory Coast stampede

ABIDJAN (Reuters) - At least 61 people were crushed to death in a stampede after a New Year's Eve fireworks display at a stadium in Ivory Coast's main city Abidjan early on Tuesday, officials said.

Witnesses said police had tried to control crowds around the Felix Houphouet-Boigny Stadium following the celebrations, triggering a panic in which scores were trampled.

"The estimate we can give right now is 49 people hospitalized ... and 61 people dead," said the chief of staff of Abidjan's fire department Issa Sacko.

Crying women searched for missing family members outside the stadium on Tuesday morning. The area was covered in patches of dried blood and abandoned shoes.

"My two children came here yesterday. I told them not to come but they didn't listen. They came when I was sleeping. What will I do?" said Assetou Toure, a cleaner.

Sanata Zoure, a market vendor injured in the incident, said New Year's revelers going home after watching the fireworks had been stopped by police near the stadium.

"We were walking with our children and we came upon barricades, and people started falling into each other. We were trampled with our children," she said.

Another witness said police arrived to control the crowd after a mob began chasing a pickpocket.

President Alassane Ouattara called the deaths a national tragedy and said an investigation was under way to find out what happened.

"I hope that we can determine what caused this drama so that we can ensure it never happens again," he said after visiting the injured in hospital.

The country, once a stable economic hub for West Africa, is struggling to recover from a 2011 civil war in which more than 3,000 people were killed.

Ivory Coast's security forces once were among the best trained in the region, but a decade of political turmoil and the 2011 war has left them in disarray.

At least 18 people were killed in another stampede during a football match in an Abidjan stadium in 2009.

(Reporting by Loucoumane Coulibaly and Alain Amontchi; Writing by Richard Valdmanis; Editing by Michael Roddy)

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US House to vote to avert fiscal cliff

WASHINGTON: After a day of twisting political drama, the US Congress was Tuesday expected to finally endorse a deal to avert the "fiscal cliff" budget crisis that had threatened to unleash a new recession.

Hours before many major global financial markets make their 2013 debut, the House of Representatives was to vote on a bid to raise taxes on the rich and put off a $109 billion dollar program of spending cuts for two months.

The deal passed the Senate early on Tuesday, but its fate hung in the balance for hours as House conservatives sought to amend it to include big spending cuts, which would likely have killed its chance of passage.

Had the deal splintered, all Americans would have been hit by tax increases and the spending cuts would have kicked in across the government, in a combined $500 billion shock that could have rocked the fragile recovery.

The House was due to vote within hours on an up or down vote on the deal agreed between Senate Republicans and President Barack Obama's White House.

A majority of 217 votes was seen as a certainty given that Obama's Democrats were certain to back the pact along with some of the Republican majority.

The vote will take place after a conservative rebellion fizzled when it became clear there were not sufficient votes in the restive Republican caucus to send an amended version of the bill with spending cuts back to the Senate.

Republican party leaders ultimately feared they would carry the can if the deal collapsed, leaving Americans enraged by higher taxes and the prospect of that an economy still slowly bouncing back from the worst crisis in decades could be plunged back into recession.

"There's a growing sense that, you know... you do have to know when to hold them and when to fold them. We've been beaten in this fight," retiring Ohio Republican Congressman Steve LaTourette told CNN.

Earlier, Boehner's coalition vented fury that the deal negotiated by the White House and top Senate Republicans had not contained significant spending cuts to eat into national debt that is worth more than $16 trillion.

"We have to in some way address spending," Republican congressman Spencer Bachus said.

Another House Republican, Tim Huelskamp, said that the powerful number two Republican in the chamber Eric Cantor told a high-stakes meeting of the party caucus that he was opposed to the bill.

"The principal reason is there are no spending cuts," said Huelskamp.

At the turn of the year, every American became liable to a tax hike with the expiry of rate cuts first passed under former president George W. Bush.

The deal to avert the fiscal cliff agreed on Monday raised income taxes only on households earning $450,000 a year and exempted anyone else.

It put off the spending cuts -- known as the sequester -- for two months, setting up another bitter political cliffhanger at the end of February.

If the legislation does pass the House unamended, it will represent a win for Obama as it raises taxes on the richest Americans in line with a re-election campaign promise -- albeit above an income threshold higher than he and other Democrats had wanted.

Obama issued a statement shortly after the 2:00 am (0700 GMT) Senate vote, urging House lawmakers to pass the bill "without delay."

The White House said the tax agreement was "a victory for middle-class families and the economy," and laid out the raft of measures contained in the legislation.

"For the first time in 20 years, Congress will have acted on a bipartisan basis to vote for significant new revenue," it said.

The deal also includes an end to a temporary two percent cut to payroll taxes for Social Security retirement savings -- meaning all Americans will pay a little more -- and changes to inheritance and investment taxes.

-AFP/ac

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NHAI slams GMR for termination notice for biggest highway project

NEW DELHI: National Highways Authority of India (NHAI) has hit back at infrastructure major GMR on its termination notice for the country's biggest highway project worth at least Rs 6,000 crore. The Authority in its reply to GMR has said that the company did not give 90-day cure period (to rectify and address the deficiencies), and how it is in violation of the norms laid down in the concession agreement.

NHAI was to respond to the GMR notice to exit from Kishangarh-Udaipur-Ahmedabad project by January 4. GMR has cited NHAI's failure to get environmental clearance for the 555-km highway project and to notify the revised toll rate on this stretch being widened from four to six lanes.

"The notice served on us had several deficiencies, and we have spelt them out clearly. The revised toll notification has been done and environment clearance will be obtained in the next few days," said a senior NHAI official.

Sources said that the toll notification was done after highways minister C P Joshi held a meeting at his residence on Monday evening and the environment and forest ministry (MoEF) has been approached to convene a special meeting of the Forest Advisory Committee (FAC) to grant clearance.

The project has huge significance considering it being the country's first mega highway project. In addition, if the contract gets cancelled, NHAI would directly lose revenue of Rs 636 crore annually, which increases 5% every successive year. The Authority's own estimate shows the total revenue during the entire contract period would be at least Rs 9,000 crore at net present value.

Indications abound that in case GMR still decides to opt out of the project, NHAI would forfeit the company's bank guarantee along with other harsh steps. "We don't want this to be a precedent for other concessionaires who would show delay in environment clearance to exit from the project and consequently forcing us to rebid them," said a senior ministry official.

NHAI also seems to use this case to draw MoEF's attention to fast track green clearance, highlighting the laxity on the green ministry's part to grant such nods. NHAI chairman R P Singh wrote to MoEF secretary V Raja Gopalan on December 24, "Any delay on our part in giving environment clearance can be construed as an indirect support to the contention of the concessionaire" while seeking his personal invention to convene a special meeting of the FAC.

According to NHAI, the project got environment clearance in early June, with a rider that stage-1 of forest clearance for the venture is obtained. This requires diversion of 37.62 hectares reserved forest and 40.39 hectares of protected forest that fall in Rajasthan. The state government has processed and sent its proposal in mid-November. Even after some of the queries of MoEF were cleared, the proposal was not placed before the FAC that met on December 21 and 22.

A part of the project also falls in Gujarat, and hence forest diversion is required for 173.39 hectares. NHAI officials said that the Gujarat government has given its nod after the poll code for the assembly election was lifted.

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Brain image study: Fructose may spur overeating

This is your brain on sugar — for real. Scientists have used imaging tests to show for the first time that fructose, a sugar that saturates the American diet, can trigger brain changes that may lead to overeating.

After drinking a fructose beverage, the brain doesn't register the feeling of being full as it does when simple glucose is consumed, researchers found.

It's a small study and does not prove that fructose or its relative, high-fructose corn syrup, can cause obesity, but experts say it adds evidence they may play a role. These sugars often are added to processed foods and beverages, and consumption has risen dramatically since the 1970s along with obesity. A third of U.S. children and teens and more than two-thirds of adults are obese or overweight.

All sugars are not equal — even though they contain the same amount of calories — because they are metabolized differently in the body. Table sugar is sucrose, which is half fructose, half glucose. High-fructose corn syrup is 55 percent fructose and 45 percent glucose. Some nutrition experts say this sweetener may pose special risks, but others and the industry reject that claim. And doctors say we eat too much sugar in all forms.

For the study, scientists used magnetic resonance imaging, or MRI, scans to track blood flow in the brain in 20 young, normal-weight people before and after they had drinks containing glucose or fructose in two sessions several weeks apart.

Scans showed that drinking glucose "turns off or suppresses the activity of areas of the brain that are critical for reward and desire for food," said one study leader, Yale University endocrinologist Dr. Robert Sherwin. With fructose, "we don't see those changes," he said. "As a result, the desire to eat continues — it isn't turned off."

What's convincing, said Dr. Jonathan Purnell, an endocrinologist at Oregon Health & Science University, is that the imaging results mirrored how hungry the people said they felt, as well as what earlier studies found in animals.

"It implies that fructose, at least with regards to promoting food intake and weight gain, is a bad actor compared to glucose," said Purnell. He wrote a commentary that appears with the federally funded study in Wednesday's Journal of the American Medical Association.

Researchers now are testing obese people to see if they react the same way to fructose and glucose as the normal-weight people in this study did.

What to do? Cook more at home and limit processed foods containing fructose and high-fructose corn syrup, Purnell suggested. "Try to avoid the sugar-sweetened beverages. It doesn't mean you can't ever have them," but control their size and how often they are consumed, he said.

A second study in the journal suggests that only severe obesity carries a high death risk — and that a few extra pounds might even provide a survival advantage. However, independent experts say the methods are too flawed to make those claims.

The study comes from a federal researcher who drew controversy in 2005 with a report that found thin and normal-weight people had a slightly higher risk of death than those who were overweight. Many experts criticized that work, saying the researcher — Katherine Flegal of the Centers for Disease Control and Prevention — painted a misleading picture by including smokers and people with health problems ranging from cancer to heart disease. Those people tend to weigh less and therefore make pudgy people look healthy by comparison.

Flegal's new analysis bolsters her original one, by assessing nearly 100 other studies covering almost 2.9 million people around the world. She again concludes that very obese people had the highest risk of death but that overweight people had a 6 percent lower mortality rate than thinner people. She also concludes that mildly obese people had a death risk similar to that of normal-weight people.

Critics again have focused on her methods. This time, she included people too thin to fit what some consider to be normal weight, which could have taken in people emaciated by cancer or other diseases, as well as smokers with elevated risks of heart disease and cancer.

"Some portion of those thin people are actually sick, and sick people tend to die sooner," said Donald Berry, a biostatistician at the University of Texas MD Anderson Cancer Center in Houston.

The problems created by the study's inclusion of smokers and people with pre-existing illness "cannot be ignored," said Susan Gapstur, vice president of epidemiology for the American Cancer Society.

A third critic, Dr. Walter Willett of the Harvard School of Public Health, was blunter: "This is an even greater pile of rubbish" than the 2005 study, he said. Willett and others have done research since the 2005 study that found higher death risks from being overweight or obese.

Flegal defended her work. She noted that she used standard categories for weight classes. She said statistical adjustments were made for smokers, who were included to give a more real-world sample. She also said study participants were not in hospitals or hospices, making it unlikely that large numbers of sick people skewed the results.

"We still have to learn about obesity, including how best to measure it," Flegal's boss, CDC Director Dr. Thomas Frieden, said in a written statement. "However, it's clear that being obese is not healthy - it increases the risk of diabetes, heart disease, cancer, and many other health problems. Small, sustainable increases in physical activity and improvements in nutrition can lead to significant health improvements."

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Online:

Obesity info: http://www.cdc.gov/obesity/data/trends.html

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House Plans Up-or-Down Vote on 'Cliff' Deal

House Republicans have agreed to have an up-or-down vote on the bipartisan Senate deal to avert the "fiscal cliff," rather than trying to amend the Senate bill with more spending cuts before voting, according to a senior GOP leadership aide.

The vote will likely come tonight despite top House Republicans' earlier opposition to the deal, which the Senate passed in the wee hours of New Year's Day, because of concerns about the cost of the deal's spending provisions.

If House Republicans had tweaked the legislation, there would have been no clear path for its return to the Senate before a new Congress is sworn in Thursday.

The Republican-controlled House was expected to launch into procedural steps leading up to a vote, which was possible late this evening.

Before deciding on the up-or-down vote, GOP leaders had emerged from a morning conference meeting disenchanted by the legislative package devised by Senate Minority Leader Mitch McConnell, R-Mo., and Vice President Biden early this morning, with several insisting they could not vote on it as it stood.

"I do not support the bill," House Majority Leader Eric Cantor, R-Va., said as he left the meeting. "We're looking for the best path forward. No decisions have been made yet."

Bill Clark/Roll Call/Getty Images

'Fiscal Cliff' Negotiations: Congress Reaches Agreement Watch Video

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House Speaker John Boehner refused to comment on the meeting, but his spokesman said, "the lack of spending cuts in the Senate bill was a universal concern amongst members in today's meeting."

"Conversations with members will continue throughout the afternoon on the path forward," Brendan Buck said in a statement.

As lawmakers wrestled with the legislation, the non-partisan Congressional Budget Office estimated that the bill's added spending combined with the cost of extending tax cuts for those making under $400,000 would actually add $3.9 trillion to the deficit over the next 10 years. The Joint Committee on Taxation reached a similar conclusion.

The impasse once again raised the specter of sweeping tax hikes on all Americans and deep spending cuts' taking effect later this week.

"This is all about time, and it's about time that we brought this to the floor," House Minority Leader Nancy Pelosi said after emerging from a meeting with Democrats.

"It was a bill that was passed in the U.S. Senate 89-8. Tell me when you've had that on a measure as controversial as this?" she said of the overwhelming vote.

Pelosi could not say, however, whether the measure had the backing of most House Democrats.

"Our members are making their decisions now," she said.

Biden, who brokered the deal with McConnell, joined Democrats for a midday meeting on Capitol Hill seeking to shore up support for the plan.

While Congress technically missed the midnight Dec. 31 deadline to avert the so-called cliff, both sides have expressed eagerness to enact a post-facto fix before Americans go back to work and the stock market opens Wednesday.

"This may take a little while but, honestly, I would argue we should vote on it today," said Rep. Tom Cole, R-Okla., who sits on the Budget Committee. "We know the essential details and I think putting this thing to bed before the markets is important.

"We ought to take this deal right now and we'll live to fight another day, and it is coming very soon on the spending front."

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Bombs kill 23 across Iraq as sectarian strife grows

BAGHDAD (Reuters) - At least 23 people were killed and 87 wounded in attacks across Iraq on Monday, police said, underlining sectarian and ethnic divisions that threaten to further destabilize the country a year after U.S. troops left.

Tensions between Shi'ite, Kurdish and Sunni factions in Iraq's power-sharing government have been on the rise this year. Militants strike almost daily and have staged at least one big attack a month.

The latest violence followed more than a week of protests against Shi'ite Prime Minister Nuri al-Maliki by thousands of people from the minority Sunni community.

No group claimed responsibility for any of Monday's attacks, which targeted government officials, police patrols and members of both the Sunni and Shi'ite communities.

Seven people from the same Sunni family were killed by a bomb planted near their home in the town of Mussayab, south of Baghdad.

In the Shi'ite majority city of Hilla, also in the south, a parked car bomb went off near the convoy of the governor of Babil province, missing him but killing two other people, police said.

"We heard the sound of a big explosion and the windows of our office shattered. We immediately lay on the ground," said 28-year-old Mohammed Ahmed, who works at a hospital near the site of the explosion.

"After a few minutes I stood up and went to the windows to see what happened. I saw flames and people lying on the ground."

In the capital Baghdad, five people were killed by a parked car bomb targeting pilgrims before a Shi'ite religious rite this week, police and hospital sources said.

Although violence is far lower than during the sectarian slaughter of 2006-2007, about 2,000 people have been killed in Iraq this year following the withdrawal last December of U.S. troops, who led an invasion in 2003 to overthrow Sunni dictator Saddam Hussein.

SUNNIS PROTEST

Violence also hit Iraq's disputed territories, over which both the central government and the autonomous Kurdish region claim jurisdiction.

Three militants and one Kurdish guard were killed in the oil-producing, ethnically mixed city of Kirkuk, where militants driving a car packed with explosives tried to break into a Kurdish security office.

Earlier on Monday, two policemen were killed in Kirkuk when a bomb they were trying to detonate exploded prematurely. An army official and his bodyguard were also killed in a drive-by shooting in the south of the city.

Kirkuk lies at the heart of a feud between Baghdad and Kurdistan over land and oil rights, which escalated last month when both sides deployed their respective armies to the swath of territory along their contested internal boundary.

Efforts to ease the standoff stalled when President Jalal Talabani, a Kurd seen as a steadying influence, suffered a stroke and was flown abroad for medical care in December.

Maliki then detained the bodyguards of his Sunni finance minister, which ignited anti-government protests in the western province of Anbar, a Sunni stronghold on the border with Syria.

A lecturer in law at Baghdad University said the protests could help create the conditions for militant Islamist groups like al Qaeda to thrive.

"Raising tension in Anbar and other provinces with mainly Sunni populations is definitely playing into the hands of al Qaeda and other insurgent groups," Ahmed Younis said.

More than 1,000 people protested in the city of Samarra on Monday and rallies continued in Ramadi, center of the protests, and in Mosul, where about 500 people took to the streets.

In the city of Falluja, where protesters have also staged large rallies and blocked a major highway over the past week, gunmen attacked an army checkpoint, killing one soldier.

Protesters are demanding an end to what they see as the marginalization of Sunnis, who dominated the country until the U.S.-led invasion. They want Maliki to abolish anti-terrorism laws they say are used to persecute them.

On Sunday, Deputy Prime Minister Saleh al-Mutlaq, himself a Sunni, was forced to flee a protest in Ramadi when demonstrators pelted him with stones and bottles.

The civil war in neighboring Syria, where majority Sunnis are fighting to topple a ruler backed by Shi'ite Iran, is also whipping up sectarian sentiment in Iraq.

"The toppling of President Bashar al-Assad and empowerment of Sunnis (in Syria) will definitely encourage al Qaeda to regain ground," Younis said.

(Reporting by Ali al-Rubaie in Hilla, Mustafa Mahmoud and Omar Mohammed in Kirkuk, Ali Mohammed in Baquba and Ahmed Rasheed and Aseel Kami in Baghdad; Writing by Isabel Coles; Editing by Alison Williams)

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Despite emerging deal, US to miss fiscal cliff deadline

WASHINGTON: US lawmakers missed a deadline to avoid the "fiscal cliff" budget crunch Monday but inched towards a deal to ease the worst impact of the crisis by heading off economy-busting tax hikes.

In dramatic New Year's Eve brinkmanship, Republicans and the White House reached an agreement that means only the richest Americans will pay more tax, but were still deadlocked on how to avert $109 billion in automatic government spending cuts.

Despite the emerging deal, the economy will technically go over the cliff at midnight after aides to Republican leaders in the House of Representatives said no vote on a pact could be scheduled in time on Monday.

Senators meanwhile were still hoping for a late-night vote if a deal is finalized. The legislation would then go to a House vote on Tuesday.

While automatic spending cuts and tax hikes will come into force on January 1, global stock markets will be closed on New Year's Day, giving lawmakers a few more hours of breathing room before panic over the US economy sets in.

"If a deal is reached, there's little difference between a vote tonight or tomorrow to give members a chance to review," a House Republican source said.

President Barack Obama earlier said a deal was close though not done and the top Senate Republican negotiator Mitch McConnell, who thrashed out a compromise with Vice President Joe Biden, agreed.

"It appears that an agreement to prevent this New Year's tax hike is within sight. It's not done. There are still issues left to resolve, but we're hopeful that Congress can get it done," Obama said at the White House.

Sources said the deal would include a two-month postponement of the sequester, the sweeping package of automatic government spending cuts that is feared, especially by the Pentagon.

It would also mean a return to Bill Clinton-era tax rates for top earners to 39.6 percent, starting at a threshold of annual household earnings of $450,000 and above.

Obama had originally campaigned for tax hikes to kick in for those making $250,000 and above and his acceptance of a higher threshold has already angered liberals, though still represents a political victory.

As he tried to sell the emerging deal to his Democratic Party's liberal base, he said it would extend tax credits for clean energy firms and also unemployment insurance for two million people due to expire later Monday.

It was also expected to include an end to a temporary two percent cut to payroll taxes for Social Security retirement savings and Medicare health care programs for seniors and changes to inheritance and investment taxes.

The president angered Republicans in remarks in which he warned -- in what is certain to be a bitter fight over cutting the deficit -- that he was not done with seeking higher taxes for the rich.

"Now, if Republicans think that I will finish the job of deficit reduction through spending cuts alone... then they've another thing coming," Obama said, and also poked fun at the glacial pace of Congressional deliberations.

Republicans immediately took to the floor of the Senate to complain.

Senator John McCain accused Obama of ridiculing Republicans and of needlessly antagonizing House of Representatives' members who will be required to vote for an eventual deal.

Republican Senator Bob Corker said his heart was pounding with disappointment at Obama's remarks.

"I know the president has fun heckling Congress. I think he lost probably numbers of votes with what he did," he said.

"It's unfortunate he doesn't spend as much time solving problems as he does with campaigns and pep rallies."

Signs that a deal could be close cheered investors Friday as US markets rose before closing for the year. The Dow Jones Industrial Average closed up 166.03 points (1.28 percent) at 13,104.14.

Even as a deal neared, both sides were gearing up for the next legislative showdown over the need to lift the government's statutory borrowing limit of $16.4 trillion, which was reached Monday.

The Treasury will now take extraordinary measures to keep the government afloat for an undisclosed period of time until the ceiling is raised. Republicans are already demanding spending cuts in return.

"I think there is going to be a pretty big showdown next time when we go to the debt limit," McCain told CNN.

-AFP/ac

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Global rights bodies slam India for 'weak' rape laws

NEW DELHI: The Indian government has come under attack from global human rights bodies for its inadequate laws against sexual violence or treatment of survivors.

Meenakshi Ganguly, South Asia director at Human Rights Watch, said, "The government needs to act now to prevent sexual assault, aggressively investigate and prosecute perpetrators, and ensure the dignified treatment of survivors."
The US embassy, in a statement, also mourned the death of the victim — ""We are deeply saddened to learn that the victim of a horrific assault in New Delhi Dec 16 has died," an embassy statement said. "As we honour the memory of this brave young woman, we also recommit ourselves to changing attitudes and ending all forms of gender-based violence which plagues every country in the world."

Meanwhile, UNICEF drew attention to the fact that an alarmingly large number of victims of sexual violence in India are children. "It is alarming that too many of these cases are children. One in three of the rape victims is a child. More than 7,200 children , including infants are raped every year. Given the stigma attached to rapes, especially when it comes to children, this most likely is only the tip of the ice berg," said Mr. Louis-Georges Arsenault, UNICEF Representative to India.

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Clinton's blood clot an uncommon complication

The kind of blood clot in the skull that doctors say Hillary Rodham Clinton has is relatively uncommon but can occur after an injury like the fall and concussion the secretary of state was diagnosed with earlier this month.

Doctors said Monday that an MRI scan revealed a clot in a vein in the space between the brain and the skull behind Clinton's right ear.

The clot did not lead to a stroke or neurological damage and is being treated with blood thinners, and she will be released once the proper dose is worked out, her doctors said in a statement.

Clinton has been at New York-Presbyterian Hospital since Sunday, when the clot was diagnosed during what the doctors called a routine follow-up exam. At the time, her spokesman would not say where the clot was located, leading to speculation it was another leg clot like the one she suffered behind her right knee in 1998.

Clinton had been diagnosed with a concussion Dec. 13 after a fall in her home that was blamed on a stomach virus that left her weak and dehydrated.

The type of clot she developed, a sinus venous thrombosis, "certainly isn't the most common thing to happen after a concussion" and is one of the few types of blood clots in the skull or head that are treated with blood thinners, said neurologist Dr. Larry Goldstein. He is director of Duke University's stroke center and has no role in Clinton's care or personal knowledge of it.

The area where Clinton's clot developed is "a drainage channel, the equivalent of a big vein inside the skull — it's how the blood gets back to the heart," Goldstein explained.

It should have no long-term consequences if her doctors are saying she has suffered no neurological damage from it, he said.

Dr. Joseph Broderick, chairman of neurology at the University of Cincinnati College of Medicine, also called Clinton's problem "relatively uncommon" after a concussion.

He and Goldstein said the problem often is overdiagnosed. They said scans often show these large "draining pipes" on either side of the head are different sizes, which can mean blood has pooled or can be merely an anatomical difference.

"I'm sure she's got the best doctors in the world looking at her," and if they are saying she has no neurological damage, "I would think it would be a pretty optimistic long-term outcome," Broderick said.

A review article in the New England Journal of Medicine in 2005 describes the condition, which more often occurs in newborns or young people but can occur after a head injury. With modern treatment, more than 80 percent have a good neurologic outcome, the report says.

In the statement, Clinton's doctors said she "is making excellent progress and we are confident she will make a full recovery. She is in good spirits, engaging with her doctors, her family, and her staff."

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Online:

Medical journal: http://dura.stanford.edu/Articles/Stam_NEJM05.pdf

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