Food servers more vulnerable to legal threats


WASHINGTON (AP) — People with severe food allergies have a new tool in their attempt to find menus that fit their diet: federal disabilities law. And that could leave schools, restaurants and anyplace else that serves food more vulnerable to legal challenges over food sensitivities.


A settlement stemming from a lack of gluten-free foods available to students at a Massachusetts university could serve as a precedent for people with other allergies or conditions, including peanut sensitivities or diabetes. Institutions and businesses subject to the Americans With Disabilities Act could be open to lawsuits if they fail to honor requests for accommodations by people with food allergies.


Colleges and universities are especially vulnerable because they know their students and often require them to eat on campus, Eve Hill of the Justice Department's civil rights division says. But a restaurant also could be liable if it blatantly ignored a customer's request for certain foods and caused that person to become ill, though that case might be harder to argue if the customer had just walked in off the street, Hill said.


The settlement with Lesley University, reached last month but drawing little attention, will require the Cambridge, Mass., institution to serve gluten-free foods and make other accommodations for students who have celiac disease. At least one student complained to the federal government after the school would not exempt the student from a meal plan even though the student couldn't eat the food.


"All colleges should heed this settlement and take steps to make accommodations," says Alice Bast, president and founder of the National Foundation for Celiac Awareness. "To our community this is definitely a precedent."


People who suffer from celiac disease don't absorb nutrients well and can get sick from the gluten found in wheat, rye and barley. The illness, which affects around 2 million Americans, causes abdominal pain, bloating and diarrhea, and people who have it can suffer weight loss, fatigue, rashes and other problems. Celiac is a diagnosed illness that is more severe than gluten sensitivity, which some people self-diagnose.


Ten years ago, most people had never heard of celiac disease. But awareness has exploded in recent years, for reasons that aren't entirely clear. Some researchers say it was under-diagnosed, others say it's because people eat more processed wheat products like pastas and baked goods than in past decades, and those items use types of wheat that have a higher gluten content.


Gluten-free diets have expanded beyond those with celiac disease. Millions of people are buying gluten-free foods because they say they make them feel better, even if they don't have a wheat allergy. Americans were expected to spend $7 billion on gluten-free foods last year.


With so many people suddenly concerned with gluten content, colleges and universities have had to make accommodations. Some will allow students to be exempted from meal plans, while others will work with students individually. They may need to do even more now as the federal government is watching.


"These kids don't want to be isolated," Bast says. "Part of the college experience is being social. If you can't even eat in the school cafeteria then you are missing out on a big part of college life."


Under the Justice Department agreement, Lesley University says it will not only provide gluten-free options in its dining hall but also allow students to pre-order, provide a dedicated space for storage and preparation to avoid cross-contamination, train staff about food allergies and pay a $50,000 cash settlement to the affected students.


"We are not saying what the general meal plan has to serve or not," Hill says. "We are saying that when a college has a mandatory meal plan they have to be prepared to make reasonable modifications to that meal plan to accommodate students with disabilities."


The agreement says that food allergies may constitute a disability under the Americans With Disabilities Act, if they are severe enough. The definition was made possible under 2009 amendments to the disability law that allowed for episodic impairments that substantially limit activity.


"By preventing people from eating, they are really preventing them from accessing their educational program," Hill said of the school and its students.


Mary Pat Lohse, the chief of staff and senior adviser to Lesley University's president, says the school has been working with the Justice Department for more than three years to address students' complaints. She says the school has already implemented most parts of the settlement and will continue to update policies to serve students who need gluten-free foods.


"The settlement agreement provides a positive road map for other colleges and universities to follow with regard to accommodating students with food allergies and modifying existing food service plans," Lohse said.


Some say the Justice Department decision goes too far. Hans von Spakovsky, a fellow at the conservative Heritage Foundation who worked in the civil rights division of the Justice Department under President George W. Bush, says food allergies shouldn't apply under the disability act. He adds that the costs could be substantial when schools are already battling backlash from high tuition costs.


"I certainly encourage colleges and universities to work with students on this issue, but the fact that this is a federal case and the Justice Department is going to be deciding what kind of meals could be served in a dining hall is just absurd," he said.


Whether the government is involved or not, schools and other food service establishments are likely to hear from those who want more gluten-free foods. Dhanu Thiyagarajan, a sophomore at the University of Pittsburgh, said she decided to speak up when she arrived at school and lost weight because there were too few gluten-free options in the cafeteria. Like Lesley University, the University of Pittsburgh requires that on-campus students participate in a meal plan.


Thiyagarajan eventually moved off campus so she could cook her own food, but not before starting an organization of students who suffer from wheat allergies like hers. She says she is now working with food service at the school and they have made a lot of progress, though not enough for her to move back on campus.


L. Scott Lissner, the disability coordinator at Ohio State University, says he has seen similar situations at his school, though people with food allergies have not traditionally thought of themselves as disabled. He says schools will eventually have to do more than just exempt students from a meal plan.


"This is an early decision on a growing wave of needs that universities are going to have to address," he said of the Lesley University agreement.


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EPA proposes compromise on Navajo Generating Station's emissions









The Environmental Protection Agency is proposing regulations to reduce emissions from the massive Navajo Generating Station by as much as 84%, in a compromise that would give the plant's operators more time to install scrubbers and would ease the economic impact on two Native American tribes.


Situated in northern Arizona, less than 20 miles from the Grand Canyon, the generating station is the source of haze viewed by tourists at nearly a dozen parks and wilderness areas in the Southwest.


The EPA's proposed rules would allow the 2,250-megawatt plant until 2023 to install pollution controls to meet emissions standards mandated by a Regional Haze Rule. The plant is one of the largest sources of harmful nitrogen oxide emissions in the country, but the agency is proposing to add five years to the compliance date in response to concerns by Navajo and Hopi tribes, EPA Regional Administrator Jared Blumenfeld said.





"It's a deserving compromise, given the real economic threats that face the tribal nations," Blumenfeld said, calling the issue the most complicated he'd ever dealt with. "We wanted to provide enough time to work out the economics so that the facility remains open."


The coal-fired power plant is on land leased from the Navajo Reservation and burns coal mined on both the Navajo and Hopi reservations. The equipment required to bring the plant into emissions compliance would cost an estimated $500 million, and the tribes and a number of groups argued that the economic burden might cause the operators to close the facility, which employs hundreds of tribal members.


The generating station is co-owned by several entities, including the Los Angeles Department of Water and Power.


Blumenfeld said the EPA proposed extending the compliance period also in recognition that the plant's operators had previously installed emission-reducing equipment. When the plant is in compliance, its emissions will total no more than 28,500 tons per year.


"For 90% of the year, the Grand Canyon's air quality is impaired by a veil of pollution haze that reduces the pristine natural visual range by an average of more than 30%," Blumenfeld said in a statement.


National parks and wilderness areas are required to maintain Class I airsheds — the highest level of clear skies. In addition to the Grand Canyon, nearby parks include Zion, Bryce Canyon, Mesa Verde, Arches and Canyonlands.


The plant also provides the power that drives the Central Arizona Project, an expansive aqueduct system that provides water to much of Arizona. State agencies had petitioned the EPA to consider the proposed rules' effect on the cost of water delivery.


The proposed regulations are open to a 90-day comment period.


julie.cart@latimes.com





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Torrential Rains Paralyze Jakarta


Adi Weda/European Pressphoto Agency


Flooding paralyzed much of Jakarta, Indonesia, on Thursday.







JAKARTA, Indonesia — Torrential rains caused flooding that paralyzed much of Jakarta on Thursday, resulting in the deaths of at least four people and forcing the evacuations of tens of thousands of others.




Parts of the capital were under at least six feet of water, and even the presidential palace was not spared as waters rushed into the complex. The central business district saw water levels rise to at least 18 inches.


“This is the worst I’ve ever seen it,” said Yudi Sukarno, 40, who has lived in the Bendungan Hilir neighborhood since he was a child. “There’s all this asphalt and concrete, so the water doesn’t have anywhere to go.”


Thirteen rivers run through Jakarta, but poor drainage caused by rubbish and a low water table frequently causes them to overflow. The problems have recently been exacerbated by deforestation outside the city.


In central Jakarta on Thursday, muddy torrents filled major thoroughfares as evacuees tramped through waist-deep water in one central neighborhood. A group of men balanced an air mattress with a sick elderly woman on their shoulders in an effort to get her to a hospital.


Flood walls in one neighborhood collapsed, inundating neighborhoods in east Jakarta. Residents in one area there, Kampung Melayu, were forced to the second levels of their homes and some have taken refuge on a highway overpass, while others gathered in mosques, which were filled with people escaping the floods, according to volunteers.


The Indonesian Meteorological Agency said that heavy rains are expected in the Jakarta region for the next three days.


“Because of the rain’s intensity we’ve declared an emergency situation from now until Jan. 27,” Jokowi Widodo, the governor of Jakarta, told reporters.


He also declared a school holiday for children in the most flooded parts of the city and many offices have told their employees to stay at home. The American Embassy issued a message telling people to exercise caution, saying, “Walking and driving in flooded areas can be dangerous and should be avoided if possible.”


Local news broadcasts showed images of President Susilo Bambang Yudhoyono standing shin deep in water that had flooded into the presidential palace.


“It’s O.K. if the palace is flooded,” Mr. Yudhoyono told reporters. “What is important is that the people are protected.”


The sluice gates upstream from Jakarta have reached record levels, according to officials at the National Disaster Management Agency. Power outages have prevented pumps from being able to drain the water from streets and houses.


Officials at the National Disaster Management Agency have encouraged residents to stay inside to reduce road congestion.


In many areas residents have filled the streets, where vendors were still preparing food and selling fruits and vegetables.


“You can’t go anywhere,” said Sigit Hardisumarjo, who was buying fried bread and hoping his home stayed dry. “It feels like we’re handicapped.”


Despite the lack of movement, Mr. Sigit said flooding was common during the rainy season. Many people in his neighborhood have elevated their houses to prepare for flooding like this.


In 2007, Jakarta saw some of the worst flooding in recent memory, with hundreds of thousands forced to flee.


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American Idol's New Judges Make Their Debut






American Idol










01/16/2013 at 11:00 PM EST







From left: Randy Jackson, Mariah Carey, Ryan Seacrest, Nicki Minaj and Keith Urban


Michael Becker/FOX.


American Idol is back!

Season 12 premiered Wednesday night with the first auditions in New York City. And fans hoping to get a taste of drama from new judges Mariah Carey and Nicki Minaj were not disappointed.

"Right away we knew it was going to be an interesting couple of days," host Ryan Seacrest said at the start of the two-hour episode.

And he was right. (Spoilers ahead!) While fellow newbie Keith Urban and veteran judge Randy Jackson were all about the business of finding talented singers, there was immediate tension between Carey and Minaj, who wore a drum major's hat to her first day on the job.

"We can have accessories?" Carey said disapprovingly after taking her seat at the panel. "I didn't know that was allowed."

"Why did you have to reference my hat?" Minaj responded.

Later, when Carey boasted about her holiday hit, "All I Want for Christmas," Minaj clenched her fists, gritted her teeth and used the b-word. Carey's response? "I rebuke it," she said.

The two women talked over each other at times, rolled eyes and seemed to annoy one another. More than once Carey said "Nicki" like an frustrated mother calls her child out for misbehaving. And Minaj pushed Carey's buttons by talking in a British accent.

But as the two formerly feuding judges have said in recent interviews, the show should be about the hopeful contestants – and there were a handful of talented singers who earned golden tickets to Hollywood:

• Tenna Torres, who attended Camp Mariah and had previously sung for the singer, impressed the panel with her version of "You've Got a Friend," and made her idol very proud.

• Christina "Isabelle," who told a story of losing weight and finding confidence, had Minaj saying, "OMG! OMG!" with her version of "Summertime."

• Frankie Ford, who sings for change on the New York City subway system, stumbled at first but delivered a soulful version of the Eurythmics' "Sweet Dreams." "I like your big voice," Urban said. "There's a lot of musicality in the tone."

Added Carey: "You have an inner glow, which is always beautiful to see."

• Despite hearing loss in both ears, Angela Miller, who sang "Mama Knows Best" by Jessie J, was "definitely one of the best," according to Jackson.

• And Ashlee Feliciano thrilled the female judges with her version of Corinne Bailey Rae's "Put Your Records On." "So pretty," Minaj said. "I want to come to your show ... I'm so inspired by you."

"The potential is great. It was beautiful," Carey said. "You should be really proud of yourself."

At the end of the first two days of auditions, the re-invented Idol panel had done its job: the judges praised the talented singers and handed out 41 tickets to Hollywood; they sent home the kooky contestants (often sweetly) and offered constructive criticism and an invitation to come back next year to the ones still on their way to greatness.

"We gel well in a weird crazy way," Minaj said at the end of the show. Carey said, "I agree."

We'll see how long that lasts! Auditions continue Thursday (8 p.m. ET) on Fox.

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Large study confirms flu vaccine safe in pregnancy


NEW YORK (AP) — A large study offers reassuring news for pregnant women: It's safe to get a flu shot.


The research found no evidence that the vaccine increases the risk of losing a fetus, and may prevent some deaths. Getting the flu while pregnant makes fetal death more likely, the Norwegian research showed.


The flu vaccine has long been considered safe for pregnant women and their fetus. U.S. health officials began recommending flu shots for them more than five decades ago, following a higher death rate in pregnant women during a flu pandemic in the late 1950s.


But the study is perhaps the largest look at the safety and value of flu vaccination during pregnancy, experts say.


"This is the kind of information we need to provide our patients when discussing that flu vaccine is important for everyone, particularly for pregnant women," said Dr. Geeta Swamy, a researcher who studies vaccines and pregnant women at Duke University Medical Center.


The study was released by the New England Journal of Medicine on Wednesday as the United States and Europe suffer through an early and intense flu season. A U.S. obstetricians group this week reminded members that it's not too late for their pregnant patients to get vaccinated.


The new study was led by the Norwegian Institute of Public Health. It tracked pregnancies in Norway in 2009 and 2010 during an international epidemic of a new swine flu strain.


Before 2009, pregnant women in Norway were not routinely advised to get flu shots. But during the pandemic, vaccinations against the new strain were recommended for those in their second or third trimester.


The study focused on more than 113,000 pregnancies. Of those, 492 ended in the death of the fetus. The researchers calculated that the risk of fetal death was nearly twice as high for women who weren't vaccinated as it was in vaccinated mothers.


U.S. flu vaccination rates for pregnant women grew in the wake of the 2009 swine flu pandemic, from less than 15 percent to about 50 percent. But health officials say those rates need to be higher to protect newborns as well. Infants can't be vaccinated until 6 months, but studies have shown they pick up some protection if their mothers got the annual shot, experts say.


Because some drugs and vaccines can be harmful to a fetus, there is a long-standing concern about giving any medicine to a pregnant woman, experts acknowledged. But this study should ease any worries about the flu shot, said Dr. Denise Jamieson of the Centers for Disease Control and Prevention.


"The vaccine is safe," she said.


___


Online:


Medical journal: http://www.nejm.org


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Robert L. Citron dies at 87; central figure in O.C. bankruptcy









Robert L. Citron, the Orange County treasurer whose bad bets on exotic Wall Street investments resulted in what at the time was the largest municipal bankruptcy in U.S. history, died Wednesday. He was 87.


Citron died at St. Joseph Hospital in Orange of complications from a heart attack, said his wife, Terry Citron.


Until the 1994 financial collapse, Citron was a low-key bureaucrat who won praise from Orange County supervisors for earning much higher yields from the county's complex array of investments than many other government agencies. His investment pools attracted funds from governments around the country as well as from schools, cities and public agencies.





The county declared bankruptcy Dec. 6, 1994, buffeted by losses that, when the final count was tallied, amounted to $1.64 billion. The county was forced to postpone repayments on bonds it had sold, ruining its credit rating, but eventually repaid its creditors in full. The bankruptcy sent shock waves through Wall Street and the municipal bond markets. It also made national headlines, with some asking how such a prosperous county could become insolvent.


A grand jury investigation would later find that the treasurer who over the years won so much praise for his investment skills relied upon a mail order astrologer and a psychic for interest rate predictions as the county's treasury began to falter.


Citron pleaded guilty to six felony counts, including filing false statements to participants in the Orange County Treasury Investment Pool. His lawyer, David Wiechert, submitted medical testimony indicating that Citron was in the early stages of dementia.


Citron was sentenced to work in the county jail, sorting inmates' requests for personal items by day before returning to his home in Santa Ana. He never spent a night behind bars but worked for months in the jail's commissary. He remained on probation until 2002.


In a 1997 interview with The Times, Citron insisted that he was duped into making rashly imprudent investments by Merrill Lynch. He became a key witness in Orange County's $2-billion lawsuit against the investment giant. The suit said that Citron was a "pigeon" for greedy brokers at the investment house.


Merrill Lynch maintained that the bankruptcy was Citron's fault. It later settled the case with the county, paying $400 million.


A third-generation Californian, Citron was born in Los Angeles on April 14, 1925, according to public records, and grew up in Burbank. Because he had asthma as a child, his family moved out to the town of Hemet in the foothills of the San Jacinto Mountains. His father, Jesse, was a doctor who earned a measure of fame for being liquor-loving W.C. Fields' doctor and weaning him off Scotch.


Citron rose through the ranks of the county's treasury department to become county treasurer-tax collector, a post he held for 24 years. He was one of the few Democrats to hold countywide elected office in a region dominated by Republicans. He lived in Santa Ana, just a few miles from work, and was famous for his long hours. In a 1994 interview, his wife told The Times that the weekends were hardest for her husband because he could not go to work.


"He can barely stand the weekend at home," she said. "He can't wait to get back. I think he'd go crazy without that job."


The bankruptcy tarnished Citron's name as well as the county's. County government slashed hundreds of jobs and cut budgets. Orange County's repayment plan siphoned money from four county departments every year, affecting projects big and small.


Citron's assistant, Matthew Raabe, was convicted of fraud and misappropriation and served 41 days in jail before the verdict was overturned. Taxpayers spent $1 million on his defense. The county's financial director, Ronald S. Rubino, was tried on fraud and misappropriation charges, but a jury deadlocked in favor of acquittal. He pleaded no contest to one record-keeping violation under a deal that allowed his record to be erased after a year. County Supervisors Roger R. Stanton and William G. Steiner were indicted by a grand jury on grounds of failing to safeguard public funds. The indictment was later dismissed by an appeals court ruling that said failing to do their jobs wasn't a crime.


Citron is survived by his wife of 57 years.


scott.reckard@latimes.com


Times staff writers Shelby Grad and Robert J. Lopez contributed to this report.





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Bombings in Disputed Iraqi City Kill 13







BAGHDAD (AP) — An explosives-packed vehicle driven by a suicide bomber blew up outside offices for the party of a key Kurdish leader early Wednesday in the disputed Iraqi city of Kirkuk, the largest in a wave of morning strikes that left at least 24 dead and scores wounded across the country.




The attacks made for Iraq's bloodiest day in two weeks. They come amid rising tensions among Iraq's ethnic and sectarian groups that threaten to plunge the country back into chaos nearly a decade after the U.S.-led invasion.


While there was no immediate claim of responsibility, car bombs and coordinated attacks are favorite tactics for Sunni insurgents such as al-Qaida's Iraq branch. They seek to exacerbate divisions within Iraq in an effort to undermine the Shiite-led government.


The blast outside the Kirkuk offices of the Kurdistan Democratic Party caused widespread damage, mangling cars and tearing apart storefronts. The KDP is led by Massoud Barzani, the president of Iraq's largely autonomous Kurdish region, who has frequently sparred with Iraq's central government in Baghdad.


The deputy police chief in the city of Kirkuk, Maj. Gen. Torhan Abdul-Rahman Youssef, said 11 people were killed in that attack. Another car bomb that exploded nearby killed another two people. Just over 100 were wounded in the two attacks, he said.


Kirkuk, 290 kilometers (180 miles) north of Baghdad, is home to a mix of Arabs, Kurds and Turkomen, who all have competing claims to the oil-rich area. The Kurds want to incorporate it into their self-ruled region in Iraq's north, but Arabs and Turkomen are opposed.


The city is at the heart of a snaking swath of territory disputed between the Kurds, who have their own armed fighting force, and Iraq's central government.


A shootout in Tuz Khormato, another contested town along the disputed area, prompted both sides to rush troops and heavy weapons to the area in November.


On Wednesday, yet another car bomb struck the local headquarters for Kurdish security forces in Tuz Khormato, killing five and wounding 36, according to Raed Ibrahim, the head of the provincial health directorate. The town is It is about 210 kilometers (130 miles) north of Baghdad.


The attacks came as hundreds of mourners gathered in the western city of Fallujah to bury a prominent Sunni lawmaker assassinated by a suicide bomber on Tuesday.


The politician, Ifan Saadoun al-Issawi, was part of the Sunni-backed Iraqiya bloc, which holds some posts in Iraq's loose power-sharing government but is at the same time the main force in opposition to Prime Minister Nouri al-Maliki's administration. He was also a founder of the local branch of the Sahwa, a group of Sunni Arabs who joined forces with the U.S. military to fight al-Qaida at the height of Iraq's insurgency.


Fallujah and the nearby city of Ramadi have been the scene of more than three weeks of demonstrations against the government.


A planted bomb went off as mourners gathered to mark al-Issawi's death, wounding three of them, authorities said.


Violent attacks hit other parts of the country as well.


In Baghdad, gunmen using silenced weapons killed three policemen as they were sitting in their police car, according to police and hospital officials. A roadside bomb hit a police patrol on a highway in eastern Baghdad, killing two policemen, said police and hospital officials.


One policeman was killed and four others wounded when a roadside bomb struck their car in Hawija, 240 kilometers (160 miles) north of Baghdad, according to authorities.


The officials providing details of the attacks outside the disputed areas spoke on condition of anonymity because they weren't authorized to release the information to reporters.


Violence has fallen since the peak of insurgency several years ago, but lethal attacks still occur frequently.


Wednesday's attacks were the deadliest in the country since New Year's Eve, when a string of attacks in Kirkuk and other areas left at least 26 dead.


___


Associated Press writers Sameer N. Yacoub and Qassim Abdul-Zahra contributed reporting.


___


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Apple scoops PBS on “Downton Abbey” episodes, but PBS is cool with it






NEW YORK (TheWrap.com) – Apple is making the entire third season of “Downton Abbey” available on iTunes before every episode airs on PBS – and that’s just fine with PBS.


Fans who buy a season pass on iTunes beginning January 29 will get to see three episodes before they air on PBS. The Season 3 finale airs February 17.






But PBS CEO Paula Kerger isn’t worried that viewers will watch the show online, then tune out PBS. In fact, she says, Apple isn’t the only place Americans can see “Downton” before they can see it on her network.


“You can also buy the DVD sets. They’re being shipped at the end of January, and the DVD sets and Apple are going up at the same time,” Kerger told TheWrap. “I think that for people who are really passionate and want to have it, it’s a great thing.”


Kerger says she hopes more viewers will discover “Downton” on whatever format they like best – and then watch it on PBS next season.


“At the end of the day, my interest is just in seeing it get to the widest possible audience, and there are people that would pick it up on Apple that may not pick it up anywhere else,” she said.


The first episode of the third season premiered to a record 7.9 million viewers earlier this month. Many of those viewers, no doubt, caught up on the previous seasons online or through DVD viewing.


“Downton” airs in the U.K. in the fall but on PBS in January, which means PBS viewers must shield themselves from spoilers. That has led to some grumbling from American fans.


But Kerger said airing the show in January allows the show to get more attention domestically than it might otherwise receive in the crowded fall season.


Internet News Headlines – Yahoo! News





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It's a Boy for Elton John




Celebrity Baby Blog





01/15/2013 at 10:00 PM ET



Elton John Welcomes Second Child
George Pimentel/WireImage


Elton John is a father again!


The musician and David Furnish welcomed their second child, son Elijah Joseph Daniel Furnish-John, via surrogate on Friday, Jan. 11 in Los Angeles, the couple confirm to HELLO.


Born at 6:40 p.m., Elijah weighed in at 8 lbs., 4 oz.


John and Furnish, who married in 2005, are already parents to son Zachary Jackson Levon, 2.


“Both of us have longed to have children, but the reality that we now have two sons is almost unbelievable. The birth of our second son completes our family in a most precious and perfect way,” the couple say in a statement.


“It is difficult to fully express how we are feeling at this time; we are just overwhelmed with happiness and excitement.”


John, 65, has been open about his desire to expand their family.


“I know when he goes to school there’s going to be an awful lot of pressure, and I know he’s going to have people saying, ‘You don’t have a mummy,’” says the singer-songwriter of his decision to have another baby.


“It’s going to happen. We talked about it before we had him. I want someone to be at his side and back him up. We shall see.”


– Sarah Michaud


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ER visits tied to energy drinks double since 2007


SAN FRANCISCO (AP) — A new government survey suggests the number of people seeking emergency treatment after consuming energy drinks has doubled nationwide during the past four years, the same period in which the supercharged drink industry has surged in popularity in convenience stores, bars and on college campuses.


From 2007 to 2011, the government estimates the number of emergency room visits involving the neon-labeled beverages shot up from about 10,000 to more than 20,000. Most of those cases involved teens or young adults, according to a survey of the nation's hospitals released late last week by the Substance Abuse and Mental Health Services Administration.


The report doesn't specify which symptoms brought people to the emergency room but calls energy drink consumption a "rising public health problem" that can cause insomnia, nervousness, headache, fast heartbeat and seizures that are severe enough to require emergency care.


Several emergency physicians said they had seen a clear uptick in the number of patients suffering from irregular heartbeats, anxiety and heart attacks who said they had recently downed an energy drink.


More than half of the patients considered in the survey who wound up in the emergency room told doctors they had downed only energy drinks. In 2011, about 42 percent of the cases involved energy drinks in combination with alcohol or drugs, such as the stimulants Adderall or Ritalin.


"A lot of people don't realize the strength of these things. I had someone come in recently who had drunk three energy drinks in an hour, which is the equivalent of 15 cups of coffee," said Howard Mell, an emergency physician in the suburbs of Cleveland, who serves as a spokesman for the American College of Emergency Physicians. "Essentially he gave himself a stress test and thankfully he passed. But if he had a weak heart or suffered from coronary disease and didn't know it, this could have precipitated very bad things."


The findings came as concerns over energy drinks have intensified following reports last fall of 18 deaths possibly tied to the drinks — including a 14-year-old Maryland girl who died after drinking two large cans of Monster Energy drinks. Monster does not believe its products were responsible for the death.


Two senators are calling for the Food and Drug Administration to investigate safety concerns about energy drinks and their ingredients.


The energy drink industry says its drinks are safe and there is no proof linking its products to the adverse reactions.


Late last year, the FDA asked the U.S. Health and Human Services to update the figures its substance abuse research arm compiles about emergency room visits tied to energy drinks.


The Substance Abuse and Mental Health Services Administration's survey was based on responses it receives from about 230 hospitals each year, a representative sample of about 5 percent of emergency departments nationwide. The agency then uses those responses to estimate the number of energy drink-related emergency department visits nationwide.


The more than 20,000 cases estimated for 2011 represent a small portion of the annual 136 million emergency room visits tracked by Centers for Disease Control and Prevention.


The FDA said it was considering the findings and pressing for more details as it undertakes a broad review of the safety of energy drinks and related ingredients this spring.


"We will examine this additional information ... as a part of our ongoing investigation into potential safety issues surrounding the use of energy-drink products," FDA spokeswoman Shelly Burgess said in a statement.


Beverage manufacturers fired back at the survey, saying the statistics were misleading and taken out of context.


"This report does not share information about the overall health of those who may have consumed energy drinks, or what symptoms brought them to the ER in the first place," the American Beverage Association said in a statement. "There is no basis by which to understand the overall caffeine intake of any of these individuals — from all sources."


Energy drinks remain a small part of the carbonated soft drinks market, representing only 3.3 percent of sales volume, according to the industry tracker Beverage Digest. Even as soda consumption has flagged in recent years, energy drinks sales are growing rapidly.


In 2011, sales volume for energy drinks rose by almost 17 percent, with the top three companies — Monster, Red Bull and Rockstar — each logging double-digit gains, Beverage Digest found. The drinks are often marketed at sporting events that are popular among younger people such as surfing and skateboarding.


From 2007 to 2011, the most recent year for which data was available, people from 18 to 25 were the most common age group seeking emergency treatment for energy drink-related reactions, the report found.


"We were really concerned to find that in four years the number of emergency department visits almost doubled, and these drinks are largely marketed to younger people," said Al Woodward, a senior statistical analyst with the Substance Abuse and Mental Health Services Administration who worked on the report.


Emergency physician Steve Sun said he had seen an increase in such cases at the Catholic hospital where he works on the edge of San Francisco's Golden Gate Park.


"I saw one young man who had mixed energy drinks with alcohol and we had to admit him to the hospital because he was so dehydrated he had renal failure," Sun said. "Because he was young he did well in the hospital, but if another patient had had underlying coronary artery disease, it could have led to a heart attack."


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Follow Garance Burke on Twitter at http://twitter.com/garanceburke


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