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WASHINGTON (AP) — The late Supreme Court Justice Antonin Scalia's voluminous public information file is remarkably short on any details related to his health, just a report of minor shoulder surgery in 2003.
But Scalia's doctor said in a letter, parts of which were read to The Associated Press on Tuesday, that the justice suffered from coronary artery disease, diabetes, chronic obstructive pulmonary disease, sleep apnea, high blood pressure and several other ailments that probably contributed to his death on Feb. 13 at age 79.
The public and reporters who cover the court were unaware that Scalia had any serious health problems before his death, except that he was overweight and was a regular smoker for most of his adult life.
That so little was known publicly about Scalia's health is reflective of an institution that zealously guards the justices' privacy and leaves to each justice how much to reveal.
Justices, especially older ones with serious health problems, might have little reason to say much of anything, said A.E. Dick Howard, a Supreme Court expert at the University of Virginia.
"The decision about what to say about a justice's health has to be seen against a backdrop of whether to stay on the bench or step down," Howard said.
Scalia, a conservative justice who was named to the court by Republican President Ronald Reagan, gave no indication he was planning to retire, certainly not with a Democrat in the White House.
There has been no indication that people close to Scalia, on the court or off, knew the extent or seriousness of his medical problems. The other justices said they were shocked by his death. Bryan Garner, who wrote two books with the justice, said Scalia was energetic and "did seem strong as ever" during a trip to Asia two weeks before he died.
Like society at large, the court lives with a range of trivial and serious ailments. Eighty-two-year-old Supreme Court Justice Ruth Bader Ginsburg has twice survived cancer and had a heart stent implanted to clear a blocked artery. Justice Anthony Kennedy also has a stent. Chief Justice John Roberts has suffered at least two unexplained seizures. Justice Sonia Sotomayor has had diabetes since childhood. Justice Stephen Breyer smashed his shoulder so thoroughly in a bicycle accident, it needed to be replaced.
The difference among the justices is how much they have revealed about their health and how promptly.
Breyer, Ginsburg and Sotomayor have provided prompt and extensive details about their conditions.
Other justices have not been as forthcoming. Kennedy said nothing publicly when he had a stent inserted to keep an artery open after experiencing mild chest pain in 2005. The court revealed the procedure when Kennedy returned to the hospital to have the stent replaced 10 months later.
Stents are mesh scaffoldings inserted into about half a million people in the U.S. each year to prop open arteries clogged by years of cholesterol buildup. Doctors guide a narrow tube through a blood vessel in the groin or an arm, inflate a tiny balloon to flatten the blockage, and then push the stent into place.
In July 2007, Roberts suffered a seizure while on vacation in Maine. The court issued an initial statement little more than an hour after the incident, saying only that Roberts had fallen and was taken to a hospital.
Several hours later, the court confirmed that he had suffered a seizure, but has never provided details of what tests Roberts underwent or whether he was prescribed medication. He had a similar episode in 1993.
In Scalia's case, there was no public word of a significant health issue before his death.
The report of his extensive medical problems was contained in a letter from Rear Adm. Brian P. Monahan, the attending physician for members of Congress and the Supreme Court, to the top administrator in Presidio County, Texas, where Scalia died. The official, Presidio County Judge Cinderela Guevara, conducted a death inquiry by phone and certified Scalia's death.
Guevara declined to order an autopsy after learning of Scalia's long list of health problems from Monahan and because the family didn't want one, she said.
Presidio County District Attorney Rod Ponton cited the letter when he told the AP on Tuesday there was nothing suspicious about Scalia's death.
Ponton declined to provide a copy of the letter, saying an open-records request must be made to Guevara, who did not respond to a phone message Tuesday.
The AP filed a records request with the judge last week, but she did not provide the letter or respond to a reporter's phone message Tuesday. The Texas Department of State Health Services has declined to release a copy of the death certificate. A death certificate is confidential under Texas law and can be released only with the family's permission.
PLAINWELL, Mich. (AP) — A man accused of randomly killing six people in Michigan had a personal cache of weapons that included handguns and long guns, but there was nothing in his past that prevented him from owning as many guns as he could afford.
Authorities seized the gun collection after the weekend attacks around the Kalamazoo area. With no criminal history or record of mental illness, Michigan residents who follow requirements can legally acquire any number of firearms.
"He was a law-abiding citizen up until he pulled the trigger on the first victim," said Jonathan Southwick, owner of a gun store in Plainwell, 20 miles north of Kalamazoo. "There are no laws you could put into place to stop what had happened."
Southwick said Dalton bought a jacket with an inside pocket designed for a handgun Saturday, just hours before the rampage. He did not buy a gun.
"He talked with my manager for a bit, was laughing and joking a bit, gave him a one-armed hug — then proceeded to purchase the jacket and said he was going out to enjoy the weather," Southwick recalled Tuesday.
Dalton did not have a permit to carry a concealed weapon, Undersheriff Paul Matyas said.
When Southwick later heard about the deadly attacks, it was "definitely a shock," he said.
Dalton, 45, is charged with murder and attempted murder. He's accused of killing six people and injuring two more outside an apartment building, a restaurant and a car dealership, pausing between shootings to make money as an Uber driver.
Prosecutor Jeff Getting said the weapon appeared to be a 9 mm semi-automatic handgun.
President Barack Obama, referring to the Kalamazoo shootings, said, "clearly we're going to need to do more if we're going to keep innocent Americans safe." His gun-control efforts after several mass shootings, including attacks on a Connecticut school and a South Carolina church, have been rebuffed by Congress.
In Michigan's Capitol, Rep. Joe Hoadley, a Democrat from Kalamazoo, said gun violence is a critical concern among his constituents. He's supporting bills to restrict open carrying of guns in certain public places and to require more background checks at gun shows. Those bills are unlikely to get a hearing in a Legislature controlled by conservative Republicans.
"There may not have been a way to stop a person from doing evil," Hoadley said of the Kalamazoo shootings. "But that should not derail a conversation about what we can do overall to reduce gun violence."
Kristen Moore, a University of Michigan math professor and member of Moms Demand Action for Gun Sense in America, said the shootings could be a "tipping point" to get lawmakers and the public to embrace a "need to do more."
But Republican state Rep. Triston Cole said Michigan's gun laws aren't lenient. He notes that the state is among only a handful in which owners must register handguns with local police.
"It's really important that we recognize this awful, senseless tragedy," Cole said. "But you need to look at good policy and not react based on emotion to infringe upon our right to own firearms."
JOAO PESSOA, Brazil (AP) — Teams of U.S. and Brazilian health workers ventured into dicey slums, fought through snarled traffic and braved torrential downpours on the first day of their effort to determine if the Zika virus is causing babies to be born with a birth defect affecting the brain.
The eight teams, each made up of one "disease detective" from the U.S. Centers for Disease Control and Prevention and three Brazilian health workers, went to work Tuesday in Paraiba, the impoverished state in northeastern Brazil that is one of the epicenters of the country's tandem outbreaks of Zika and microcephaly.
Their goal is to persuade about 100 mothers of infants recently born with the defect as well to enroll in the study. They also need participation as controls of two to three times as many mothers from the same areas who delivered babies without microcephaly at about the same time.
The study aims to determine if the Brazilian government is right that Zika can cause microcephaly, or whether the mosquito-borne virus is not in fact to blame or is only partially responsible, as a growing chorus of doctors in Brazil and beyond have begun to suggest.
The seemingly straightforward task of locating the women and infants was fraught on day one by traffic jams, logistical snags and menacing weather, though the teams soldiered stoically on.
Stuck in the chronic gridlock of the state capital, Joao Pessoa, one team missed its first appointment, and the two home visits that it had scheduled for morning didn't get underway until well after lunchtime.
"Obviously, we've seen the problems of logistics — to be able to reach the families, to have them be there," said Dr. Alexia Harrist, a Boston-born pediatrician who works for the CDC's Epidemic Intelligence Service. "If things take longer, things take longer, but I think we're all really dedicated to getting it done."
Packed into a small sedan, Harrist, three Brazilian health workers and a driver weaved from the CDC's headquarters in a beachfront hotel to the outskirts of Joao Pessoa along pothole-marred streets swimming with runoff from recent rains.
They turned onto a side street lined with trash, then turned again and again onto successively narrower and more pocked streets that carried them deep into the heart of the Taipa shantytown. The Aedes aegypti mosquito that spreads Zika proliferates in such neighborhoods, where omnipresent trash provides breeding grounds in discarded margarine tubs, yogurt containers and plastic bottle caps.
When the going got too rough, Harrist and her colleagues parked and headed on foot along a dirt road running with raw sewage and dotted by foraging chickens and goats to a three-room cinderblock home.
Janine dos Santos, a 23-year-old unemployed former towel factory worker, shares the space with her mother, two siblings and two children, including Shayde Henrique — born in November with the truncated head and brain damage caused by microcephaly.
"I didn't expect to see all these people," Santos said, adding that the visit renewed her hopes of understanding what happened to Shayde. "Not only me, but all the mothers, we want to understand the mystery behind all this — what really causes microcephaly?"
She and the family answered an extensive questionnaire probing everything from whether she used insect repellent during pregnancy to what was the source of their drinking water. The team also drew blood samples from mother and infant, setting off screams from a child who, like many infants with microcephaly, is rarely quiet.
Down the street, the team knocked at an abandoned warehouse where another new mother, 26-year-old Aline Ferreira, squats with her fisherman husband and three kids.
Her 4-month-old, Angeline Karolayne, is in good health and doesn't suffer from microcephaly, and Ferreira agreed to take part in the study as a control case. Such cases will be a critical element in understanding whether Zika is triggering microcephaly and, if so, whether it's doing so alone or with contributing factors.
Ferreira patiently responded to the litany of questions. "When I was pregnant, there were all these problems with Zika and microcephaly and ... I could very well be in the place of any mother whose baby has microcephaly," she said.
Organizers expect it will take a month to gather data, but acknowledge it could take longer. Ferreting out results from the data will take several more months.
Despite Tuesday's rocky start, the CDC's Harrist said the generosity and openness of the two young mothers her team managed to contact gave her hope.
"I'm actually encouraged by what happened today," said Harrist, who worked in Sierra Leone during the Ebola outbreak in West Africa.
She said Santos and Ferreira seemed enthusiastic to join in the study. "I hope that means they think that the study is important," she said.