The Centers for Medicare and Medicaid Services is investigating two hospitals that “did not offer necessary stabilizing care to an individual experiencing an emergency medical condition, in violation of the Emergency Medical Treatment and Labor Act (EMTALA),” according to a letter from US Health and Human Services Secretary Xavier Becerra.
Under EMTALA, health care professionals are required to “offer treatment, including abortion care, that the provider reasonably determines is necessary to stabilize the patient’s emergency medical condition,” Becerra said Monday in his letter to national hospital and provider associations.
The National Women’s Law Center, which said in a statement that it filed the initial EMTALA complaint on behalf of Mylissa Farmer, identified the hospitals as Freeman Hospital West of Joplin, Missouri, and the University of Kansas Health System in Kansas City, Kansas.
The patient was nearly 18 weeks pregnant when she had a preterm premature rupture of membranes, Becerra wrote, but she was told that her pregnancy wasn’t viable.
“Although her doctors advised her that her condition could rapidly deteriorate, they also advised that they could not provide her with the care that would prevent infection, hemorrhage, and potentially death because, they said, the hospital policies prohibited treatment that could be considered an abortion,” Becerra wrote.
Becerra added in a statement Monday, “fortunately, this patient survived. But she never should have gone through the terrifying ordeal she experienced in the first place. We want her, and every patient out there like her, to know that we will do everything we can to protect their lives and health, and to investigate and enforce the law to the fullest extent of our legal authority.”
Abortion is banned in Missouri, with limited exceptions, such as to save the mother’s life. State law requires counseling and a 72-hour waiting period. In Kansas, abortion is generally banned at or after 22 weeks of pregnancy, with a 24-hour waiting period and counseling required.
Passed in 1986, EMTALA requires that hospitals provide stabilizing treatment to patients who have emergency medical conditions, or transfer them to facilities where such care will be provided, regardless of any conflicting state laws or mandates.
Changes to state laws in the wake of the US Supreme Court decision that overturned the right to an abortion have left many hospitals and providers uncertain or confused about the steps they can legally take in such cases. HHS issued guidance last year reaffirming that EMTALA requires providers to offer stabilizing care in emergency cases, which might include abortion.
Hospitals found to be in violation of EMTALA could lose their Medicare and Medicaid provider agreements and could face civil penalties. An individual physician could also face civil penalties if they are found to be in violation.
HHS may impose a $119,942 fine per violation for hospitals with more than 100 beds and $59,973 for hospitals with fewer than 100 beds. A physician could face a $119,942 fine per violation.
The National Women’s Law Center says the new actions are the first time since Roe v. Wade was overturned that EMTALA has been enforced against a hospital that denied emergency abortion care.
“The care provided to the patient was reviewed by the hospital and found to be in accordance with hospital policy,” the University of Kansas Health System said in a statement to CNN. “It met the standard of care based upon the facts known at the time, and complied with all applicable law. There is a process with CMS for this complaint and we respect that process. The University of Kansas Health System follows federal and Kansas law in providing appropriate, stabilizing, and quality care to all of its patients, including obstetric patients.”
Freeman Hospital did not immediately respond to CNN’s request for comment.
An HHS spokesperson told CNN that both hospitals are working toward coming into compliance with the law.
In the law center’s statement, Farmer said she was pleased with the investigations, “but pregnant people across the country continue to be denied care and face increased risk of complications or death, and it must stop. I was already dealing with unimaginable loss and the hospitals made things so much harder. I’m still struggling emotionally with what happened to me, but I am determined to keep fighting because no one should have to go through this.”
As fighting between warring factions has engulfed Sudan in recent days, hospitals treating people wounded in clashes have themselves become the targets for attacks, dealing the nation’s healthcare sector a devastating blow.
In one episode, five eyewitnesses told CNN that the paramilitary group battling Sudan’s military for control of the country besieged and shelled a hospital in the capital Khartoum on Sunday, leaving at least one child dead and sending panicked medical staff fleeing for their lives.
The leaders of the opposing sides, Sudan’s military leader Abdel Fattah al-Burhan and his former deputy and paramilitary chief Mohamed Hamdan Dagalo, have traded blame for instigating the fighting that has spread across the country since Saturday. Burhan has accused Dagalo of staging an “attempted coup”; Dagolo has in turn called Burhan a “criminal.”
But at al-Moallem hospital in central Khartoum, where intense shelling forced staffers to evacuate, leaving some patients behind, witnesses said they have little doubt about what happened.
“I have no doubt that they deliberately targeted the hospital,” said one medic who evacuated the hospital on Sunday after Dagalo’s paramilitary Rapid Support Forces (RSF) laid siege to it. CNN is not using any of the real names of the hospital medics in this article for safety reasons.
The hospital is meters away from Sudan’s army headquarters, which the RSF has made repeated attempts to take over. Medics said it was treating scores of wounded army soldiers and their families. The hospital’s maternity ward was struck in the shelling, causing a wall there to collapse, according to hospital employees.
A 6-year-old child died in the building, one medic said. Two other children were seriously wounded. As the shelling intensified, medics and patients huddled together in the corridor and prayed.
At first we were praying for salvation,” the medic said. “Then when the shelling got worse, we started to discuss what would be the most painless part of the body to be shot in and began to pray instead to die painlessly.”
It’s unclear whether the RSF has taken control of the hospital as it attempts to take over the nearby army headquarters, a flashpoint in Khartoum’s violence.
“The evacuation was chaos,” the medic said. “I thought I was going to vomit. I was stumbling and falling on the ground.”
“Can you believe that we left the hospital and left behind children in incubators and patients in intensive care without any medical personnel,” another medic said. “The smell of death was everywhere.”
“There was no electricity, no water there inside the hospital,” said a third medic. “None of our equipment was working, a woman sheltering with us had a two-day-old baby. I don’t even know what happened to her.”
At least half a dozen hospitals have been struck by both warring sides, according to Sudan’s Doctors Trade Union.
“Sudan’s hospitals under fire,” the Central Committee of Sudan doctors said in a statement on its Facebook page, warning of the potential collapse of the health sector if clashes continue.
“Most of the large and specialized hospitals are out of service as a result of being forcibly evacuated by the conflicting military forces or being targeted by bombing and others. Some other hospitals have been cut off from human and medical supplies, water and electricity,” the committee said.
Doctors Without Borders said its teams were “trapped by the ongoing heavy fighting and are unable to access warehouses to deliver vital medical supplies to hospitals,” and that its premises in Nyala, South Sarfur, had been looted.
Food, water and power shortages are rampant as Sudan has endured a third day of fighting, that has spread from Khartoum across the nation.
“Food in the fridge and freezers have gone bad,” Eman Abu Garjah, a Sudanese-British doctor based in Khartoum, told CNN. “We don’t have any supplies at the moment, that’s why we’re trying to go somewhere where the shops are open.”
“The planes were flying overhead earlier in the day. They didn’t just wake us up, they prevented us from going back to sleep,” she said.
“It’s Ramadan, we’re up for early morning prayers and after that usually you have a little bit of a siesta and wake up again for the afternoon prayers. But sleep was just not possible. The house was rattling and the windows were shaking.”
Until recently, Dagalo and Burhan were allies. The pair worked together to topple ousted Sudanese President Omar al-Bashir in 2019 and played a pivotal role in the military coup in 2021.
However, tensions arose during recent negotiations to integrate the RSF into the country’s military as part of plans to restore civilian rule.
In an interview with CNN on Monday, Burhan accused Dagalo of attempting to “capture and kill” him during an attempt by the paramilitary leader to seize the presidential palace.
In response to the allegation, an RSF spokesperson called Burhan, “a wanted fugitive.”
“We are seeking to capture him and bringing him to justice. We are fighting for all Sudanese people,” the RSF spokesperson said.
Burhan also accused the RSF of breaking a proposed ceasefire on Sunday and Monday.
“Yesterday and today a humanitarian ceasefire proposal was put forward and agreed upon,” said Burhan from army headquarters, as gunshots rang out in the background.
“Sadly, he did not abide by (the ceasefire),” he added. “You can hear right now the attempts to storm the Army headquarters, and indiscriminate mortar attacks. He’s using the humanitarian pause to continue the fight.”
The RSF denies that it broke ceasefire.
It is unclear how much control the RSF has wrested from the country’s military. Dagalo claims he now controls the country’s main military sites, a claim repeatedly disputed by Burhan.
“We’re under attack from all directions,” Dagalo told CNN’s Larry Madowo in a telephone interview on Sunday. “We stopped fighting and the other side did not, which put us in a predicament and we had to keep fighting to defend ourselves,” he claimed.
The RSF is the preeminent paramilitary group in Sudan, whose leader, Dagalo, has enjoyed a rapid rise to power.
During Sudan’s Darfur conflict, starting in the early 2000s, he was the leader of Sudan’s notorious Janjaweed forces, implicated in human rights violations and atrocities.
An international outcry saw ex-President Bashir formalize the group into paramilitary forces known as the Border Intelligence Units.
In 2007, its troops became part of the country’s intelligence services and, in 2013, Bashir created the RSF, a paramilitary group overseen by him and led by Dagalo. Dagalo turned against Bashir in 2019.
Months before the coup that unseated Bashir in April 2019, Dagalo’s forces opened fire on an anti-Bashir, pro-democracy sit-in in Khartoum, killing at least 118 people.
He was later appointed deputy of the transitional Sovereign Council that ruled Sudan in partnership with civilian leadership.
International powers have expressed alarm at the current violence in Sudan. Apart from concerns over civilians there are likely other motivations at play, the country is resource-rich and strategically located. CNN has previously reported on how Russia has colluded with its military leaders to smuggle gold out of Sudan.
Intense fighting has gripped Sudan for a third day and hospitals are under attack from missiles as they battle to save lives, amid a bloody tussle for power that has left close to 100 people dead and injured hundreds more.
Clashes first erupted Saturday between the country’s military and the paramilitary group Rapid Support Forces (RSF), led by Mohamed Hamdan Dagalo, also known as Hemedti, who told CNN on Sunday the army had broken a UN-brokered temporary humanitarian ceasefire.
On Monday, residents in the capital Khartoum endured sounds of artillery and bombardment by warplanes with eyewitnesses telling CNN they heard mortars in the early hours. The fighting intensifying after dawn prayers in the direction of Khartoum International Airport and Sudanese Army garrison sites.
Hospitals in the country – which are short of blood supplies and life-saving equipment – are being targeted with military strikes by both the Army and the RSF, according to eyewitness accounts to CNN and two doctors’ organizations, leaving medical personnel unable to reach the wounded and to bury the dead.
One doctor at a Khartoum hospital – whom CNN is not naming for security reasons – said his facility has been targeted since Saturday. “A direct strike hit the maternity ward. We could hear heavy weaponry and lay on the floor, along with our patients. The hospital itself was under attack.”
CNN has reached out to the Sudanese military and the RSF for comment.
Another doctor at the same al-Moallem Hospital told CNN that hospital staff stayed on site under bombardment from the RSF for two days, before being evacuated by the Sudanese military. “We were living in a real battle,” the doctor said. “Can you believe that we left the hospital and left behind children in incubators and patients in intensive care without any medical personnel? I can’t believe that I survived dying at the hospital, where the smell of death is everywhere.”
Hemedti said Monday his group will pursue the leader of Sudan’s Armed Forces Abdel Fattah al-Burhan “and bring him to justice,” while Sudan’s army called on paramilitary fighters to defect and join the armed forces.
Verified video footage shows military jets and helicopters hitting the airport; other clips show the charred remains of the army’s General Command building nearby after it was engulfed in fire on Sunday.
Residents in neighborhoods east of the airport told CNN they saw warplanes bombing sites east of the command. “We saw explosions and smoke rising from Obaid Khatim Street, and immediately after that, anti-aircraft artillery fired massively towards the planes,” one eyewitness said.
Amid the chaos, both parties to the fighting are working to portray a sense of control in the capital. The armed forces said Monday the Rapid Support Forces are circulating “lies to mislead the public,” reiterating the army have “full control of all of their headquarters” in the capital Khartoum.
Sudan’s national state television channel came back on air on Monday, a day after going dark, and is broadcasting messages in support of the army.
A banner on the channel said “the armed forces were able to regain control of the national broadcaster after repeated attempts by the militias to destroy its infrastructure.” Although the armed forces appear to have control of the television signal, CNN cannot independently verify that the army is in physical control of the Sudan TV premises.
A banner on the channel said “the armed forces were able to regain control of the national broadcaster after repeated attempts by the militias to destroy its infrastructure.”
In the Kafouri area, north of Khartoum, clashes and street fights broke out at dawn Monday, prompting residents to begin evacuating women and children from the area, Sudanese journalist Fathi Al-Ardi wrote on Facebook. In the Kalakla area, south of the capital, residents reported the walls of their houses shaking from explosions.
Reports also emerged of battles hundreds of miles away in the eastern city of Port Sudan and the western Darfur region over the weekend.
As of Monday, at least 97 people have been killed, according to the Preliminary Committee of Sudanese Doctors trade union. Earlier on Sunday, the World Health Organization estimated more than 1,126 were injured.
The WHO has warned that doctors and nurses are struggling to reach people in need of urgent care, and are lacking essential supplies.
“Supplies distributed by WHO to health facilities prior to this recent escalation of conflict are now exhausted, and many of the nine hospitals in Khartoum receiving injured civilians are reporting shortages of blood, transfusion equipment, intravenous fluids, medical supplies, and other life-saving commodities,” the organization said on Sunday.
Water and power cuts are affecting the functionality of health facilities, and shortages of fuel for hospital generators are also being reported,” the WHO added.
In the CNN interview, Dagalo blamed the military for starting the conflict and claimed RSF “had to keep fighting to defend ourselves.”
He speculated that the army chief and his rival, al-Burhan, had lost control of the military. When asked if his endgame was to rule Sudan, Dagalo said he had “no such intentions,” and that there should be a civilian government.
Amid the fighting, civilians have been warned to stay indoors. One local resident tweeted that they were “trapped inside our own homes with little to no protection at all.”
“All we can hear is continuous blast after blast. What exactly is happening and where we don’t know, but it feels like it’s directly over our heads,” they wrote.
Access to information is also limited, with the government-owned national TV channel now off the air. Television employees told CNN that it is in the hands of the RSF.
The conflict has put other countries and organizations on high alert, with the United Nations’ World Food Program temporarily halting all operations in Sudan after three employees were killed in clashes on Saturday.
UN and other humanitarian facilities in Darfur have been looted, while a WFP-managed aircraft was seriously damaged by gunfire in Khartoum, impeding the WFP’s ability to transport aid and workers within the country, the international aid agency said.
Qatar Airways announced Sunday it was temporarily suspending flights to and from Khartoum due to the closure of its airport and airspace.
On Sunday, Dagalo told CNN the RSF was in control of the airport, as well as several other government buildings in the capital.
Meanwhile, Mexico is working to evacuate its citizens from Sudan, with the country’s foreign minister saying Sunday it is looking to “expedite” their exit.
The United States embassy in Sudan said Sunday there were no plans for a government-coordinated evacuation yet for Americans in the country, citing the closure of the Khartoum airport. It advised US citizens to stay indoors and shelter in place, adding that it would make an announcement “if evacuation of private US citizens becomes necessary.”
The fresh clashes have prompted widespread calls for peace and negotiations. The head of the African Union Commission, Moussa Faki, is scheduled to arrive in Khartoum on Monday, in an attempt to stop the fighting.
US Secretary of State Antony Blinken and UK Foreign Secretary James Cleverly also for an immediate ceasefire.
“People in Sudan want the military back in the barracks, they want democracy, they want a civilian-led government. Sudan needs to return to that path,” Blinken said, speaking on the sidelines of the G7 foreign minister talks in Japan on Monday.
The UN’s political mission in Sudan has said the country’s two warring factions have agreed to a “proposal” although it is not yet clear what that entails.
At the heart of the clashes is a power struggle between the two military leaders, Dagalo and Burhan.
The pair had worked together to topple ousted Sudanese President Omar al-Bashir in 2019, and played a pivotal role in the military coup in 2021, which ended a power-sharing agreement between the military and civilian groups.
The military has been in charge of Sudan since then, with Burhan and Dagalo at the helm.
But recent talks led to cracks in the alliance between the two men. The negotiations have sought to integrate the RSF into the country’s military, as part of the effort to transition to civilian rule.
Sources in Sudan’s civilian movement and Sudanese military sources told CNN the main points of contention included the timeline for the merger of the forces, the status given to RSF officers in the future hierarchy, and whether RSF forces should be under the command of the army chief, rather than Sudan’s commander-in-chief, who is currently Burhan.
Village of Oregon police arrested the mother of a 4-year-old Wednesday after the child was taken to the emergency room the day before because the child had overdosed on marijuana gummies.
Police said they were called to Stoughton Hospital just before 5 p.m. Tuesday because the child’s mother and another adult were having difficulty getting the child to respond.
Police later determined that the overdose had occurred at a home in Oregon. In a search of the home at about 12:30 p.m. Wednesday, they found drug paraphernalia and arrested the child’s mother on a tentative child neglect charge. Police did not release the mother’s name.
The child was treated at the hospital and released.
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Irvo Otieno had a million-dollar smile, respected others and stood up for what he believed was right, family and friends said Wednesday at the funeral for the man who died after he was pinned to the floor by security officers at a Virginia mental health hospital.
Now it’s time for society to stand for what is right – by implementing law enforcement and mental health care reforms, speakers told mourners during Otieno’s service at First Baptist Church of South Richmond.
Seven sheriff’s deputies and three hospital employees are accused of second-degree murder in the March 6 death of the aspiring musician, 28, who prosecutors say was smothered during what the family said was a mental health crisis.
“What kind of sickness would make men pile on a man that’s already handcuffed and shackled?” Rev. Al Sharpton said during the eulogy.
“He had an illness. He should have been doctored to, not treated with brutality,” Sharpton said.
The minister and family attorney Ben Crump said police need to be better equipped to deal with those with mental illness.
They also encouraged Virginia officials to make reforms.
“We can develop mental health courts where they will be treated like they have illness and not like they are criminals and degenerates not worthy of dignity and respect,” Crump told mourners. “Irvo deserved dignity and respect.”
On March 3, Henrico Police responded to a report of a possible burglary and encountered Otieno. Police officers – along with the county’s crisis intervention team – put Otieno under an emergency custody order due to their interactions with and observations of him, police said.
According to Virginia law, a person can be placed under an emergency custody order when there is reason to believe they could hurt themselves or others as a result of mental illness.
The officers transported Otieno to a hospital where authorities say he assaulted three officers. Police took him to county jail and he was booked. At around 4 p.m. on March 6, Otieno was taken to Central State Hospital, a state-run mental health facility south of Richmond, by the Henrico County Sheriff’s Office, according to the commonwealth attorney’s office. It’s not clear why deputies transferred Otieno.
State police investigators were later told Otieno became “combative” and was “physically restrained” during the intake process, the commonwealth attorney’s office said on March 14.
Surveillance video recently released by a prosecutor shows Otieno being pinned to the floor.
Dinwiddie County Commonwealth’s Attorney Ann Cabell Baskervill’s office released 911 calls about the incident in which a caller described Otieno as “very aggressive” and repeatedly asked for an ambulance, saying he was not breathing.
The video begins as Otieno, bound by his hands and feet, is forcibly taken into a room and dragged into an upright seated position on the floor with his back against a chair. Ten minutes later, after Otieno has turned onto his side with three people holding him, his body jerks, and five more deputies and workers move to pin Otieno to the floor.
A clear view of Otieno is blocked in much of the video, but one deputy appears to be lying across Otieno for most of the incident as he is forced onto his stomach. Eventually, Otieno is rolled onto his back, where several deputies appear to be restraining him with their knees. One deputy holds Otieno’s head still by grabbing his braided hair.
After 12 minutes of Otieno being pinned to the ground, one deputy can be seen shaking Otieno’s hair and attempting to take a neck pulse, but Otieno is unresponsive. Three more minutes pass before CPR begins, with Otieno’s limbs still shackled.
Medical workers from the hospital are seen converging on the room as CPR continues for nearly an hour. After he is pronounced dead, Otieno is covered in a white sheet, still lying on the floor, his body briefly left alone in the room.
An attorney for one of the deputies charged in the case told CNN he’s “disappointed” the prosecutor released the video because he thinks it could influence the jury pool.
Seven Henrico County deputies, who turned themselves in to state police earlier this month, are on administrative leave as investigations by their agency and state police continue, Henrico County Sheriff Alisa Gregory said in a statement.
CNN has sought comment from the deputies. Caleb Kershner, deputy Randy Joseph Boyer’s attorney, told CNN recently that they had yet to see video but claimed “nothing was outside of the ordinary” in the lead-up to Otieno’s death.
“They delivered him as fast as they could because obviously this was a man in tremendous need of some sort of medical attention,” Kershner said. He added that his client said they had dealt with Otieno “for a long time and he had a significant amount of violent noncompliance.”
Prosecutor describes VA death in custody
Three Central State Hospital workers who were arrested were placed on leave “pending the results of the legal proceedings,” the Department of Behavioral Health and Developmental Services and Central State Hospital said in a statement. Officials said they will ensure the family receives information about “the tragic events at the hospital.”
The Henrico Fraternal Order of Police Lodge 4, the local law enforcement officers’ union, “stands behind” the deputies, it said in a statement on Facebook.
CNN has reached out to attorneys, the hospital and jail for additional comment.
Crump has said Otieno was not being aggressive or resisting during the incident. “He was trying to breathe,” he told reporters. “If you were down there, restrained and all of these people on top of you, you would be trying to breathe. You would try to move, too, to let your lungs expand.”
The attorney told those attending Wednesday’s funeral that the situation should have been treated differently.
“When Black people in America have mental health issues, we cannot treat them like criminal issues,” Crump said.
Sharpton said Otieno was a man of talent whose life was unnecessarily cut short.
“If he’d been cared for, rather than cared-less law enforcement, he could have been a shining example of how people, despite their challenges, can be productive anyway.”
The musician’s mother spoke near the end of the service, saying her son had character and will be missed.
“May your spirit lead us in this pursuit of truth and justice. I will miss your infectious smile and your big hugs,” said Caroline Ouko. “We will get to the bottom of what happened to you.”
Three of the 10 people facing murder charges in the death last week of a 28-year-old Black man at a Virginia mental health facility were security guards at the hospital who watched and then participated in the fatal smothering, the prosecutor told CNN Friday.
The victim’s family wants answers as to how a promising musician having what they called a mental health crisis ended with him dying – and why no one stood up for him and kept him from being killed.
The county prosecutor said seven law enforcement deputies, joined by the hospital workers, “smothered him to death” while restraining him.
“I’ve never seen anything like this,” Commonwealth’s Attorney Ann Cabell Baskervill said, referring to unreleased video that shows the man’s death.
Baskervill said the hospital security guards passively watched the alleged smothering but eventually joined in and piled on top of the victim along with the deputies.
The local law enforcement officers’ union says they “stand behind” the deputies while an attorney for one of the deputies charged said he looked forward to the full truth being shared in court.
Here’s what we know about the deadly incident.
Irvo (pronounced EYE-voh) Otieno was 28. He had a passion for music, family attorney Mark Krudys said Thursday, and was working to become a hip-hop artist. Originally from Kenya, he came to the United States when he was 4.
His mother, Caroline Ouko, said he had “found his thing” with music and could write a song in less than five minutes. “He put his energy in that and he was happy with it,” she said at a news conference Thursday.
Irvo had a big heart, she said, and was the one his classmates came to when they had problems. He was a leader who brought his own perspective to the table, she added.
“If there was discussion, he was not afraid to go the other way when everybody else was following,” she said.
Her son had a mental illness that necessitated medicine, Ouko said. He had long stretches where “(you) wouldn’t even know something was wrong” and then there were times when “he would go into some kind of distress and then you know he needs to see a doctor,” she said.
On March 3, Otieno was arrested by Henrico County police who were responding to a report of a possible burglary, according to a police news release. The officers, accompanied by members of the county’s crisis intervention team, placed him under an emergency custody order.
The officers transported him to a hospital where authorities say he assaulted three officers. Police took him to county jail and he was booked.
On March 6, Otieno was taken to a state mental health facility in Dinwiddie County and died during the intake process, according toBaskervill.
“They smothered him to death,” the prosecutor said.
A preliminary report from the Office of Chief Medical Examiner in Richmond identified asphyxiation as a cause of death, the commonwealth attorney’s office said in a statement.
Otieno was held on the ground in handcuffs and leg irons for 12 minutes by seven deputies, Baskervill said.
Baskervill said Friday that video of the apparent smothering shows there were hands over Otieno’s mouth, hands on his head and hands holding his braids back.
At the Henrico County jail, just before Otieno’s transfer to Central State Hospital on March 6, he was naked in his cell, with feces all over, according to Baskervill.
She told CNN the video from his cell, which she viewed, shows Otieno was clearly agitated and in distress. CNN has not seen the video.
Otieno was pepper sprayed before five or six Henrico jail deputies entered the cell and tackled him, Baskervill said.
“He’s on the ground underneath them for several minutes there,” she said. “And blows are sustained at the Henrico county jail.”
Asked if Otieno appeared combative, Baskervill said, “I would really characterize his behavior as being distressed, rather than assaultive, combative.”
Later, at Central State Hospital, Otieno was on the ground at one point with at least 10 people on top of him, Baskervill said.
“They’re putting their back into it, leaning down. And this is from head to toe, from his braids at the top of his head, unfortunately, to his toes,” she said.
Baskervill said Otieno was eventually put on his stomach, with the pressure on him continuing, and he died in that position.
Baskervill believes Otieno was dead before a 911 call was even made. Paramedics left and State Police were not called until 7:28 pm, according to Baskervill.
“The delay in contacting proper authorities is inexplicable. Truly inexplicable,” she said.
The seven sheriff’s deputies and three hospital workers have been charged with second-degree murder.
The seven deputies who were charged were identified in Baskervill’s release Tuesday as Randy Joseph Boyer, 57, of Henrico; Dwayne Alan Bramble, 37, of Sandston; Jermaine Lavar Branch, 45, of Henrico; Bradley Thomas Disse, 43, of Henrico; Tabitha Renee Levere, 50, of Henrico; Brandon Edwards Rodgers, 48, of Henrico; and Kaiyell Dajour Sanders, 30, of North Chesterfield.
The Henrico Fraternal Order of Police Lodge 4, the local law enforcement officers’ union, issued a statement Tuesday saying they “stand behind” the deputies.
“Policing in America today is difficult, made even more so by the possibility of being criminally charged while performing their duty,” the group said. “The death of Mr. Otieno was tragic, and we express our condolences to his family. We also stand behind the seven accused deputies now charged with murder by the Dinwiddie County Commonwealth’s Attorney Ann Baskervill.”
The hospital workers arrested Thursday were identified as Darian M. Blackwell, 23, of Petersburg; Wavie L. Jones, 34, of Chesterfield; and Sadarius D. Williams, 27, of North Dinwiddie.
There is video footage but it will not be released to the public. CNN requested the footage but was told the material is not subject to mandatory disclosure because the investigation is ongoing.
“To maintain the integrity of the criminal justice process at this point, I am not able to publicly release the video,” said Baskervill, noting surveillance video from the mental health facility recorded the intake process.
Otieno’s family has viewed the video provided by prosecutors Thursday and his mother says Otieno was tortured.
“My son was treated like a dog, worse than a dog,” she screamed, angry that no one stopped what led to her son’s death. “We have to do better.”
His older brother, Leon Ochieng, said people should be confident in calling for help when their loved ones are in crisis. He did not believe the people he saw on the video cared about preserving a life.
“What I saw was a lifeless human being without any representation,” Ochieng said, adding that his family is now broken and is calling for more awareness on how to treat those with mental illnesses.
“Can someone explain to me why my brother is not here, right now?” Ochieng said.
CNN has sought comment from the deputies and received word from attorneys of three of the individuals charged.
Caleb Kershner, the attorney for Boyer, told CNN he has yet to see the video but said “nothing was outside the ordinary” in the process of transferring Otieno from jail to the mental health facility.
Kershner told CNN that Otieno refused to get out of the vehicle when arriving at the hospital and deputies had to use force to get him out.
Kershner also said hospital staff administered a sedative to Otieno when he was still alive and resisting. However, Baskervill on Wednesday said the shot was given after Otieno was already dead. CNN has reached out to the hospital for comment but did not receive an immediate response.
“My client was simply holding his leg throughout any ordeal in order to ensure that what we estimate to be a 350-pound man, who was having a severe mental health episode, as not let loose in a medical facility where he could severely injure other people,” Kershner said. “From my review of the case, nothing was outside the ordinary or outside the scope of their training for what they did.”
Peter B. Baruch, an attorney for Disse, issued a statement defending his client.
“Deputy Disse has had a 20-year career with the Sheriffs department, and has served honorably. He is looking forward to his opportunity to try this case and for the full truth to be shared in court and being vindicated,” he said.
Bramble’s attorney, Steven Hanna, said he was still gathering information and declined to comment further.
CNN has not heard from the other attorneys it has identified as representing the other defendants.
An attorney representing one of the deputies told CNN he and other defense attorneys have not yet been able to review the video of Otieno’s death.
The lawyer said he is “shocked” the video has not been released and believes “they are overcharging” the deputies in this case.
Family attorneys say Otieno posed no threat to the deputies.
Civil rights attorney Ben Crump, who is working on behalf of the family, said Otieno was not violent or aggressive with the deputies.
“You see in the video he is restrained with handcuffs, he has leg irons on, and you see in the majority of the video that he seems to be in between lifelessness and unconsciousness, but yet you see him being restrained so brutally with a knee on his neck,” Crump said Thursday.
Crump said the video is a “commentary on how inhumane law enforcement officials treat people who are having a mental health crisis as criminals rather than treating them as people who are in need of help.”
Much like the arrest and death of George Floyd in Minneapolis in 2020, Otieno was face down and restrained, Crump said.
“Why would anybody not have enough common sense to say we’ve seen this movie before?” he said.
Family attorney Mark Krudys said the deputies had engaged in excessive force.
“His mother was basically crying out for help for her son in a mental health situation. Instead, he was thrust into the criminal justice system, and aggressively treated and treated poorly at the jail,” he said.
The video from the mental health facility shows the charges are appropriate, Krudys said.
“When you see that video … you’re just going to ask yourself, ‘Why?’” he said.
The 10 defendants will appear in court Tuesday before a grand jury, according to online court records. If the case goes to trial and any of them are convicted, the prison sentence for second-degree murder in Virginia is a minimum of five years with a maximum of 40 years.
Crump has called for the US Department of Justice to take part in the investigation.
Effie Schnacky was wheezy and lethargic instead of being her normal, rambunctious self one February afternoon. When her parents checked her blood oxygen level, it was hovering around 80% – dangerously low for the 7-year-old.
Her mother, Jaimie, rushed Effie, who has asthma, to a local emergency room in Hudson, Wisconsin. She was quickly diagnosed with pneumonia. After a couple of hours on oxygen, steroids and nebulizer treatments with little improvement, a physician told Schnacky that her daughter needed to be transferred to a children’s hospital to receive a higher level of care.
The physical and mental burnout that occurred during the height of the Covid-19 pandemic has not gone away for overworked health care workers. Shortages of doctors and technicians are growing, experts say, but especially in skilled nursing. That, plus a shortage of people to train new nurses and the rising costs of hiring are leaving hospitals with unstaffed pediatric beds.
But a host of reasons building since well before the pandemic are also contributing. Children may be the future, but we aren’t investing in their health care in that way. With Medicaid reimbursing doctors at a lower rate for children, hospitals in tough situations sometimes put adults in those pediatric beds for financial reasons. And since 2019, children with mental health crises are increasingly staying in emergency departments for sometimes weeks to months, filling beds that children with other illnesses may need.
“There might or might not be a bed open right when you need one. I so naively just thought there was plenty,” Schnacky told CNN.
The number of pediatric beds decreasing has been an issue for at least a decade, said Dr. Daniel Rauch, chair of the Committee on Hospital Care for the American Academy of Pediatrics.
By 2018, almost a quarter of children in America had to travel farther for pediatric beds as compared to 2009, according to a 2021 paper in the journal Pediatrics by lead author Dr. Anna Cushing, co-authored by Rauch.
“This was predictable,” said Rauch, who has studied the issue for more than 10 years. “This isn’t shocking to people who’ve been looking at the data of the loss in bed capacity.”
The number of children needing care was shrinking before the Covid-19 pandemic – a credit to improvements in pediatric care. There were about 200,000 fewer pediatric discharges in 2019 than there were in 2017, according to data from the US Department of Health and Human Services.
“In pediatrics, we have been improving the ability we have to take care of kids with chronic conditions, like sickle cell and cystic fibrosis, and we’ve also been preventing previously very common problems like pneumonia and meningitis with vaccination programs,” said Dr. Matthew Davis, the pediatrics department chair at Ann & Robert H. Lurie Children’s Hospital of Chicago.
Pediatrics is also seasonal, with a typical drop in patients in the summer and a sharp uptick in the winter during respiratory virus season. When the pandemic hit, schools and day cares closed, which slowed the transmission of Covid and other infectious diseases in children, Davis said. Less demand meant there was less need for beds. Hospitals overwhelmed with Covid cases in adults switched pediatric beds to beds for grownups.
Only 37% of hospitals in the US nowoffer pediatric services, down from 42% about a decade ago, according to the American Hospital Association.
While pediatric hospital beds exist at local facilities, the only pediatric emergency department in Baltimore County is Greater Baltimore Medical Center in Towson, Maryland, according to Dr. Theresa Nguyen, the center’s chair of pediatrics. All the others in the county, which has almost 850,000 residents, closed in recent years, she said.
The nearby MedStar Franklin Square Medical Center consolidated its pediatric ER with the main ER in 2018, citing a 40% drop in pediatric ER visits in five years, MedStar Health told CNN affiliate WBAL.
In the six months leading up to Franklin Square’s pediatric ER closing, GBMC admitted an average of 889 pediatric emergency department patients each month. By the next year, that monthly average jumped by 21 additional patients.
“Now we’re seeing the majority of any pediatric ED patients that would normally go to one of the surrounding community hospitals,” Nguyen said.
In other cases, it’s the hospitals that have only 10 or so pediatric beds that started asking the tough questions, Davis said.
“Those hospitals have said, ‘You know what? We have an average of one patient a day or two patients a day. This doesn’t make sense anymore. We can’t sustain that nursing staff with specialized pediatric training for that. We’re going to close it down,’” Davis said.
Saint Alphonsus Regional Medical Center in Boise closed its pediatric inpatient unit in July because of financial reasons, the center told CNN affiliate KBOI. That closure means patients are now overwhelming nearby St. Luke’s Children’s Hospital, which is the only children’s hospital in the state of Idaho, administrator for St. Luke’s Children’s Katie Schimmelpfennig told CNN. Idaho ranks last for the number of pediatricians per 100,000 children, according to the American Board of Pediatrics in 2023.
The Saint Alphonsus closure came just months before the fall, when RSV, influenza and a cadre of respiratory viruses caused a surge of pediatric patients needing hospital care, with the season starting earlier than normal.
The changing tide of demand engulfed the already dwindling supply of pediatric beds, leaving fewer beds available for children coming in for all the common reasons, like asthma, pneumonia and other ailments. Additional challenges have made it particularly tough to recover.
Another factor chipping away at bed capacity over time: Caring for children pays less than caring for adults. Lower insurance reimbursement rates mean some hospitals can’t afford to keep these beds – especially when care for adults is in demand.
Medicaid, which provides health care coverage to people with limited income, is a big part of the story, according to Joshua Gottlieb, an associate professor at the University of Chicago Harris School of Public Policy.
“Medicaid is an extremely important payer for pediatrics, and it is the least generous payer,” he said. “Medicaid is responsible for insuring a large share of pediatric patients. And then on top of its low payment rates, it is often very cumbersome to deal with.”
Medicaid reimburses children’s hospitals an average of 80% of the cost of the care, including supplemental payments, according to the Children’s Hospital Association, a national organization which represents 220 children’s hospitals. The rate is far below what private insurers reimburse.
More than 41 million children are enrolled in Medicaid and the Children’s Health Insurance Program, according to Kaiser Family Foundation data from October. That’s more than half the children in the US, according to Census data.
At Children’s National Hospital in Washington, DC, about 55% of patients use Medicaid, according to Dr. David Wessel, the hospital’s executive vice president.
“Children’s National is higher Medicaid than most other children’s hospitals, but that’s because there’s no safety net hospital other than Children’s National in this town,” said Wessel, who is also the chief medical officer and physician-in-chief.
And it just costs more to care for a child than an adult, Wessel said. Specialty equipment sized for smaller people is often necessary. And a routine test or exam for an adult is approached differently for a child. An adult can lie still for a CT scan or an MRI, but a child may need to be sedated for the same thing. A child life specialist is often there to explain what’s going on and calm the child.
“There’s a whole cadre of services that come into play, most of which are not reimbursed,” he said. “There’s no child life expert that ever sent a bill for seeing a patient.”
“When insurance pays more, people build more health care facilities, hire more workers and treat more patients,” Gottlieb said.
“Everyone might be squeezed, but it’s not surprising that pediatric hospitals, which face [a]lower, more difficult payment environment in general, are going to find it especially hard.”
Dr. Benson Hsu is a pediatric critical care provider who has served rural South Dakota for more than 10 years. Rural communities face distinct challenges in health care, something he has seen firsthand.
A lot of rural communities don’t have pediatricians, according to the American Board of Pediatrics. It’s family practice doctors who treat children in their own communities, with the goal of keeping them out of the hospital, Hsu said. Getting hospital care often means traveling outside the community.
Hsu’s patients come from parts of Nebraska, Iowa and Minnesota, as well as across South Dakota, he said. It’s a predominantly rural patient base, which also covers those on Native American reservations.
“These kids are traveling 100, 200 miles within their own state to see a subspecialist,” Hsu said, referring to patients coming to hospitals in Sioux Falls. “If we are transferring them out, which we do, they’re looking at travels of 200 to 400 miles to hit Omaha, Minneapolis, Denver.”
Inpatient pediatric beds in rural areas decreased by 26% between 2008 and 2018, while the number of rural pediatric units decreased by 24% during the same time, according to the 2021 paper in Pediatrics.
“It’s bad, and it’s getting worse. Those safety net hospitals are the ones that are most at risk for closure,” Rauch said.
In major cities, the idea is that a critically ill child would get the care they need within an hour, something clinicians call the golden hour, said Hsu, who is the critical care section chair at the American Academy of Pediatrics.
“That golden hour doesn’t exist in the rural population,” he said. “It’s the golden five hours because I have to dispatch a plane to land, to drive, to pick up, stabilize, to drive back, to fly back.”
When his patients come from far away, it uproots the whole family, he said. He described families who camp out at a child’s bedside for weeks at a time. Sometimes they are hundreds of miles from home, unlike when a patient is in their own community and parents can take turns at the hospital.
“I have farmers who miss harvest season and that as you can imagine is devastating,” Hsu said. “These aren’t office workers who are taking their computer with them. … These are individuals who have to live and work in their communities.”
Back at GBMC in Maryland, an adolescent patient with depression, suicidal ideation and an eating disorder was in the pediatric emergency department for 79 days, according to Nguyen. For months, no facility had a pediatric psychiatric bed or said it could take someone who needed that level of care, as the patient had a feeding tube.
“My team of physicians, social workers and nurses spend a significant amount of time every day trying to reach out across the state of Maryland, as well as across the country now to find placements for this adolescent,” Nguyen said before the patient was transferred in mid-March. “I need help.”
Nguyen’s patient is just one of the many examples of children and teens with mental health issues who are stayingin emergency rooms and sometimes inpatient beds across the country because they need help, but there isn’t immediately a psychiatric bed or a facility that can care for them.
It’s a problem that began before 2020 and grew worse during the pandemic, when the rate of children coming to emergency rooms with mental health issues soared, studies show.
Now, a nationwide shortage of beds exists for children who need mental health help. A 2020 federal survey revealed that the number of residential treatment facilities for children fell 30% from 2012.
“There are children on average waiting for two weeks for placement, sometimes longer,” Nguyen said of the patients at GBMC. The pediatric emergency department there had an average of 42 behavioral health patients each month from July 2021 through December 2022, up 13.5% from the same period in 2017 to 2018, before the pandemic, according to hospital data.
When there are mental health patients staying in the emergency department, that can back up the beds in other parts of the hospital, creating a downstream effect, Hsu said.
“For example, if a child can’t be transferred from a general pediatric bed to a specialized mental health center, this prevents a pediatric ICU patient from transferring to the general bed, which prevents an [emergency department] from admitting a child to the ICU. Health care is often interconnected in this fashion,” Hsu said.
“If we don’t address the surging pediatric mental health crisis, it will directly impact how we can care for other pediatric illnesses in the community.”
Funding for children’s hospitals is already tight, Rauch said, and more money is needed not only to make up for low insurance reimbursement rates but to competitively hire and train new staff and to keep hospitals running.
“People are going to have to decide it’s worth investing in kids,” Rauch said. “We’re going to have to pay so that hospitals don’t lose money on it and we’re going to have to pay to have staff.”
Virtual visits, used in the right situations, could ease some of the problems straining the pediatric system, Rauch said. Extending the reach of providers would prevent transferring a child outside of their community when there isn’t the provider with the right expertise locally.
Increased access to children’s mental health services
With the ongoing mental health crisis, there’s more work to be done upstream, said Amy Wimpey Knight, the president of CHA.
“How do we work with our school partners in the community to make sure that we’re not creating this crisis and that we’re heading it off up there?” she said.
There’s also a greater need for services within children’s hospitals, which are seeing an increase in children being admitted with behavioral health needs.
“If you take a look at the reasons why kids are hospitalized, meaning infections, diabetes, seizures and mental health concerns, over the last decade or so, only one of those categories has been increasing – and that is mental health,” Davis said. “At the same time, we haven’t seen an increase in the number of mental health hospital resources dedicated to children and adolescents in a way that meets the increasing need.”
Most experts CNN spoke to agreed: Seek care for your child early.
“Whoever is in your community is doing everything possible to get the care that your child needs,” Hsu said. “Reach out to us. We will figure out a way around the constraints around the system. Our number one concern is taking care of your kids, and we will do everything possible.”
Nguyen from GBMC and Schimmelpfennig from St. Luke’s agreed with contacting your primary care doctor and trying to keep your child out of the emergency room.
“Anything they can do to stay out of the hospital or the emergency room is both financially better for them and better for their family,” Schimmelpfennig said.
Knowing which emergency room or urgent care center is staffed by pediatricians is also imperative, Rauch said. Most children visit a non-pediatric ER due to availability.
“A parent with a child should know where they’re going to take their kid in an emergency. That’s not something you decide when your child has the emergency,” he said.
After Effie’s first ambulance ride and hospitalization last month, the Schnacky family received an asthma action plan from the pulmonologist in the ER.
It breaks down the symptoms into green, yellow and red zones with ways Effie can describe how she’s feeling and the next steps for adults. The family added more supplies to their toolkit, like a daily steroid inhaler and a rescue inhaler.
“We have everything an ER can give her, besides for an oxygen tank, at home,” Schnacky said. “The hope is that we are preventing even needing medical care.”
The European Union regulates all sorts of banks: money banks, blood banks, sperm banks.
Its next target? Breast milk banks.
Brussels bureaucrats want to homogenize the rules overseeing the donation and use of donor breast milk across the bloc.
It’s part of the European Commission’s proposed revamp of the laws covering safety and quality standards for substances of human origin (SoHO) intended for human use. Currently, the laws cover blood, tissues and cells, but the EU wants to extend coverage to all SoHO — including donor breast milk.
While, at first glance, it might seem like the EU is trying to milk its regulatory powers, experts are largely in favor of the plan to set EU-wide standards, saying it will improve its availability and safety.
With lawmakers and EU countries debating the revamp, POLITICO walks you through the issue.
What are breast milk banks?
Women who make more breast milk than their babies need can donate it to a breast milk bank.
These banks screen donors and collect, process and distribute the milk to infants in need — those whose mother’s own milk is not available or sufficient.
While exclusive breastfeeding is recommended for all babies in the first six months of their life, it’s especially important for premature or sick newborns, experts say.
Among many other benefits, breast milk contains antibodies that are important for newborns’ immune systems. Babies born before 30 weeks of pregnancy are especially susceptible to infections, particularly from necrotizing enterocolitis, a type of gut inflammation that can be fatal. Their survival rates improve when they get human milk as compared with formula, said Elien Rouw, a breastfeeding medicine specialist in Germany and president-elect of the Academy of Breastfeeding Medicine.
There are currently 282 breast milk banks in Europe, including Turkey and Ukraine, according to the European Milk Bank Association.
Aren’t they already regulated?
Donor breast milk is regulated differently in different countries. For example, it’s considered a health product in France, a food in Germany, and is uncategorized and unregulated in Romania. And while the safety standards are set at the national level in France, for instance, they are setat the regional level in Belgium.
The Commission wants to harmonize breast milk safety standardsacross the EU | Kenzo Tribouillard/AFP via Getty Images
There is some level of convergence though. For example, most national guidelines in the world recommend donor breast milk should be pasteurized, according to the European Milk Bank Association.
In France, for example, the milk is first tested for bacteria and highly contaminated milk is thrown out, explains Jean-Charles Picaud, professor of pediatrics specialized in neonatology at Hôpital de la Croix-Rousse in Lyon, and president of the French Human Milk Bank Association. The rest is then pasteurized at precisely 62.5 degrees Celsius for exactly 30 minutes and then retested before being made available for babies.
What does the Commission want to do?
The Commission wants to harmonize safety standardsacross the EU, not only to ensure the safety of the babies that consume breast milk, but also to make it easier for donor breast milk — and other SoHO — to cross borders.
Donor milk banks are unevenly spread out across the Continent. There are over 30 in France, for example, but only four in Belgium and one in Romania.And parts of Europe are facing a shortage of donor breast milk, while it remains in limited supply elsewhere.
“There are children dying in Germany because they didn’t have, or didn’t have enough, human milk,”Rouw, the breastfeeding medicine specialist in Germany, said. Centers in Germany caring for extremely premature babies without direct access to a milk bank are buying it in part from Belgium and the United States, she added.
Experts agree that having harmonized safety standards would make the cross-border exchange of breast milk easier, improving babies’ access to it. These include things like donor selection criteria, maternal blood tests for infections, hygiene standards during collection, cold chain conditions during transport, and testing the milk for bacteria, said Picaud, president of the French Human Milk Bank Association.
However, while the Commission is setting out the principle of bloc-wide standards in its regulation, it aims to leave it to expert bodies — the European Centre for Disease Prevention and Control (ECDC) and the European Directorate for the Quality of Medicines & HealthCare (EDQM) — to hammer out the precise scientific and technical details so that these can be more easily updated should the need arise.
Should donors get paid?
The debate over paying for substances of human origin is a divisive one. Germany’s Human Milk Bank Initiative, a nongovernmental organization that promotes nonprofit donor milk banks, warned in a position statement to the Commission in 2020that “ethically questionable approaches” have been used globally to acquire human milk from “lactating mothers in resource-limited regions or from socio-economically disadvantaged populations.”
EU countries take varying approaches when it comes to donor compensation for breast milk. Donors in France, for instance, receive no financial compensation. In Sweden, donating mothers receive a nominal 250 Swedish krona (€22.56) per liter of donated milk.
The Commission’s proposed revision includes guidance on compensation for all SoHO donors, to allow any financial losses to be covered — but leaves it to EU countries to determine whether to allow it and if so, the conditions for it, ensuring they remain “financially neutral.”
As well as human milk banks, the new law would also apply to any company looking to commercialize breast milk as an ingredient.
A nurse checks reserves of breast milk in the Sant’Anna hospital in Turin, Italy | Diana Bagnoli/Getty Images
Given the growing body of research showing the clinical benefits of donor breast milk for premature babies, hospital-affiliated milk banks around the world are expanding their activities — and there’s also growing commercial interest, a Commission spokesperson told POLITICO.
At least one company is using breast milk to make fortifiers for sick and premature babies in the neonatal intensive care unit, which are then added to either a mother’s milk or donor milk.
MOSCOW — Every year, during the anniversary of the battle that turned back the Nazi assault on the Soviet Union, the city of Volgograd is briefly renamed Stalingrad, its Soviet-era name.
During this year’s commemoration, however, authorities went further. They unveiled a bust of the Soviet dictator Joseph Stalin, and paraded soldiers dressed as secret police in a bid to emphasize the parallels between Russia’s past and its present.
“It’s unbelievable but true: we are again being threatened by German Leopard tanks,” said Russian President Vladimir Putin, who traveled to Volgograd to deliver a speech on February 2. “Again and again, we have to repel the aggression of the collective West.”
Putin’s statement was full of factual inaccuracies: Russia is fighting not the West but Ukraine, because it invaded the country; the German Leopards being delivered to Kyiv date back only to the 1960s; there’s no plan for them to enter Russian territory.
But the Russian president’s evocation of former victories was telling — it was a distillation of his approach to justifying an invasion that hasn’t gone to plan. These days in Russia, if the present is hard to explain, appeal to the past.
“The language of history has replaced the language of politics,” said Ivan Kurilla, a historian at the European University at St. Petersburg. “It is used to explain what is happening in a simple way that Russians understand.”
Putin has long harkened back to World War II — known in the country as The Great Patriotic War, in which more than 20 million Soviet citizens are estimated to have died.
Invoking the fight against Adolf Hitler simultaneously taps into Russian trauma and frames the country as being on the right side of history. “It has been turned into a master narrative through which [Putin] communicates the basic ideas of what is good and bad; who is friend and who foe,” said Kurilla.
Putin’s announcement of his full-scale assault on Ukraine was no exception. On February 24, 2022, Russians awoke to a televised speech announcing the start of “a special military operation” to “demilitarize” and “denazify” Ukraine.
“The official narrative was: ‘there are fascists in Ukraine, and we want to help people there. We are fighting for the sake of a great cause,’” said Tamara Eidelman, an expert in Russian propaganda.
On the streets, however, Russians seemed confused.
Asked in the early days of the war what “denazification” meant by the Russian website 7×7, one man suggested: “Respect for people of different ethnicities, respect for different languages, equality before the law and freedom of the press.”
Russia’s laws punish those seen as discrediting the Russian Armed Forces or spreading fake news by using the word “war” | Dimitar Dilkoff/AFP via Getty Images
Another interviewee ventured a different definition: “Destroy everyone who is not for a normal, peaceful life.”
The term “special military operation” at least was somewhat clearer. It suggested a speedy, professional, targeted offensive.
“There is a certain mundaneness to it — ‘yes, this is going to be unpleasant, but we’ll take care of it quickly,’” said Eidelman, the propaganda expert.
А week after the invasion, Russia’s laws were amended to punish those seen as discrediting the Russian armed forces or spreading fake news, including by using the word “war.”
Historical parallels
As the special military operation turned into a protracted conflict, and the facts on the ground refused to bend to Putin’s narrative, the Kremlin has gradually been forced to change its story.
Images of a bombed maternity hospital in Mariupol or corpses littering the streets of Bucha were dismissed by state propaganda as fake or a provocation — and yet by spring the terms “demilitarization” and “denazification” had practically disappeared from the public sphere.
New justifications for the invasion were inserted into speeches and broadcasts, such as a claim that the United States had been developing biological weapons in Ukraine. In October, Putin declared that one of the main goals of the war had been to provide Crimea, annexed by Russia in 2014, with a stable water supply.
But the appeal to history has remained central to Putin’s communication effort.
While World War II remains his favorite leitmotif, the Russian president has been expansive in his historical comparisons. In June, he referenced Peter the Great’s campaign to “return what was Russia’s.” And during an October ceremony to lay claim to four regions in Ukraine, it was Catherine the Great who got a mention.
“Every so many months, another story is put forward as if they’re studying the reaction, looking to see what resonates,” said Kurilla.
The search for historical parallels has also bubbled up from below, as even supporters of the war search for justification. “Especially in spring and early summer, there was an attempt to Sovietize the war, with people waving red flags, trying to make sense of it through that lens.”
In the city of Syzran, students were filmed late last year pushing dummy tanks around in a sports hall in a re-enactment of the World War II Battle of Kursk. More recently, law students in St. Petersburg took part in a supposed restaging of the Nuremberg trials, which the region’s governor praised as “timely” in light of Russia’s current struggle against Nazism.
More recent statement by Foreign Minister Sergei Lavrov and Vladimir Putin himself have made the idea of “war” less taboo | Brendan Smialowski/AFP via Getty Images
Throughout, the Kremlin has sought to depict the conflict as a battle against powerful Western interests bent on using Ukraine to undermine Russia — a narrative that has become increasingly important as the Kremlin demands bigger sacrifices from the Russian population, most notably with a mobilization campaign in September.
“Long before February last year, people were already telling us: We are being dragged into a war by the West which we don’t want but there is no retreating from,” said Denis Volkov, director of the independent pollster Levada Center.
The sentiment, he added, has been widespread since the nineties, fed by disappointment over Russia’s diminished standing after the Cold War. “What we observe today is the culmination of that feeling of resentment, of unrealized illusions, especially among those over 50,” he said.
Long haul
With the war approaching the one-year mark, the narrative is once again having to adapt.
Even as hundreds in Russia are being prosecuted under wartime censorship laws, slips of the tongue by top officials such as Foreign Minister Sergei Lavrov and even Putin himself in December have made the idea of “war” less taboo.
“We are moving away from a special military operation towards a holy war … against 50 countries united by Satanism,” the veteran propagandist Vladimir Solovyov said on his program in January.
According to Levada, Russians are now expecting the war to last another six months or longer. “The majority keep to the sidelines, and passively support the war, as long as it doesn’t affect them directly,” said Volkov, the pollster.
Meanwhile, reports of Western weapons deliveries have been used to reinforce the argument that Russia is battling the West under the umbrella of NATO — no longer in an ideological sense, but in a literal one.
“A year of war has changed not the words that are said themselves but what they stand for in real life,” said Kurilla, the historian. “What started out as a historic metaphor is being fueled by actual spilled blood.”
In newspaper stands, Russians will find magazines such as “The Historian,” full of detailed spreads arguing that the Soviet Union’s Western allies in World War II were, in fact, Nazi sympathizers all along — another recycled trope from Russian history.
“During the Cold War, you would find caricatures depicting Western leaders such as President Eisenhower in fascist dress and a NATO helmet,” said Eidelman, the expert in Russian propaganda.
“This level of hatred and aggressive nationalism has not been seen since the late Stalin period,” she added.
The anti-West sentiment in Russia has been fed by disappointment over the country’s diminished standing after the Cold War | Keystone/Hulton Archive/Getty Images
On Tuesday, three days before the one-year anniversary of the invasion, Putin is scheduled to give another speech. He is expected to distract from Russia’s failure to capture any new large settlements in Ukraine by rehearsing old themes such as his gripes with the West and Russia’s past and present heroism.
There may be a limit, however, to how much the Russian president can infuse his subjects with enthusiasm for his country’s past glories.
In Volgograd, proposals to have the city permanently renamed to Stalingrad have been unsuccessful, with polls showing a large majority of the population is against such an initiative.
When it comes to embracing the past, Russians are still one step behind their leaders.
While officials have repeatedly sought to assure residents that the water and air in East Palestine, Ohio, are safe after the derailment of a train carrying hazardous materials earlier this month, anxiety has permeated the community amid reports of rashes, nausea and headaches.
The state now plans to open a health clinic in East Palestine Tuesday for residents concerned about possible symptoms related to the derailment and the Biden administration announced it deployed experts to help assess what dangers remain in the area after Ohio Gov. Mike DeWine requested medical teams from the US Centers for Diseases Control and Prevention and the US Department of Health.
It’s been over two weeks since a train carrying vinyl chloride derailed in the small community of less than 5,000 people, igniting a dayslong inferno and prompting crews to carry out detonations to the toxic chemical to prevent a potentially deadly explosion.
The detonations unleashed a black cloud of smoke over the area, where a chemical stench lingered for days. While it was deemed safe for evacuated residents to return home on February 8, community members have questioned how safe their village is and the validity of the air and water tests.
“We think the water’s safe,” Brown told CNN, citing comments made by the administrators of the state and federal Environmental Protection Agencies. “But when you return to your home, you should be tested again for your water and your soil and your air, not to mention those that have their own wells.”
Testing of air quality in more than 530 homes has shown no detection of contaminants, the US Environmental Protection Agency said Sunday.
As for the water, no vinyl chloride has been detected in any down-gradient waterways near the train derailment, EPA official Tiffani Kavalec told CNN last week.
And while some waterways in the area were contaminated – killing thousands of fish downstream – officials have said they believe those contaminants to be contained.
After crews discovered the contaminated runoff ontwo surface water streams, Sulphur Run and Leslie Run, Norfolk Southern installed booms and dams to restrict the flow of contaminated water, according to the EPA.
Still, despite the assurances from officials that the water is safe, some residents are too afraid to drink from their taps and the town has been distributing bottled water.
Desiree Walker – a 19-year residentof the town who lives just 900 feet from the derailment site – told CNN affiliate WOIO that she refuses to let her children drink the water, fearing it could have long-term health effects.
“There’s a big concern because they’re young. They’ve got their whole life ahead of them,” Walker said. “I don’t want this to impact them down the road. I want them to have a long, happy life.”
Walker said her family is feeling symptoms, but doctors tell them they don’t know what to test for.
“At nighttime especially is when we smell it the most,” she told the station. “Our throats are sore, we’re coughing a lot now. My son, his eyes matted shut.”
Residents reported a variety of issues – including rashes, sore throats, nausea and headaches – and shared worries that the symptoms could potentially be related to chemicals released after a train derailment.
“Why are people getting sick if there’s nothing in the air or in the water,” one resident yelled during the gathering.
Ayla Antoniazzi and her family returned to their house less than a mile from the crash site the day after evacuation orders were lifted. The mother made sure to air the house out and wash all the linen before bringing her children home.
“But the next day when they woke up, they weren’t themselves,” Antoniazzi said. “My oldest had a rash on her face. The youngest did too but not as bad. The 2-year-old was holding her eye and complaining that her eye was hurting. She was very lethargic, so I took them back to my parents’ home.”
The Ohio Department of Health’s clinic opening Tuesday is meant to help East Palestine recover from the incident, officials said. The clinic will have registered nurses, mental health specialists and, at times, a toxicologist, the agency said.
“I heard you, the state heard you, and now the Ohio Department of Health and many of our partner agencies are providing this clinic, where people can come and discuss these vital issues with medical providers,” said the department’s director, Dr. Bruce Vanderhoff.
The decision to conduct controlled detonations at the derailment site on February 6 has also fueled skepticism and questions about safety.
Officials said the move was meant to avert an explosion at the site of the derailment by venting the toxic vinyl chloride gas and burning it in a pit, a move that shot up a thick plume of smoke over the town.
Vinyl chloride – a man-made substance used to make PVC – can cause dizziness, sleepiness and headaches and has also been linked to an increased risk of cancer in the liver, brain, lungs and blood.
The burning vinyl chloride gas could break down into compounds including hydrogen chloride and phosgene, a chemical weapon used during World War I as a choking agent, according to the US Environmental Protection Agency and CDC.
After the detonation, crews checked the air for chemicals of concern, including phosgene and hydrogen chloride,as well as butyl acrylate, ethylene glycol monobutyl ether acetate, and 2-ethylhexyl acrylate, according to the EPA, and reported that the data was normal.
Work now continues to clear the crash site.
The train’s operator, Norfolk Southern, is “scrapping and removing rail cars at the derailment location, excavating contaminated areas, removing contaminated liquids from affected storm drains, and staging recovered waste for transportation to an approved disposal facility,” the EPA said Sunday.
“Air monitoring and sampling will continue until removal of heavily contaminated soil in the derailment area is complete and odors subside in the community,” the agency said.
US Transportation Secretary Pete Buttigieg sent a letter Sunday to Norfolk Southern CEO Alan Shaw, demanding accountability and calling for greater safety regulations.
“The people of East Palestine cannot be forgotten, nor can their pain be simply considered the cost of doing business,” Buttigieg wrote to the railway’s chief executive.
“You have previously indicated to me that you are committed to meeting your responsibilities to this community, but it is clear that area residents are not satisfied with the information, presence, and support they are getting from NorfolkSouthern in the aftermath and recovery,” Buttigieg added.
Brown also pledged to hold the rail company accountable for the impacts on the community, saying in a news conference he would “make sure Norfolk Southern does what it says it’s going to do, what it’s promised.”
“All the cleanup, all the drilling, all the testing, all the hotel stays, all of that is on Norfolk Southern. They caused it, there’s no question they caused it,” Brown said, adding the total cost could amount to either tens or hundreds of millions of dollars.
Norfolk Southern’s CEO posted an open letter Saturday telling East Palestine residents, “I hear you” and “we are here and will stay here for as long as it takes to ensure your safety and to help East Palestine recover and thrive.”
“Together with local health officials, we have implemented a comprehensive testing program to ensure the safety of East Palestine’s water, air, and soil,” Shaw said in the letter, adding that the company also started a $1 million fund “as a down payment on our commitment to help rebuild.”
More than 10 days after the devastating 7.8 magnitude earthquake that hit Turkey and Syria, people continue to be pulled from the rubble alive, defying expectations for survival after so many hours.
“We, of course, thought this wouldn’t be possible, because getting somebody out alive after 10 days would’ve been a really great surprise for us,” rescue worker Özer Aydinli told CNN Chief Medical Correspondent Dr. Sanjay Gupta this week.
Aydinli and his team rescued a 13-year-old boy named Mustafa from the rubble 228 hours – nearly 10 days – after the quake.
“When [our friends] said, ‘We found a person alive,’ we thought, ‘No, they must be hallucinating.’ We couldn’t believe it. But it is a miracle. … The only thing we can say is that this is a great miracle,” he said.
Search and rescue teachings have historically emphasized the “golden 48 hours” after a building collapse in which the chance of live rescues is highest. Some studies say the majority of live rescues happen within the first five or six days.
However, people continue to be rescued alive from the rubble of the February 6 quake, including Mustafa.
“I have no clue how he survived for 228 hours, because as the excavator was in operation, there was more debris falling around, filling the space above and under him, and so we couldn’t see any intact residential structure, because it was all rubble,” rescue worker Uğur Sevgin told Gupta. “Then, from the rubble, we got him out, digging him out by hand.”
Amid the rubble, Aydinli said, there was just a pair of eyes and then the call of “Brother!”
“When we saw it, when we heard it, there were 70, 80 people in the crew, and when we said there was a person alive, all our friends swarmed the area,” Aydinli said. “Nobody moved, and we all cried. And even now, we get tears in our eyes from time to time.”
Aydinli says Mustafa may have been trapped in the “triangle of life,” explained by a theory that when buildings collapse, ceilings fall on objects or furniture inside, leaving a viable space next to the person.
“After seeing Mustafa, I absolutely believe that there will be others. It is a miracle,” Sevgin said. “But, of course, it seems scientifically impossible. It has been 10 days and counting.”
Some rescue teams follow a “rule of fours,” which assumes that trapped people can survive four minutes without air, four days without water and four weeks without food.
However, research suggests that “rigid, universal timeframes” may be inaccurate, as survival can be extended under rare conditions.
In Turkey, for example, experts say those who were stuck in collapsed residential buildings may have had access to some source of water or food.
“You really only need a little bit of air, oxygen, water and probably a little bit of food to survive, hopefully just enough to get to a point where the rescuers can find you,” said Dr. Jarone Lee, an emergency and disaster medicine expert at Massachusetts General Hospital. “But I think it also relates to what kind of injuries happen during the initial sort of collapse and insult, if they only had a minor injury versus a major injury to the internal organs like your liver and such.”
Lee said a person’s baseline health status is key. Those with pre-existing medical conditions – who may be unable to access their medication or whose medication includes side effects such as dehydration – have a lower likelihood of survival.
“I do think that the ones that will continue to be found will be the younger, probably kids and other folks who are more robust. … Kids are usually smaller too, and there’s always a chance that they might be in an area of the collapse that they can survive longer just because they are smaller,” Lee said.
Experts say cold temperatures may prevent dehydration and heat exhaustion among trapped people, but the subfreezing temperatures in Turkey and Syria are doing more harm than good.
“In trauma patients, cold temperature is not a good thing for the physiology in general. After some degree of hypothermia, cardiac arrest can be a problem. Blood clotting factors do not work well, and other serious physiologic derangements happen,” said Dr. Girma Tefera, medical director of the American College of Surgeons’ Operation Giving Back.
Advances in search and rescue training and technologies, including the use of dogs, drones and on-site IV rehydration, may also account for the extended survival times.
Lee said that although he is hopeful there will be many more survivors, these are “extraordinary or rare circumstances” amid the more than 43,000 deaths after the earthquake. “These are in many ways still a handful of survivors in a massive amount of unfortunate devastation and death.”
Rescue is only the beginning of a survivor’s road to recovery.
At the Adana City Teaching and Research Hospital, the largest trauma hospital in the region, more than 5,000 patients were treated in the week after the earthquake.
Dr. Suleyman Cetinkunar, chief of staff at the hospital, told Gupta that the majority of injuries include “limb loss, tissue crushes and brain trauma.”
In addition to traumatic injuries from the collapse, patients may have “crush syndrome,” when compressed muscle tissues are finally freed and broken down, releasing toxins into the blood. These toxins can injure the kidneys and lead to kidney failure, causing seemingly stable patients to rapidly deteriorate after rescue.
During their interview, the team received another call to the helipad to receive a 26-year-old who had crush syndrome and was in need of immediate dialysis.
“Even just getting out of the rubble is a big step to get them stabilized into the hospital. But they are not out of the woods in any way. There’s a good chance that they still might not survive in the hospital,” said Massachusetts General’s Lee.
Receiving lifesaving medical care becomes even more difficult as hospital buildings, like most other buildings, were not spared by the earthquake.
The government and nonprofit organizations have set up field hospitals, tent hospitals and even hospital ships to continue to care for earthquake victims.
Gupta spoke to doctors who are performing essential orthopedic surgery in tents set up in the parking lot of a ruined hospital in Antakya, Hatay province.
“I’ve worked in places before where people like this don’t have the operation. They lay at home, languish. Some of them would get bedsores, blood clots, pneumonia and maybe die from that,” Dr. Greg Hellwarth, an orthopedic surgeon from Indiana, told Gupta.
Dr. Elliott Tenpenny, an ER doctor from North Carolina and director of the International Health Unit for Samaritan’s Purse, showed Gupta around the field hospital where, amid 5.0 aftershocks, they continue to manage critical conditions like blood loss and asthma.
“It’s not just about the broken bones and the crush injuries. It’s about these patients also,” Tenpenny told Gupta.
The floating hospital also provides immediate beds, operating rooms and even a maternity ward. Unlike the field hospitals on the ground, hospital ships are relatively protected from the aftershocks that continue to devastate the land, the captain told Gupta.
Experts say this disaster causes disruptions in the health care system that put people with chronic medical conditions at risk of losing access to lifesaving medications or medical appointments.
“The consequences of that are going to be in weeks to years, months to years,” Lee said. “The fallout is going to be unfortunately massive from this.”
Sen. John Fetterman is being kept overnight in a Washington, DC, hospital “for observation,” after being admitted earlier Wednesday after feeling lightheaded, his office said in a statement.
The Pennsylvania Democrat was elected to the Senate in November while recovering from a stroke he had suffered in May. According to his spokesperson, there was no evidence of a new stroke Wednesday, but he was set to undergo more tests during his hospital stay.
“Towards the end of the Senate Democratic retreat today, Senator John Fetterman began feeling lightheaded. He left and called his staff, who picked him up and drove him to The George Washington University Hospital. Initial tests did not show evidence of a new stroke, but doctors are running more tests and John is remaining overnight for observation,” Fetterman’s communications director, Joe Calvello, said in the statement.
Last year, Fetterman checked himself into a hospital in Lancaster, Pennsylvania, several days before the primary. Fetterman won the nomination while in the hospital and underwent a nearly three-hour surgery that same day to implant a defibrillator. He was released from the hospital after a nine-day stay.
Fetterman’s cardiologist later issued a statement, providing more insight into what caused his stroke and outlining that the Democrat suffers from both atrial fibrillation and cardiomyopathy.
Calvello said Wednesday night that Fetterman was “in good spirits and talking with his staff and family.”
An apparent cyberattack has forced a network of Florida health care organizations to send some emergency patients to other facilities and to cancel some non-emergency surgeries, the health care network said Friday.
Tallahassee Memorial HealthCare, which operates a 772-bed hospital and multiple specialty care centers, said an “IT security issue” late Thursday night forced it to take down its computer system.
“We are also diverting EMS [emergency medical services] patients and will only be accepting Level 1 traumas from our immediate service area,” the hospital system said in a statement. Level 1 trauma refers to the most acute injuries and illnesses.
Tallahassee Memorial HealthCare spokesperson Tori Lynn Schneider told CNN “some” emergency patients were being diverted to facilities outside of the organization’s network, but declined to say how many patients. All non-emergency and elective procedures scheduled for Monday were canceled because of the hacking incident, Schneider said.
It’s the latest in a series of cyberattacks that have continued to hit resource-strapped US health care providers in the nearly three years of the Covid-19 pandemic. In another case, hackers accessed the personal data of nearly 270,000 patients in an attempted ransomware attack on a Louisiana health care system in October.
The FBI last month shut down the computer infrastructure used by a notorious ransomware gang to attack multiple US hospitals, according to the bureau. But the threat remains as multiple ransomware groups are known to target the health sector.
It’s unclear who was responsible for the apparent hack of Tallahassee Memorial. Tallahassee Memorial did not specify whether it had suffered a ransomware attack, but the organization’s statement described activity, including the need to shut down computer networks, consistent with a ransomware attack.
Staff have been unable to access digital patient records and lab results because of the shutdown, a hospital source told CNN.
Mark O’Bryant, Tallahassee Memorial’s CEO, notified staff in person Friday morning that the system had suffered a “cyberattack,” according to the source.
“To help us contain the issue, please completely turn off all PCs connected to TMH’s network immediately and leave them off until notified otherwise,” Tallahassee Memorial leadership said in a memo sent to employees Friday morning and obtained by CNN.
Max Henderson, a Tallahassee native and cybersecurity specialist who focuses on health care, said the effects of a shutting down a hospital’s computer network can last for weeks or months.
“Immediate, unplanned shutdowns can lead to a loss of recently gathered data regarding diagnosis, clinical notes, shift handovers and other various setbacks for the medical staff,” Henderson, who is senior manager for incident response at security firm Pondurance, told CNN.
“Nearly all hospitals rely on the internet for connectivity with vendors and remote offices for processing information in critical departments such as radiology, pharmacy, medical device maintenance, patient document scanning and payment processing,” Henderson added.
KYIV — Pete Reed, an American volunteer medic and founder of the NGO Global Response Medicine, was killed while helping to evacuate civilians in the eastern Ukrainian city of Bakhmut.
Reed, a former U.S. Marine, died on Thursday in the besieged city in the Donetsk region of the country, GRM said late Friday.
“In January, Pete stepped away from GRM to work with Global Outreach Doctors on their Ukraine mission and was killed while rendering aid,” the NGO said. “Pete was the bedrock of GRM, serving as Board President for 4 years,” it said.
Bakhmut has been one of the major hot spots during Russia’s invasion of Ukraine. In the ongoing attempts to seize the city, Moscow has been throwing thousands of troops at the Ukrainian positions in Bakhmut in tactics that have gained the name “meat waves.” Ukrainian President Volodymyr Zelenskyy visited the city in December, calling it the “hottest spot” in the war.
“Pete was just 33 years old, but lived a life in service of others, first as a decorated U.S. Marine and then in humanitarian aid,” GRM said. “We fully support Pete’s family, friends, and colleagues during this devastating time.”
Global Outreach Doctors also confirmed the death of Reed, who was the organization’s Ukraine Country director. “Pete was actively aiding in the evacuation of Ukrainian civilians when his evacuation vehicle was hit with a reported missile in Bakhmut, Ukraine, on Feb. 2,” the group said in a statement.
Reed’s wife, Alex Kay Potter, wrote on Instagram that her husband apparently died saving another team member’s life, CNN reported. “He was evacuating civilians and responding to those wounded when his ambulance was shelled,” her post said, according to the CNN report.
“Pete Reed, a volunteer medic, was killed by shelling in Bakhmut, Ukraine, yesterday while trying to evacuate civilians. One of the most selfless people I’ve ever met,” documentary photographer Cengiz Yar wrote in a tweet.
The same day Reed was killed, two other foreign volunteer doctors were injured in a bombing in Bakhmut. The medics — Norwegians Sander Sørsveen Trelvik and Simon Johnsen — were working for Frontline Doctors. They were taken to a hospital in Dnipro for surgery.
They both are recovering and preparing to return to Norway on Tuesday, Grethe Sørsveen, Sander’s mother, wrote on Facebook.
KYIV — President Volodymyr Zelenskyy refused to veto a new law that strengthens punishment for wayward military personnel on Thursday, rejecting a petition signed by over 25,000 Ukrainians who argue it’s too harsh.
“The key to the combat capability of military units and ultimately of Ukraine’s victory, is compliance with military discipline,” Zelenskyy said in his written response to the petition.
Ukrainian soldiers have stunned the world with their resilience and battlefield successes, withstanding a year-long onslaught from Russian troops. But among Kyiv’s forces, made up largely of fresh recruits lacking previous military experience or training, some are struggling to cope. There are those who have rebelled against commanders’ orders, gotten drunk or misbehaved; others, running low on ammunition and morale, have fled for their lives, abandoning their positions.
Seeking to bring his forces into line, Zelenskyy in January signed into force a punitive law that introduces harsher punishment for deserters and wayward soldiers, and strips them of their right to appeal.
The law aims to standardize and toughen the repercussions for rule-breaking, improving discipline and the combat readiness of military units. Disobedience will be punishable by five to eight years in prison, rather than the previous two to seven; desertion or failure to appear for duty without a valid reason by up to 10 years. Threatening commanders, consuming alcohol, questioning orders and many other violations will also be dealt with more harshly, potentially with prison time; those who broke these rules in the past may have gotten away with a probation period or the docking of their combat pay.
Those who lobbied in favor of the new law, such as the Ukrainian Army General Staff, argue it will make discipline fairer: Previously, because courts adjudicated infractions on a case-by-case basis, some perpetrators were able to escape punishment for serious rule-breaking entirely, while others received harsher sentences for less significant violations, according to an explanatory note that accompanied the new law.
But soldiers, lawyers and human rights watchdogs have slammed the measures as an inappropriate and blunt instrument that won’t deal with the root causes of military indiscipline — and over 25,000 Ukrainians called on the president to veto the law altogether in a petition submitted to the president late last year.
The new punitive rules remove discretion and turn courts into a “calculator” for doling out punishment to soldiers, regardless of the reasons for their offenses, lawyer Anton Didenko argued in a column on Ukraine’s Interfax news agency.
“This law will have negative consequences for the protection of the rights of military personnel who are accused of committing a crime and will reduce the level of motivation during service,” an NGO, called the Reanimation Package of Reforms Coalition, said in a statement. “This can carry risks both for the protection of human rights and for the defense capability of the state.”
Zelenskyy’s military commanders disagree, arguing the measures are necessary to hold firm in the face of Russia’s assault.
Ukraine’s armed forces have swelled to over a million soldiers in the past year | Sameer Al-Doumy/AFP via Getty Images
“The army is based on discipline. And if the gaps in the legislation do not ensure compliance, and refuseniks can pay a fine of up to 10 percent of combat pay or receive a punishment with probation, this is unfair,” argued the Commander-in-Chief of the Armed Forces of Ukraine Valerii Zaluzhnyi in a video in favor of the new rules.
Zelenskyy, in his response to the popular petition asking him to scrap the changes, agreed that disciplinary action against military personnel should take into account their individual circumstances, and promised that the cabinet of ministers would further consider how to improve the disciplinary mechanism — though he did not specify when this work might be done; nor suspend the law in the meantime.
Army of civilians
Ukraine’s armed forces have swelled rapidly to over a million soldiers in the year since Russia launched its full-scale invasion in February 2022 — up from 250,000 personnel.
The influx of hundreds of thousands of new recruits, whom Ukraine has had to equip and train while withstanding the barrage from Russia, has compromised the usual vetting process and meant some unsuitable soldiers have ended up in combat, Valerii Markus, the chief master sergeant of the 47th Separate Assault Brigade, told subordinates in a lecture about “desertion at the front,” posted to his YouTube channel in January.
“We were trying to vet the candidates as well as we could in those circumstances,” Markus said. “However, many people in our own brigade don’t want to be there.” He said some of those who had joined up for the wrong motivations, such as for a pay check, subsequently “break down under pressure and want to flee; start to revolt.”
Markus said commanders frequently didn’t understand the problems and shortages faced by their troops on the ground due to local sergeants failing to communicate with them. He played videos of soldiers complaining about a lack of weapons or inappropriate or illegal orders from their commanders, before telling those in the audience that most problems could be resolved internally through the proper channels, while publicly airing complaints discredited Ukraine’s army and undermined attempts to help troops.
“Do I recognize the existence of problems that lead to the arbitrary abandonment of positions? Yes,” Zaluzhnyi said in his video supporting the reforms. “Am I working on their elimination? Successful operations to liberate the territories of our state are a confirmation of that.”
But members of Ukraine’s armed forces, many of whom have expressed respect for Zaluzhnyi, were deeply disappointed by his support of the new law.
“It is very demotivating. This is such a striking contrast with Zaluzhnyi’s human- and leader-oriented ‘religion,’” said Eugenia Zakrevska, a human rights lawyer who enlisted in the war effort and is now a member of the 92nd Ivan Sirko Separate Mechanized Brigade. This was a pointed reference to an interview the commander-in-chief gave to the Economist in December, in which he said that unlike the Kremlin, the “religion” he and Ukraine practised was “to remain human in any situation.”
Treating the symptoms, not the disease
Those who oppose the new law argue that Ukraine needs to deal with the underlying causes of desertion and misbehavior, rather than punishing soldiers who break the rules more harshly.
A Ukrainian army officer who recently left the frontline city of Bakhmut (and requested anonymity as officers are not authorized to speak to the press) told POLITICO: “Sometimes abandonment of positions becomes the only way to save personnel from senseless death. If they cannot deliver ammunition or [relieve troops], when you sit in the trenches for several days without sleep or rest, your combat value goes to zero.”
In responding to the petition asking him to reconsider, President Zelenskyy agreed that disciplinary action should take into account the individual circumstances of military personnel | Yuriy Dyachyshyn/ AFP via Getty Images
The officer added that many discipline problems are rooted in ineffective or careless command, as well as the strain placed on Kyiv’s forces battling a far larger army of invaders, meaning they are not rotated as often as they ought to be.
“Fatigue and trauma lead to mental disorders, and bring chaos, negligence and even depravity into a soldier’s life. This strongly affects fighting qualities and obedience,” the officer said.
Zakrevska, from the Ivan Sirko brigade, said Ukrainian soldiers rarely abandon their positions — continuing to fight even when outnumbered and carrying significant casualties.
“Once, I had to call the command and ask for our sergeant to be ordered to go to the hospital — because he refused evacuation even though he was badly wounded,” Zakrevska said. “He stayed with us, although he could not get proper medical help as our doctor was also injured.”
It is only out of sheer desperation that soldiers leave their posts, Zakrevska argued, adding that to prevent desertion, commanders should rotate fighters more frequently. But she acknowledged that in many places, R&R for the troops is impossible due to a shortage of combat-capable fighters.
Most brigades are full, Zakrevska said — but some of those in them aren’t fit to fight, and “it is impossible to fire them. Because no one can be fired from the army at all. Only after a verdict in a criminal case. Such a system also greatly undermines morale. Because it turns service in the army from an honorable duty into a punishment.”
“In the situations of despair and complete exhaustion, fear of criminal liability does not work,” Zakrevska argued.
LONDON — Public sector workers on strike, the cost-of-living climbing, and a government on the ropes.
“It’s hard to miss the parallels” between the infamous ‘Winter of Discontent’ of 1978-79 and Britain in 2023, says Robert Saunders, historian of modern Britain at Queen Mary, University of London.
Admittedly, the comparison only goes so far. In the 1970s it was a Labour government facing down staunchly socialist trade unions in a wave of strikes affecting everything from food deliveries to grave-digging, while Margaret Thatcher’s Conservatives sat in opposition and awaited their chance.
But a mass walkout fixed for Wednesday could yet mark a staging post in the downward trajectory of Rishi Sunak’s Conservatives, just as it did for Callaghan’s Labour.
Britain is braced for widespread strike action Wednesday, as an estimated 100,000 civil servants from government departments, ports, airports and driving test centers walk out alongside hundreds of thousands of teachers across England and Wales, train drivers from 14 national operators and staff at 150 U.K. universities.
It follows rolling action by train and postal workers, ambulance drivers, paramedics, and nurses in recent months. In a further headache for Sunak, firefighters on Monday night voted to walk out for the first time in two decades.
While each sector has its own reasons for taking action, many of those on strike are united by the common cause of stagnant pay, with inflation still stubbornly high. And that makes it harder for Sunak to pin the blame on the usual suspects within the trade union movement.
Mr Reasonable
Industrial action has in the past been wielded as a political weapon by the Conservative Party, which could count on a significant number of ordinary voters being infuriated by the withdrawal of public services.
Tories have consequently often used strikes as a stick with which to beat their Labour opponents, branding the left-wing party as beholden to its trade union donors.
Sunak has so far attempted to cast himself as Mr Reasonable, stressing that his “door is always open” to workers but warning that the right to strike must be “balanced” with the provision of services. To this end, he is pressing ahead with long-promised legislation to enforce minimum service standards in sectors hit by industrial action.
Sunak has made tackling inflation the raison d’etre of his government, and his backbenchers are reasonably content to rally behind that banner | POOL photo by Oli Scarff/Getty Images
Unions are enraged by the anti-strike legislation, yet Sunak’s soft-ish rhetoric is still in sharp relief to the famously bellicose Thatcher, who pledged during the 1979 strikes that “if someone is confronting our essential liberties … then, by God, I will confront them.”
Sunak’s careful approach is chosen at least in part because the political ground has shifted beneath him since the coronavirus pandemic struck in 2020.
Public sympathy for frontline medical staff, consistently high in the U.K., has been further embedded by the extreme demands placed upon nurses and other hospital staff during the pandemic. And inflation is hitting workers across the economy — not just in the public sector — helping to create a broader reservoir of sympathy for strikers than has often been found in the past.
James Frayne, a former government adviser who co-founded polling consultancy Public First, observes: “Because of the cost-of-living crisis, what you [as prime minister] can’t do, as you might be able to do in the past, is just portray this as being an ideologically-driven strike.”
Starmer’s sleight of hand
At the same time, strikes are not the political headache for the opposition Labour Party they once were.
Thatcher was able to portray Callaghan as weak when he resisted the use of emergency powers against the unions. David Cameron was never happier than when inviting then-Labour leader Ed Miliband to disown his “union paymasters,” particularly during the last mass public sector strike in 2011.
Crucially, trade union votes had played a key role in Miliband’s election as party leader — something the Tories would never let him forget. But when Sunak attempts to reprise Cameron’s refrains against Miliband, few seem convinced.
QMUL’s Saunders argues that the Conservatives are trying to rerun “a 1980s-style campaign” depicting Labour MPs as being in the pocket of the unions. But “I just don’t think this resonates with the public,” he added.
Labour’s current leader, Keir Starmer, has actively sought to weaken the left’s influence in the party, attracting criticism from senior trade unionists. Most eye-catchingly, Starmer sacked one of his own shadow ministers, Sam Tarry, after he defied an order last summer that the Labour front bench should not appear on picket lines.
Starmer has been “given cover,” as one shadow minister put it, by Sunak’s decision to push ahead with the minimum-service legislation. It means Labour MPs can please trade unionists by fighting the new restrictions in parliament — without having to actually stand on the picket line.
So far it seems to be working. Paul Nowak, general secretary of the Trades Union Congress, an umbrella group representing millions of U.K. trade unionists, told POLITICO: “Frankly, I’m less concerned about Labour frontbenchers standing up on picket lines for selfies than I am about the stuff that really matters to our union” — namely the government’s intention to “further restrict the right to strike.”
The TUC is planning a day of action against the new legislation on Wednesday, coinciding with the latest wave of strikes.
Sticking to their guns
For now, Sunak’s approach appears to be hitting the right notes with his famously restless pack of Conservative MPs.
Sunak has made tackling inflation the raison d’etre of his government, and his backbenchers are reasonably content to rally behind that banner.
As one Tory MP for an economically-deprived marginal seat put it: “We have to hold our nerve. There’s a strong sense of the corner (just about) being turned on inflation rising, so we need to be as tough as possible … We can’t now enable wage increases that feed inflation.”
Another agreed: “Rishi should hold his ground. My guess is that eventually people will get fed up with the strikers — especially rail workers.”
Furthermore, Public First’s Frayne says his polling has picked up the first signs of an erosion of support for strikes since they kicked off last summer, particularly among working-class voters.
“We’re at the point now where people are feeling like ‘well, I haven’t had a pay rise, and I’m not going to get a pay rise, and can we all just accept that it’s tough for everybody and we’ve got to get on with it,’” he said.
More than half (59 percent) of people back strike action by nurses, according to new research by Public First, while for teachers the figure is 43 percent, postal workers 41 percent and rail workers 36 percent.
‘Everything is broken’
But the broader concern for Sunak’s Conservatives is that, regardless of whatever individual pay deals are eventually hammered out, the wave of strikes could tap into a deeper sense of malaise in the U.K.
Inflation remains high, and the government’s independent forecaster predicted in December that the U.K. will fall into a recession lasting more than a year.
More than half (59 percent) of people back strike action by nurses, according to new research by Public First, while for teachers the figure is 43 percent, postal workers 41 percent and rail workers 36 percent | Joseph Prezioso/AFP via Getty Images
Strikes by ambulance workers only drew more attention to an ongoing crisis in the National Health Service, with patients suffering heart attacks and strokes already facing waits of more than 90 minutes at the end of 2022.
Moving around the country has been made difficult not only by strikes, but by multiple failures by rail providers on key routes.
One long-serving Conservative MP said they feared a sense of fatalism was setting in among the public — “the idea that everything is broken and there’s no point asking this government to fix it.”
A former Cabinet minister said the most pressing issue in their constituency is the state of public services, and strike action signaled political danger for the government. They cautioned that the public are not blaming striking workers, but ministers, for the disruption.
Those at the top of government are aware of the risk of such a narrative taking hold, with the chancellor, Jeremy Hunt, taking aim at “declinism about Britain” in a keynote speech Friday.
Whether the government can do much to change the story, however, is less clear.
Saunders harks back to Callaghan’s example, noting that public sector workers were initially willing to give the Labour government the benefit of the doubt, but that by 1979 the mood had fatally hardened.
This is because strikes are not only about falling living standards, he argues. “It’s also driven by a loss of faith in government that things are going to get better.”
With an election looming next year, Rishi Sunak is running out of time to turn the public mood around.
Annabelle Dickson and Graham Lanktree contributed reporting.
If you drive down a busy suburban strip mall or walk down a street in a major city, chances are you won’t go long without spotting a Concentra, MedExpress, CityMD or another urgent care center.
Demand at urgent care sites surged during the Covid-19 pandemic as people searched for tests and treatments. Patient volume has jumped 60% since 2019, according to the Urgent Care Association, an industry trade group.
That has fueled growth for new urgent care centers. A record 11,150 urgent care centers have popped up around the United States and they are growing at 7% a year, the trade group says. (This does not include clinics inside retail stores like CVS’ MinuteClinic or freestanding emergency departments.)
Urgent care centers are designed to treat non-emergency conditions like a common cold, a sprained ankle, an ear infection, or a rash. They are recommended if patients can’t get an immediate appointment with their primary care doctor or if patients don’t have one. Primary care practices should always be the first call in these situations because they have access to patients’ records and all of their health care history, while urgent care sites are meant to provide episodic care.
Urgent care sites are often staffed by physician assistants and nurse practitioners. Many also have doctors on site. (One urgent care industry magazine says, in 2009, 70% of its providers were physicians, but that the percentage had fallen to 16% by last year.) Urgent cares usually offer medical treatment outside of regular doctor’s office hours and a visit costs much less than a trip to the emergency room.
Urgent care has grown rapidly because of convenience, gaps in primary care, high costs of emergency room visits, and increased investment by health systems and private-equity groups. The urgent care market will reach around $48 billion in revenue this year, a 21% increase from 2019, estimates IBISWorld.
The growth highlights the crisis in the US primary care system. A shortage of up to 55,000 primary care physicians is expected in the next decade, according to the Association of American Medical Colleges.
But many doctors, health care advocates and researchers raise concerns at the proliferation of urgent care sites and say there can be downsides.
Frequent visits to urgent care sites may weaken established relationships with primary care doctors. They can also lead to more fragmented care and increase overall health care spending, research shows.
And there are questions about the quality of care at urgent care centers and whether they adequately serve low-income communities. A 2018 study by Pew Charitable Trusts and the Centers for Disease Control and Prevention found that antibiotics are overprescribed at urgent care centers, especially for common colds, the flu and bronchitis.
“It’s a reasonable solution for people with minor conditions that can’t wait for primary care providers,” said Vivian Ho, a health economist at Rice University. “When you need constant management of a chronic illness, you should not go there.”
Urgent care centers have been around in the United States since the 1970s, but they were long derided as “docs in a box” and grew slowly during their early years.
They have become more popular over the past two decades in part due to pressures on the primary care system. People’s expectations of wait times have changed and it can be difficult, and sometimes almost impossible, to book an immediate visit with a primary care provider.
Urgent care sites are typically open for longer hours during the weekday and on weekends, making it easier to get an appointment or a walk-in visit. Around 80% of the US population is within a 10-minute drive of an urgent care center, according to the industry trade group.
“There’s a need to keep up with society’s demand for quick turnaround, on-demand services that can’t be supported by underfunded primary care,” said Susan Kressly, a retired pediatrician and fellow at the American Academy of Pediatrics.
Health insurers and hospitals have also become more focused on keeping people out of the emergency room. Emergency room visits are around ten times more expensive than visits to an urgent care center. During the early 2000s, hospital systems and health insurers started opening their own urgent care sites, and they have introduced strategies to deter emergency room visits.
Additionally, passage of the Affordable Care Act in 2010 spurred an increase in urgent care providers as millions of newly insured Americans sought out health care. Private-equity and venture capital funds also poured billions into deals for urgent care centers, according to data from PitchBook.
Urgent care centers can be attractive to investors. Unlike ERs, which are legally obligated to treat everyone, urgent care sites can essentially choose their patients and the conditions they treat. Many urgent care centers don’t accept Medicaid and can turn away uninsured patient,s unless they pay a fee.
Like other health care options, urgent care centers make money by billing insurance companies for the cost of the visit, additional services, or the patient pays out of pocket. In 2016, the median charge for a 30-minute new insured patient visit was $242 at an urgent care center, compared with $294 in a primary care office and $109 in a retail clinic, according to a study by FAIR Health, a nonprofit that collects health insurance data.
“If they can make it a more convenient option, there’s a lot of revenue here,” said Ateev Mehrotra, a professor of health care policy and medicine at Harvard Medical School who has researched urgent care clinics. “It’s not where the big bucks are in health care, but there’s a substantial number of patients.”
Mehrotra research has found that between 2008 and 2015, urgent care visits increased 119%. They became the dominant venue for people seeking treatment for low-acuity conditions like acute respiratory infections, urinary tract infections, rashes, and muscle strains.
Some doctors and researchers worrythat patients with primary care doctors – and those without – are substituting urgent care visits in place of a primary care provider.
“What you don’t want to see is people seeking a lot care outside their pediatrician and decreasing their visits to their primary care provider,” said Rebecca Burns, the urgent care medical director at the Lurie Children’s Hospital of Chicago.
Burns’ research has found that high urgent care reliance fills a need for children with acute issues but has the potential to disrupt primary care relationships.
The National Health Law Program, a health care advocacy group for low-income families and communities, has called for state regulations to require coordination among urgent care sites, retail clinics, primary services, and hospitals to ensure continuity of patients’ care.
And while the presence of urgent care centers does prevent people from costly emergency department visits for low-acuity issues, Mehrotra from Harvardhas found that, paradoxically, they increase health care spending on net.
Each $1,646 visit to the ER for a low-acuity condition prevented was offset by a $6,327 increase in urgent care center costs, his research has found. This is in part because people may be going to urgent care for minor illnesses they would have previously treated with chicken soup.
There are also concerns about the oversaturation of urgent care centers in higher-income areas that have more consumers with private health care and limited access in medically underserved areas.
Urgent care centers selectively tend not to serve rural areas, areas with a high concentration of low-income patients, and areas with a low concentration of privately-insured patients, researchers at the University of California at San Francisco found in a 2016 study. They said this “uneven distribution may potentially exacerbate health disparities.”
Most winters, headlines warn that Britain’s National Health Service (NHS) is at “breaking point.” The alarms sound over and over and over again. But the current crisis has set warning bells ringing louder than before.
“This time feels different,” said Peter Neville, a doctor who has worked in the NHS since 1989. “It’s never been as bad as this.”
Scenes that would until recently have been unthinkable have now become commonplace. Hospitals are running well over capacity. Many patients don’t get treated in wards, but in the back of ambulances or in corridors, waiting rooms and cupboards – or not at all. “It’s like a war zone,” an NHS worker at a hospital in Liverpool told CNN.
These stories are borne out by the data. In December, 54,000 people in England had to wait more than 12 hours for an emergency admission. The figure was virtually zero before the pandemic, according to data from NHS England. The average wait time for an ambulance to attend a “category 2” condition – like a stroke or heart attack – exceeded 90 minutes. The target is 18 minutes. There were 1,474 (20%) more excess deaths in the week ending December 30 than the 5-year average.
Ambulance staff and nurses have staged a series of strikes over pay and working conditions, with the latest walkout by ambulance workers happening Monday. More are planned for the coming weeks. The chief executive of the NHS Confederation, which represents NHS organizations in England, wrote to the government on the eve of an ambulance strike last month to warn of NHS leaders’ concerns that they “cannot guarantee patient safety” that day. In response, a government health minister advised the public to avoid “risky activity.”
While the NHS has suffered crises before, this winter has brought a new reality: In Britain, people can no longer rely on getting healthcare in an emergency.
Founded shortly after World War II, the NHS is treated with an almost religious reverence by many. Britons danced for it during the 2012 London Olympics and clapped for it during the pandemic. “Our NHS” is a source of national pride.
Now, it is coming unstuck. There has long been an implicit contract between British people and the state: Pay taxes and National Insurance contributions in return for a health service that is free at the point of use.
Some of these strains can be seen elsewhere in Europe. Doctors in both France and Spain have held strikes in recent weeks, as many countries face the same problems of providing care to an increasingly aging population – when inflation is at its highest level in decades.
Yet there are fears that the NHS is in worse shape than its international peers, and CNN spoke with experts who said they fear they’re witnessing the “collapse” of the service.
So how did Britain get here?
When Covid-19 hit, the NHS went into full crisis-fighting mode, diverting staff and resources from across the organization to care for patients with the disease.
But, for many in the NHS, Covid-19 remains a crisis from which they are yet to emerge.
During the height of the pandemic, many ordinary practices were put on hold. Millions of operations were canceled. The NHS “backlog” has ballooned. Data from November showed there were more than 7 million people on a hospital waiting list in England.
This winter, a “twindemic” of Covid and flu continues to put additional strain on capacity.
Explanations for the current crisis “have to start with a consideration of Covid-19,” Ben Zaranko, an economist at the Institute for Fiscal Studies (IFS) whose work focuses on Britain’s health care system, told CNN. “There’s the simple fact that there are beds in hospitals occupied by Covid patients, which means those beds can’t be used for other things.”
Covid also created a strain on the amount of work the NHS can do. “If you add up all the time that staff spend doing infection control measures, donning protective equipment and separating out wards into people with and without Covid … that might impede the overall productivity of the system,” Zaranko said. Rates of NHS staff sickness are also considerably higher than they were pre-pandemic, according to IFS analysis.
But, again, Britain was not alone in battling the pandemic, yet it appears to have suffered a worse hit than comparable nations.
This is despite there being more doctors and nurses in the NHS now than there were before Covid. According to an IFS report, even after adjusting for staff sickness absences, there are 9% more consultants, 15% more junior doctors and 8% more nurses than in 2019.
Yet the NHS is treating fewer patients than before the pandemic.
“It seems to be that bits of the system aren’t fitting together anymore,” Zaranko said. “It’s not just about how much staff there are and how much money there is. It’s how it’s being used.”
Even with the increase in funding since the pandemic, the UK is still playing catchup, after what critics say is more than a decade of underfunding the NHS.
Neville, a consultant in a hospital, judges 2008 the “best” he has seen the NHS in more than 30 years of working in it. By that time, the NHS had enjoyed nearly a decade of hugely increased investment. Waiting lists fell substantially. Some even complained about getting doctor appointments too quickly.
“When the Labour government came in in 1997, they injected considerably more money into the NHS. It enabled us to appoint an adequate number of staff and get on top of our waiting lists,” Neville told CNN.
But this level of investment did not last. In response to the 2007-2008 financial crisis, the Conservatives elected in the coalition government in 2010 embarked on a program of austerity. Budgets were cut and staff salaries frozen. For Neville, the ensuing decade saw a gradual “erosion” of the system: “Slow, subtle, but nonetheless happening.”
According to analysis by health charity the Health Foundation, average day-to-day health spending in the UK between 2010 and 2019 was £3,005 ($3,715) per person per year – 18% below the EU14 [countries that joined the EU before 2004] average of £3,655 ($4,518).
During this period, capital expenditure – the amount spent on buildings and equipment – was especially low, according to the Health Foundation analysis. The UK has far fewer MRI and CT scanners per person than the Organisation for Economic Co-operation and Development (OECD) average, meaning staff often have to wait for equipment to become available.
Hospital beds are particularly scarce. Over the past 30 years the number of beds in England has more than halved, from around 299,000 in 1987 to 141,000 in 2019, according to analysis by the King’s Fund, an independent think tank.
Siva Anandiciva, chief analyst at the King’s Fund, told CNN this decrease was partly attributable to the “changing model of care.” As technology and treatments improved, people spent less time in hospital, reducing the need for beds. The last Labour government, in power from 1997 to 2010, also cut bed numbers, despite increasing investment elsewhere.
“You can keep reducing how long patients stay in hospital,” said Anandaciva, but eventually “you approach a minimum. If you then keep cutting bed numbers … that’s when you start to get into problems like performance.”
During the austerity years, bed numbers continued to be cut, leaving the UK with fewer beds per capita than almost any developed nation, according to OECD data.
“For a long time we knew we just didn’t have the bed capacity,” Anandaciva said. But cuts continued in the name of “efficiency,” he added.
While low bed numbers were seen as a marker of “success” indicating that the NHS was running efficiently, it left the UK woefully underprepared for a shock like Covid-19. The same factors that made the NHS “efficient” in one context made it grossly inefficient when that context changed, in his analysis.
The bed shortage has been made even more acute by the fact that many of those in hospital no longer need to be there – there is simply nowhere else for them to go.
“The longest I had a patient that was physically and medically ready to go home, but was sitting around waiting for discharge, was four weeks,” said Angus Livingstone, a doctor working in the John Radcliffe Hospital in Oxford.
The problem is caused by a crisis in another sector: Social care. Patients that could leave the hospital end up staying there because they cannot access more modest care in a home setting and so cannot be safely discharged.
Health and social care are separate sectors in the UK system. Healthcare is provided by the NHS, whereas social care is provided by local councils. Unlike the NHS, social care is not free at the point of use: It is rationed and means-tested.
There have long been calls to integrate the two systems, since a crisis in one system feeds through into the other.
“If you allow us to regain the enormous number of beds that are currently occupied by people awaiting social care, then I would be very confident that the immediate snarl-up in A&E and ambulances waiting outside would pretty much disappear overnight,” Neville said.
“When people ask me, ‘where do you want the money in the NHS?’ My answer is ‘I don’t want it in the NHS. I want it in social care.’”
With an increasingly aging population – the latest census data show nearly 19% of the population of England and Wales is now 65 or older – demand for social care is increasing. But the sector is struggling to provide it in the face of staffing shortages, rising costs and funding pressures.
The NHS is also reporting an alarming number of vacancies, with about 133,000 open positions as of September.
This points to a deeper crisis: Morale.
Jatinder Hayre, a doctor completing the foundation program at a hospital in East London, told CNN that morale is “at an all time low.” Staff are “stressed, fatigued, tired,” he said. “There doesn’t seem to be an end to this.”
“When you walk into the hospital in the morning, you’re met with this cacophony of grief and dismay and dissatisfaction from patients, who are lined up in the corridor,” Hayre said.
“You feel awful, but there’s nothing you can do. You’re fighting against a system that’s collapsing.”
Hayre said that most days there are “around 40 to 50 patients lined up in the corridors” as there is no space left in the wards. “It’s not appropriate. It’s not a safe or dignified environment.”
Unable to deliver an acceptable standard of care, many staff are demoralized – and considering their options. At Hayre’s hospital, “the day-to-day workplace talk is, ‘are we going to leave?’”
A junior doctor at a hospital in Manchester, who wished to remain anonymous, told CNN that she had made the decision to join the growing number of NHS doctors who are moving abroad. She plans to move abroad in the summer, to work in a country that offers doctors better pay and working conditions.
Of the eight doctors she lived with at university, six have already left. “They’ve all gone to Australia. They love it,” she said. Only one is planning to stay in the UK.
Medical students are watching in alarm as their future workplace deteriorates.
“For everyone I know, it’s almost a given that at some point they’re going to go to Australia or New Zealand,” said Eilidh Garrett, who studies medicine at Newcastle University. She is considering taking exams to work as a doctor in Canada.
This is a hugely painful decision for many young doctors. “I think about my closest friends. If I go to another country and treat other people’s closest friends, while my friends struggle to see a doctor in the UK – that is really heartbreaking,” Garrett told CNN.
Meanwhile, Britain’s vote to leave the European Union in 2016 has likely not helped the situation. Research by the Nuffield Trust health think tank, published in November, finds that long-standing staff shortages in nursing and social care “have been exacerbated by Brexit.”
The picture is “more complex” for doctors working in the NHS, the researchers found. While overall “EU numbers have remained relatively stable,” the report says, the data suggest a slowdown in the registration of specialists from the EU and European Free Trade Association countries since Brexit, particularly in certain specialties such as anesthetics.
The concern is that these issues get worse the longer they go untreated.
When patients finally get seen, their treatments take more time, forcing those after them to wait even longer as they get sicker.
“In terms of the system performance, it feels like we’re past the tipping point,” Zaranko said. “The NHS has been gradually deteriorating in its performance for some time. But we’ve gone off a cliff in recent months.”
It is unclear how the NHS regains its footing. Some compare this crisis to a period in the 1990s when services were rapidly deteriorating. The NHS was in bad shape, but restored its levels of service after a decade of historically high investment while Labour was in power.
Injections of cash on this scale are unlikely to be replicated. The most recent budget announced by the government in November will see NHS England spending rise by only 2% in real terms on average over the next two years.
“We recognize the pressures the NHS is facing so announced up to £250 million [$309 million] of additional funding to immediately help reduce hospital bed occupancy, alleviate pressures on A&E and unlock much-needed ambulance handovers,” a spokesperson from the Department of Health and Social Care told CNN in a statement.
“This is on top of the £500 million [$618 million] Discharge Fund to speed up the safe discharge of patients and rolling out virtual wards to free up hospital beds and cut waiting cuts,” the statement continued.
Pay negotiations between the government and nursing unions have so far been unsuccessful. British media outlets have reported that Prime Minister Rishi Sunak may be considering offering a one-off hardship payment of £1,000 ($1,236) to attempt to resolve the dispute, but many feel this underestimates the true nature of the crisis.
“All I hear about is sticking plasters,” Neville said. “It depresses us all.”
Rep. Greg Steube was discharged from the hospital Saturday after being injured in an accident on his property in Sarasota, Florida, according to a tweet from the Republican congressman.
“I’m grateful to be home and recovering after being discharged from the hospital today,” Steube said from his official Twitter account. “All praise and glory goes to God! Jen and I remain endlessly blessed by the prayers and support from our friends, family, and community.”
On Wednesday, Steube “was knocked approximately 25 feet down off a ladder while cutting tree limbs,” and spent Wednesday evening in the intensive care unit, CNN previously reported.
He was then moved out of the intensive care unit on Thursday, his office said in a statement.
The Florida Republican on Saturday also thanked health care staff at Sarasota Memorial Hospital in a subsequent tweet, and said his office will provide updates next week on his recovery and his return to Washington, DC.
Steube was first elected to the US House of Representatives in 2018. He comfortably won a third term in November representing Florida’s safely Republican 17th Congressional District.
A 76-year-old woman is in custody after fatally shooting her terminally ill husband in the head in what police say was an intended murder-suicide at a hospital in Daytona Beach, Florida, on Saturday.
The terminally ill man, 77, was hospitalized at the Advent Health Hospital and made a plan with his wife three weeks ago to “end it” should his health get worse, Daytona Beach Police Chief Jakari E. Young said in a news conference. Police did not specify the man’s illness.
The man intended to turn the gun on himself but was physically too weak to do so, police said. His wife, who indented to take her own life after, said she “couldn’t go through with it,” according to Young.
The woman then barricaded herself in the hospital room.
Officers responded to the hospital shortly after 11:30 a.m. and hostage negotiators made contact with the woman, whose identity hasn’t been released. She was taken into police custody at approximately 3 p.m., Young said.
Keeping other patients on the 11th floor, where the hostage situation took place, was a “logistical nightmare” as many patients were on ventilators and could not be easily evacuated, he added.
The woman is in custody and could be awaiting a first-degree murder charge, according to Young.
“She’s very sad, it’s a tough situation,” Young said.
It’s unclear how the woman entered the hospital with a gun and if the hospital had a metal detection security system. The exact gun used in the shooting also remains unclear.
CNN reached out to AdventHealth for comment.
There is no longer a police presence at the hospital, according to Young.
Dr. Joshua Horenstein, a cardiologist at Advent Health Hospital, was working in the emergency department when he learned of the shooting incident.
“Someone came in screaming in the emergency department that this was not a drill and to shelter in place,” Horenstein told CNN while hiding in a supply room with a nurse.
Horenstein said he was finally able to leave the supply room after roughly 90 minutes.
