Well: Ask Well: Squats for Aging Knees

You are already doing many things right, in terms of taking care of your aging knees. In particular, it sounds as if you are keeping your weight under control. Carrying extra pounds undoubtedly strains knees and contributes to pain and eventually arthritis.

You mention weight training, too, which is also valuable. Sturdy leg muscles, particularly those at the front and back of the thighs, stabilize the knee, says Joseph Hart, an assistant professor of kinesiology and certified athletic trainer at the University of Virginia, who often works with patients with knee pain.

An easy exercise to target those muscles is the squat. Although many of us have heard that squats harm knees, the exercise is actually “quite good for the knees, if you do the squats correctly,” Dr. Hart says. Simply stand with your legs shoulder-width apart and bend your legs until your thighs are almost, but not completely, parallel to the ground. Keep your upper body straight. Don’t bend forward, he says, since that movement can strain the knees. Try to complete 20 squats, using no weight at first. When that becomes easy, Dr. Hart suggests, hold a barbell with weights attached. Or simply clutch a full milk carton, which is my cheapskate’s squats routine.

Straight leg lifts are also useful for knee health. Sit on the floor with your back straight and one leg extended and the other bent toward your chest. In this position, lift the straight leg slightly off the ground and hold for 10 seconds. Repeat 10 to 20 times and then switch legs.

You can also find other exercises that target the knees in this video, “Increasing Knee Stability.”

Of course, before starting any exercise program, consult a physician, especially, Dr. Hart says, if your knees often ache, feel stiff or emit a strange, clicking noise, which could be symptoms of arthritis.

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India Ink: Jeet Thayil's Novel of Opium and Bombay Takes DSC Prize

Jeet Thayil, an Indian poet and author, won the DSC Prize for South Asian Literature at the Jaipur Literature Festival on Friday for his debut novel “Narcopolis.”

“Finally!” Mr. Thayil exclaimed when he was presented the award. His book, about the narcotic underbelly of Bombay 30 years ago, had been short-listed for four awards, but never won any.

The award is special because it is an Indian prize, he said. “How you are perceived at home does matter,” he said.

The Kerala-born author will take home a $50,000 prize purse. Mr. Thayil noted that it was a substantial amount of money, and part of the reason that the award was taken seriously.

“Writers like money,” he said. “We don’t have a job, but we have bills to pay.”

Mr. Thayil is the first Indian to win the award since its introduction by the infrastructure company DSC Limited in 2010. The first winner was a Pakistani writer, H.M. Naqvi, for his debut novel the “Home Boy.” Last year the Sri Lankan author Shehan Karunatilake’ s novel “Chinaman” won the prize.

A five-member jury received more than 80 entries for the prize, including translations of non-English writing. The contest is open to any writing about South Asia, not just to South Asian writers. The Indian poet and literary critic K. Satchidanandan, who led the jury, said, the award is significant because it is the first award that honors literary works about South Asia.

Other finalists included two Indians, two Pakistanis and a Bangladeshi writer.

Jamil Ahmed, a Pakistani author whose book, “The Wandering Falcon,” was a finalist, said that it took 40 years to publish the book. The retired bureaucrat wrote about the tribal population living along the Pakistan-Afghanistan border. He was born in pre-partition India and during his childhood he traveled across India with his family. That was when he said he first came in contact with tribes, which led him to “romanticize the tribes.”

“I want people to understand that tribes are not savage,” he said.

A work by the Indian author Uday Prakash, “The Walls of Delhi,” was also a finalist. The book, actually three novellas, was originally written in Hindi. The stories highlight the flaws of the state, including bureaucracy and the deep entrenchment of corruption, and it is narrated by three characters, a weaver, sweeper and a baby in a slum suffering from an undiagnosed disease. Mr. Prakash said these narratives symbolized the lives led by 70 percent Indians.

Other finalists included the Indian writer Amitav Ghosh for his book “River of Smoke,” the Pakistani writer Mohammed Hanif, for “Our Lady of Alice Bhatti” and Tahmima Anam, the author of “The Good Muslim,” from Bangladesh.

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Terrorists Knocked Off Twitter After Threats

The Twitter account belonging to a self-identified spokesperson for an al Qaeda-allied terrorist organization has been suspended.

The account, which began in late 2011 and is believed to belong to a representative of al-Shabaab, a Somalia-based terrorist organization, is currently out of service, days after it threatened the lives of Kenyan hostages, according to a report by The Associated Press.

Representatives for Twitter declined to comment on exactly when or why al-Shabaab’s account was suspended, due to “privacy and security reasons,” but under “Twitter Rules,” the company writes on its website that “you may not publish or post direct, specific threats of violence against others.”

In addition to the reported threats against the Kenyans, earlier this month the same account posted a long missive about France’s failed attempt to rescue a French intelligence agent codenamed Denis Allex and posted images of another man it said was a French special operations soldier who was killed in the doomed raid. The statement said the group had reached a “verdict” on what to do about Allex and, a few days later, al-Shabaab said they planned to execute the spy. Then, using Twitter, they announced Allex was dead.

READ: Terrorists Say They’ll ‘Execute’ Spy Who May Already Be Dead

The account, along with those of other terrorist organizations, for years has provided a window, tinted by propaganda, into the group, its ambitions and inner troubles – a resource for journalists and, presumably, interested intelligence agencies.

For instance, in March 2012, Twitter was the forum al-Shabaab used to deny it had arrested or was trying to kill its most high-profile member, Omar Hammami, a rapping American jihadist who goes by the nom de guerre Abu Mansoor al-Amriki. Hammami had taken to the internet to describe, in detail, a fissure within the terror group. He may himself be operating another Twitter account with which he engages in long exchanges about the state of jihadism in Somalia.

In September 2011, ABC News reported on a curious public spat that emerged between NATO forces and the Taliban – all over Twitter. Lebanon-based Hezbollah, considered a terrorist organization by the U.S. government, also has a media arm that Tweets frequently.

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Armstrong meeting with USADA appears unlikely

AUSTIN, Texas (AP) — Lance Armstrong's lawyers say the cyclist will talk more about drug use in the sport, just likely not to the U.S. Anti-Doping Agency that led the effort to strip him of his Tour de France titles.

In a testy exchange of letters and statements revealing the gulf between the two sides, USADA urged Armstrong to testify under oath to help "clean up cycling."

Armstrong's attorneys responded that the cyclist would rather take his information where it could do more good — namely to cycling's governing body and World Anti-Doping Agency officials.

USADA's response to that: "The time for excuses is over."

The letters, obtained Friday by The Associated Press, underscore the continuing feud between Armstrong and USADA CEO Travis Tygart, the man who spearheaded the investigation that uncovered a complex doping scheme on Armstrong's U.S. Postal Service teams.

Armstrong's seven Tour de France victories were taken away last year and he was banned for life from the sport.

In an interview with Oprah Winfrey last week, Armstrong admitted doping, said he owed a long list of apologies and that he would like to see his lifetime ban reduced so he can compete again.

His most realistic avenue toward that might be telling USADA everything he knows in a series of interviews the agency wants started no later than Feb. 6.

That seems unlikely.

Armstrong attorney Tim Herman responded to USADA's first letter, sent Wednesday, by saying his client's schedule is already full, and besides, "in order to achieve the goal of 'cleaning up cycling,' it must be WADA and the (International Cycling Union) who have overall authority to do so."

By Friday night, Herman strongly suggested Armstrong won't meet with USADA at all but intends to appear before the UCI's planned "truth and reconciliation" commission.

"Why would we cooperate (with USADA)?" Herman said in a telephone interview. "USADA isn't interested in cleaning up cycling. Lance has said, 'I'll be the first guy in the chair when cycling is on trial, truthfully, under oath, in every gory detail.' I think he's going testify where it could actually do some good: With the body that's charged with cleaning up cycling," Herman said.

In its last letter to Armstrong, sent Friday evening, USADA attorney William Bock said his agency and WADA work hand-in-hand in that effort.

"Regardless, and with or without Mr. Armstrong's help, we will move forward with our investigation for the good of clean athletes and the future of sport," Bock's letter reads.

The letters confirm a Dec. 14 meeting in Denver involving Armstrong, Tygart and their respective attorneys, which is when, in Tygart's words, Armstrong should have started thinking about a possible meeting with USADA.

"He has been given a deadline of February 6th to determine whether he plans to come in and be part of the solution," Tygart said in a statement. "Either way, USADA is moving forward with our investigation on behalf of clean athletes."

The letters were sent to the AP after details about a Tygart interview with "60 Minutes," being aired Sunday, were made public.

Among Tygart's claims: Armstrong is lying when he says he didn't dope during his 2009-10 comeback.

Tygart said USADA's report on Armstrong's doping included evidence Armstrong was still cheating in those years.

"His comeback was totally clean," Herman said. "It's pretty fashionable to kick Lance Armstrong around right now."

Tygart also reiterated that an Armstrong associate offered USADA a donation of more than $200,000. Armstrong denied that in his interview with Winfrey, too.

In advancing his claim that USADA is only a bit player in the investigation, Herman noted in his letter, sent to USADA on Friday, that most cycling teams are based in Europe.

"I'm pretty sick of people trying to blame a European cycling culture that goes back to the 1920s on one guy," Herman said.

Bock's response to that: "Your suggestion that there is some other body with which Lance should coordinate is misguided," he said in his final letter.

___

AP National Writer Eddie Pells contributed to this report.

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40 Years After Roe v. Wade, Thousands March to Oppose Abortion

Drew Angerer/The New York Times

Pro-life activists made their way down Constitution Avenue toward the Supreme Court during the March for Life in Washington on Friday.

WASHINGTON — Three days after the 40th anniversary of the decision in Roe v. Wade, the landmark Supreme Court case that legalized abortion, tens of thousands of abortion opponents from around the country came to the National Mall on Friday for the annual March for Life rally, which culminated in a demonstration in front of the Supreme Court building.

On a gray morning when the temperature was well below freezing, the crowd pressed in close against the stage to hear more than a dozen speakers, who included Tony Perkins, the president of the Family Research Council; Representative Diane Black, Republican of Tennessee, who recently introduced legislation to withhold financing from Planned Parenthood, and Senator Rand Paul, Republican of Kentucky; Cardinal Seán Patrick O’Malley of Boston; and Rick Santorum, the former senator from Pennsylvania and Republican presidential candidate.

Mr. Santorum spoke of his wife’s decision not to have an abortion after they learned that their child — their daughter Bella, now 4 — had a rare genetic disorder called Trisomy 18.

“We all know that death is never better, never better,” Mr. Santorum said. “Bella is better for us, and we are better because of Bella.”

Jeanne Monahan, the president of the March for Life Education and Defense Fund, said that the march was both somber and hopeful.

“We’ve lost 55 million Americans to abortion,” she said. “At the same time, I think we’re starting to win. We’re winning in the court of public opinion, we’re winning in the states with legislation.”

Though the main event officially started at noon, the day began much earlier for the participants, with groups in matching scarves engaged in excited chatter on the subway and gaggles of schoolchildren wearing name tags around their necks. Arriving on the Mall, attendees were greeted with free signs (“Defund Planned Parenthood” and “Personhood for Everyone”) and a man barking into a megaphone, “Ireland is on the brink of legalizing abortion, which is not good.”

The march came two months after the 2012 campaign season, in which social issues like abortion largely took a back seat to the focus on the economy. But the issue did come up in Congressional races in which Republican candidates made controversial statements about rape or abortion. In Indiana, Richard E. Mourdock, a Republican candidate for the Senate, said in a debate that he believed that pregnancies resulting from rape were something that “God intended,” and in Illinois, Representative Joe Walsh said in a debate that abortion was never necessary to save the life of the mother because of “advances in science and technology.” Both men lost, hurt by a backlash from female voters.

Recent polls show that while a majority of Americans do not want Roe v. Wade to be overturned entirely, many favor some restrictions. In a Gallup poll released this week, 52 percent of those surveyed said that abortions should be legal only under certain circumstances, while 28 percent said they should be legal under all circumstances, and 18 percent said they should be illegal under all circumstances. In a Pew poll this month, 63 percent of respondents said they did not want Roe v. Wade to be overturned completely, and 29 percent said they did — views largely consistent with surveys taken over the past two decades.

“Most Americans want some restrictions on abortion,” Ms. Monahan said. “We see abortion as the human rights abuse of today.”

Speaker John A. Boehner of Ohio, who spoke via a recorded video, called on the protest group, particularly the young people, to make abortion “a relic of the past.”

“Human life is not an economic or political commodity, and no government on earth has the right to treat it that way,” he said.

The crowd was dotted with large banners, many bearing the names of the attendees’ home states and churches and colleges. Gary Storey, 36, stood holding a handmade sign that read “I was adopted. Thanks Mom for my life.” Next to him stood his adoptive mother, Ellen Storey, 66, who held her own handmade sign with a picture of her six children and the words “To the mothers of our four adopted children, ‘Thank You’ for their lives.”

Mr. Storey said he was grateful for the decision by his biological mother to carry through with her pregnancy. “Beats the alternative,” he joked.

Last week, the Planned Parenthood Federation of America started a new Web site, and on Tuesday, its president, Cecile Richards, released a statement supporting abortion rights.

“Planned Parenthood understands that abortion is a deeply personal and often complex decision for a woman to consider, if and when she needs it,” she said. “A woman should have accurate information about all of her options around her pregnancy. To protect her health and the health of her family, a woman must have access to safe, legal abortion without interference from politicians, as protected by the Supreme Court for the last 40 years.”

This article has been revised to reflect the following correction:

Correction: January 25, 2013

A summary that appeared on the home page of NYTimes.com with an earlier version of this article misstated the day of the march. It took place on Friday, not Thursday.

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Labor Relations Board Rulings Could Be Undone

By ruling that Mr. Obama’s three recess appointments last January were illegal, the federal appeals court ruling, if upheld, would leave the board with just one member, short of the quorum needed to issue any rulings. The Obama administration could appeal the court ruling, but no announcement was made on Friday.

If the Supreme Court were to uphold Friday’s ruling, issued by the United States Court of Appeals for the District of Columbia Circuit, it would mean that the labor board did not have a quorum since last January and that all its rulings since then should be nullified.

Many Republicans and business groups applauded Friday’s ruling. They often assert that the appointments Mr. Obama made to the board have transformed it into a tool of organized labor. But many Democrats and labor unions say Mr. Obama’s appointments restored ideological balance to the board after it was tipped in favor of business interests under President George W. Bush

Mark G. Pearce, the board’s chairman, issued a statement saying the board disagreed with the ruling and suggested that other appeals courts hearing cases about the constitutionality of Mr. Obama’s appointments could reach a different conclusion.

“In the meantime, the board has important work to do,” said Mr. Pearce, whose agency oversees enforcement of the laws governing strikes and unionization drives. “We will continue to perform our statutory duties and issue decisions.”

Unless the Senate confirms future nominees to the board — Senate Republicans have blocked several of Mr. Obama’s board nominees — Mr. Pearce will be the only member left if Friday’s ruling is upheld. The board has five seats.

Representative Darrell Issa, a California Republican who is the chairman of the Oversight and Government Reform Committee, issued a statement that urged the recess appointees to “do the right thing and step down.” He added, “To avoid further damage to the economy, the N.L.R.B. must take the responsible course and cease issuing any further opinions until a constitutionally sound quorum can be established.”

The three disputed recess appointees included two Democrats, Sharon Block, deputy labor secretary, and Richard Griffin, general counsel to the operating engineers’ union; and one Republican, Terence Flynn, a counsel to a board member. Mr. Flynn resigned last May after being accused of leaking materials about the group’s deliberations. Another Republican member, Brian Hayes, stepped down when his term expired last month.

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North Korea Turns Its Ire on the South

SEOUL, South Korea — North Korea threatened on Friday to take “physical countermeasures” against South Korea if it helps enforce sanctions against the besieged North, calling the United Nations-endorsed penalties a “declaration of war” and warning of a prolonged chill in the relations between the two Koreas.

North Korea’s confrontational posture was likely to significantly limit room for the South’s incoming conservative president, Park Geun-hye, to make overtures for reconciliation with the North; like the outgoing President Lee Myung-bak and President Obama in the United States, Mr. Park considers the dismantling of the North’s nuclear program the premise in all South Korea’s diplomacy toward the North. Since her December election, she has said she would not tolerate the North’s nuclear program and would deal sternly with North Korean provocations.

In a statement issued in the name of its Committee for the Peaceful Reunification of the Fatherland, which manages relations with South Korea, North Korea gave no hint of what those countermeasures might be. While its earlier pronouncements more often than not turned out to be bluster, North Korea does have a history of following up some with unexpected military attacks — most recently, its shelling of a border island in 2010 that left four South Koreans dead. It was also blamed for sinking a South Korean warship the same year, leaving 46 sailors dead.

Those two incidents brought the two Koreas closer to waging a full-scale war than ever in recent decades, dispelling Washington’s desire to engage North Korea in serious negotiation. While calling for a vigorous enforcement of U.N. sanctions, Glyn Davies, Washington’s special envoy on North Korea, also appealed to the North’s new leader, Kim Jong-un, not to miss the opportunities for a new beginning, stressing that Washington cannot improve ties with Pyongyang without progress in inter-Korean relations.

North Korea outburst against South Korea on Friday in the latest installment of a verbal barrage it has launched since the United Nations Security Council on Tuesday unanimously adopted a resolution condemning North Korea’s Dec. 12 rocket launching. The resolution called the rocket a violation of earlier U.N. resolutions banning it from testing ballistic missile technology, and called for tightening sanctions against the country.

“If the puppet group of traitors takes a direct part in the U.N. ‘sanctions,’ the D.P.R.K. will take strong physical countermeasures against it,” North Korea said, using the nickname it often uses for the South Korean government and the acronym of its official name, the Democratic People’s Republic of Korea. “‘Sanctions’ mean a war and a declaration of war against us.”

The U.N. resolution was the fifth to be slapped on the North for its rocket and nuclear programs since 1993. It calls for tightening existing sanctions, such as expanding a travel ban on North Korean officials and the freezing of assets of North Korean banks and other agencies accused of engaging in shipments and financing for the North’s missile and nuclear programs. It also broadened the means for U.N. member nations to intercept and confiscate cargo headed for the North.

Since the Security Council resolution, North Korea has said it would conduct a nuclear test and launch more long-range rockets and that there would be no more talks on the “denuclearization” of the Korean Peninsula, a main goal of Washington’s thus-far unsuccessful diplomacy on the Korean Peninsula for the last two decades.

With Friday’s threat against the South, North Korea, under the young Mr. Kim, appeared to be following a well-worn track established under his late father, Kim Jong-il, before his death in December 2011: a cycle of North Korean provocation such as a rocket launching, U.N. condemnation, North Korean warnings of “physical countermeasures,” which were sometimes followed by provocative actions, such a nuclear test.

While this familiar cycle repeated itself in recent years, North Korea also steadily boosted its nuclear and missile capabilities. The North Korean nuclear crisis began in the early 1990s with nothing but a tiny amount of fissile material North Korea was suspected of gleaning from its experimental research reactor. It has since accumulated enough plutonium for an estimated half dozen nuclear bombs, built a full-scale uranium-enrichment program, conducted two nuclear tests and made strides toward building intercontinental ballistic missiles that U.S. officials feared could one day be tipped with nuclear warheads.

On Thursday, North Korea said it felt no need to hide its intention of building rockets and nuclear weapons with the United States as a “target” because Washington had intensified its “hostile” policy of “stifling” the already impoverished country.

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New PlayStation 4 details emerge: 8-core AMD ‘Bulldozer’ CPU, redesigned controller and more

2013 is a huge year for gamers. Nintendo (NTDOY) just launched the Wii U ahead of the holidays and both Sony (SNE) and Microsoft (MSFT) are expected to issue next-generation consoles before the year is through. We’ve seen plenty of rumors about both systems over the past few months, and the latest comes from Kotaku and focuses on Sony’s PlayStation 4.

[More from BGR: BlackBerry 10 said to be overhyped, RIM’s comeback chances remain slim]

The site claims to have gotten its hands on documents describing Sony’s developer system given to premier partners so they can build games ahead of the next-generation console launch. The specs, if accurate, will obviously line up with the release version of the system. Included in the specs Kotaku is reporting are an AMD64 “Bulldozer” CPU with eight cores total, an AMD GPU, 8GB of system RAM, 2.2GB of video memory, a 160GB hard drive, a Blu-ray drive, four USB 3.0 ports and more.

[More from BGR: Apple: ‘Bent, not broken’]

Sony also reportedly has a redesigned controller in the works that will include a capacitive touch pad.

This article was originally published on BGR.com

Gaming News Headlines – Yahoo! News

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Voice of Te'o prankster? Couric plays voicemails

NEW YORK (AP) — The person Manti Te'o says was pretending to be his online girlfriend told the Notre Dame linebacker "I love you" in voicemails that were played during his interview with Katie Couric.

Taped earlier this week and broadcast Thursday, the hour-long talk show featured three voicemails that Te'o claims were left for him last year. Te'o said they were from the person he believed to be Lennay Kekua, a woman he had fallen for online but never met face-to-face.

After the first message was played, Te'o said: "It sounds like a girl, doesn't it?"

"It does," Couric responded.

The interview was the All-American's first on camera since his tale of inspired play after the deaths of his grandmother and girlfriend on the same day in September unraveled as a bizarre hoax in an expose by Deadspin.com on Jan. 16.

Te'o's parents appeared with him for part of the interview and backed up his claim that he wasn't involved in the fabrication, saying they, too, had spoken on the phone with a person they believed to be Kekua.

Couric addressed speculation that the tale was concocted by Te'o as a way to cover up his sexual orientation. Asked if he were gay, Te'o said "no" with a laugh. "Far from it. Faaaar from that."

He also said he was "scared" and "didn't know what to do" after receiving a call on Dec. 6 — two days before the Heisman Trophy presentation — from a person who claimed to be his "dead" girlfriend.

The first voicemail, he said, was from what was supposed to be Kekua's first day of chemotherapy for leukemia.

"Hi, I am just letting you know I got here and I'm getting ready for my first session and, um, just want to call you to keep you posted. I miss you. I love you. Bye," the person said.

In the second voicemail, the person was apparently upset by someone else answering Te'o's phone.

The third voicemail was left on Sept. 11, according to Te'o, the day he believed Kekua was released from the hospital and the day before she "died."

"Hey babe, I'm just calling to say goodnight," the person on the voicemail said. "I love you. I know that you're probably doing homework or you're with the boys. ... But I just wanted to say I love you and goodnight and I'll be ok tonight. I'll do my best. Um, yeah, so get your rest and I'll talk to you tomorrow. I love you so much, hon. Sweet dreams."

Couric suggested the person who left those messages might have been Ronaiah Tuisasosopo, a 22-year-old man from California, who Te'o said has apologized to him for pulling the hoax.

"Do you think that could have been a man on the other end of the phone?" she asked.

"Well, it didn't sound like a man," Te'o said. "It sounded like a woman. If he somehow made that voice, that's incredible. That's an incredible talent to do that. Especially every single day."

Tuiasosopo has not spoken publicly since news of the hoax broke. The Associated Press has learned that a home in California where Te'o sent flowers to the Kekua family was once a residence of Tuiasosopo and has been in his family for decades.

Also on Thursday, the woman whose pictures were used in fake online accounts for Kekua said Tuiasosopo confessed to her in a 45-minute phone conversation as the scheme unraveled.

Diane O'Meara spoke with The Associated Press in a telephone interview. She said Tuiasosopo told her he'd been "stalking" her Facebook profile for five years and stealing photos.

O'Meara's attorney, Jim Artiano, said they had not decided on whether to take any legal action.

The 23-year-old O'Meara, of Long Beach, Calif., said she knew Tuiasosopo from high school and he contacted her through Facebook on Dec. 16. She said that, over the next three weeks, Tuiasosopo got in touch with her several times, attempting to get photos and video of O'Meara. She said he made up a story about wanting them to help cheer up a cousin who was injured in a car crash.

O'Meara learned her identity had been stolen on Jan. 13 when she was contacted by Deadspin.com.

The next day she got in touch with Tuiasosopo.

"When I contacted Ronaiah I got a very bizarre vibe from him, he became very nervous, he wasn't asking the questions I expected. He was asking 'Who contacted you? What did they say?'" O'Meara said.

Later that day, he confessed, O'Meara said. She said she asked Tuiasosopo why he didn't simply stop the hoax.

"He told me he wanted to end the relationship," O'Meara said. "He said he wanted to stop the relationship between Lennay and Manti, but Manti didn't want Lennay to break up with him ... He said he tried to stop the game many times."

When news of the hoax broke a few days later, O'Meara said she received a text from Tuiasosopo asking her to call him as soon as possible. O'Meara said she didn't respond.

___

Associated Press writer Tami Abdollah contributed to this report from Los Angeles.

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HCA Must Pay Kansas City Foundation $162 Million

HCA, the nation’s largest profit-making hospital chain, was ordered on Thursday to pay $162 million after a judge in Missouri ruled that it had failed to abide by an agreement to make improvements to dilapidated hospitals that it bought in the Kansas City area several years ago.

The judge also ordered a court-appointed accountant to determine whether HCA had actually provided the levels of charitable care that it agreed to at the time.

The ruling came in response to a suit filed in 2009 by a community foundation that was created when HCA acquired the hospitals. Among other things, the foundation was responsible for ensuring that HCA met the obligations outlined in the deal.

The dispute in Kansas City is the second time in recent years that HCA has come under legal fire from officials in communities that sold troubled nonprofit community hospitals to HCA.

In another dispute in New Hampshire in 2011, a judge ruled in HCA’s favor, deciding that Portsmouth Regional Hospital would remain part of HCA after community leaders tried to regain control. During testimony in a 2011 trial, a former hospital official claimed he had difficulties getting HCA to pay for what he and others described as critical equipment and facility upgrades.

In an e-mailed statement, a spokesman for HCA said the company was disappointed in the court’s ruling and intended to appeal. He also added that the two cases were “rare exceptions” and that the company had enjoyed positive relationships with communities across the country.

The suit is among several problems for HCA. The company disclosed last year, for example, that the United States attorney’s office in Miami had subpoenaed documents as part of an inquiry to determine whether unnecessary cardiology procedures had been performed at HCA hospitals in Florida and elsewhere. At stake in that case is whether HCA inappropriately billed Medicare and private insurers for the procedures. HCA has denied any wrongdoing.

Financially, Thursday’s judgment is a slap on the wrist for HCA, which posted net income of $360 million in just the third quarter of last year. But the ruling may reverberate beyond HCA as communities across the country put their troubled nonprofit hospitals up for sale.

In many cases, the buyers with the deepest pockets have been profit-making hospital chains that want to convert the community hospitals to profit status, typically agreeing to spend money to fix them and to maintain certain levels of charitable care in the community.

In 2011, for instance, Vanguard Health Systems, which went public that year and has as its largest shareholder the private equity firm Blackstone Group, bought eight hospitals in Detroit. As part of that deal, Vanguard Health agreed to spend $850 million over five years to fix and maintain the hospitals.

The trouble in the Kansas City area began a year after HCA acquired a dozen hospitals from Health Midwest in 2003 for $1.125 billion. As part of the deal, HCA agreed to make $300 million in capital improvements in the first two years and an additional $150 million in the following three. The hospital chain also agreed to maintain the levels of care that had been provided to low-income individuals and families in the area for 10 years.

But when the members of the Health Care Foundation of Greater Kansas City, a nonprofit created from the proceeds of the sale of the hospital, received their first report from HCA in 2004 they discovered the hospital was already way behind.

Of the $300 million it was supposed to spend in the first two years, its own documents showed it had spent only about $50 million, according to Mark G. Flaherty, one of the founding members of the foundation and its general counsel.

HCA’s reports to the foundation also indicated that the level of charitable care it provided at the system’s large inner-city hospital had fallen while charitable care provided at the more affluent suburban hospital had risen sharply, Mr. Flaherty said.

“That was a big red flag to us,” he said.

After repeatedly asking HCA executives for explanations but receiving none, the foundation sued HCA in 2009. The case went to trial for several weeks in 2011.

HCA argued in the trial that it had met its obligation to spend money on hospital facilities by building two new hospitals at a cost of hundreds of millions of dollars, rather than repairing older facilities. But Judge John Torrence of Jackson County Circuit Court ruled that the agreement called for improvements to existing hospitals.

He said HCA still owed $162 million of the $300 million it had agreed to spend between 2003 and 2005. He then named a court-appointed forensic accountant to determine whether HCA had met its other capital commitments and whether it provided the charitable care it had said it would.

HCA’s own written statements claimed “differing amounts,” the judge wrote in his ruling. One HCA report said it provided $48 million in charitable care to the area in 2009 while another report on its Web site said it provided more than $87 million. The annual report to the foundation claimed it provided $185 million in uncompensated and charity care that year, the judge wrote.

During the trial, when asked about the widely differing numbers, the president of HCA’s Midwest division and other HCA executives had no explanation.

The money will be paid to the foundation, which will use it to create grants to provide care for uninsured or underinsured families in the area. It is unclear whether the spending on improvements will occur.

Depending on what the court-appointed accountant discovers, HCA may owe even more money, said Paul Seyferth of Seyferth Blumenthal & Harris, which represents the foundation.

“We think they’re going to have a tremendously difficult time convincing anybody that they spent what they claim they spent,” Mr. Seyferth said.

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