Today, some morning showers, pe-riodic afternoon rain and thunder,high 66. Tonight, clearing, low 58.Tomorrow, a heavy thunderstorm,high 73. Weather map, Page B16.
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U(D54G1D)y+$!z!,!#!]
BRIDGEPORT, W.Va. — Thedoctors wanted to talk about ill-ness, but the patients — oftenminers, waitresses, tree cuttersand others whose jobs were pun-ishingly physical — wanted to talkonly about how much they hurt.They kept pleading for opioidslike Vicodin and Percocet, the po-tent drugs that can help chronicpain, but that have fueled an epi-demic of addiction and deadlyoverdoses.
“We needed to talk about con-gestive heart failure or diabetesor out-of-control hypertension,”said Dr. Sarah Chouinard, thechief medical officer at Communi-ty Care of West Virginia, whichruns primary care clinics across abig rural chunk of this state. “Butwe struggled over the course of avisit to get patients to focus onany of those.”
Worse, she said, some of the or-ganization’s doctors were pre-scribing too many opioids, oftento people they had grown up within the small towns where theypracticed and whom they were re-luctant to deny. So four years ago,Community Care tried a new ap-proach. It hired an anesthesiolo-gist to treat chronic pain, reliev-ing its primary care doctors andnurse practitioners of their thorn-
iest burden and letting them con-centrate on conditions they feelmore comfortable treating.
Since then, more than 3,000 ofCommunity Care’s 35,000 pa-tients have seen the anesthesiolo-gist, Dr. Denzil Hawkinberry, forpain management, while continu-
ing to see their primary careproviders for other health prob-lems. Dr. Chouinard said Commu-nity Care was doing a better job ofkeeping them well over all, whileletting Dr. Hawkinberry make allthe decisions about who should beon opioid painkillers.
“I’m part F.B.I. investigator,part C.I.A. interrogator, part drillsergeant, part cheerleader,” Dr.Hawkinberry said. He is also a re-covering opioid addict who hasexperienced the difficulties of thedrugs himself.
Treating Pain Without Feeding the Epidemic of Opioid Addiction
By ABBY GOODNOUGH
Dr. Denzil Hawkinberry, a pain specialist in Bridgeport, W.Va., examining Daniel Myers.
RAYMOND THOMPSON JR FOR THE NEW YORK TIMES
Continued on Page A18
Thieves have again found theirway into what was thought to bethe most secure financial messag-ing system in the world and stolenmoney from a bank. The crime ap-pears to be part of a broad onlineattack on global banking.
New details about a second at-tack involving Swift — the mes-saging system used by thousandsof banks and companies to movemoney around the world — areemerging as investigators are stilltrying to solve the $81million heistfrom the central bank ofBangladesh in February. In thattheft, the attackers were able tocompel the Federal Reserve Bankof New York to move money to ac-counts in the Philippines.
The second attack involves acommercial bank, which Swift de-clined to identify. But in a letterSwift plans to share with its userson Friday, the messaging networkwarned that the two attacks borenumerous similarities and werevery likely part of a “wider andhighly adaptive campaign target-ing banks.”
The unusual warning fromSwift, a copy of which was re-viewed by The New York Times,shows how serious the financialindustry regards these attacks tobe. Some banking experts saythey may be impossible to solve ortrace. Swift said the thieves some-how got their hands on legitimatenetwork credentials, initiated thefraudulent transfers and installedmalware on bank computers todisguise their movements.
“The attackers clearly exhibit adeep and sophisticated knowl-
Global Network
Exploited Again
In a Bank Theft
By MICHAEL CORKERY
Continued on Page B6
LOS ANGELES — Dozens ofRussian athletes at the 2014 Win-ter Olympics in Sochi, including atleast 15 medal winners, were partof a state-run doping program,meticulously planned for years toensure dominance at the Games,according to the director of thecountry’s antidoping laboratoryat the time.
The director, Grigory Rod-chenkov, who ran the laboratorythat handled testing for thou-sands of Olympians, said he haddeveloped a three-drug cocktail ofbanned substances that he mixedwith liquor and provided todozens of Russian athletes, help-ing to facilitate one of the mostelaborate — and successful —doping ploys in sports history.
It involved some of Russia’s big-gest stars of the Games, including14 members of its cross-countryski team and two veteran bobsled-ders who each won two golds.
In a dark-of-night operation,Russian antidoping experts andmembers of the intelligence serv-ice surreptitiously replaced urinesamples tainted by performance-enhancing drugs with clean urinecollected months earlier, some-how breaking into the supposedlytamper-proof bottles that are thestandard at international compe-titions, Dr. Rodchenkov said. Forhours each night, they worked in ashadow laboratory lit by a singlelamp, passing bottles of urinethrough a hand-size hole in thewall, to be ready for testing thenext day, he said.
By the end of the Games, Dr.Rodchenkov estimated, as many
as 100 dirty urine samples wereexpunged.
None of the athletes werecaught doping. More important,Russia won the most medals of theGames, easily surpassing its mainrival, the United States, and un-dermining the integrity of one ofthe world’s most prestigioussporting events.
“People are celebratingOlympic champion winners, butwe are sitting crazy and replacingtheir urine,” Dr. Rodchenkov said.“Can you imagine how Olympicsport is organized?”
After The New York Timesasked Russian officials to respondto the claims, Russia’s sports min-ister, Vitaly Mutko, released astatement to the news media call-ing the revelations “a con-tinuation of the information attack
AN INSIDER IN SOCHI
TELLS HOW RUSSIA
BEAT DOPING TESTS
Shadow Lab Used to Replace Tainted
Samples in 2014 Olympic Quest
By REBECCA R. RUIZ and MICHAEL SCHWIRTZ
Sample bottles, assumed to betamper-proof, were breached.
TONY CENICOLA/THE NEW YORK TIMES
Continued on Page B10
Dilma Rousseff acknowledged supporters after Brazil’s Senate voted to suspend her on Thursday.
ERALDO PERES/ASSOCIATED PRESS
BRASÍLIA — The new Brazil-ian president’s first pick for sci-ence minister was a creationist.He chose a soybean tycoon whohas deforested large tracts of theAmazon rain forest to be his agri-culture minister. And he is the firstleader in decades to have no wom-en in his cabinet at all.
The new government of Presi-dent Michel Temer — the 75-year-old lawyer who took the helm ofBrazil on Thursday after his pred-ecessor, Dilma Rousseff, was sus-pended by the Senate to face animpeachment trial — could causea significant shift to the politicalright in Latin America’s largestcountry.
“Temer’s government is start-ing out well,” Silas Malafaia, a tele-vision evangelist and author ofbest-selling books like “How toDefeat Satan’s Strategies,” wroteon Twitter.
“He’ll be able to sweep away the
ideology of pathological leftists,”Mr. Malafaia added of a conserva-tive lawmaker whom Mr. Temerchose as education minister.
For more than a decade, Brazilhas been an anchor of leftist poli-tics in the region, less stridentthan the governments in coun-tries like Venezuela and Cuba, butopenly supportive of them andcommitted to its own platform ofreducing inequality.
But parts of Latin America arenow drifting away from the left af-ter elections in neighboring coun-tries like Argentina and Paraguay.Mr. Temer seems to be embracinga more conservative dispositionfor his government as well, with
the country’s business establish-ment pressuring him to privatizestate-controlled companies andcut public spending.
To many of Mr. Temer’s critics,the shift is perhaps most evidentin the role of women in his and Ms.Rousseff’s administrations.
The contrasts could not be moreglaring. Ms. Rousseff, 68, was aformer operative in an urbanguerrilla group. She was torturedduring the military dictatorshipand eventually rose to lead theboard of the national oil companybefore becoming Brazil’s first fe-male president.
Until recently, relatively fewBrazilians had even heard of Mr.
New Leader in Brazil Hints at a Tilt to the Right
By SIMON ROMERO All-Male Cabinet and
Other Shifts Amid
an Impeachment
Continued on Page A11
The suspension of the presidentof Brazil was a blow to her Work-ers’ Party, which had governedthe country for 13 years. Page A10.
A Party’s Rise and Fall
WASHINGTON — Donald J.Trump and Speaker Paul D. Ryanappeared to take half a step backfrom their political standoff onThursday, as Mr. Trump touredWashington for a swirl of meet-ings with Republican lawmakersconcerned about the direction ofhis presidential campaign.
In public, Mr. Ryan praised Mr.Trump, the presumptive Republi-can presidential nominee, as“warm and genuine,” and de-clared that a process of reconcilia-tion was underway. Behind closeddoors, Mr. Trump pulled back histhreat to remove Mr. Ryan aschairman of the Republican Na-tional Convention, and offered tohelp elect the party’s candidatesrunning for the House and theSenate.
Significant fissures remain be-tween Mr. Trump and Republicancongressional leaders: Mr. Ryanreminded the candidate privatelythat many voters opposed him inthe primaries, and in a separatemeeting with senators, severallawmakers urged Mr. Trump tomodulate his tone on immigration.
But the abrupt shift in posturetoward Mr. Trump, especiallyfrom Mr. Ryan, represented a re-markable turnaround. Only aweek ago, Mr. Ryan took the un-usual step of announcing on tele-vision that he was “just not readyto support” Mr. Trump. (Mr.Trump responded that he was“not ready to support SpeakerRyan’s agenda.”)
On Thursday, Mr. Ryan ap-peared to be cautiously leaning in
Signs of Thaw
In Trump Visit
With Speaker
By JENNIFER STEINHAUERand ALEXANDER BURNS
Continued on Page A16
Dean G. Skelos, left, the once powerfulRepublican majority leader of the NewYork State Senate who was convictedwith his son on corruption charges, wassentenced to five years in prison. Hisson got six and a half years. PAGE A19
NEW YORK A19-24
Prison Term for Ex-Lawmaker
The family of Joan Rivers has reached asettlement with the doctors and a clinicin a malpractice suit over thecomedian’s death in 2014. PAGE A20
NEW YORK
Suit Settled in Rivers’s DeathClimate changes are reducing the foodsupplies available to the red knot shore-bird and are shrinking the size of itsflocks, researchers have found. PAGE A8
INTERNATIONAL A3-12
Winged Heralds of Peril
It’s early in the season, but the ChicagoCubs are playing like a juggernaut andaiming for the World Series. PAGE B8
SPORTSFRIDAY B8-13, 16
Fear the Cubs. Yes, the Cubs.
George Zimmerman listed the gun heused to kill Trayvon Martin in Florida in2012 on an auction site online, with a$5,000 starting bid. The sale attractedthe latest round of widespread, scathingcriticism for Mr. Zimmerman. PAGE A13
NATIONAL A13-18
Notorious Gun Put Up for Sale
The Cannes Film Festival continues itslong tradition of cinema and silliness. Areport by Manohla Dargis. PAGE C1
WEEKEND ARTS C1-26
Movies Most Marvelous
“Roberto Burle Marx” is an eye-open-ing survey of this modernist’s work. Areview by Holland Cotter. PAGE C19
About the Brazilian Landscape
Ted Cruz PAGE A27
EDITORIAL, OP-ED A26-27
The social media network releasedrules for its editors as it tried to rebutaccusations of political bias. PAGE B1
Facebook’s Editorial Rules
WASHINGTON — The Obamaadministration is planning to is-sue a sweeping directive tellingevery public school district in thecountry to allow transgender stu-dents to use the bathrooms thatmatch their gender identity.
A letter to school districts willgo out Friday, adding to a highlycharged debate over transgenderrights in the middle of the admin-istration’s legal fight with NorthCarolina over the issue. The decla-ration — signed by Justice andEducation department officials —will describe what schools shoulddo to ensure that none of their stu-dents are discriminated against.
It does not have the force of law,but it contains an implicit threat:Schools that do not abide by theObama administration’s interpre-tation of the law could face law-suits or a loss of federal aid.
The move is certain to drawnew criticism, particularly fromRepublicans, that the federal gov-ernment is wading into local mat-ters and imposing its own valueson communities across the coun-try that may not agree. It repre-sents the latest example of theObama administration using acombination of policies, lawsuitsand public statements to changethe civil rights landscape for gays,lesbians, bisexual and transgen-der people.
After supporting the rights ofgay people to marry, allowingthem to serve openly in the mili-tary and prohibiting federal con-tractors from discriminatingagainst them, the administrationis wading into the battle over bath-rooms and siding with transgen-der people.
“No student should ever have togo through the experience of feel-ing unwelcome at school or on acollege campus,” John B. King Jr.,the secretary of the Departmentof Education, said in a statement.“We must ensure that our young
U.S. ISSUES NOTICE ON STUDENTS WHOARE TRANSGENDER
ACCESS TO BATHROOMS
A Directive to Public
Schools to Safeguard
Gender Identity
By JULIE HIRSCHFELD DAVISand MATT APUZZO
Continued on Page A18
Pope Francis said a commission wouldstudy whether women could be deaconsin the Roman Catholic Church. PAGE A12
Pope to Mull Female Deacons
The tech giant said it was investing inDidi Chuxing, the pre-eminent ride-hailing service in China. PAGE B1
BUSINESS DAY 1-7
Apple Bets $1 Billion on China
VOL. CLXV . . . No. 57,231 © 2016 The New York Times NEW YORK, FRIDAY, MAY 13, 2016
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