Stanislas Wawrinka beats an ailing Rafael Nadal to claim Australian Open title

Stanislas Wawrinka savors the moment of victory in Melbourne after beating world no. 1 Rafael Nadal.

• Stanislas Wawrinka wins Australian Open men’s singles title against ailing Rafael Nadal


• Swiss claims first grand slam title in four sets 6-3 6-2 3-6 6-3 at Rod Laver Arena, Melbourne

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Melbourne, Australia (CNN) — Stanislas Wawrinka won his first grand slam tennis title when he beat an ailing Rafael Nadal in Sunday’s Australian Open final.

Wawrinka defeated the world No. 1 6-3 6-2 3-6 6-3 in Melbourne to join his good friend Roger Federer as a Swiss grand slam champion.

Wawrinka had never even taken a set off the world No. 1 in 12 previous matches but when an emotional Nadal took a medical timeout for a back injury in the second set, the odds swung in his favor.

Nadal, who downed Federer in the semifinals, was seeking to join Pete Sampras on 14 majors. That would have placed him three behind Federer, the men’s all-time leader.

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Stanislas Wawrinka beats an ailing Rafael Nadal to claim Australian Open title

Doctors Brace for Surge of Ailing Patients...

Holy Cross Hospital’s health center in Aspen Hill, Maryland, is bracing for more business.

The center treats the uninsured, and has been busy since it opened in 2012 with a waiting list of more than 400 people at its clinic. Now, as a result of the U.S. Affordable Care Act, it’s mulling adding staff and hours in anticipation of next year’s rush of newly-insured patients, many with chronic medical conditions that have gone untreated for years.

Poorly controlled diabetes can cause stroke, kidney failure and blindness. Undiagnosed cancer can translate into complex end-of-life care, and untreated high blood pressure can lead to heart attacks. In effect, the 2010 health law’s biggest promise becomes its most formidable challenge: unprecedented access to care for a needy population when the nation is already grappling with overtaxed emergency rooms and a shortage of physicians.

“When you’re getting people that haven’t had insurance, they have significant health issues,” said Kevin Sexton, president and chief executive officer of Holy Cross Health, in a telephone interview. “A lot of people need these services.”

About 25 million Americans are expected to gain coverage under the health law, commonly known as Obamacare. Starting Oct. 1, as many as 7 million uninsured Americans will begin shopping for private plans through government-run exchanges, with many people eligible to have their premiums subsidized by taxpayers. On Jan. 1, Medicaid programs for low-income people will be expanded in about half the U.S. states.

Strained System

The increase in newly insured patients arrives at a time when the nation has 15,230 fewer primary-care doctors than it needs, according to an Aug. 28 assessment by the U.S. Department of Health and Human Services. And emergency rooms report being strained with visits that have risen at twice the rate of population growth.

“It’s like we’re handing out bus tickets and the bus is already full,” said Perry Pugno, vice president for medical education at the American Academy of Family Physicians, by telephone. “The shortfall of primary-care access is not an insignificant problem, and it’s going to get worse.”

Almost half of all uninsured, non-elderly adults had a chronic condition, based on a 2005 report by the Urban Institute and the University of Maryland. One in six with hypertension reported no visits to health professionals in a year.

Most who come to Holy Cross’s health center now lack insurance, and have lived for years with serious ailments, according to Elise Riley, the center’s medical director. “It’s frustrating to see diseases that could have been prevented,” she said in an interview in her office.

More demand may lead to months-long waits to see doctors, delays in finding specialists, and strains on hospitals and outpatient clinics, others said.

Patient Access

Ensuring patient access is critical to the Affordable Care Act’s success: if the newly insured swamp the medical system, it could hand critics pushing to derail the law another argument to fray public support. Sara Rosenbaum, a health-law professor at George Washington University in Washington, said she doesn’t believe it’s going to happen.

“It’s going to be a slow ramp up,” Rosenbaum said in a telephone interview. “It’s not like seven million people will get insurance at once. They’re not going to all come racing in the door.”

While that number of new patients can be debated, the status of those who do come in the door is not.

Patients who have had gaps in health insurance were more likely to have not gone to a doctor when sick or to have skipped getting prescriptions, according to an April 2013 report by the Commonwealth Fund, a New York-based foundation that works for health-care access. The uninsured were less likely to be up-to-date on recommended cholesterol, blood pressure, colon cancer screenings and mammograms.

Massachusetts Overhaul

Massachusetts pioneered health reform in 2006 when it enacted near universal coverage under then governor Mitt Romney. Community health centers and hospitals that care for a larger share of lower-income residents saw a 12 percent jump in patient volume from 2009 to 2010, with almost 100,000 more visits to safety net hospitals during that time, according to a 2012 report by the Kaiser Family Foundation.

David Longworth, chairman of the Medicine Institute at Ohio’s Cleveland Clinic, was working in Massachusetts when the state passed near universal health coverage.

“Practices closed and patients would wait for eight to nine months to get in,” Longworth said by telephone. “We overwhelmed the primary care health system.”

In cities such as Lawrence, Massachusetts, a former textile city that has long been home to a large immigrant community, doctors have coped with rising volume.

Patient Surplus

The Lawrence Family Medicine Residency, which provides primary care and other medical services to a largely low-income patient population, saw an uptick in patients, said Joseph Gravel, chief medical officer and residency program director.

“When you look at the experience in Massachusetts, it’s going to be bumpy” when Obamacare rolls out, Gravel said in a telephone interview.

The percentage of family doctors in the state accepting new patients has dropped 19 percent in the past seven years and the percentage of internists accepting new patients has fallen 21 percent over nine years, according to a July report by the Massachusetts Medical Society, an advocacy group for patients and physicians. Only about half of family doctors were accepting new patients this year.

The Cleveland Clinic predicts as many as 90,000 new patients in northeast Ohio if everyone signs up for coverage. The health system is working to ramp up its primary care practices in anticipation.

Exciting Challenge

At Grady Health System in Atlanta, more patients are expected, especially at its six outpatient centers. San Francisco General Hospital and Trauma Center in California has some expanded hours its 19 primary care centers. The centers are located in the hospital and out in the community.

“We anticipate an increase in primary care and specialty,” Chief Executive Officer Sue Currin said.

On a recent Friday morning at the Holy Cross clinic in Aspen Hill, Riley donned a white coat and prepared to see patients. While there may be more patients under reform, Riley said an increase in business will be welcome.

“I’ve very excited,” Riley said. “I’ve been dealing with uninsured patients for a long time. If they get coverage, we can prevent a lot of problems.”

To contact the reporter on this story: Stephanie Armour in Washington at sarmour@bloomberg.net

To contact the editor responsible for this story: Reg Gale at rgale5@bloomberg.net

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Affordable Care Act Literature

About 25 million Americans are expected to gain coverage under the health law, commonly known as Obamacare.

About 25 million Americans are expected to gain coverage under the health law, commonly known as Obamacare. Photographer: Michael Nagle/Bloomberg

4:45

Sept. 20 (Bloomberg) — Ron Cohen, chief executive officer of Acorda Therapeutics Inc., talks about implementation of the Affordable Care Act and its implications for the health-care industry. Cohen speaks with Sara Eisen, Tom Keene and Anna Edwards on Bloomberg Television’s “Surveillance.” Federal Reserve Bank of St. Louis President James Bullard also speaks. (Source: Bloomberg)

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Doctors Brace for Surge of Ailing Patients...

Family visits ailing Nelson Mandela

He has been vulnerable to respiratory problems since contracting tuberculosis while imprisoned. | AP Photo

Nelson Mandela received visits from family members on Sunday at a hospital where the former president and anti-apartheid leader was being treated for a recurring lung infection, while South Africans expressed their appreciation for a man widely regarded as the father of the nation.

There was no official update on 94-year-old Mandela after his second night in the hospital. His condition was described as “serious but stable” on Saturday.

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The office of President Jacob Zuma had said that Mandela was taken to a Pretoria hospital after his condition deteriorated at around 1:30 a.m. on Saturday.

The anti-apartheid leader has now been taken to a hospital four times since December, with the last discharge coming on April 6 after doctors diagnosed him with pneumonia and drained fluid from his lung area.

Members of Mandela’s family on Sunday were seen visiting the Pretoria hospital where he is believed to be staying. They included Makaziwe Mandela, the eldest of the ex-leader’s three surviving children, and Ndileka Mandela, one of his 17 grandchildren.

Worshippers at a Sunday church service in the Johannesburg township of Soweto prayed for the recovery of Mandela, who was freed in 1990 after 27 years as a prisoner of white racist rule and won election to the presidency in all-race elections in 1994. He retired from public life years ago and had received medical care at his Johannesburg home until his latest transfer to a hospital.

At the Regina Mundi church in Soweto, Father Sebastian Rousso said Mandela, seen by many as a symbol of reconciliation for his peacemaking efforts, played a key role “not only for ourselves as South Africans, but for the world.”

There is a stained glass image of Mandela with arms raised in the Catholic church, a center of protests and funeral services for activists during the apartheid years.

“We still need him in our lives because he did so much for us,” said Mantsho Moralo, a receptionist who was in the congregation. Siyabonga Nyembe, a student, described Mandela as a “pillar of strength” for South Africans.

A stream of tourists visited Mandela’s former home, now a museum, on Vilakazi Street in Soweto. Visitors and vendors wished a quick recovery for the man whose sacrifices in the fight against apartheid made their lives better, even if South Africa today is struggling today with high unemployment and other severe challenges.

“He’s like one in a million. I don’t think we’re ever going to get a leader like him. We’re living the life that we have because of him and for that we wish him well,” said Seponono Kekana, who toured the brick, one-storey house.

On April 29, state television broadcast footage of a visit by Zuma and other leaders of the ruling African National Congress to Mandela’s home. Zuma said at the time that Mandela was in good shape, but the footage – the first public images of Mandela in nearly a year – showed him silent and unresponsive, even when Zuma tried to hold his hand.

The Nobel Peace Prize laureate has been particularly vulnerable to respiratory problems since contracting tuberculosis during his long imprisonment. The bulk of that period was spent on Robben Island, an outpost off the coast of Cape Town where Mandela and other prisoners spent part of the time toiling in a stone quarry.

The Sunday Times, a South African newspaper, quoted Andrew Mlangeni, an old friend of Mandela, as saying he wished the former president would get better but noted his infirmity had become a drawn-out process. He said Mandela had been taken to the hospital “too many times” and that there was a possibility he would not be well again.

“The family must release him so that God may have his own way. They must release him spiritually and put their faith in the hands of God,” said Mlangeni, a co-defendant of Mandela in the 1960s trial on sabotage charges that led to a sentence of life imprisonment for them and other anti-apartheid leaders.

“Once the family releases him, the people of South Africa will follow. We will say thank you, God, you have given us this man, and we will release him too,” Mlangeni told the newspaper.

Nhlanhla Ngcobobo, a street vendor who works a few steps from the Mandela Family Restaurant next to the former leader’s old home, said the ailing Mandela was a kind of psychological anchor for his compatriots. South Africa has held peaceful elections since 1994 and remains an economic powerhouse on the continent, but many worry that the sense of promise that Mandela represented in the early years of democracy is in peril.

“There’s a lot of corruption and when Mandela dies, people will start feeling they can do what they like and corruption will be worse than it is,” Ngcobobo said. “By him being alive, there’s a lot more order.”

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Family visits ailing Nelson Mandela

Ailing Chavez returns to Venezuela from Cuba

A supporter of Venezuela’s President Hugo Chavez attends a celebration marking the leader’s return, in Bolivar Square, in Caracas, Venezuela, Monday, Feb. 18, 2013. The woman holds a cutout image of Chavez along with a Saint Judas statue and a note that reads in Spanish: “Thank you St. Judas,” because she believes her prayers to the Catholic saint helped in the return of the ailing president. Chavez returned to Venezuela early Monday after more than two months of medical treatment in Cuba following cancer surgery, and was being treated at the Carlos Arvelo Military Hospital in Caracas, his government said. (AP Photo/Fernando Llano)

A supporter of Venezuela’s President Hugo Chavez attends a celebration marking the leader’s return, in Bolivar Square, in Caracas, Venezuela, Monday, Feb. 18, 2013. The woman holds a cutout image of Chavez along with a Saint Judas statue and a note that reads in Spanish: “Thank you St. Judas,” because she believes her prayers to the Catholic saint helped in the return of the ailing president. Chavez returned to Venezuela early Monday after more than two months of medical treatment in Cuba following cancer surgery, and was being treated at the Carlos Arvelo Military Hospital in Caracas, his government said. (AP Photo/Fernando Llano)

A supporter of Venezuela’s President Hugo Chavez holds a heart-shaped placard with his image in Bolivar Square, where supporters gathered to celebrate his return, in Caracas, Venezuela, Monday, Feb. 18, 2013. Chavez returned to Venezuela early Monday after more than two months of medical treatment in Cuba following cancer surgery. Vice President Nicolas Maduro said on television that Chavez arrived at 2:30 a.m. and was taken to the Carlos Arvelo Military Hospital in Caracas, where he will continue his treatment. (AP Photo/Fernando Llano)

A woman holds a painting of President Hugo Chavez as supporters gather around Bolivar square after his return to the country in Caracas, Venezuela, Monday, Feb. 18, 2013. Chavez returned to Venezuela early Monday after more than two months of medical treatment in Cuba following cancer surgery. The government didn’t offer an explanation as to why Chavez made his surprise return while he is undergoing other treatments that have not been specified.(AP Photo/Fernando Llano)

Supporters of Venezuela’s President Hugo Chavez celebrate his return at Bolivar Square in Caracas, Venezuela, Monday, Feb. 18, 2013. Chavez returned to Venezuela early Monday after more than two months of treatment in Cuba following cancer surgery, his government said, triggering street celebrations by supporters who welcomed him home while he remained out of sight at the Carlos Arvelo Military Hospital in Caracas, where he will continue his treatment. (AP Photo/Fernando Llano)

Welcome home and get well messages for Venezuela’s President Hugo Chavez are taped to a board on a wall near Bolivar Square in Caracas, Venezuela, Monday, Feb. 18, 2013. Chavez returned to Venezuela early Monday after more than two months of treatment in Cuba following cancer surgery, his government said. Hundreds of Chavez supporters celebrated his return in downtown Caracas, chanting his name and holding photos of the president, in the nearby plaza. (AP Photo/Fernando Llano)

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CARACAS, Venezuela (AP) — President Hugo Chavez returned to Venezuela early Monday after more than two months of treatment in Cuba following cancer surgery, his government said, triggering street celebrations by supporters who welcomed him home while he remained out of sight at Caracas’ military hospital.

Chavez’s return was announced in a series of three messages on his Twitter account, the first of them reading: “We’ve arrived once again in our Venezuelan homeland. Thank you, my God!! Thank you, beloved nation!! We will continue our treatment here.”

They were the first messages to appear on Chavez’s Twitter account since Nov. 1.

“I’m clinging to Christ and trusting in my doctors and nurses,” another tweet on Chavez’s account said. “Onward toward victory always!! We will live and we will triumph!!”

Vice President Nicolas Maduro said on television that Chavez arrived at 2:30 a.m. and was taken to the Dr. Carlos Arvelo Military Hospital in Caracas, where he will continue his treatment.

Chavez’s announced return to Caracas came less than three days after the government released the first photos of the president in more than two months, showing him looking bloated and smiling alongside his daughters. The government didn’t release any additional images of Chavez upon his arrival in Caracas, and unanswered questions remain about where he stands in a difficult and prolonged struggle with an undisclosed type of pelvic cancer.

Chavez was re-elected to a new six-year term in October, and his inauguration, originally scheduled for Jan. 10, was indefinitely postponed by lawmakers in a decision that the Supreme Court upheld despite complaints by the opposition. Some speculated that with Chavez back, he could finally be sworn in.

Government officials didn’t address that possibility.

Information Minister Ernesto Villegas broke into song on television early Friday, exclaiming: “He’s back, he’s back!”

“Bravo,” Villegas said, before state television employees joined him in the studio clapping and celebrating.

A giant inflated Chavez doll was placed beside a corner of the National Assembly building.

Villegas reiterated in an interview with Venezuelan broadcaster Union Radio that Chavez is going through a “difficult, hard and complex” recovery process, and that his return doesn’t change the “difficult circumstances he has been in.”

Villegas said that he hadn’t yet seen the president and that the government will provide updates about his condition “whether they’re good or they’re bad.”

The vice president later announced that a Cabinet meeting would be held Monday evening at the military hospital where Chavez is staying to “revise a number of issues,” but he did not provide any details.

Hundreds of Chavez supporters celebrated his return in downtown Caracas, chanting his name and holding photos of the president in Bolivar Plaza. A man holding a megaphone boomed: “Our commander has returned!”

Fireworks exploded in some parts of Caracas while the president’s followers celebrated.

Dozens of supporters gathered outside the hospital, where a sign atop the building is adorned with a photo of Chavez. Holding photos of Chavez and wearing the red T-shirts of his socialist movement, they chanted: “He’s back!” As cars passed, drivers honked in support.

“I want to see my president,” said Alicia Morroy, a seamstress who stood outside the hospital on the verge of tears. “I’ve missed him a lot because Chavez is the spirit of the poor.”

Six hospital employees who were asked about the president said they hadn’t seen him. Yusmeli Teran, a waitress who serves food to patients, told The Associated Press that the area where Chavez was being treated on the 9th floor is a restricted area guarded by police and soldiers. “No one has seen him at all,” she said.

Chavez’s precise condition and the sort of cancer treatments he is undergoing remain a mystery, and speculation has grown recently that he may not be able to stay on as president.

Dr. Carlos Castro, scientific director of the Colombian League Against Cancer in Bogota, Colombia, said that given the government’s accounts that Chavez is undergoing “complex” treatment, he thinks he likely will have to step down.

“Unfortunately, the cancer he has isn’t going to go away, and he’s returning to continue his battle. But I think he’s conscious that he isn’t going to win his fight against cancer, as much as he’d like to win it,” Castro told the AP in a telephone interview.

Based on the government’s accounts, doctors must have performed a tracheotomy on Chavez, cutting an opening in his windpipe to facilitate breathing, according to Dr. Jose Silva, a pulmonary specialist and president of the Venezuela Pulmonology Society. Silva said he thinks Chavez is breathing with the help of a ventilator through a tube attached to his windpipe.

Patients with breathing problems often require a tracheotomy to avoid damage to the vocal chords when a ventilator is used for an extended period.

The Venezuelan Constitution says that if a president dies or steps down, a new vote must be called and held within 30 days. Chavez raised that possibility before he left for Cuba in December by saying that if necessary, Maduro should run in a new vote to replace him.

Chavez’s return could be used to give a boost to his would-be successor and gain time to “consolidate his alternative leader” ahead of a possible new presidential vote this year, said Luis Vicente Leon, a Venezuelan pollster and political analyst.

Leon told the AP that even if Chavez isn’t seen in public, his presence will allow the government to keep up his emotional connection to his followers and rally support.

Many in Cuba were taken by surprise by the news and wondered what it could mean about his health. The island nation depends on Venezuela for a steady flow of oil shipments.

“I hope he’s truly getting better, but I doubt it because what he has is irreversible,” said Mirta Blanco, a 67-year-old retiree. “Maybe they sent him back to die. I think that’s going to be his exit.”

In a letter to Chavez that was read on Cuban state TV and radio, retired leader Fidel Castro said he was pleased that Chavez was able to return home.

“You learned much about life, Hugo, during those difficult days of suffering and sacrifice,” Castro wrote.

Venezuela’s opposition, which has strongly criticized what it calls the undue influence of Cuba’s leaders during Chavez’s long absence, responded to the news saying that it’s natural for the president to be back in his own country and that creating a “spectacle” with his return serves no useful purpose.

“The government should tell the truth and dedicate itself to working to confront Venezuelans’ serious problems,” the opposition coalition said in a statement. It cited problems such as violent crime, food shortages and soaring inflation.

The 58-year-old president hasn’t spoken publicly since he left for Cuba on Dec. 10. He underwent his fourth cancer-related surgery on Dec. 11, and the government says that he is now breathing through a tracheal tube that makes talking difficult.

___

Associated Press journalists Anne-Marie Garcia and Andrea Rodriguez in Havana, Cesar Garcia in Bogota, Colombia, and Vicente Marquez in Caracas contributed to this report.

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Ailing Chavez returns to Venezuela from Cuba