NYT > Home Page: Health Spending Growth Stays Low for Third Straight Year

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Health Spending Growth Stays Low for Third Straight Year
Jan 7th 2013, 22:52

WASHINGTON — National health spending climbed to $2.7 trillion in 2011, or an average of $8,700 for every person in the country, but as a share of the economy, it remained stable for the third consecutive year, the Obama administration said Monday.

The rate of increase in health spending, 3.9 percent in 2011, was the same as in 2009 and 2010 — the lowest annual rates recorded in the 52 years the government has been collecting such data.

Federal officials could not say for sure whether the low growth in health spending represented the start of a trend or reflected the continuing effects of the recession, which crimped the economy from December 2007 to June 2009. So far, the report said, the 2010 health care law has had "no discernible impact" on overall health spending.

The recession increased unemployment, reduced the number of people with private health insurance, and lowered household income and assets, and therefore tended to slow health spending, said Micah B. Hartman, a statistician at the federal Centers for Medicare and Medicaid Services.

In their annual report, federal officials said that total national spending for prescription drugs and doctors' services grew faster in 2011 than in the year before, but that the growth in spending for hospital care slowed.

Medicaid spending likewise grew less quickly in 2011, as states struggled with budget problems. Medicare grew more rapidly because of an increase in "the volume and intensity" of doctors' services and a one-time increase in Medicare payments to skilled nursing homes, said the report, published in the journal Health Affairs.

National health spending grew at roughly the same pace as the overall economy, without adjusting for inflation, so its share of the economy stayed the same, at 17.9 percent in 2011, where it has been since 2009. By contrast, health spending accounted for 13.8 percent of the economy in 2000.

Health spending grew more than 5 percent each year from 1961 to 2007. Sometimes it spurted at double-digit rates, including every year from 1966 to 1984 and from 1988 to 1990.

The report did not forecast the effects of the new health care law on future spending. Some provisions of the law, including subsidized insurance for millions of Americans, could increase spending, officials said. But the law also trims Medicare payments to many health care providers and authorizes experiments to slow the growth of health spending.

"The jury is still out, whether all the innovations we're testing will have much impact," said Richard S. Foster, who supervised preparation of the report as chief actuary of the Medicare agency. "I am optimistic. There's a lot of potential. More and more health care providers understand that the future cannot be like the past, in which health spending almost always grew faster than the gross domestic product."

Evidence of the new emphasis can be seen in a series of articles published in The Archives of Internal Medicine, now known as JAMA Internal Medicine, under the title "Less Is More." The series highlights cases in which "the overuse of medical care may result in harm and in which less care is likely to result in better health."

Total spending for doctors' services rose 3.6 percent in 2011, to $436 billion, while spending for hospital care increased 4.3 percent, to $850.6 billion.

Spending on prescription drugs at retail stores reached $263 billion in 2011, up 2.9 percent from 2010, when growth was just four-tenths of 1 percent. The latest increase was still well below the average increase of 7.8 percent a year from 2000 to 2010.

Federal officials said the increase in 2011 resulted partly from rapid growth in prices for brand-name drugs.

Prices for specialty drugs, typically prescribed by medical specialists for chronic conditions, have increased at double-digit rates in recent years, the government said. In addition, it said, spending on new brand-name drugs — those brought to market in the prior two years — more than doubled from 2010 to 2011, driven by an increase in the number of new medicines.

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NYT > Home Page: Troubled Oil Rig in Alaska Reaches Safer Waters

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Troubled Oil Rig in Alaska Reaches Safer Waters
Jan 7th 2013, 21:53

A week after it ran aground along a rocky shoreline in the Gulf of Alaska, a Shell Oil drilling rig was refloated and towed to safer water for inspection, officials said Monday.

The Kulluk, a drilling rig owned by Shell Oil, had been grounded along Sitkalidak Island.

Sean Churchfield, operations manager for Shell Alaska and a member of the response team that includes representatives from Shell, the Coast Guard and Alaska's environmental agency, said the rig was refloated late Sunday night and arrived in Kiliuda Bay, a sheltered area on Kodiak Island about 300 miles southwest of Anchorage, on Monday morning.

The calmer waters will enable the rig, the Kulluk, to be inspected above and below the waterline. The next step depends on the extent of the damage; one possibility is that the rig would be towed to Seattle for repairs.

The 266-foot-diameter Kulluk, one of two rigs that Shell is using in its ambitious effort to open Arctic waters to oil production, was en route to Seattle late last month when it ran aground on Sitkalidak Island after its tow ship lost power. The rig has no propulsion system.

The Kulluk remained upright and stable during the six days it sat in 25 feet of water about 350 yards offshore, and there was no sign of leakage of any of the 150,000 gallons of fuel and lubricating oil aboard.

The towing operation began Sunday afternoon, when salvage crews attached a line between the rig and its tow ship, the Aiviq. Then shortly after 10 p.m., near high tide, the Aiviq pulled the rig from the spot where it had been marooned. The Aiviq, accompanied by tugs, a Coast Guard ship and oil spill response vessels, towed the Kulluk about 50 miles north. The trip took 12 hours, Mr. Churchfield said.

Monitoring equipment showed there was no discharge of pollutants from the rig during the tow, said Steven Russell of the Alaska Department of Environmental Conservation, a member of the response team.

Capt. Paul Mehler III of the Coast Guard, the head of the response team, said getting the Kulluk to safer waters was a major milestone. "I wouldn't say I saw anyone high-fiving," said Captain Mehler, who was nearby aboard a Coast Guard ship when the Kulluk became unstuck. "But there certainly was a sense of relief."

After drilling test wells off the North Slope of Alaska in 2012, the Kulluk and Shell's second rig were expected to return to the Arctic this year. But the grounding and several other episodes last year have raised questions about the company's drilling plans in the region.

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NYT > Home Page: Lessons in Community From Chicago’s South Side

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Lessons in Community From Chicago's South Side
Jan 7th 2013, 21:01

Saving Chatham: The middle-class enclave of Chatham, on the South Side of Chicago, has struggled to remain stable through the recession. It had done so for decades, but poverty from surrounding areas is closing in.

CHICAGO — The neighborhood's best-known restaurants were failing, its crime rate was on the rise, and for the first time that anyone could remember there were foreclosures, with once tidy bungalows sitting empty and dark.

Interactive Feature

Inside Captain's Hard Times Dining in Chatham.

A view of Chatham from the Bull's Eye Barber Shop on 79th Street at the start of the day. The shop's owner said the economy hit them hard enough that they would keep the lights off until the first customer arrived.

Izola White, 89, ran a 24-hour soul food restaurant in Chatham for 50 years. She recently had to close the restaurant due to financial troubles.

For all that, the social scientists studying Chicago neighborhoods in 2010 were betting that the middle-class enclave of Chatham, on the city's South Side, would remain stable through the recession. It had done so for decades, while surrounded by impoverished areas. It had somehow absorbed a wave of newcomers from recently demolished housing projects. And the researchers' data suggested that its strong identity and scores of active block groups had helped protect residents from larger economic threats and offered clues about how to preserve threatened urban communities all over the country.

Chatham should hold, barring some unforeseen cataclysm.

The cataclysm hit on May 19 of that year. That night, a group of assailants jumped Thomas Wortham IV, an off-duty police officer and Iraq war veteran, as he was leaving his parents' house. He resisted and was shot, bleeding to death on the street where he grew up.

The entire city seemed to stop for breath, holding a memorial attended by hundreds of fellow police officers and citizens, Mayor Richard M. Daley and Gov. Pat Quinn of Illinois.

"We were blindsided by this; blindsided by what happened to Tommy," said his mother, Carolyn Wortham. "And yes, you begin to question everything."

In Chatham, it seemed, all bets were off. Many residents began to think the unthinkable, that maybe it was time to escape the place they had done so much to build.

The community's response to the crisis would test a theory emerging from an ambitious, nearly decade-long study of all of Chicago's neighborhoods — that a neighborhood's character shapes its economic future at least as much as more obvious factors like income levels and foreclosure rates.

"If Chatham could maintain its relative stability despite such great challenges," said William Julius Wilson, a professor of sociology and social policy at Harvard and the author of the 1987 classic, "The Truly Disadvantaged," "then I think this concept of a neighborhood effect will be a landmark contribution, helping us understand how to prevent the out-migration of citizens and strengthen neighborhoods" at risk of falling into poverty.

In the days before he died, Officer Wortham was on an East Coast swing, attending a police memorial service in Washington, and later participating in a fund-raising race in New York. On May 19th, he was just back and eager to see his parents, to catch up and show off some photographs from the trip.

Fraying at the Edges

Chatham looked the same as ever, but residents were nervous. The recession seemed to be deepening that spring, and local businesses were hanging on for life. Ken Blow, who runs Bull's Eye Barber Shop on East 79th, said that his revenues were down almost 40 percent in the first years of the downturn. He rented out his office to a tattoo artist to help pay expenses. "For a while there, we would keep the lights off until our first customer walked in, to save money," Mr. Blow said.

Captain's Hard Times Dining, across the street from the barbershop, also saw business dwindle. The owner, known as Mother Wade, said she has had to branch out and do catering to stay open. "Some of what's going on here is that people are not supporting their own, not sitting down to a meal like we used to do," Ms. Wade said. "They'd rather go eat fast food."

Older residents, perpetually anxious that the younger generation is losing their values of tidiness and mutual respect, now had visible evidence of social erosion. They saw it in the habits of their new neighbors, many of them moving from the Robert Taylor Homes, which were torn down in the mid-2000s.

"The big change going on is that the grandparents are moving out, and some of the younger kids coming in here are picking up behaviors that you would never have seen in Chatham before," said Worlee Glover, a salesman who runs a blog called Concerned Citizens of Chatham. "Loitering out on 79th. Walking up and down the street, eating out of a bag. Eating out on the porch. Those kinds of things."

The numbers tell part of the story. Chatham historically had a waiting list of would-be buyers, but during the recession its foreclosure rate was 14th highest among some 80 Chicago neighborhoods, according to data gathered from all of the city's neighborhoods to determine which local factors shape behavior.

"Chatham and neighboring Avalon Park are both working class communities, not core ghetto areas, and both were hit hard by recession, particularly Chatham, which got hit economically and with incidents of violence," said Robert J. Sampson, a sociologist at Harvard who led the Chicago study and wrote a recently released book based on it, "Great American City: Chicago and the Enduring Neighborhood Effect" (University of Chicago, 2012).

Twice in previous weeks, young men from outside the area had fired shots into the scrum around the basketball courts at Cole Park, just across the street from the Worthams' house. Cole Park, all picnics and playgrounds when Thomas IV was growing up, now resembled a street party on most evenings, with teenagers coming just to hang out, Mrs. Wortham said. Seniors and parents of young children stayed away.

"People came from all over the South Side to play at Cole Park for the very reason that it was a safe park," said Thomas Wortham III, his father. "But it got to where no one was controlling it."

After a short visit with his parents, the younger Mr. Wortham said goodbye around 11 o'clock. As he walked along South King Drive to his motorcycle, he had company: someone approaching fast — no, two men — and a car trolling, close by.

The next few moments are snapshots in time. A confrontation over the motorcycle. The elder Mr. Wortham yelling from his porch. Gunshots. The father ducking into the house and back out, now with his own gun. More shots. The screeching of tires as two of the assailants fled.

When it was over, three men were down and bleeding on the 8400 block of King Drive, near the playground, here in the Mayberry of the South Side. One assailant was wounded, another dead. Officer Wortham was beyond help.

"We were up all night," Mrs. Wortham said. "I don't even remember what we did. You just can't believe any of it is happening."

The police arrived in minutes, and the news spread just as fast. "When I heard, it hurt me so badly I could barely talk," said Keith O. Tate, president of the Chatham Avalon Park Community Council. "I had no voice. A lot of us who'd been working to preserve the neighborhood thought, 'What are we doing all this for? What on earth are we doing here? Are we done here?' "

They weren't, and what unfolded in the weeks after Officer Wortham's death was partly foreshadowed in the research done by Dr. Sampson and the Chicago neighborhood research team.

In their surveys, asking residents how highly their neighbors valued and enforced respectful behavior from children, the researchers found that Chatham ranked No. 1, above all other similar neighborhoods. On social cohesion, a measure of how regularly people work together to achieve common goals — organizing street fairs to raise money for a senior home, for example — it ranked second among black communities on the South Side, behind Avalon Park, just to the east.

Array of Advantages

Chatham has more than a hundred block groups, citizen volunteers who monitor the tidiness of neighborhood lawns, garbage, and noise, as well as organize events, Mr. Tate said.

The neighborhood has something else that many nearby areas do not: uniformly small buildings. Neat rows of one-story brick bungalows and ranch houses stand shoulder to shoulder, at attention, astride modest commercial strips, with few buildings more than three stories tall.

"This is what I call ecological advantage," said criminologist Peter St. Jean, the author of "Pockets of Crime," an analysis of the physical spaces criminals occupy. "In a community with small buildings — single family houses, like here, for instance — it is relatively easy for the old lady next door to walk over and tell you there's trash on your lawn, or to turn down the music. It is much more intimidating to approach troublemakers in a larger apartment building; you don't even know where in the building they live."

Smaller structures provide another advantage in a recession, Dr. St. Jean said: If a building is vacated and boarded up, it's a small blemish on the face of the community, not a large one. "You do not see any large empty lots or abandoned buildings in this neighborhood," he said.

In the wake of Officer Wortham's death, residents of Chatham didn't wait long to act.

"My own father wanted to go to the park by where Tommy Wortham was killed, just to be there," said Mr. Tate, the community council president. "And I told him no, I didn't want to worry about him falling. He said, 'Look, I'm going, with or without you.' "

Others felt just as strongly, and soon there was a neighborhood gathering to "take back the park," Mrs. Wortham said. Not long after, about 20 police officers, many former colleagues of the Worthams, father and son, showed up at Cole Park and spent the day, in support. "It was a hot day, and all I can remember is running back and forth from the house to get water for everyone," Mr. Wortham said. "These were officers from all over the city, not just from here. They organized it themselves."

It's far too early to say that Chatham has rebounded, but there are encouraging signs. The Bull's Eye barbershop is busy again. The neighborhood successfully lobbied a billboard company to remove a gaudy sign advertising cigarettes, Mr. Glover said. Several new businesses are now thriving, including Garrett Popcorn, a boutique popcorn shop that on most days has lines out the door.

Mr. Tate has started an investment pool with other residents who have the means, to buy up foreclosed houses and sell them to "people who will make good neighbors."

And according to an analysis by Dr. Sampson, crime around Cole Park almost stopped in the months after Officer Wortham was killed. Crime crept back up in 2012, especially near the neighborhood's borders, but it has been a violent year in Chicago, with homicides up 16 percent over 2011. The crime rate in Chatham remains well below that of nearby areas.

For the social scientists, these findings apply far beyond Chatham, and beyond Chicago. Other South Side neighborhoods, with similar poverty rates, scored significantly lower on these measures of social cohesion and "efficacy." And these neighborhoods — West Pullman, to the south, for instance, and Greater Grand Crossing to the north, which has newer developments and more young professionals — have been slower to rebound from the recession, and crime rates remain elevated. The study seems to have zeroed in on the mostly invisible factors that immunize, or at least help protect, a neighborhood from internal wounds, as well as trauma from global economic convulsions.

"The specific neighborhood has a personality that affects virtually all aspects of social life, the choices we make about where to live, about how much disorder we'll tolerate, about how we raise our kids," Dr. Sampson said. "Large-scale forces like the recession of course matter, but they are moderated by local neighborhood factors, whether you're in Chicago or Stockholm" or other cities.

The ultimate verdict, for Chatham and for the neighborhood effect, may lie in what the Worthams and people like them do in historically cohesive urban communities threatened by creeping poverty and violence. "I sure did consider leaving when Tommy was killed," Mrs. Wortham said.

She took a deep breath. "But you know, whenever something like this happens, there's plenty of blame to go around. People want to blame the city, the community organizations, the churches, all that. But nothing changes unless people look after their children, and the neighbors do, too. If people aren't behaving, you say something. When I went to school, if I did something wrong, by the time I got home my mother knew about it."

So did friends' mothers, Mr. Wortham added. Then he gave her a look: it was time for dinner, and to head for home.

More than two years after their son was killed, the Worthams still live across from the park. For now, like many of their longtime neighbors and friends, they're staying put.

This article has been revised to reflect the following correction:

Correction: January 7, 2013

Because of an editing error, an earlier version of a photo caption with this article misstated the name of a restaurant. It is Captain's Hard Times Dining, not Captain Hard Times Cafe.

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NYT > Home Page: The Quad: Live Blog of B.C.S. Title Game

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The Quad: Live Blog of B.C.S. Title Game
Jan 7th 2013, 20:16

Top-ranked Notre Dame and No. 2 Alabama will meet Monday night for the national championship, and Mike Huguenin — with help from Greg Bishop, Harvey Araton and Tim Rohan — will offer updates and analysis.

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NYT > Home Page: Obama Picks Hagel as Defense Secretary, Brennan for C.I.A.

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Obama Picks Hagel as Defense Secretary, Brennan for C.I.A.
Jan 7th 2013, 19:50

Doug Mills/The New York Times

President Obama with Chuck Hagel, center, nominated to be Secretary of Defense, and John O. Brennan nominated to head the C.I.A. during the announcement in the East Room of the White House, on Monday.

WASHINGTON — Risking a potentially rancorous battle with Congress at the start of his second term, President Obama on Monday nominated Chuck Hagel, a former Republican senator from Nebraska whom Mr. Obama hailed as "the leader that our troops deserve," to be secretary of defense.

Mr. Obama also nominated John O. Brennan, his chief counterterrorism adviser, to be director of the Central Intelligence Agency, putting a close aide who was at his side during the raid that resulted in the death of Osama bin Laden into the top job at the agency.

The president extolled Mr. Hagel's record as a decorated veteran of the Vietnam War, describing how he once dragged his brother to safety after he struck a landmine.

"Just as Sergeant Hagel was there for his brother, Secretary Hagel will be there for you," said Mr. Obama, who was flanked by Mr. Hagel and the current defense secretary, Leon E. Panetta, at the White House ceremony.

"More than most, Chuck understands that war is not just an abstraction," Mr. Obama said.

Of Mr. Brennan, the president said he was one of the architects of the counterterrorism strategy that dealt setbacks to the leadership of Al Qaeda.

"Think about the results," Mr. Obama said, noting that Mr. Brennan had been a tireless sentry for the American people.

The president also emphasized that Mr. Brennan had embedded counterterrorism within a legal framework, saying, "he understands we are a nation of laws."

The announcements, which were widely expected, complete a troika of personnel moves, along with that of Senator John Kerry, Democrat of Massachusetts, who was named as secretary of state last month, that fill out Mr. Obama's national security team for his second term.

The nomination of Mr. Hagel sets up a showdown between the president and Congress, with Republican senators predicting he will face a bruising confirmation because of his views on Israel, Iran and Islamic militant groups. He has also faced criticism from gay rights organizations forremarks he made 14 years ago – for which he has since apologized – about an openly gay diplomat.

Conservative and Jewish groups say that Mr. Hagel has opposed sanctions on Iran, has inadequately supported Israel and has advocated engagement with groups like Hamas and Hezbollah. They also fault him for having once referred to pro-Israel lobbying groups on Capitol Hill as "the Jewish lobby."

Still, it was not clear how hard those groups would fight to block Mr. Hagel's nomination after having failed to derail his candidacy since he emerged as front-runner for the job.

"We're not in the opposition camp, we're in the concerned camp," said David A. Harris, the executive director of the American Jewish Committee, a centrist Jewish group. "We're going to count on the Senate to examine, as it must, key issues of concern."

Mr. Harris said that Iran topped his list of concerns because Mr. Hagel had voted against American sanctions against the Iranian government over its nuclear program and had argued against using military force to prevent Tehran from obtaining a nuclear weapon.

Abraham H. Foxman, the national director of the Anti-Defamation League, said in a statement that Mr. Hagel "would not have been my first choice, but I respect the president's prerogative."

However, Mr. Foxman said that the senators should challenge Mr. Hagel on his positions on Israel and Iran, which he said were "so out of sync" with those of the president. "I particularly hope Senator Hagel will clarify and explain his comments about the 'Jewish lobby' that were hurtful to many in the Jewish community," Mr. Foxman added.

Mr. Obama referred obliquely to the controversy swirling around Mr. Hagel, saying that soldiers in the field were far away from the politics of Washington, but should not be handicapped by it.

Mr. Obama's choices for the Pentagon and the C.I.A. reflect a determination to fill his central national security jobs with people in whom he has deep trust and with whom he has personal rapport, according to White House aides.

Mr. Brennan, these advisers said, has developed exceptionally close ties to the president in his four years at the White House, briefing him on terrorist plots, pushing to expand the strategy of using unmanned drones to kill suspected terrorists and advising him on decisions like authorizing the Bin Laden raid.

Mr. Obama's rapport with Mr. Hagel goes back to their days in the Senate. In July 2008, Mr. Hagel and Senator Jack Reed, Democrat of Rhode Island, accompanied Mr. Obama on a trip to Afghanistan that helped establish the Democratic presidential nominee's foreign policy credentials.

Like the president, Mr. Hagel is deeply suspicious of a lingering American military presence in Afghanistan, and would most likely be comfortable with a more rapid drawdown of American troops after the United States and its allies turn over responsibility for security to the Afghans at the end of 2014.

John Nagl, a retired Army officer and professor of history at the United States Naval Academy, recalled Mr. Hagel addressing a class he was teaching at West Point. "He said, 'I was that 19-year-old rifleman. Look me in the eye and tell me that if you send a kid to get killed, it will be for a mission that matters.' "

"He'll be a voice for G.I. Joe, and that's a very valuable thing," Mr. Nagl said.

At Monday's ceremony, Mr. Obama praised Mr. Panetta, the outgiung defense secretary, whom he said earned a break after heading both the Pentagon and the C.I.A.

The president also thanked Michael J. Morell, who stepped in to run the C.I.A. as acting director after David H. Petraeus resigned in the wake of a sex scandal last fall.

"I hope the Senate will act on these nominations promptly," he said. "When it comes to national security, we don't like to leave gaps."

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NYT > Home Page: Obama Nominates Hagel as Defense Secretary, Brennan for CIA

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Obama Nominates Hagel as Defense Secretary, Brennan for CIA
Jan 7th 2013, 18:53

Luke Sharrett for The New York Times

President Obama on Monday nominated John Brennan, second right, as C.I.A. director and the former Republican senator Chuck Hagel, second from left, as defense secretary to succeed Leon E. Panetta, left. Michael Morell, the acting C.I.A. director, is at right.

Reuters

WASHINGTON (Reuters) - President Barack Obama on Monday nominated Chuck Hagel, a former Republican senator, as his next defense secretary and counterterrorism adviser John Brennan to head the CIA, urging the U.S. Senate to confirm them quickly.

Hagel, a decorated Vietnam veteran, would replace Leon Panetta at the Pentagon. Critics have already launched attacks over Hagel's record on Israel and Iran.

Brennan is a CIA veteran who withdrew from consideration for the spy agency's top job in 2008 after questions were raised about his views on enhanced interrogation techniques used on terrorism suspects during the Bush administration.

He would succeed retired General David Petraeus, who resigned amid a scandal over an extramarital affair with his biographer.

(Reporting by Mark Felsenthal, Steve Holland; Editing by Sandra Maler)

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NYT > Home Page: Hearing Expected to Offer Details of Plotting Before Colorado Massacre

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Hearing Expected to Offer Details of Plotting Before Colorado Massacre
Jan 7th 2013, 17:57

CENTENNIAL, Colo. — A police officer testified at a preliminary hearing here on Monday that when he responded to emergency calls about a mass shooting at a crowded movie theater this summer that he found the suspected gunman standing calmly outside his car in a parking lot just moments after he had opened fire inside, the authorities say, killing 12 people and injuring 58 others.

"He was very relaxed," said the police officer, Jason Oviatt. "It was like there weren't normal emotional responses to anything. He seemed very detached."

Officer Oviatt said that because the suspect, James E. Holmes, had been swathed in so many layers of body armor and equipped with a helmet and a gas mask, that he had first thought that Mr. Holmes was a fellow police officer.

Mr. Holmes eventually told arresting officers that he had booby-trapped his apartment.

Police officers were among the first people to testify at a weeklong court hearing that will determine whether there is sufficient evidence to move the case against Mr. Holmes to trial, a decision that will be made by William Sylvester, a district judge in Arapahoe County.

But for victims and their families, the hearing may offer the best, and perhaps only, opportunity to understand how the July 20 shooting unfolded, and to get a glimpse into Mr. Holmes's actions and mind-set in the weeks before the attack. A criminal trial — if one ever convenes — remains months away, probably at the end of a long series of legal arguments, including over Mr. Holmes's mental fitness to stand trial.

It has been more than five months since Mr. Holmes, a neuroscience graduate student, was accused of striding into a midnight screening of "The Dark Knight Rises" at a movie theater in an Aurora shopping mall and opening fire.

He faces more than 160 counts of first-degree murder and attempted murder.

Lawyers for Mr. Holmes, 25, have signaled that they might call witnesses this week to discuss his mental state in the hope of rebuting the prosecution's evidence that Mr. Holmes spent months methodically buying 6,000 rounds of ammunition, handguns, a shotgun and an assault rifle.

Minutes after the shooting, he was arrested outside the theater, still encased in black body armor, his shaggy hair dyed neon orange.

The fact that Mr. Holmes did not kill himself, unlike gunmen at Sandy Hook Elementary School, Columbine High School or Virginia Tech, has transformed the aftermath of the tragedy into a trying and costly legal case.

Although Mr. Holmes has not yet filed a plea, his lawyers have said several times that he is mentally ill. Mr. Holmes had seen a psychologist at the University of Colorado, Denver, where he had been a graduate student, and had so alarmed his doctor that she contacted the campus police about him.

Less than a month before the shooting, after he had dropped out of his neuroscience program, Mr. Holmes sent a text message to a classmate that suggested he believed that he suffered from dysphoric mania, a bipolar condition that combines manic behavior and dark, depressive tendencies. Mr. Holmes warned the classmate to stay away from him "because I am bad news," the classmate has said.

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