Cruise line pleads guilty in deadly blast

Federal prosecutors on Friday charged Norwegian Cruise Line with gross negligence almost five years after a boiler explosion on the historic SS Norway killed eight crew members and seriously injured 10 others in the Port of Miami.

The U.S. attorney's office said Norwegian agreed to plead guilty to the criminal charge, which alleges the cruise line operated the vessel in a ``grossly negligent manner that endangered the lives, limbs and property of the persons on board.''

Norwegian is liable for at least $500,000 in criminal penalties for the deadliest accident on a U.S.-based ocean liner in more than a decade. The cruise line also has agreed to carry out safety inspections of its vessels with an independent consultant.

Coast Guard Rear Admiral Robert Branham called the May 25, 2003, explosion a ``preventable tragedy.''

''Hopefully, this case will send a message to the maritime industry that marine safety should be the paramount consideration in maintaining their vessels,'' he said in a statement.

The cruise line said Friday evening that it has cooperated with federal authorities since the explosion and will continue to do so. ''The safety and security of our passengers and crew has been and always will be of the utmost importance,'' Norwegian's statement said.

A National Transportation Safety Board report on the accident, quietly completed in November, showed NCL engineers had expressed concerns since the late 1990s about the condition of the four boilers that powered the elegant ship. The massive high-pressure boilers, each holding 20 tons of 528-degree water, had a history of cracks, leaks, corrosion and repairs.

''We must realize that we have reached a point where the operation of the vessel is not safe,'' one unnamed NCL port engineer wrote in a 1998 e-mail to the company's vice president of ship operations, the NTSB report said. The engineer cited ''numerous boiler tube failures'' that were subsequently repaired.

PATCH JOBS

The NTSB found the primary cause of the explosion was the fracture of a weld on a seam of a high-pressure drum. The scalding water flashed into steam, swept through the engine spaces and some adjacent crew berthing areas and killed eight crew members while injuring nearly a dozen others. No passengers were hurt.

Investigators also found questionable welds and crack-repair efforts; inconsistent water chemistry that led to corrosion; inadequate inspections from both NCL and Bureau Veritas, an international inspection agency, and an operating schedule that exposed the aging boilers to extreme thermal stresses.

In January and July 2002, a year before the boiler burst, NCL port engineers e-mailed NCL management with concerns that the ship's routes and busy schedules forced crew to fire up and cool down the boilers more rapidly than the operating manual called for.

The report was also critical of NCL's handling of persistent cracks in the boilers, which first appeared in original welds in the 1970s. Cracks were ground down until boiler walls reached a minimum allowable thickness then built back up with weld repairs. The length and width of the welds, the NTSB found, probably accelerated pitting and cracking.

At some point, copper -- an unacceptable metal for repairs -- also appeared to have been deliberately applied to cracks on the boiler that exploded.

''The only explanation for the presence of the copper is that it was introduced to mask the crack, impede inspection and avoid necessary repairs,'' the report said.

Investigators also found a lengthy gap in formal inspections, ``even though it was known that they were susceptible to cracking and were in fact cracked in 1996.''

The report found that the header, the part of boiler No. 23 that failed, had not had a material test or appropriate visual inspection since 1990.

The cruise line was charged in an ''information,'' not a criminal complaint or indictment. That means Norwegian executives and prosecutors negotiated the misdemeanor charge.

''Charges such as those today are necessary to show that companies operating and managing ships have a duty to take reasonable measures to assure the safety of all onboard -- passengers and crew,'' said U.S. Attorney R. Alexander Acosta.

In addition, the NTSB noted that NCL had agreed to improve its fleet emergency response, safety measures and maintenance records. Though few ships, aside from Naval vessels, still rely on large high-pressure boilers for primary power, smaller low-pressure ones are routinely used to heat water or for other shipboard systems.

FAMILIES CAN'T SUE

Miami attorney Charles Lipcon, who represented many of the victims and is the author of the new book, Unsafe on the High Seas, praised the criminal charge.

''I'm pleased to see that the U.S. attorney stepped up to the plate and got involved,'' he said. But he called it ''unfortunate'' that the crew members and their families were not able to press civil lawsuits against Norwegian in federal court in Miami.

The dead and injured seamen were mostly Filipino. Their contracts with Norwegian called for settling claims in arbitration, so their lawsuits were dismissed from federal court in Miami. The cruise line negotiated settlements afterward.

A cruise industry representative called the criminal case a strong signal.

''We take safety very seriously as an industry, and we hope this gets resolved and look forward to a resolution,'' said Michael Crye, executive vice president of the Cruise Lines International Association, a trade group.

The SS Norway had a storied past. It was launched as the SS France in 1960. At 1,035 feet, it was the longest passenger ship afloat and could carry more than 2,000. It was too long and too wide for the Panama Canal.

Deemed unprofitable in 1974, the ocean-liner was mothballed in France. In 1979, Norwegian Cruise Line bought it for $18 million -- its value in scrap metal -- and revamped it at a cost of $120 million. After a ''farewell cruise'' to Europe in 2001, the SS Norway returned to Miami for seven-day cruises in the eastern Caribbean. It was among the last ocean-liners powered by high-pressure steam boilers.

It has been out of commission since the boiler explosion five years ago. The company has since sold it for scrap.

Miami Herald staff writer Martha Brannigan contributed to this report.

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Fat chance: A diet pill won't make you thin

Richard Drew / AP

The side effects are part of the reason that GlaxoSmithKline's Alli, the first over-the-counter diet pill, works for dieters who take it.

When the fat-blocker Alli hit pharmacy shelves last June, hopeful consumers stampeded for the first government-approved over-the-counter weight-loss drug. But it didn’t take long for the troublesome side effects such as not being able to control your bowels, and the lack of real weight loss for some, to convince many dieters that Alli wasn’t the sole answer to their weight problems.

In addition to Alli, there are about six prescription weight-loss drugs on the market. Some, like Alli, block the absorption of fat in the body. Others work in the brain to suppress appetite. But the reality is, no matter how many weight-loss pills you take, they don’t work by themselves.

“The pills we currently have don’t seem to be terribly effective for long-term weight loss,” says registered dietitian Anne Fletcher of Mankato, Minn. “When people go off the pills, many put weight back on.”

Still, the drug industry and many dieters remain convinced that a pill is the answer to the nation's growing obesity epidemic. Several new prescription diet pills are in late stage trials, including the experimental drug lorcaserin, a variation of Fen-phen which was pulled for causing heart problems. At least 30 companies are developing weight-loss drugs, with experts estimating that in the next few years there will be 10 to 15 medications meant to help dieters in different ways. The pharmaceutical research firm Decision Resources projects that the obesity drug market will grow in the U.S. from $222 million in 2006 to nearly $2 billion by 2016.

When combined with diet and exercise, anti-obesity drugs can help someone lose about 5 to 10 percent more weight, research suggests. But because the various pills affect the body in different ways, it’s possible that certain people may be better suited to using one type of pill over another.

For example, a study looking at the differences between sibutramine (Meridia) and orlistat (Xenical and Alli), found that greater weight loss with orlistat occurred in people who could be described as “conscientious,” that is, their personalities were more order-oriented or deliberate. Therefore, carefully monitoring fat intake works for them. People who have a hard time restraining their eating habits saw a greater impact with sibutramine — which affects serotonin in the brain and makes you feel full sooner when eating.

If at first, you don't succeed ...
In general, the biggest mistake people make in taking diet pills is looking at them as magic bullets.

"People cannot expect a medication to do it for them,” says Gary Foster, director of the Center for Obesity Research and Education at Temple University in Philadelphia. “It’s a 50/50 partnership with the pill being half the equation. Exercise, what we eat and our lifestyle habits … are critical to long-term success.”

When clients request to use a weight loss medication, Fletcher, author of the book “Thin for Life,” tells them to think of it as “one leg of a four-legged stool.”

“One leg is physical activity; one is diet; one is behavior change and the final leg can be diet pills,” she says. “Take out any of the legs that support the diet pill and the stool will fall over.”

From her research Fletcher found that people who lost significant amounts of weight often had made multiple efforts to lose weight before they realized long-term success.

“When we try to change any behavior it takes most of us a few attempts to get it right,” she says.

Side effects
There’s no real data on how safe the pills are long-term, especially for young people. However, the Food and Drug Administration has only approved them for adults for up to two years of continuous use. According to an analysis of 30 trials done on adults taking anti-obesity drugs for one to four years, about 30 to 40 percent stopped taking them after a year, although it wasn't clear why.

In addition, side effects are common. Sibutramine can increase blood pressure and heart rate in some patients. Orlistat, which alters the absorption of fat in food, can have embarrassing intestinal side effects. Rimonabant (used in Europe, but awaiting approval in this country) may, for some users, cause nausea, anxiety, depression and insomnia.

However, for the obese — people with a body-mass index of 30 or greater— the benefits of prescription diet drugs can outweight the risks, experts believe.

“The people most successful are those who are ready to make a serious commitment to losing weight and willing to take responsibility for their actions and for change," says Pat Baird, a dietitian and nutrition consultant for GlaxoSmithKline’s Consumer Healthcare division, who serves as an online moderator for people using Alli. She talks with 25 people a day, fielding questions about weight loss, the program and the pill.

Baird concedes that the side effects are part of the reason Alli works for some people. When someone eats more than the prescribed 15 grams of fat per meal, they can experience the not-so-pleasant digestive problems. "It helps keep people honest," she says.

Susan Moores, R.D., is a nutrition consultant and spokesperson for The American Dietetic Association

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Watch what you touch: A bad germ gets worse

Scientists cultured the imprint of a health care worker's gloved hand after examining a patient infected with Clostridium difficile, known as C. diff. The larger yellow colonies outlining the fingers are clusters of the potentially deadly bacteria responsible for at least 300,000 infections a year in U.S. hospitals. The patient had showered an hour before the specimen was collected, say researchers. View related photos

Courtesy Dr. Curtis Donskey, Clinical Infectious Diseases, February 2008. Amy Warren had never heard of the germ that made her so miserable. In January 2005, weeks after giving birth to her daughter, the Ohio mother of two knew only that she was in pain, suffering cramping so severe she felt like she was still in labor. Then came the diarrhea, uncontrollable bouts up to 50 times a day, which left Warren weak and raw and stranded in her Maineville home. "I was so sick; I thought I had colon cancer and was dying," Warren recalled. Three tests failed to detect the source of her intestinal trouble. A fourth, however, confirmed Warren as part of a toxic trend: She was among growing numbers of people sickened by an especially virulent form of the bacterial infection Clostridium difficile, known as C. diff. Doctors told Warren she’d contracted the NAP1 type of the bacteria, a mutated version that produces roughly 20 times the toxins responsible for illnesses ranging from simple diarrhea to blood poisoning — and death. “It’s like a science fiction disease,” said Warren, who struggled for six months through three relapses before controlling the infection. “That’s what scared me. People die from this.” C. diff has long been a common, usually benign bug associated with simple, easily treated diarrhea in older patients in hospitals and nursing homes. About 3 percent of healthy adults harbor the bacteria with no problem. But overuse of antibiotics has allowed the germ to develop resistance in recent years, doctors said, creating the toxic new type that stumps traditional treatment. "This is the one we're scared of," said Dr. Brian Koll, chief of infection control at Beth Israel Medical Center in New York. C. diff produces anaerobic spores transmitted through feces that are able to survive for months on most surfaces. People are infected when they ingest the bacteria, typically by touching contaminated surfaces and then touching their mouths, or by eating contaminated food. Overall infections caused by C. diff more than doubled between 2000 and 2005, according to the latest government figures. In 2005, the year of Warren’s illness, 301,200 cases of C. difficile-associated disease (CDAD) were logged in discharge records kept by the nation’s hospitals. Some 28,600 people who had the infection died. That's only hospitals, however. Counting nursing homes and other care centers, the number of cases nationally is likely closer to 500,000, experts estimate. Contaminated health care settings remain the main source of C. diff infections, primarily because they treat so many people with serious diarrheal illness. The NAP1 strain has been found in other sites and populations in recent years, infecting young adults and pregnant women with no history of antibiotic use, according to federal sources. Despite the concern, scientists don't know how many people contract NAP1 infections, or how many die from them. C. diff infection is not a reportable condition in most states, although a rare pilot project that mandated reporting in Ohio in 2006 found more than 14,000 cases in hospitals and nursing homes that year, according to the state health department. Mutant strain detected in 38 states What is clear is that the most toxic strain is taking hold, according to the federal Centers for Disease Control and Prevention. In February 2007, 23 states told the CDC they'd seen cases of the NAP1 strain; by November, that number had grown to 38. Officials in the remaining states and territories contacted by msnbc.com said they hadn't detected the virulent bug, but most also said they don't look for it. Better data about the scope of the C. diff problem may be available by this fall, when the Association for Professionals in Infection Control (APIC) presents the results of a prevalence study being conducted this month. Last year, APIC was among the first agencies to note that rates of Methicillin-resistant Staphylococcus aureus, known as MRSA, were about 10 times previous estimates. The so-called superbug claimed headlines last year when researchers linked it to more than 94,000 infections and nearly 19,000 deaths in the U.S. in 2005. Health officials now rank C. diff on par with MRSA as one of the top two infections acquired in hospitals. “In light of how frequently it is already occurring as well as the trajectory of its recent increase, it is an infection that definitely deserves our respect and attention,” said Dr. L. Clifford McDonald, chief of prevention and response for a division of the CDC. Attention must also be paid, scientists say, because the infection that mostly affects older, sicker people with long histories of antibiotic use now appears to be showing up in younger, healthier patients like Warren. Warren’s not sure how she contracted the infection, which is caused when normal flora in the gut is disturbed, typically by antibiotics. About 90 percent of CDAD cases occur in patients who've used antibiotics recently, especially fluroquinolines such as the popular drug Cipro. The resistance allows the C. diff bacteria to take over and flourish. Consequences can range from severe diarrhea to colitis and toxic megacolon, a condition that can lead to shock and death. Courtesy Amy Warren Amy Warren of Maineville, Ohio, smiled despite her illness in a 2005 photograph with her children, Shane and Celeste. Warren was 37 when she contracted a toxic strain of C. difficile after her baby's birth. Warren, now 39, may have gotten the infection from her daughter, Celeste, who had a mild C. diff infection shortly after birth. Infants often harbor C. diff harmlessly in their intestines for about the first year of life, before more mature flora take over, experts said. It's also possible Warren may have acquired the bacteria the previous fall, when she was briefly hospitalized and wound up sharing a room with a woman with severe diarrhea. “I was sharing a bathroom with her,” Warren said. ‘Filthy’ hospitals perpetuate problem There's no question that the rise of C. diff is tied to the cleanliness of the nation's hospitals, say researchers and health care advocates lobbying for better infection control. "Outbreaks highlight the fact that standard infection control procedures in hospitals are not as good as they could be," said Dr. Curtis Donskey, director of infection control at the Louis Stokes Veterans Affairs Medical Center in Cleveland, Ohio. Even after cleaning, studies show that C. diff spores linger on virtually every hospital surface, including bedrails, telephones, call buttons and toilets. C. diff spores cling to patient skin, and not only in expected areas, such as the groin, according to a small-but-telling study published by Donskey and colleagues in the February issue of the journal Clinical Infectious Disease. Nearly 40 percent of patients diagnosed with CDAD infections tested positive for C. diff on their hands, and nearly 20 percent had the bacteria on their forearms, researchers found. About 60 percent had C. diff detected on their chest and abdomen. Click for related content Discuss: How far would go to protect yourself against hospital germs like C. diff? Typical hospital germicides and alcohol hand sanitizers don’t kill C. diff, experts said. Instead, it takes bleach to eliminate it from surfaces and the friction of soap and water to remove it from hands. But many hospitals have failed to make controlling C. diff a priority, critics contend. “The biggest problem in our hospitals is that they are filthy dirty,” said Dr. Alfonso Torress-Cook, an epidemiologist who says he adopted practices that cut C. diff infections by 90 percent at his acute rehabilitation center in Orange County, Calif. "If we start cleaning the environment, the infection will take care of itself," he added. Interventions can range from ultra-violet light targeted to kill C. diff germs to silver-infused flooring and antimicrobial curtains aimed at resisting the bugs. Original here