By GINA KOLATA

With his smooth, fleshy faceand twinkly eyes, Herbert Aus-pitz, 93, had an air of vigor, but hewas fading fast. He had a fataldisease with a prognosis worsethan that of most cancers: severeaortic valve stenosis. It is a nar-

rowing of the valve that controlsblood flow from the heart. Thereis no way to prevent it, and thereare no drugs to treat it.

Until recently, his fate wouldhave been sealed. His doctorsthought he was too likely to die ifthey cracked open his ribs andstopped his heart while they cutout his old valve and sewed in anew one.

This time, they had a new op-tion. They were able to replacehis valve using a method recentlyapproved by federal regulatorsfor people who are inoperable orat high risk from open-heart sur-gery. His cardiologists, led by Dr.Howard C. Herrmann, inserted anew valve made from the lining

of a cow’s heart through a cathe-ter, then opened it like an umbrel-la.

Lying on a stretcher after thehourlong procedure at the Hospi-tal of the University of Penn-sylvania in Philadelphia, a smil-ing Mr. Auspitz said, “I’m very,very, very grateful.”

The new valve procedure is

part of the changing face of cardi-ac care in the United States. Buteven as speedier treatment hashelped slash the death toll fromheart attacks over all in the pastdecade, the number of deathsfrom heart failure caused by aor-tic valve disease has risen 35 per-cent, in large part because more

Heart Valve Implants, Using Catheter and Cow

JESSICA KOURKOUNIS FOR THE NEW YORK TIMES

Surgeons in Philadelphia inserted a valve made from a cow’sheart through a catheter into Herbert Auspitz, 93, last year.

Continued on Page A9

MENDING HEARTS

Pioneering a New Method

U(D54G1D)y+$!]!#!=!,

By SHERYL GAY STOLBERG

SACRAMENTO — In the fall of1987, a package arrived on thedesk of Laurence H. Tribe, a Har-vard law professor who had justlost a Supreme Court case on gayrights. It contained the legal opin-ions of Anthony M. Kennedy, astrait-laced, conservative Repub-lican jurist from Sacramento whohardly seemed sympathetic tothat cause.

The package was sent by oneof the most influential men in theCalifornia capital then, GordonSchaber, a law school dean whohad enlisted a young Mr. Ken-nedy to teach night classes andnurtured his career. Now Mr.Schaber was angling for Presi-dent Ronald Reagan to elevate

his friend to the Supreme Court— and he wanted the Harvardprofessor’s support.

“Gordon Schaber said thatTony Kennedy was entirely com-fortable with gay friends,” saidProfessor Tribe, who later testi-fied to urge the Senate to confirmJustice Kennedy. “He said henever regarded them as inferiorin any way or as people whoshould be ostracized, and I didthink that was a good signal ofwhere he was on these matters.”

Now, as the Supreme Courtprepares to rule on whether togrant a constitutional right tosame-sex marriage, Justice Ken-nedy, a onetime altar boy, hasemerged as an unlikely gayrights icon. At 78, he has ad-vanced legal equality for gaysmore than any other Americanjurist, making his friend Mr.Schaber, who died in 1997 — andwho was, many who knew himbelieve, a closeted gay man —look prescient.

In three landmark opinions, in-cluding the 2013 decision over-turning a ban on federal benefitsfor married same-sex couples, hehas invoked human dignity with“a sense of empathy and sensitiv-ity that is unusual,” said Prof. Ar-

Justice’s Tolerance Seen in His Sacramento Roots

Continued on Page A10

Examples Surrounded

Kennedy, a Key Vote

on Gay Marriage

By DAN LEVIN

SHANGHAI — Ordering illegaldrugs from China is as easy astyping on a keyboard.

On guidechem.com, more than150 Chinese companies sell alpha-PVP, also known as flakka, astimulant that is illegal in theUnited States but not in China,and was blamed for 18 recentdeaths in one Florida county.

The e-commerce portal Qin-jiayuan sells air-conditioners,trampolines and a banned hallu-cinogen known as spice, whichset off a devastating spike inUnited States emergency roomvisits in April.

The stimulant mephedrone,sometimes sold as “bath salts,” isbanned in China but readily forsale at the Nanjing TakanobuChemical Company for about$1,400 a pound.

“I can handle this for you le-gally or illegally,” a companysalesman said by phone whenasked about shipping the productoverseas from China. “How muchdo you want?”

In a country that has perfectedthe art of Internet censorship, theopen online drug market is a bla-tant example of what internation-al law enforcement officials say isChina’s reluctance to take actionas it has emerged as a majorplayer in the global supply chainfor synthetic drugs.

While China says it has madethousands of arrests and “joinedhands” with foreign law enforce-ment agencies, officials from sev-eral countries say Chinese au-thorities have shown little inter-est in seriously combating whatthey see as the drug problems ofother countries.

“They just didn’t see what wasin it for them to look into theirown industries exporting thesechemicals,” said Jorge Guajardo,the former Mexican ambassador

ChinaWebsitesFlouting LawsOn Illicit Drugs

Trade Flourishes Amid

Loose Oversight

Continued on Page A3

POOL PHOTO BY DAVID GOLDMAN

Worshipers at Emanuel A.M.E. Church Sunday. The Rev. Norvel Goff Sr. told them “no weapon formed against us shall prosper.”

By JOHN ELIGON and RICHARD FAUSSET

CHARLESTON, S.C. — TheEmanuel A.M.E. Church has sur-vived antebellum laws barringblack worship, an angry whitemob that burned down its origi-nal edifice, and the execution ofits founder and dozens of othersplanning a slave revolt.

So when a white gunman fa-tally shot nine of its members, in-cluding the head pastor, duringBible study last week, there wasonly one way, church leaderssaid, to respond: by pressing for-ward.

In a display of unity, resolveand defiance, “Mother Emanuel,”as people here call the church,opened its doors for its regularSunday service, just four days af-ter three men and six womenwere left in a bloody pile in itsbasement.

The chocolate wooden pewswith scarlet cushions werepacked here, with whites sittingnext to blacks, locals next to visi-tors. Similar gatherings spannedthe country, as churchgoersmourned and prayed and hon-ored the lives lost Wednesdayevening. They hoped to show thatthe suspect’s reported goal of set-ting off a race war had failed mis-

erably.“I want you to know, because

the doors of Mother Emanuel”are open, the Rev. Norvel GoffSr., a presiding elder in the Afri-can Methodist Episcopal Church,said in a rousing sermon there onSunday, “it sends a message toevery demon in hell and onearth.”

Later, with his voice roaring,Mr. Goff added, “Some wanted todivide the race — black and whiteand brown — but no weaponformed against us shall prosper.”

Here in this city — where stee-ples dot the skyline, earningCharleston the nickname HolyCity — worship normally con-tained within church walls spilledinto the streets on Sunday. Largebanners hung from the buildingsnear Emanuel.

“Holy City . . . Let Us Be theExample of Love That ConquersEvil,” read one.

At 10 a.m., church bells acrossthe city began to toll. Nine min-utes passed, one minute for eachvictim.

Hundreds of people, most ofthem white, had gathered a block

Defiant Show of Unity in ChurchThat Lost 9 to Racial Violence

Continued on Page A11

By JONATHAN MARTIN

WASHINGTON — The massa-cre of nine African-Americans ina storied Charleston church lastweek, which thrust the issues ofrace relations and gun rights intothe center of the 2016 presidentialcampaign, has now added an-other familiar, divisive questionto the emerging contest for theRepublican nomination: what todo with the Confederate battleflag that flies on the grounds ofthe South Carolina Capitol.

And like some of their prede-cessors seeking to win the state’sprimary, the first in the South,the leading Republican candi-dates for 2016 are treading del-icately. They do not want to riskoffending the conservative white

voters who venerate the mostrecognizable emblem of the Con-federacy and who say it is a sym-bol of their heritage.  

Jeb Bush issued a statement onSaturday saying he was confi-dent that South Carolina “will dothe right thing.” As Florida’s gov-ernor, Mr. Bush in 2001 orderedthe Confederate flag to be takenfrom its display outside hisstate’s Capitol “to a museumwhere it belonged.”

Senator Marco Rubio, also ofFlorida, told reporters that he

A Capitol’s Confederate Flag

Is a Test for G.O.P. Hopefuls

Continued on Page A11

DONATIONS AT ISSUE

The leader of a white supremacistgroup tied to Dylann Roof has giv-en to G.O.P. campaigns. Page A12.

VOL. CLXIV . . . No. 56,905 + © 2015 The New York Times NEW YORK, MONDAY, JUNE 22, 2015

Late EditionToday, partly sunny, very warm,high 87. Tonight, partly cloudy, low73. Tomorrow, partly sunny, an af-ternoon shower or thunderstorm,hot, high 92. Weather map, Page C8.

$2.50

This article is by Michael Wine-rip, Michael Schwirtz and VivianYee.

DANNEMORA, N.Y. — By thetime David Sweat and Richard W.Matt engineered their extraordi-nary escape from the maximum-security prison here, correctionsofficers were rarely shininglights over the faces of inmatesduring hourly bed checks, mak-ing it hard to know whether a liv-ing, breathing person was insidea cell.

The catwalks and undergroundtunnels that made their getawaypossible were no longer being in-spected regularly.

And no one was inside two ofthe 35-foot-high guard towerswhen Mr. Sweat and Mr. Matt,convicted killers, climbed out of amanhole outside the prison wallsand fled into the night.

No single lapse or mistake insecurity enabled the two men tobreak out of the Clinton Correc-tional Facility, long consideredone of the most secure prisons inthe nation. But it now appears anarray of oversights, years in themaking, set the stage for the pris-on break a little over two weeksago and for the ensuing manhunt,which this weekend zeroed in ona possible sighting of the men inFriendship, N.Y., more than 350miles southwest of the prison,even as the State Police said thefocus of the search would remainaround Dannemora.

At Clinton, a sense of compla-

LAPSES AT PRISONMAY HAVE AIDED

KILLERS’ ESCAPE

LAX RULES AND SECURITY

Workers at a New York

Penitentiary Describe

Complacency

Continued on Page A16

TIPS POUR IN Troopers searchedFriendship, N.Y., where resi-dents were wary. Page A17.

HEATHER AINSWORTH FOR THE NEW YORK TIMES

Despite warmer relations, myriad lawsstill restrict commerce between theUnited States and Cuba. PAGE A8

NATIONAL A8-12

Door to Cuba Only Ajar

Prime Minister Narendra Modi led thefirst International Yoga Day in Delhi,which he said would help restore peaceand train the human spirit. PAGE A4

INTERNATIONAL A3-7

India Reaches for a New Age

Days after Pope Francis issued his en-cyclical on the environment, few sharedhis message from the pulpit. PAGE A4

Assessing Pope’s Call to Action

Queens residents and airport adminis-trators are on better footing as theyseek solutions to plane noise. PAGE A14

NEW YORK A14-17, 20

Clearer Conversation on Noise

Only a few states have plans in placeshould the Supreme Court block federalhealth insurance subsidies. PAGE A8

Backup Plans on Health Law

“Voodoo,” by a pioneering African-American composer, will be performedfor the first time since 1928. PAGE C1

ARTS C1-7

Reviving a Forgotten Opera

Paul Krugman PAGE A19

EDITORIAL, OP-ED A18-19

Gunther Schuller, who won a Pulitzerfor his orchestral work, coined the termThird Stream for music that drew fromclassical and jazz. He was 89. PAGE A13

OBITUARIES A12-13

Composer Who Fused Genres

Jordan Spieth, the reigning Masterschampion, became the first man sinceGene Sarazen in 1922 to win a secondmajor before turning 22. PAGE D1

SPORTSMONDAY D1-8

Spieth Captures U.S. Open

After Taylor Swift complained that Ap-ple was not planning to pay royalties toartists in a trial period of its streamingservice, the company relented. PAGE B1

BUSINESS DAY B1-6

Swift Speaks, Apple Listens

C M Y K Nxxx,2015-06-22,A,001,Bs-BK,E2_+