Atlanta authorities are searching for the person who shot five people Wednesday at Northside Hospital Medical in Midtown Atlanta, killing one person and sending four others to the hospital, and then fleeing in a carjacked vehicle, Atlanta Police Chief Darin Schierbaum said Wednesday.
A 39-year-old woman died, Schierbaum said during a Wednesday afternoon news conference. The injured victims were also all women, ranging from 25 to 71 years old.
The suspect, whom authorities identified as 24-year-old Deion Patterson, left the building and is believed to have carjacked a vehicle nearby, the police chief said.
He is still at large and there are active leads in Cobb County and in the city of Atlanta, Schierbaum said. Officers in Cobb County were searching in the areas of Vinings, Cumberland and Truist Park, according to a Twitter post from the Cobb County Police Department.
“We are working diligently to bring this individual into custody,” the police chief added.
The suspect is a former Coast Guardsman.
Patterson “entered the Coast Guard in July 2018 and last served as an Electrician’s Mate Second Class,” a statement from the Coast Guard said on Wednesday. “He was discharged from active duty in January 2023.”
The Coast Guard said they are working “closely” with Atlanta police and other authorities in the investigation of the shooting.
“Our deepest sympathies are with the victims and their families,” the statement said.
Multiple victims were undergoing surgery at Downtown’s Grady Memorial Hospital – Atlanta’s only Level 1 trauma center. Their conditions were not immediately available.
Three of the patients are in critical condition, Dr. Robert Jansen, chief medical officer at Grady Health System, told reporters in an earlier news conference.
Police issued a “be on the lookout” for the suspect saying he should be considered armed and dangerous and should not be approached.
The Atlanta Police Department earlier released images showing the suspected shooter wearing a hoodie, asking anyone with information about his whereabouts to call 911.
A high-level source within the Atlanta Police Department told CNN the suspect and his mother arrived Wednesday for a medical appointment for himself. The man at some point became agitated and started shooting using a handgun. The suspect has a military background, the source said.
Atlanta Police spokesperson Chata Spikes similarly said the man was attending a medical appointment for himself when the shooting occurred. Police declined to further describe the nature of the appointment, citing HIPAA regulations.
The man’s mother, who was uninjured, is currently cooperating with police, Atlanta Police told CNN.
Northside Hospital confirmed the shooting at its Midtown location, saying on Twitter it was cooperating with law enforcement.
“We urge people in the area to shelter in place and follow instructions from law enforcement on the scene,” the hospital system said. “This tragedy is affecting all of us, and we ask for patience and prayers at this time.”
In what has become routine in America, Wednesday’s shooting interrupted daily life in a place many would consider safe. This time, it was in a doctor’s office, but so often it’s been US schools, grocery stores and houses of worship.
Including the shooting at the Atlanta medical facility, there have been at least 190 mass shootings in the United States this year, according to the Gun Violence Archive, which, like CNN, defines a mass shooting as one in which four or more people are shot, excluding the shooter.
The Atlanta Police Department tweeted earlier Wednesday it was investigating an active shooter incident inside a building on West Peachtree Street, between 12th and 13th streets, saying multiple people had been injured.
Videos shared with CNN showed police running on the scene as sirens blared. Multiple fire trucks, at least one armored police vehicle and deputies from the Fulton County Sheriff’s Office were seen outside the building, which sits in a bustling area of the city, with Google’s offices, hotels, restaurants, apartment buildings and at least two day care centers located nearby.
Atlanta resident Annie Eaveson lives at the Atlantic House apartments a block away and told CNN her building was placed on lockdown as the incident unfolded.
I saw two people taken out on stretchers. Waves of armored officers went inside in shifts almost. You can see medical professionals huddled up in offices.”
Breast density is known to naturally decrease as a woman ages, and now a study suggests that the more time it takes for breast density to decline, the more likely it is that the woman could develop breast cancer.
Researchers have long known that women with dense breasts have a higher risk of breast cancer. But according to the study, published last week in the journal JAMA Oncology, the rate of breast density changes over time also appears to be associated with the risk of cancer being diagnosed in that breast.
“We know that invasive breast cancer is rarely diagnosed simultaneously in both breasts, thus it is not a surprise that we have observed a much slower decline in the breast that eventually developed breast cancer compared to the natural decline in density with age,” Shu Jiang, an associate professor of surgery at Washington University School of Medicine in St. Louis and first author of the new study, wrote in an email.
Breast density refers to the amount of fibrous and glandular tissue in a person’s breasts compared with the amount of fatty tissue in the breasts – and breast density can be seen on a mammogram.
“Because women have their mammograms taken annually or biennially, the change of breast density over time is naturally available,” Jiang said in the email. “We should make full use of this dynamic information to better inform risk stratification and guide more individualized screening and prevention approaches.”
The researchers, from Washington University School of Medicine in St. Louis and Brigham and Women’s Hospital in Boston, analyzed health data over the course of 10 years among 947 women in the St. Louis region who completed routine mammograms. A mammogram is an X-ray picture of the breast that doctors use to look for early signs of breast cancer.
The women in the study were recruited from November 2008 to April 2012, and they had gotten mammograms through October 2020. The average age of the participants was around 57.
Among the women, there were 289 cases of breast cancer diagnosed, and the researchers found that breast density was higher at the start of the study for the women who later developed breast cancer compared with those who remained cancer-free.
The researchers also found that there was a significant decrease in breast density among all the women over the course of 10 years, regardless of whether they later developed breast cancer, but the rate of density decreasing over time was significantly slower among breasts in which cancer was later diagnosed.
“This study found that evaluating longitudinal changes in breast density from digital mammograms may offer an additional tool for assessing risk of breast cancer and subsequent risk reduction strategies,” the researchers wrote.
Not only is breast density a known risk factor for breast cancer, dense breast tissue can make mammograms more difficult to read.
“There are two issues here. First, breast density can make it more difficult to fully ‘see through’ the breast on a mammogram, like looking through a frosted glass. Thus, it can be harder to detect a breast cancer,” Dr. Hal Burstein, clinical investigator in the Breast Oncology Center at Dana-Farber Cancer Institute, who was not involved in the new study, said in an email. “Secondly, breast density is often thought to reflect the estrogen exposure or estrogen levels in women, and the greater the estrogen exposure, the greater the risk of developing breast cancer.”
In March, the US Food and Drug Administration published updates to its mammography regulations, requiring mammography facilities to notify patients about the density of their breasts.
“Breast density can have a masking effect on mammography, where it can be more difficult to find a breast cancer within an area of dense breast tissue,” Jiang wrote in her email.
“Even when you take away the issue of finding it, breast density is an independent risk factor for developing breast cancer. Although there is lots of data that tell us dense breast tissue is a risk factor, the reason for this is not clear,” she said. “It may be that development of dense tissue and cancer are related to the same biological processes or hormonal influences.”
The findings of the new study demonstrate that breast density serves as a risk factor for breast cancer – but women should be aware of their other risk factors too, said Dr. Maxine Jochelson, chief of the breast imaging service at Memorial Sloan Kettering Cancer Center in New York, who was not involved in the study.
“It makes sense to some extent that the longer your breast stays dense, theoretically, the more likely it is to develop cancer. And so basically, it expands on the data that dense breasts are a risk,” Jochelson said, adding that women with dense breasts should ask for supplemental imaging when they get mammograms.
But other factors that can raise the risk of breast cancer include having a family history of cancer, drinking too much alcohol, having a high-risk lesion biopsied from the breast or having a certain genetic mutation.
For instance, women should know that “density may not affect their risk so much if they have the breast cancer BRCA 1 or 2 mutation because their risk is so high that it may not make it much higher,” Jochelson said.
Some ways to reduce the risk of breast cancer include keeping a healthy weight, being physically active, drinking alcohol in moderation or not at all and, for some people, taking medications such as tamoxifen and breastfeeding your children, if possible.
“Breast density is a modest risk factor. The ‘average’ woman in the US has a 1 in 8 lifetime chance of developing breast cancer. Women with dense breasts have a slightly greater risk, about 1 in 6, or 1 in 7. So the lifetime risk goes up from 12% to 15%. That still means that most women with dense breasts will not develop breast cancer,” Burstein said in his email.
“Sometimes radiologists will recommend additional breast imaging to women with dense breast tissue on mammograms,” he added.
The US Preventive Services Task Force – a group of independent medical experts whose recommendations help guide doctors’ decisions – recommends biennial screening for women starting at age 50. The task force says that a decision to start screening earlier “should be an individual one.” Many medical groups, including the American Cancer Society and Mayo Clinic, emphasize that women have the option to start screening with a mammogram every year starting at age 40.
“It’s also very clear that breast density tends to be highest in younger women, premenopausal women, and for almost all women, it tends to go down with age. However, the risk of breast cancer goes up with age. So these two things are a little bit at odds with each other,” said Dr. Freya Schnabel, director of breast surgery at NYU Langone’s Perlmutter Cancer Center and professor of surgery at NYU Grossman School of Medicine in New York, who was not involved in the new study.
“So if you’re a 40-year-old woman and your breasts are dense, you could think about that as just being really kind of age-appropriate,” she said. “The take-home message that’s very, very practical and pragmatic right now is that if you have dense breasts, whatever your age is, even if you’re postmenopausal – maybe even specifically, if you are postmenopausal – and your breasts are not getting less dense the way the average woman’s does, that it really is a reason to seek out adjunctive imaging in addition to just mammography, to use additional diagnostic tools, like ultrasound or maybe even MRI, if there are other risk factors.”
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 he took his short walk from the speaker’s suite to the House floor on Wednesday evening, the California Republican wasn’t entirely sure he would have the votes on the most important bill of his young speakership: To raise the $31.4 trillion national debt limit on Republican support alone.
McCarthy knew he was close but couldn’t guarantee it, according to a person familiar with the matter.
After months of internal discussions, the speaker had been engaged in round-the-clock talks with pockets of dissident members, cutting deals and horse-trading to pick off one GOP vote after another in his high-stakes fight – all an attempt to show the White House and the country that his party speaks with one voice on the consequential economic battle.
But one Republican member was absent on Wednesday – and some hard-right members would not explicitly say how they’d vote, forcing the speaker to make a risky bet. In the end, it was two Democratic absences that helped McCarthy: Allowing him to pass the bill on the narrowest of margins, 217-215, and now shifting the focus to the White House and Senate Democrats.
“We are the only ones to lift the debt limit to make sure this economy is not in jeopardy,” McCarthy beamed in the Capitol’s ornate Statuary Hall moments after the gavel came down, calling on President Joe Biden to negotiate a spending-cut deal he has resisted for months. He added: “You’ve underestimated us.”
It was an effort that was months in the making. Immediately after securing the speakership in a messy, 15-ballot race, McCarthy made the concerted decision to avoid the pitfalls of a predecessor, John Boehner, and allow rank-and-file members to feel like they could shape the ultimate package rather than being steamrolled by leadership. A dozen listening sessions were held by two members of his whip team, Reps. Tom Emmer of Minnesota and Guy Reschenthaler of Pennsylvania, starting in February and continuing with them calling every member through this past weekend. Then there were regular meetings of the so-called “five families” – nicknamed after the mob families in “The Godfather” – that represent various ideological factions of the conference and were led by Rep. Garret Graves of Louisiana.
But even after they had agreed to an outline of their deal last week, McCarthy continued to run into pitfalls. In a meeting last week in the basement of the Capitol, he and his team moved to appease conservatives who wanted to target tax breaks for biofuels in the Democrats’ Inflation Reduction Act. McCarthy agreed, prompting a furious pushback by Iowa Republicans, including a tense phone call between Gov. Kim Reynolds and McCarthy.
It was an issue that could have derailed the bill and one that put McCarthy in familiar crosshairs between competing factions of his conference. But he ultimately cut a deal past 2 a.m. on Wednesday and helped move closer to securing the votes more than 15 hours later.
“They realized that you were not going to be able to steamroll four people from Iowa,” said Rep. Zach Nunn, an Iowa freshman, referring to the four GOP members of the delegation.
Yet more problems emerged, and McCarthy moved to head them off. Rep. Nancy Mace told reporters Wednesday morning she was ready to vote against the plan over her concerns it didn’t go far enough to balance the budget. But after an afternoon meeting in his office, the South Carolina Republican said she would back the plan. The promise, according to a source familiar with the matter: Votes on bills dealing with women’s access to reproductive health care and a vote on a bill dealing with active shooter alerts.
“I haven’t gotten rolled yet by the leadership on anything,” Mace said, defending her deal-cutting.
The ultimate plan would raise the debt limit by $1.5 trillion and propose to implement a slew of spending cuts to domestic programs, in addition to new work requirements on Medicaid beneficiaries and provisions targeting Biden’s domestic and regulatory agenda. It would save $4.8 trillion over the next 10 years, according to the Congressional Budget Office. But the $1.5 trillion increase would only last through March 2024 at the latest.
In a private meeting in the Capitol, GOP leaders debated how high of a debt limit increase they should seek. Some had floated odd numbers because it sounded more intentional than an even number. One member suggested $1.69 trillion, but that was rejected because of the innuendos associated with such a figure, according to three GOP sources. Ultimately, a $1. 5 trillion increase was the number they settled on.
Republicans say the deal-cutting that has since transpired was the result of new relationships forged from McCarthy’s drawn-out fight for the speaker’s gavel in January.
“Absolutely, it has reaped benefits to everyone in the conference,” Rep. French Hill, a Republican of Arkansas, said of the relationships that were formed.
But passing the bill was never a sure bet – something McCarthy sensed last week as he moved to appease conservatives and push for a repeal of energy tax breaks.
“This is going to come back to bite us,” McCarthy warned conservatives last week, according to a person in the room, as they demanded the bill repeal green energy tax credits and other provisions in the Inflation Reduction Act. McCarthy feared taking that step would unlock a process allowing the Senate to later jam the House on thorny tax-related provisions.
But he had a more immediate problem: The governor of Iowa.
A fired-up Reynolds, the two-term Republican governor, was on the phone with McCarthy on Tuesday, relaying concerns over the provision in his debt ceiling plan to repeal tax breaks for ethanol use, according to people familiar with the call, warning it would be detrimental to farmers in her state.
All four GOP members of the Iowa delegation, who were also in constant communication with the governor, informed leadership in a Tuesday night meeting that clawing back the tax credits was a “red line” for them, according to sources in the room.
McCarthy now had a math problem. His allies had believed that the Iowa Republicans, some of the closest allies of leadership, would swallow the provisions and ultimately side with their party in their high-stakes fight with the White House. But they had miscalculated, forcing the speaker to cut a last-ditch deal after repeatedly insisting they would not open the bill to changes.
Nunn, the Iowa Republican, told CNN he learned about the deal at around 2:30 a.m. on Wednesday, when Graves came to his office along with Rep. Michelle Fischbach, a Minnesota Republican who had similar issues with the ethanol provisions.
“We had been in conversation throughout the entire day, but by Tuesday, we had really ratcheted up,” Nunn told CNN. “Iowa nice also means Iowa stubborn.”
It was an issue that GOP leaders had sought to avoid. They had worried that if they cut a deal with the Iowa delegation, they would have to make similar deals with members from fossil-fuel heavy districts in order to make them happy.
And the leadership knew if they were going to make 11th-hour changes to appease Midwestern Republicans, they’d have to offer some concessions to conservatives as well, and ultimately agreed to a faster implementation of the Medicaid work requirements. Yet even that wasn’t enough to satisfy some conservatives who had been pushing for that change – namely GOP Rep. Matt Gaetz of Florida, who was upset that the deal was cut at the last minute after the leaders said they wouldn’t change the bill, according to people familiar with the matter. He was one of four who later voted against the plan.
Rep. Ken Buck, a member of the whip team, said in the end, he voted “no” because the GOP bill didn’t do enough to reduce the deficit. The Colorado Republican told CNN, “$58 trillion with Biden’s numbers and $53 trillion, it’s just too much debt.”
But one member that McCarthy had been lobbying came through: freshman Rep. Eli Crane. The Arizona Republican had been wavering on the bill and was being heavily whipped by leadership, but said he ultimately backed the legislation because of his constituents.
“We conducted a poll at a teletown hall last night and the people that responded overwhelmingly supported this bill,” he told CNN. “It kind of surprised me, honestly.”
With this victory secured, McCarthy could later have an even bigger test on his hands: If he is forced to ask his conference to get behind any deal with Biden to raise the debt limit – something that almost certainly wouldn’t go as far as the House plan for spending cuts.
His members are watching him closely.
“What Kevin has assured us is he’s not coming back and presenting a watered-down version,” said Rep. Ralph Norman of South Carolina, a member of the House Freedom Caucus.
A Black Texas couple has been reunited with their newborn daughter after authorities removed the baby and placed her in foster care last month citing a doctor’s concerns about how they were treating a jaundice diagnosis.
Rodney and Temecia Jackson of DeSoto, Texas, regained custody of their daughter, Mila, on April 20 following a nearly month-long battle with the state’s Child Protective Services, according to The Afiya Center, a reproductive justice advocacy group.
A spokesperson for the Texas Department of Family Protective Services, which includes CPS, confirmed to CNN that the office had recommended a dismissal of the case to an assistant district attorney. Mila’s release was granted on Thursday, according to a court filing.
The Jacksons had been pleading for Mila’s return in videos posted to social media, and news conferences as reproductive justice activists protested and rallied behind the family.
The removal, the Jacksons say, was sparked by their decision to let their midwife treat Mila’s jaundice instead of taking her to the hospital for care as their doctor had recommended. Temecia Jackson said during a news conference earlier this month that she gave birth to Mila at home on March 21 with the help of a midwife and wanted that same trusted midwife to provide medical care for her baby. But Mila’s pediatrician disagreed with this decision and ultimately contacted CPS, Temecia Jackson said.
“We’ve been treated like criminals,” Rodney Jackson said during the news conference. “This is a nightmare that I wouldn’t wish on anyone.”
Reproductive justice advocates say Mila’s removal is just the latest example of the criminalization of Black parents, who lose their children to the child welfare system at disproportionate rates. In the US in 2018, Black children made up 23% of youth in foster care, but only 14% of the nation’s child population, according to the Annie E. Casey Foundation. Additionally, one study found that between 2003-2014, 53% of Black children were the subjects of child welfare investigations by the time they reached age 18.
Marsha Jones, executive director of The Afiya Center – a Dallas, Texas, based non-profit that advocates for Black women and girls – said there is a systemic problem with the child welfare system that unfairly targets Black parents. In many cases, Black families have their first experiences with the criminal justice system in family court, Jones said.
“It’s almost unspoken and unseen because there is just this thought that Black women are not good parents and that we are criminalized because of poverty,” Jones told CNN. “This is not new.”
Jones said the center stepped in last month to support the Jackson family and put pressure on public officials to return Mila home. She believes this played a role in reuniting the family last week.
“There’s no reason this baby should have been removed from her home,” Jones told CNN. “This family was not being heard. The Black midwife wasn’t being heard.”
Rodney and Temecia Jackson could not be reached for comment.
In a letter to CPS obtained by CNN affiliate WFAA, the family’s pediatrician, Dr. Anand Bhatt, who is with the Baylor Scott & White healthcare system, wrote that while the Jacksons “are very loving and they care dearly” about Mila, “their distrust for medical care and guidance has led them to make a decision for the baby to refuse a simple treatment that can prevent brain damage.”
“I authorized the support of CPS to help get this baby the care that was medically necessary and needed,” the letter continued.
CBS News, which obtained a copy of the affidavit filed by the Texas Department of Family and Protective Services, reported that Bhatt reached out to a DFPS investigator on March 25 and indicated that Mila’s bililrubin test showed levels of 21.7 milligrams.
A bilirubin test can screen for jaundice and other conditions. That level was “cause for a lot of concern,” Bhatt told the investigator, according to CBS News, and could lead to brain damage, he said, “because the bilirubin can cross the blood brain barrier.”
Bhatt said he reserved a bed for Mila at Children’s Medical Center of Dallas and asked the Jacksons to take her there or he would call police for a welfare check, according to court documents obtained by CBS News. WFAA reported that Bhatt wanted Mila to receive phototherapy – a common treatment for jaundice.
But court documents, according to CBS News, say Rodney Jackson told Bhatt he and Temecia Jackson planned to treat their baby “naturally” and didn’t believe in “modern medicine.”
The midwife, Cheryl Edinbyrd, told CBS News the family had ordered a blanket and goggles to provide light therapy to treat Mila’s jaundice.
When the Jacksons didn’t show up at the hospital, a CPS investigator and police went to the Jackson’s home at 4 a.m. on March 25 but Rodney Jackson declined to speak with them, according to court documents obtained by CBS News. An hour later, authorities returned with an ambulance and fire truck and Rodney Jackson still denied them entry.
Authorities returned to the home on March 30 with a warrant and arrested Rodney Jackson on charges of preventing the execution of a civil process, according to CBS News. Police entered the home and took Mila from Temecia Jackson. According to CBS News, the Jacksons’ other two children were not removed.
Temecia Jackson said in a press conference that when she asked to see the affidavit, she noticed it had the name of a different mother on it.
“Instantly I felt like they had stolen my baby as I had had a home birth and they were trying to say that my baby belonged to this other woman,” Temecia Jackson.
Marissa Gonzales, a spokesperson from the Texas Department of Family and Protective Services, said in an email to CNN that her department was given an incorrect name for the initial affidavit. The mistake, she said, was corrected in the case filings.
Gonzales declined an interview with CNN to discuss the case further, citing “state confidentiality restrictions.”
“It is always the goal of DFPS to safely reunite children with their parents,” Gonzales also said. “The decision about when that happens rests with the judge who ordered the removal.”
CNN’s request to interview Bhatt was also denied by Baylor Scott & White.
“In respect of patient privacy, it is inappropriate to provide comment on this matter,” the health system said in an emailed statement. “We do abide by reporting requirements set forth in the Texas Family Code and any other applicable laws.”
Advocates say the racial bias of professionals such as teachers, doctors and social workers has created inequity in the child welfare system.
Dorothy Roberts, a law professor and sociologist at the University of Pennsylvania, said decisions to report neglect and abuse are largely shaped by racist stereotypes of Black families.
The child welfare system, she said, needs to consider the trauma inflicted on children when they are separated from their families.
“We have to ask whether there is a better way of addressing children’s medical needs instead of the system we have now where doctors are reporting suspicions, which we know is highly biased, and investigating families, which we know is very traumatic,” said Roberts, author of “Torn Apart: How the Child Welfare System Destroys Black Families – and How Abolition Can Build a Safer World.” “Hospitals should not be places of fear for parents.”
Roberts said there is also a longstanding cultural conflict between the healthcare system and midwives who are often devalued. Black midwives provided care for mothers for hundreds of years, delivering the babies of enslaved women and even slave owners’ wives. But as medicine became more professionalized in the late 1800s, male doctors wanted to take control of childbirth, with some suggesting midwives were unfit, according to a report by Vox.
Monica Simpson, executive director of Sistersong, a reproductive justice organization advocating for women of color, said many Black women are choosing midwives because they have lost trust in doctors and hospitals.
Much of that is driven by the harrowing statistics: Black women are 2.6 times likelier to die of pregnancy-related complications than White women, according to the most recent data from the National Center for Health Statistics.
Simpson said the child welfare system is broken. She said racism has played a part in the continued criminalization and separation of Black families.
“There’s been this narrative that Black women can’t parent their children properly,” Simpson said. “We have been battling these narratives for decades. The way that Black women are criminalized around their motherhood, it’s horrible.”
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.
After he scored the 1-yard touchdown, Hollins pointed to the sky and placed the ball over one of his three teammates’ names that were painted in the endzone.
The fifth-year running back also got the first touch of the game to a standing ovation, and finished with 11 carries for 40 yards in the first half.
Saturday’s game marked UVA’s first time returning to the field since D’Sean Perry, Devin Chandler and Lavel Davis Jr. were shot deadon a bus as it returned to campus from a class field trip in November.
Hollins was one of two people wounded, and spent time intubated in the hospital’s intensive care unit.
“It’s great to be back, it’s a blessing and I want to thank all you Hoos fans for coming out and supporting us,” he said in a video posted on the Cavaliers’ official Twitter account.
The deaths of Chandler, Davis Jr. and Perry left three enormous holes on a team that felt more like family than anything, University of Virginia head coach Tony Elliott said in November. He went on to describe them, calling Chandler “the life of the party,” Davis “the big man on campus” and Perry “the quiet guy everyone wanted to know about.”
Hollins said in March that it was a “miracle” that he was able to return to the practice field, adding that he had considered leaving the school to get a fresh start but decided it was best for him to stay.
“I feel like anyone would think about leaving after something like that. But I also thought what better place to re-find who I am and reestablish my mental than the place that everything took place,” he said.
The running back, who was hospitalized for days, learned about the deaths of his teammates days after the shooting.
“I’ve never cried like that before,” Hollins told ABC. “I mean, I lost a brother that day. I love Lavel with all my heart, love Devin with all my heart. But D’Sean – it was different with him.”
“That was my brother,” Hollins said, getting visibly emotional. “It was tragic hearing that he was gone.”
The suspect in the University of Virginia shooting, former UVA walk-on football player Christopher Darnell Jones Jr., faces three charges of second-degree murder and three counts of using a handgun in the commission of a felony, authorities said. Jones also faces two counts of malicious wounding, each accompanied by a firearm charge.
Jones had his first court appearance on November 16 and a court ordered that he be held without bond.
Starbucks is betting big on olive oil infused coffee, hoping customers will be enticed by the anomaly and the health benefits of extra virgin olive oil.
“It is one of the biggest launches we’ve had in decades,” Brady Brewer, Starbucks’ chief marketing officer, told CNN. Former CEO Howard Schultz added in an interview with Poppy Harlow that it will “transform the coffee industry,” and be “a very profitable new addition to the company.”
But what the company may not have taken into account: Some customers say it’s making them have to run to the bathroom.
“Half the team tried it yesterday and a few ended up… needing to use the restroom, if ya know what I mean,” a barista on the Starbucks Reddit page posted. CNN has reached out to the Redditor for comment.
It might be the sheen from the oil. Or it could be the aftertaste. Social media was swift with condemning the drink – and the after effects.
“That oleato drink from starbs makin my stomach speak,” one user tweeted.
Those with sensitive stomachs are already weary.
“IBD patient here. I wouldn’t touch these drinks with a ten-foot pole,” one Redditor said.
The new platform, Oleato, rolled out in Italy in February. Each beverage – an oat milk latte, ice shaken espresso with oat milk and a golden foam cold brew – are made with a spoonful of oil, adding 120 calories to a drink. Select Starbucks stores in Seattle and Los Angeles and Reserves in Chicago, Seattle and New York are now serving the platform of beverages.
CNN has reached out to Starbucks for comment.
Olive oil is a staple in Mediterranean culture and some drink bits of olive oil in the region daily.
But the Starbucks drink has a potentially fragile combination: caffeine, which is a stimulant, and olive oil, which is a relaxant.
A 16-ounce drink has as much as 34 grams of fat, which is more than what many find in a meal, registered dietitian nutritionist Erin Palinski-Wade said. And mineral oils like olive oils tend to be used to treat constipation because it helps soften the stool, making it easier to go the bathroom.
“If you combined high fat in a meal or in a beverage along with coffee, which already stimulates the bowels,” Palinski-Wade said, “that combination can cause cramping. It can cause increased mobility in the colon and therefore have that laxative effect.”
Some customers said the speed at which they had to use the restroom after having the drink caught them off guard. But high fat meals take longer to digest than liquid olive oil, which will hit the digestive track faster, Palinski-Wade said. And most people in the US are drinking coffee on the go and aren’t pairing the drink with any carbohydrates and fibers to negate the impact.
“(The drink) is not going to make somebody physically ill from the standpoint of having a negative impact on health,” Palinski-Wade said. “But more of that uncomfortable feeling of having to go in the bathroom or potentially cramping.”
In the Mediterranean, taking a spoonful of olive oil a day is part of a daily routine. Former CEO Howard Schultz picked up this habit himself from olive oil producer Tommaso Asaro while in Sicily, Italy.
“When we got together and started doing this ritual I said to [Asaro], I know you think I’m going to be crazy, but have you ever thought of infusing a tablespoon of olive oil with Starbucks coffee?” Schultz told CNN’s Poppy Harlow. “He thought it was a little strange.” Asaro is the chairman of United Olive Oil, through which Starbucks is sourcing its olive oil.
The manufacturer of eye drops that have been linked to an outbreak of serious bacterial infections in the US, including at least three deaths, did not follow proper protocol to prevent contamination of its products, according to an inspection report published Friday by the US Food and Drug Administration.
The FDA visited a Global Pharma Healthcare facility in India for an inspection that started in mid-February, 2½ weeks after the company recalled EzriCare Artificial Tears due to possible contamination.
At the time of the recall, there were 55 reports of adverse events including eye infections, permanent loss of vision and at least one death with a bloodstream infection. As of late last month, 68 infections had been identified in 16 states, according to the US Centers for Disease Control and Prevention. There have been three deaths, eight cases of vision loss and four surgical eye removals reported.
An 11-day inspection of the Global Pharma facility resulted in 11 observations by the FDA, including a “manufacturing process that lacked assurance of product sterility,” specifically for batches of product that were manufactured between December 2020 and April 2022 and shipped to the US.
The EzriCare Artificial Tears product, which is manufactured by Global Pharma, is part of an outbreak of infections from bacteria called Pseudomonas aeruginosa.
This rare drug-resistant bacteria can spread among people who don’t have symptoms – and to people who haven’t used the eye drops, according to the CDC. This type of spread is particularly common in health care settings.
“The bacteria can spread when one patient carrying the bacteria exposes another patient, or when patients touch common items or when healthcare workers transmit the germs which is why infection control, like hand hygiene, is so important,” the agency told CNN in an email Monday.
Several cases in the current outbreak have been identified in people who were carrying the bacteria without signs or symptoms of clinical infections, the CDC said. These cases were discovered through screenings at inpatient health care facilities that had clusters of infections.
The particular strain of the bacteria associated with this outbreak had never before been reported in the US, and related infections have been identified at acute care hospitals, long-term care facilities, emergency departments, urgent care clinics and other outpatient facilities.
People affected by the outbreak reported using different brands of artificial tears, but EzriCare Artificial Tears was most commonly reported.
The FDA inspection of the Global Pharma facility is part of an ongoing compliance matter.
“The FDA’s highest priority is protecting public health – this includes working with manufacturers to quickly remove unsafe drugs from shelves when they are identified,” the agency said in an email Monday. “The FDA continues to monitor this issue and is working with the Centers for Disease Control and Prevention (CDC) and the companies recalling these affected products. We urge consumers to stop using these products which may be harmful to their health.”
A federal judge in Texas said Thursday that some Affordable Care Act mandates cannot be enforced nationwide, including those that require insurers to cover a wide array of preventive care services at no cost to the patient, including some cancer, heart and STD screenings, and tobacco programs.
In the new ruling, US District Judge Reed O’Connor struck down the recommendations that have been issued by the US Preventive Services Task Force, which is tasked with determining some of the preventive care treatments that Obamacare requires to be covered.
The decision applies to task force recommendations issued on or after March 23, 2010 – the day the Affordable Care Act was signed into law. While the group had recommended various preventive services prior to that date, nearly all have since been updated or expanded.
O’Connor’s ruling comes after the judge had already said that the task force’s recommendations violated the Constitution’s Appointments Clause. The judge also deemed unlawful the ACA requirement that insurers and employers offer plans that cover HIV-prevention measures such as PrEP for free.
Other preventive care mandates under the ACA remain in effect.
The full extent of the ruling’s impact and when its effects could be felt are unclear.
It is likely the case will be appealed, and the Justice Department has the option to ask that O’Connor’s ruling be put on pause while the appeal is litigated.
The Justice Department did not immediately respond to a CNN request for comment, nor did the US Department of Health and Human Services.
White House spokesperson Karine Jean-Pierre called the case “yet another attack on the Affordable Care Act” and said that DOJ and HHS were reviewing Thursday’s ruling.
The decision, in a case brought by employers and individuals in Texas, represents the latest legal affront to the landmark 2010 health care law. It is unclear what immediate practical effect O’Connor’s new ruling will have for those with job-based and Affordable Care Act policies because insurance companies will likely continue no-cost coverage for the remainder of the contracts even though the Obamacare requirements in question have been blocked. Contracts often last one calendar year.
O’Connor’s Thursday ruling is expected to kick off a new phase of the legal battle over Obamacare’s preventive care measures. The judge rejected other claims that the ACA’s foes brought against the law – including challenges to the entities that determine no-cost coverage mandates for vaccines, an assortment of women’s health preventive care treatments, and services for infants and children. It’s possible that the plaintiffs appeal those aspects of O’Connor’s handling of the case, which could put at risk coverage requirements for additional preventive services at no cost.
A lawyer for the challengers did not respond to CNN’s inquiry about Thursday’s decision.
O’Connor is a George W. Bush-appointee who sits in the Northern District of Texas and who has issued anti-Obamacare rulings in major challenges to the law in the past. An appeal of the current case would head to the 5th US Circuit Court of Appeals, perhaps the most conservative federal appeals court in the country.
While the case does not pose the existential threat to the Affordable Care Act that previous legal challenges did, legal experts say that O’Connor’s ruling nonetheless puts in jeopardy the access some Americans will have to a whole host of preventive treatments.
“We lose a huge chunk of preventive services because health plans can now impose costs,” said Andrew Twinamatsiko, associate director of the O’Neill Institute for National and Global Health Law at Georgetown University. “People who are sensitive to cost will go without, mostly poor people and marginalized communities.”
Thursday’s ruling, if left standing, could have significant consequences for Americans nationwide by limiting access to key preventive services aimed at early detection of diseases, including lung and colorectal cancer, depression and hypertension.
Some of the US Preventive Services Task Force’s recommendations – including lung and skin cancer screenings, the use of statins to prevent cardiovascular disease and the offer of PrEP for those at high risk of HIV – were issued after the ACA’s enactment.
Certain older recommendations have been updated with new provisions, such as screening adults ages 45 to 49 for colorectal cancer.
“It would effectively lock in place coverage of evidence-based prevention with no cost sharing from 13 years ago,” said Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation.
Some of the cost-sharing for these preventive services can be substantial. PrEP, for instance, can cost up to $20,000 a year, plus lab and provider charges, according to Kaiser.
In an earlier ruling, the judge upheld certain free preventive services for children, such as autism and vision screenings and well-baby visits, and for women, such as mammograms, well-woman visits and breastfeeding support programs.
O’Connor also upheld the mandate that provides immunizations at no charge for the flu, hepatitis, measles, shingles and chickenpox.
These services are recommended by the Health Resources and Services Administration and the Advisory Committee on Immunization Practices.
Insurers will have to continue to cover preventive and wellness services since they are one of the Affordable Care Act’s required essential health benefits. But under O’Connor’s ruling, they could require patients to pick up part of the tab.
Insurers’ trade associations stressed there would be no immediate disruption to coverage.
“It is vitally important for patients to know that their care and coverage will not change because of today’s court decision,” said David Merritt, senior vice president of policy and advocacy for the Blue Cross Blue Shield Association. “Blue Cross and Blue Shield companies strongly encourage their members to continue to access these services to promote their continued well-being. We will continue to monitor further developments in the courts.”
More than 150 million people with private insurance can receive preventive services without cost-sharing under the Affordable Care Act, according to a 2022 report published by HHS.
Overall, about 60% of the 173 million people enrolled in private health coverage used at least one of the ACA’s no-cost preventive services in 2018 prior to the Covid-19 pandemic, according to a recent Kaiser analysis. These include some services that will continue to be available at no charge under the judge’s ruling.
The most commonly received preventive care includes vaccinations, not including Covid-19 vaccines, well-woman and well-child visits, and screenings for heart disease, cervical cancer, diabetes and breast cancer, according to Kaiser. The most commonly used preventive services will continue to be covered at no cost.
Studies have shown the Obamacare mandate prompted an uptake in preventive services and narrowed care disparities in communities of color.
“There’s plenty of evidence that people responded to this incentive and started using preventive care more often,” said Paul Shafer, assistant professor of health policy at Boston University.
This story has been updated with additional details.
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.”
Georgia’s Republican Gov. Brian Kemp signed a bill Thursday to ban certain gender-affirming care for minors, joining a growing number of GOP-led states looking to restrict the treatments across the country.
Senate Bill 140 will bar licensed medical professionals in Georgia from providing patients under the age of 18 with hormone therapy or surgery related to gender transition. Violations of the legislation could lead to the revocation of a health practitioner’s license.
Kemp announced the signing in a tweet, saying that the law would “ensure we protect the health and wellbeing of Georgia’s children.”
“As Georgians, parents, and elected leaders, it is our highest responsibility to safeguard the bright, promising futures of our kids – and SB 140 takes an important step in fulfilling that mission,” he said.
LGBTQ advocates, however, have expressed concern over restricting access to such treatment, which is medically necessary, evidence-based care that uses a multidisciplinary approach to help a person from their assigned gender – the one the person was designated at birth – to their affirmed gender, the gender by which one wants to be known.
“SB 140 will outlaw the care necessary to save children’s lives,” Rep. Nikema Williams, who chairs the Democratic Party of Georgia, said in a statement after the signing. “It is not only cruel, but it flies in the face of medical science, standards of patient care, and the lived experiences of those whom it impacts.”
Democratic state Sen. Josh McLaurin shared similar concerns about the bill’s consequences for Georgia’s youth, after it passed in Georgia’s Senate Tuesday with a 31-21 vote.
“Kids will commit suicide. Kids will feel like they’re not being heard, that their basic existence is being invalidated and erased,” McLaurin said.
The Trevor Project, a suicide prevention and crisis intervention organization for LGBTQ youth, noted in a 2022 report that 55% of transgender and nonbinary youth in Georgia “seriously considered suicide in the past year” and 16% attempted suicide in the same timeframe.
While the bill grants exemptions to the law “for individuals born with a medically verifiable disorder of sex development” and other medical conditions, it does not count gender dysphoria – a psychological distress that may result when a person’s gender identity and sex assigned at birth do not align, according to the American Psychiatric Association – among them.
Minors who started hormone replacement therapy before July 1, 2023, will be allowed to continue the treatment under the new legislation.
Cory Isaacson, a legal director for the American Civil Liberties Union of Georgia, warned ahead of the signing that the legal organization would sue the state over the law, claiming that Georgia’s politicians are “interfering with the rights of Georgia parents to get life-saving medical treatment for their children and preventing physicians from properly caring for their patients.”
“The ACLU of Georgia and our partners will now consider all available legal options in order to protect the rights of parents, young people, and medical providers in our state,” she said
Major medical associations agree that gender-affirming care is clinically appropriate for children and adults with gender dysphoria.
Though the care is highly individualized, some children may decide to use reversible puberty suppression therapy. This part of the process may also include hormone therapy that can lead to gender-affirming physical change. Surgical interventions, however, are not typically done on children and many health care providers do not offer them to minors.
The Georgia bill does not explicitly prohibit puberty blockers, breaking with similar bans across the country. Instead, the bill takes aim at hormone therapy that comes with more permanent effects than puberty blockers, according to The American College of Obstetricians and Gynecologists, which notes the treatment is shown to help transgender people with depression and boost self-esteem.
Georgia’s legislation is similar in its goal to dozens of bills seeking to restrict access to gender-affirming care across the country, according to data compiled by the American Civil Liberties Union and shared with CNN.
Some GOP-led states have already made restrictions on transgender youth’s access to health care in their states. On Wednesday, Iowa enacted its own ban on all forms of gender affirming care for minors, joining Tennessee, Mississippi, Utah and South Dakota, which passed their own bans earlier this year. Alabama, Arizona and Arkansas also enacted bans on gender-affirming care in recent years, though the laws in Alabama and Arkansas have been temporarily blocked by federal courts.
Other potential bans are waiting in the wings, with Missouri’s Republican attorney general Monday announcing he would seek to implement an emergency regulation restricting gender-affirming care. Kentucky’s Republican-led legislature passed its own ban earlier this month while boasting a majority that could overturn the likely veto of its Democratic governor. That bill would also allow educators to refuse to refer to transgender students by their preferred pronouns and would not allow schools to discuss sexual orientation or gender identity with students of any age.
This story has been updated with additional information.
Editor’s Note: Catherine Poisson is an associate professor of Romance Languages at Wesleyan University in Middletown, Connecticut. Her research has focused on literature and culture of France from the 19th century to the present. The views expressed in this article are her own. Read more opinion at CNN.
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As a native of France who has lived in America for many years, I never fail to be shocked at the sight of older workers packing groceries at the supermarket. It suggests to me a deplorable lack of social supports that could allow aged people to enjoy a dignified retirement.
While it’s true that some people choose to work past retirement, most of us in this country, at some point or the other, have seen elderly people hard at work in occupations that people many years younger would find taxing.
And yet, many Americans somehow seem to be puzzled by the recent protests over retirement benefits that are roiling the country of my birth.
For the past three months, a spasm of demonstrations has gripped France over moves by the government to raise the retirement age from 62 to 64. In recent days, French indignation led to a no-confidence vote that President Emmanuel Macron only narrowly survived. A new round of mass protests called by organized labor took place on Thursday — the ninth day of strikes since the bill was introduced in January.
Schools are closed because teachers are on strike. Transportation, including France’s usually reliable train service, is suddenly erratic because of the work stoppages. On top of all this, Parisians have seen their city’s streets strewn with tons of trash, after sanitation workers launched a labor action in solidarity.
I return to France for several weeks each year, but have lived in the United States some 30 years and know both countries well. One thing that seems clear to me is that the kind of upheaval playing out in the country of my birth would be almost unthinkable in America. Americans seem not to be able to understand the source of the boiling national rage felt by the French over the planned increase in the retirement age.
The closest analogy in the United States to anything like what my compatriots are experiencing would be the decision four decades ago to raise the age at which Social Security benefits are doled out.
And that’s exactly what happened: The US government announced in 1983 that it would gradually raise the age for collecting full Social Security retirement benefits from 65 to 67 over a 22-year period, beginning in 2000. Of course, older Americans care deeply about Social Security — and often cast their votes accordingly. Still, it’s hard to imagine such a change going over quite so easily in France.
For the most part, the demonstrations in France haven’t awakened Americans’ sense of empathy or solidarity. Instead, it has elicited expressions of sheer befuddlement. What on earth, my friends and acquaintances here ask, do the French have to complain about?
Life in France is not perfect. But French citizens have a generous health care system, which means workers pay next-to-nothing out of pocket for medical care. University education is nearly free. Unemployment benefits allow laid-off workers to sustain a reasonable quality of life while they look for their next jobs.
Yes, French workers have all of that. It is, in short, part of their birthright as citizens of France.
After World War II, both the retirement system and the National Health care system were introduced in France, and though there have been limitations over the last twenty years, social benefits still make it among the most envied countries in Europe in terms of its social programs.
If Americans are baffled by the French willingness to fight to hold onto these hard-won benefits, it is in part because the two countries have very different ideas about what it means to be a worker. In the United States, work is an identity. You are what you do.
For those of us raised in French culture, work refers to a finite period of life lasting roughly 40 years. And when that work is done, you are still young enough and fit enough to enjoy the best of what life has to offer. It’s the norm that retirement years — or decades actually — are spent traveling, caring for grandchildren or picking up new hobbies.
It’s part of our social compact: The French work hard during their most productive years during which time they pay what most Americans would consider usuriously high taxes. But then comes the much anticipated “Troisieme Age” — the “third age.” It’s a concept French people grow up with and cling to fervently for their entire lives.
The “first age” is childhood. During life’s “second age,” many of us are saddled with responsibilities of work and raising children. The third age however promises a good, healthy retirement free from want and worry — the kind of retirement many in the United States cannot even dream of. It is no wonder that people are willing to take to the streets to protect it.
The ongoing protests are also seen as a pushback against Macron’s imperious governing style. Years ago, he earned the nickname “Jupiter” — after the king of the Roman gods — as he was derided by some for his highhanded approach to governing — imposing his will, in the eyes of his critics, as if he were a sovereign rather than elected.
Macron says retirement reform is necessary because the system is near collapse. There’s some disagreement about that, however. The budget appears to be balanced for the next dozen years, although it’s true that falling birth rates and increasing longevity pose a problem that will have to be addressed.
Still, there are less draconian ways to fix problems posed by a future retirement fund shortfall. For starters, Macron might reverse his move to abolish the wealth tax. He might also reconsider corporate tax breaks that have benefited big business handsomely.
His administration’s use last week of a constitutional maneuver to bypass a vote in the National Assembly and raise the retirement age is an example of his imperial style. It’s an approach to governing that Macron has used multiple times, including when he passed a budget late last year. And as the protests wear on, there’s been another sign of government heavy-handedness: Macron now has resorted to the “requisition” of some striking workers — in short requiring them to return to their places of employment or risk losing their jobs.
Such moves are, in my view, an admission of political impotence rather than strength. The president has failed to see politics as the art of persuasion and is instead ruling by fiat. The brutal police crackdown on demonstrators protesting pension reforms led to hundreds of arrests in recent days, another sign that he lacks political deftness. The unions meanwhile show no sign of backing down, and are continuing to organize massive protests urging workers to stand firm and remain off the job.
So what’s next? Surely the French will continue to take to the streets, something they always do with great gusto. Beyond this, it’s hard to say how this upheaval ends.
There’s no question that the French are slow to embrace change. I am and will always remain staunchly French, although after many years in the US, I can see that my compatriots need to show greater flexibility. They hold on too long to obsolete aspects of their cherished way of life. It’s time for the French to abandon their “c’est tout ou rien” (“all or nothing”) approach as we negotiate what French society will look like in the future.
But then I read about the latest moves to raise the US retirement age to 70, and think that my protesting countrymen have a thing or two that they can teach workers in America when it comes to protecting the sanctity of their golden years.
When Nabilah Islam began running for Congress in the 2020 cycle, she said she quickly discovered the high price of her decision.
“It was impossible for me to have a full-time job and wage a competitive campaign,” the Georgia Democrat recalled. So, she gave up her work as a campaign consultant, paused paying her student loans and went without health insurance – in the middle of a pandemic – because she could no longer afford to pay the premiums. She drained her savings to pay living expenses.
“I was eating ramen and turkey sandwiches every day,” said Islam, who lost her bid for a House seat and now serves in the Georgia state Senate. “It was one of the hardest things I had ever done in my life.”
Now, the Federal Election Commission is taking up a request that Islam lodged in 2021 to change some of the federal rules governing the use of political cash. At a hearing Wednesday, the regulators weighed boosting the amount of campaign money candidates can use to pay themselves while running for office. They also are considering whether to allow federal candidates to use donors’ money to underwrite health insurance premiums and other benefits.
Although the FEC now allows candidates to use campaign funds to pay themselves a salary, the agency set strict limits. That salary is capped at the annual salary for the office they are seeking or their earnings in the year before they became a candidate, whichever is the lower amount.
The limits are aimed at preventing candidates from enriching themselves at donors’ expense, but they also bar candidates who were unemployed or at home caring for children in the prior year from using contributors’ money to draw a candidate salary.
Supporters of the change say it would make it easier for a broader spectrum of Americans to run for federal office, including full-time caregivers, students and people from working-class backgrounds. But critics question whether it would encourage grift.
“The reality is that giving up your salary for a year or two to run for Congress is unsustainable for most working people,” said Liuba Grechen Shirley, a former House candidate and founder and CEO of the Vote Mama Foundation, which aims to overcome the obstacles mothers face in running for office. She supports the rule change.
“We have to make it the norm that candidates pay themselves a livable wage, so that they can run for office because that’s how we start to change the system,” she told CNN in an interview this week.
Running for Congress is a time-consuming and expensive enterprise. The average successful House winner in the 2022 midterms spent nearly $2.8 million in campaign funds, according to OpenSecrets, a nonpartisan organization that tracks political money.
And members of Congress, as a group, are far wealthier than the general US population. An OpenSecrets analysis of congressional financial disclosures reports in 2020 found that more than half the people in Congress that year were millionaires.
Although a record number of women serve in Congress, they still make up just over a quarter of total representation, according to the Center for American Woman and Politics (CAWP) at Rutgers University.
Only about 28% of all candidates for the House in 2022 were women, said Kelly Dittmar, CAWP’s director of research, underscoring that the gender disparities start long before Election Day.
“If you could tell a potential candidate that they would have greater financial security if they decided to wage a campaign for office, then it might increase the pool of candidates, including women,” Dittmar said.
The limits don’t just affect women.
Florida Rep. Maxwell Frost, who last year became the first Gen Z candidate to win a congressional seat, told the commissioners he “put himself in a bad financial place” by seeking a House seat.
The 26-year-old Democrat said he left his job at a gun-violence prevention organization to run for office but quickly realized that he couldn’t sustain campaigning and driving part-time for Uber as he had planned.
Frost drew headlines late last year after a landlord denied his application to rent an apartment in Washington, DC, because of his low credit score.
“I did overcome the odds,” he testified Wednesday. “But there are often consequences when you participate in a system that’s not set up for you.”
The FEC, which is not likely to make a decision in the coming weeks, is considering a range of options.
Among them: Allowing candidates to earn, on a pro-rated basis, up to 50% – or as much as 100% – of the federal office they are seeking, regardless of what they earned in the year before they launched their campaigns. Rank-and-file members of Congress earn $174,000 a year, with those in top leadership positions collecting more.
Other options include allowing candidates to receive a salary that’s tied to a $15-an-hour rate or to the minimum wage set by federal or state law.
So far, a range of individuals and organizations – including the campaign arms for House Democrats and Republicans – have expressed general support for a change, although they diverge on the specific remedies.
Some Republicans on the panel, including Commissioner James “Trey” Trainor, questioned whether the agency is overstepping its bounds by weighing a rule change and should instead ask Congress to change the federal law that bars candidates from converting campaign contributions to personal use.
Bradley Smith, a former Republican FEC commissioner, testified that the agency should be wary of going too far with “feel-good rule-making.”
“Why not allow candidates to pay for haircuts, better clothes, better food to keep a candidate’s energy up and fundraising or recharging time at the country club, all of which could be helpful to a campaign?” he asked.
The commission also is considering whether to allow candidates to begin drawing a donor-funded salary as soon as they file a statement of candidacy rather than waiting, as is currently required, for primary ballot deadlines, which vary widely by state.
Frost, the freshman congressman from Florida, also urged the commission to allow candidates to continue drawing a campaign salary after the election as they wait for their salaries as officeholders to kick in.
Although the FEC often deadlocks along partisan lines, the commission has signaled an openness to easing some rules for candidates in the past.
In 2018, the agency opened the door to candidates using campaign contributions to pay for child care benefits, following a request from Grechen Shirley. She said she did so after trying for months to juggle care for her small children while running for a House seat in Long Island. “I would literally be nursing my son, while my daughter put hairclips in my hair, and I’d have my headphones on and would be dialing for dollars,” she said.
To date, 59 federal candidates have used campaign dollars for child care, according to Vote Mama. The group now is pressing states around the country to extend the policy to state and local candidates.
This year, 19 bills to do so have been introduced in 13 states, Grechen Shirley said.
Last year, Islam, 33, made history by becoming the youngest woman and the first Muslim woman elected to the Georgia state Senate. Although she is not currently planning another run for Congress, she said she is determined to see federal policy change.
“I’m very persistent,” she said. “No one should have to go through all that in order to run for office.”
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Americans took fewer steps during the height of the Covid-19 pandemic, and they still haven’t gotten their mojo back, a new study found.
“On average, people are taking about 600 fewer steps per day than before the pandemic began,” said study author Dr. Evan Brittain, associate professor of cardiovascular medicine at Vanderbilt University Medical Center in Nashville.
“To me, the main message is really a public health message — raising awareness that Covid-19 appears to have had a lasting impact on people’s behavioral choices when it comes to activity,” he said.
The study used data from the National Institutes of Health’s All of Us Research Program, which is focused on identifying ways to develop individualized health care. Many of the 6,000 participants in the program wore activity trackers for at least 10 hours a day over multiple years and allowed researchers access to their electronic health records.
In the new study, published Monday in JAMA Network Open, researchers compared steps taken by nearly 5,500 people who wore the program’s activity trackers. Most were White women, with an average age of 53.
Step counts collected between January 1, 2018, and January 31, 2020, were considered pre-Covid. Steps tracked after that date until the end of 2021, which is when the study ended, were considered post-Covid.
Results showed no difference in identified step activity based on sex, obesity, diabetes and other illnesses or conditions such as coronary artery disease, hypertension or cancer.
People who took the fewest steps were socioeconomically disadvantaged, under psychological stress and not vaccinated, the study said.
Age made a difference as well, but in an unexpected manner: People over 60 were not impacted by the pandemic, the study found — they continued to keep their steps up.
Oddly, it was younger people between 18 and 30 whose step counts were most impacted, Brittain said. “In fact, we found every 10-year decrease in age was associated with a 243 step reduction per day.”
“If this persists over time, it could certainly raise the risk of cardiovascular disease, obesity, hypertension, diabetes and other conditions strongly linked to being sedentary,” Brittian said. “However, it’s too soon to know whether this trend will last.”
Why would a younger generations lose steps while older people did not?
“I think it’s difficult to interpret because it’s only 600 steps, which you could argue is what some people would get simply walking into work and through their day,” said Dr. Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health, a hospital in Denver, who was not involved in the research. “I think the question is who is more likely to work from home?”
Younger generations make up the majority of workers in technology, software and other professions that are able to work from anywhere, “whereas older people may have less of those jobs,” Freeman said.
Whatever the reason, the study data shows that people were not moving as much during the pandemic as they used to. That is worrisome, Freeman added.
“If this trend remains, we should really be cognizant that if you’re going to work from home, use either a standing, treadmill or bike desk,” he said, adding that managers of remote employees should “insist people take periodic breaks for people to do exercise, which also is proven to improve mental clarity and acuity,” he said.
Health professionals should always be talking to their patients about activity levels, but “the impact of Covid-19 might make those kinds of messages all the more important to discuss with patients,” Brittain said.
Chilling details of the chaotic and bloody aftermath of the Uvalde school massacre show how emergency medics desperately treated multiple victims wherever they could and with whatever equipment they had, according to never-before-heard interviews.
Some came from off-duty or far away to back up their colleagues sent to Robb Elementary School, where classrooms had become kill zones but there were still lives to be saved.
There was the state trooper with emergency medical certification who always carried five chest seals with him, never imagining he would ever need them all at once; the local EMT who crouched behind a wall as gunshots rang out and was soon treating three children at the same time; and her off-duty colleague who found herself caring for her son’s classmates, not knowing if her own boy was alive.
Amanda Shoemake was on the first Uvalde EMS ambulance to arrive at the school last May 24, she told an investigator from the Texas Department of Public Safety. But with law enforcement officers waiting for 77 minutes to challenge the shooter, she spent time trying to direct traffic to maintain a lane for ambulances to get through once victims started coming out, she said, according to investigation records obtained by CNN.
“We were just waiting for what felt like a while. And then somebody … came and they were like, ‘OK, we need EMS now,’” she said in the interview, part of the DPS investigation into the failed response to the school shooting, in which 19 children and two teachers were killed. At least one teacher and two children were alive when officers finally stormed the classrooms, but they died later.
As Shoemake and colleagues reached the school building, they were told the shooter had not yet been found and could be in the ceiling, she recounted, saying how they sheltered behind a brick wall as the shooter was confronted.
“We just squatted down there and waited there until the shooting stopped,” she said. “And then after some time they brought out the first kid that was an obvious DOA.”
DPS trooper Zach Springer was one of the hundreds of law enforcement officers from across southwest Texas who responded to Robb when alerts went out for reinforcements. He had become certified as an EMT a few months earlier, he told the Texas Ranger who interviewed him.
“I made a conscious decision not to bring my rifle,” he said he thought as he drove up. “I knew there were so many people up there, they’re not going to need rifles, they’re going to need med gear.”
Springer entered the school and started getting a triage area ready at the end of the hallway where armed officers from the school force, local police department, sheriff’s office, state police and federal agencies were lined up. While commanders like then school police chief Pete Arredondo, then acting city police chief Mariano Pargas and Sheriff Ruben Nolasco have given various statements about whether they knew children were hurt and needed rescue, medics from many agencies prepared for victims.
“I set up as best I could,” he said. “I put tourniquets, gauze, Israeli bandages, compression bandages, hemostatic gauze. I was like, ‘I got everything, I think.’ … I had five chest seals, which is ridiculous in my opinion, like I’ve made fun of myself – when am I ever going to need five chest seals?”
He heard the breach and then started seeing children brought out amid the smoke from the brief but intense firefight, he said.
He went to help a Border Patrol medic treating a girl shot through the chest. He said he started checking her legs for injuries when he heard colleagues ask for a chest seal. In the chaos of the response, all had been taken.
Springer said they covered the girl’s wounds with gauze, got her onto a backboard and he repeatedly told the others to secure her head as they moved her, though he later believed the young victim was too small for the carrier.
“I don’t think that they secured her head because she wasn’t tall enough for her head to be secured,” he said. And while the girl was thought to be alive when they pulled her from the classroom, she did not survive, he said.
When he ran back in, the hallway lined with posters celebrating the end of the school year had been transformed. “You could smell the iron – there was so much blood,” he said.
Back outside, Uvalde EMS Shoemake had put the first victim in her ambulance to hide him from the crowds of anxious parents frantic for information, when another child was brought out. She saw an unattended ambulance from a private company with its door open and no stretcher, she said.
“I had them put her on the floor of that ambulance and I started treating her there. Then while I was treating her, there was two more 10-year-old boys brought to me and so I put one on the bench and one in the captain’s seat.”
Shoemake’s colleagues including Kathlene Torres came to help and got the little girl onto a stretcher and into another ambulance, working to save her life as they first thought a helicopter would take her and then getting her to the hospital themselves, they said.
Torres told a DPS officer the girl was critically injured but still managed to share her name and date of birth. She was Mayah Zamora, who would spend 66 days in hospital before she could go back to her family. “I can still hear her voice,” Torres said.
At least two of the EMTs had been at Robb earlier in the day to see awards presented to their children. One of them, Virginia Vela, had watched her 4th-grader son at a 10 a.m. ceremony and then two hours later was corralled in the funeral home parking lot across the street from the school with her husband and other parents who were being held back by officers.
She told the DPS investigator that she was recognized as a local EMT and allowed into the funeral home to treat some children who had been hurt climbing through windows to get away from the school.
Photos show chaotic scene as Uvalde students escape
When she went closer to the school to help the other EMTs, she saw the first victim brought out, a boy who was dead, she said.
“I thought it was my son,” she said. “Once I saw his clothes, I knew it wasn’t my son, but the fear … ran through my body.”
More children came for emergency medical treatment.
“One of the kids that I had in the unit, he was shot in the shoulder. The student that I was helping up from the side of the unit, he had bullet fragments on his thigh,” she said. “And then we had another student with blown off fingers. And she was just in and out. We were trying to get her oxygen and trying to keep her alive. And I realized those were my son’s classmates and my son was not coming out.”
Vela opened the ambulance to see if more children were being brought to them. And finally, she saw her boy running from the school.
“I didn’t even run to him. I didn’t go get him. What I was thinking was ‘run buddy … get the hell away from that school, just run to the bus,’” she said. “I grabbed my phone, and I called my husband and my husband’s like, ‘I see him, I see him, he’s getting onto the bus, he’s OK.’ And I said, ‘OK, but I’ve got to stay here with these students.’ And I hung up and I continued to do my job.”
Vela told DPS she remembered a little more of the day after she knew her son was safe, but it was still a blur as she worked with Shoemake and the others, writing a child’s vitals on their arms and getting them on their way – load and go, load and go.
And once the emergency work was done, she had an important question.
“I asked my partner, ‘Did I freeze? Did I even help you?’ She goes, ‘Yes, girl. You were like jumping from unit to unit, helping everybody that was coming out,’” Vela said. “And I was like, I need to know this. I need to know that I continued doing my job.”
New Mexico Democratic Gov. Michelle Lujan Grisham on Thursday signed into law a bill that prohibits local municipalities and other public bodies from inferring with a person’s ability to access reproductive or gender-affirming health care services.
HB7, the Reproductive and Gender-Affirming Health Care Freedom Act, also prohibits any public body from imposing laws, ordinances, policies or regulations that prevent patients from receiving reproductive or gender-affirming care.
The move comes in the wake of the reversal of federal abortion rights last year and as several states have enacted measures to prevent minors from accessing gender-affirming care.
Gender-affirming care is medically necessary, evidence-based care that uses a multidisciplinary approach to help a person transition from their assigned gender – the one the person was designated at birth – to their affirmed gender – the gender by which one wants to be known.
“New Mexicans in every corner of our state deserve protections for their bodily autonomy and right to health care,” Lujan Grisham said in a media release. “I’m grateful for the hard work of the Legislature and community partners in getting this critical legislation across the finish line.”
Each violation of the law can result in a fine of $5,000 or damages, if the amount is greater, according to the bill.
The law follows ordinances that several municipalities in the state had previously passed related to abortion care access after the Supreme Court overturned Roe v. Wade last summer.
While abortion is legal in New Mexico, several GOP-led states have introduced or enacted measures restricting abortion, including Texas and Oklahoma, which have banned the procedure at all stages of pregnancy with limited exceptions. In response, New Mexico, which neighbors both states, allocated $10 million to build a new abortion clinic near the Texas border.
Several other Democratic-controlled states have moved to reaffirm reproductive care in response to the Supreme Court’s landmark ruling.
Minnesota’s Democratic governor signed a bill into law earlier this year that enshrined the “fundamental right” to access abortion in the state. Last year, California passed several bills expanding abortion access, including protections for abortion providers and patients seeking abortion care in the state from civil action started in another state.
As states move to enact measures, new legal challenges could further complicate abortion access in a post-Roe America.
A federal court in Texas heard arguments this week to block the US Food and Drug Administration’s approval of mifepristone, one of the two drugs used in a medication abortion, which made up more than half of US abortions in 2020, according to the Guttmacher Institute. Though the Trump-appointed judge has not issued a ruling, he suggested during arguments that he is seriously considering undoing the FDA’s approval.
Also at risk is access to gender-affirming care for trans youth, which LGBTQ advocates have long stressed is life-saving health care.
So far this year, lawmakers in Tennessee, Mississippi, Utah and South Dakota have enacted legislation to restrict minors’ access to such care.
Additionally, more than 80 bills seeking to restrict access to gender-affirming care have been introduced around the country through early last month, according to data compiled by the American Civil Liberties Union and shared with CNN.
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.”
