July 22, 2011 – Her wedding dress is put on display at Buckingham Palace.
January 5, 2012 – Announces the four charities she will support as a patron: the Art Room, which helps disadvantaged children express themselves through art; the National Portrait Gallery, which houses a famous collection of royal paintings and photographs; East Anglia’s Children’s Hospices, which helps children with life-threatening conditions; and Action on Addiction, which assists those with addiction issues.
March 19, 2012 – Gives her first official public address at East Anglia’s Children’s Hospice facility in Ipswich, England.
September 2012 – The French magazine Closer runs photographs of the Duchess privately sunbathing topless. The pictures also run in the Irish Daily Star newspaper.
September 17, 2012 – The Duchess and William file a complaint in France against the photographer who took the topless sunbathing pictures. They are seeking damages and would like to prevent further publication of the photos. The French magazine Closer, the Irish Daily Star and the Italian magazine Chi have each published some of the topless photos.
December 3, 2012 – The royal household announces that the Duchess is pregnant. According to the announcement, she is admitted to hospital with acute morning sickness.
June 18, 2021 – The Duchess launches The Royal Foundation Centre for Early Childhood. In a video announcing the center’s creation, the duchess says the goal is to “raise awareness of why the first five years of life are just so important for our future life outcomes.”
March 11, 2024 – Apologizes for an edited official photograph that was recalled by a number of international news agencies over concerns it had been manipulated. Catherine says she is sorry for “any confusion” caused by the image after her “experiment” with photo editing. The photograph, released to mark Mother’s Day in the UK, was the first official picture of Catherine since she underwent abdominal surgery in January.
“While many women obtain medication abortion from a clinic or their OB-GYN, others obtain the pills on their own to self-induce or self-manage their abortion,” said Dr. Daniel Grossman, a professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco.
“A growing body of research indicates that self-managed abortion is safe and effective,” he said.
Mifepristone blocks the hormone progesterone, which is needed for a pregnancy to continue. The drug isapproved to end a pregnancy through 10 weeks’ gestation, which is “70 days or less since the first day of the last menstrual period,” according to the FDA.
In a medication abortion, a second drug, misoprostol, is taken within the next 24 to 48 hours. Misoprostol causes the uterus to contract, creating cramping and bleeding. Approved for use in other conditions, such as preventing stomach ulcers, the drug has been available at pharmacies for decades.
Together, the two drugs are commonly known as the “abortion pill,” which is now used in more than half of the abortions in the United States, according to the Guttmacher Institute, a research group that supports abortion rights.
“Some people do this because they cannot access a clinic — particularly in states with legal restrictions on abortion — or because they have a preference for self-care,” said Grossman, who is also the director of Advancing New Standards in Reproductive Health, a research group that evaluates the pros and cons of reproductive health policies and publishes studies on how abortion affects a woman’s health.
What happens during a medication abortion? To find out, CNN spoke with Grossman. This conversation has been condensed and edited for clarity.
CNN: What is the difference between a first-trimester medication abortion and a vacuum aspiration in terms of what a woman experiences?
Dr. Daniel Grossman: A vacuum aspiration is most commonly performed under a combination of local anesthetic and oral pain medications or local anesthetic together with intravenous sedation, or what is called conscious sedation.
An injection of local anesthetic is given to the area around the cervix, and the cervix is gently dilated or opened up. Once the cervix is opened, a small straw-like tube is inserted into the uterus, and a gentle vacuum is used to remove the pregnancy tissue. Contrary to what some say, if the procedure is done before nine weeks or so,there’s nothing in the tissue that would be recognizable as a part of an embryo.
The aspiration procedure takes just a couple of minutes. Then the person is observed for one to two hours until any sedation has worn off. We also monitor each patient for very rare complications, such as heavy bleeding.
A medication abortion is a more prolonged process. After taking the pills, bleeding and cramping can occur over a period of days. Bleeding is typically heaviest when the actual pregnancy is expelled, but that bleeding usually eases within a few hours. On average people continue to have some mild bleeding for about two weeks or so, which is a bit longer than after a vacuum aspiration.
Nausea, vomiting, fever, chills, diarrhea and headache can occur after using the abortion pill, and everyone who has a successful medication abortion usually reports some pain.
In fact, the pain of medication abortion can be quite intense. In the studies that have looked at it, the average maximum level of pain that people report is about a seven to eight out of 10, with 10 being the highest. However, people also say that the pain can be brief, peaking just as the pregnancy is being expelled.
The level of cramping and pain can depend on the length of the pregnancy as well as whether or not someone has given birth before. For example, a medical abortion at six weeks or less gestation typically has less pain and cramping than one performed at nine weeks. People who have given birth generally have less pain.
CNN: What can be done to help with the pain of a medication abortion?
Grossman: There are definitely things that can be used to help with the pain. Research has shown that ibuprofenis better than acetaminophen for treating the pain of medication abortion. We typically advise people to take 600 milligrams every six hours or so as needed.
Some people take tramadol, a narcotic analgesic, or Vicodin, which is a combination of acetaminophen and hydrocodone. Recent research I was involved in found medications like tramadol can be helpful if taken prophylactically before the pain starts.
Another successful regimen that we studied combined ibuprofen with a nausea medicine called metoclopramide that also helped with pain. Other than ibuprofen, these medications require a prescription.
Another study found that a TENS device, which stands for transcutaneous electrical nerve stimulator, helps with the pain of medication abortion. It works through pads put on the abdomen that stimulate the nerves through mild electrical shocks, thus interfering with the pain signals. That’s something people could get without a prescription.
Pain can be an overlooked issue with medication abortion because, quite honestly, as clinicians, we’re not there with patients when they are in their homes going through this. But as we’ve been doing more research on people’s experiences with medication abortion, it’s become quite clear that pain control is really important. I think we need to do a better job of treating the pain and making these options available to patients.
CNN: Are there health conditions that make the use of a medication abortion unwise?
Grossman: Undergoing a medication abortion can be dangerous if the pregnancy is ectopic, meaning the embryo is developing outside of the uterus. It’s rare, happening in about two out ofevery 100 pregnancies — and it appears to be even rarer among people seeking medication abortion.
People who have undergone previous pelvic, fallopian tube or abdominal surgery are at higher risk of an ectopic pregnancy, as are those with a history of pelvic inflammatory disease. Certain sexually transmitted infections can raise risk, as does smoking, a history of infertility and use of infertility treatments such as in vitro fertilization (IVF).
If a person is on anticoagulant or blood thinning drugs or has a bleeding disorder, a medication abortion is not advised. The long-term use of steroids is another contraindication for using the abortion pill.
Anyone using an intrauterine device, or IUD, must have it removed before taking mifepristone because it may be partially expelled during the process, which can be painful.
People with chronic adrenal failure or who have inherited a rare disorder called porphyria are not good candidates.
CNN: Are there any signs of trouble a woman should watch for after undergoing a medication abortion?
Grossman: It can be common to have a low-grade fever in the first few hours after taking misoprostol, the second drug in a medication abortion. If someone has a low-grade fever — 100.4 degrees to 101 degrees Fahrenheit — that lasts more than four hours, or has a high fever of over 101 degrees Fahrenheit after taking the medications, they do need to be evaluated by a health care provider.
Heavy bleeding, which would be soaking two or more thick full-size pads an hour for two consecutive hours, or a foul-smelling vaginal discharge should be evaluated as well.
One of the warning signs of an ectopic pregnancy is severe pelvic pain, particularly on one side of the abdomen. The pain can also radiate to the back. Another sign is getting dizzy or fainting, which could indicate internal bleeding. These are all very rare complications, but it’s wise to be on the lookout.
We usually recommend that someone having a medication abortion have someone with them during the first 24 hours after taking misoprostol or until the pregnancy has passed. Many people specifically choose to have a medication abortion because they can be surrounded by a partner, family or friends.
Most people know that the abortion is complete because they stop feeling pregnant, and symptoms such as nausea and breast tenderness disappear, usually within a week of passing the pregnancy. A home urine pregnancy test may remain positive even four to five weeks after a successful medication abortion, just because it takes that long for the pregnancy hormone to disappear from the bloodstream.
If someone still feels pregnant, isn’t sure if the pregnancy fully passed or has a positive pregnancy test fiveweeks after taking mifepristone, they need to be evaluated by a clinician.
People should know that they can ovulate as soon as two weeks after a medication abortion. Most birth control options can be started immediately after a medication abortion.
Jane Chen is racing against the clock, again. She knows well how every minute that passes is crucial for a new life that emerges prematurely into the world in the most vulnerable of circumstances — in the midst of war, in the aftermath of a natural disaster or in a remote village far away from a medical center.
Embrace, based in San Francisco, California, makes low-cost portable baby incubators that don’t require a stable electricity supply.
The Embrace incubator resembles a sleeping bag, but for a baby. It’s a three-part system consisting of an infant sleeping bag, a removable and reusable pouch filled with a wax-likephase-change material which maintains a constant temperature of 98 degrees F for up to eight hours at a stretch when heated, and a heater to reheat the pouch when it cools.
Chen said the pouch requires just a 30-minute charge to be fully ready for reuse. “This is really ideal for settings that have intermittent access to electricity, which is a lot of places where we work in the world,” she said.
The stats are startling to Chen, who is bracing for a swell of need there. She’s learned how access to incubators becomes critical in conflict areas through the organization’s efforts to donate 3,000 Embrace incubators with the help of UNICEF to doctors and hospitals in Ukraine where a war with Russia rages on. The nonprofit also sent the devices to Turkey and Syria after devastating earthquakes there earlier this year.
Medical experts point to elevated stress as a potentially serious factor that could trigger preterm deliveries in these situations.
“There’s been plenty of data that show stress not only causes preterm birth but also low-birth-weight,” said Dr. Veronica Gillispie-Bell, an obstetrician-gynecologist and associate professor with Ochsner Health in New Orleans, Louisiana
In general, babies born preterm or before 37 weeks, have difficulty maintaining their body temperature, said Bell. “Specifically, if we are speaking of disasters…. in my own experience of being here during [Hurricane] Katrina, in those very stressful situations, we have seen an uptick during those times in preterm birth and low birth weight,” she said.
Because preterm and low-birth-weight babies don’t have as much body fat, it’s harder for them to maintain their body temperature, which for a healthy baby is between 96.8 and 99.5 degrees F, she said. “The lower it is below that, the more oxygen and energy they need to stay warm. So they would have use even more energy.”
In both cases of preterm and low-birth-weight infants, quick and constant access to an incubator is vital.
In Ukraine, Chen said doctors have indicated that preterm births are on the rise across the country at the same time that intermittent power outages have made the use of conventional incubators very challenging. Several doctors and nurses, she said, also must consistently take babies and mothers to basement shelters as bombings continue.
Dr. Halyna Masiura, a general practitioner, is experiencing this first hand at the Berezivka Primary Healthcare Center in the Odesa region of Ukraine.
“Half of the babies being born in this area need more care,” Masiura told CNN. “They are being born early and with low birth weight. When air raids happen, we all have to go into shelters.” Masiura said her staff members have been relying on donated Embrace incubators for babies born with a birth weight of 2 kg (4 lbs) and up.
In Gaza, where half of the overall population are children, access to medical aid, food, water, fuel, electricity and other normal daily necessities of life have evaporated in recent days amid sustained Israeli bombardment.
Over the weekend, after days of a complete siege of the exclave by Israel, the first trucks reported to be carrying medicine and medical supplies, food and water entered Gaza on Saturday.
For Chen, the most pressing problem is to figure out how to get the incubators to where they are most needed on the ground there. “As we did for Ukraine, we’re looking for partnerships with organizations that can get into the region effectively and also for funding,” she said. As a nonprofit, Chen said donations are sought through GoFundMe and a mix of individual donors, foundations and corporate donations.
Her team is working on a partnership with a humanitarian relief organization to respond in Gaza. “We’re also reaching out to organizations in Israel to assess the need for our incubators there,” she added.
A couple of hundred incubators are ready to immediately be sent to Israel and Gaza. Said Chen, “Depending on the need, we would go into production for more. But the big question is, can we get into those areas? We don’t want to ship products and then have them sit there.”
Linus Liang, along with Chen, was among the original team of graduate students at Stanford University who, as part of a class assignment in 2007, were given a challenge to develop a low-cost infant incubator for use in developing countries.
Liang, a software engineer who had already created and sold two gaming companies by then, was intrigued. “This class deliberately brought together people from different disciplines – law, business, medical school, engineers – to collaborate to solve world problems,” he said.
“Our challenge was that about 20 million premature and low-birth-weight babies are born globally every year,” he said. “Many of them don’t survive, or if they do, they live with terrible health conditions.”
The reasons why came down to factors such as a shortage of expensive conventional incubators or families living far away from medical centers to access quickly for their newborns.
The team formed their company in 2008 and then took a few years to engineer and produce the solution, with Liang and Chen both moving to India for a few years to get it off the ground and market test it there. Chen said the incubators, made in India, underwent rigorous testing and are CE certified, a regulatory standard that a device must meet to be approved for use in the European market and in Asia and Africa.
“We chose that route instead of seeking FDA approval because the need really is outside of the US,” said Liang. The cost per incubator is about $500, including cost of the product, training, distribution, shipping, implementation, monitoring and evaluation, said Chen. That compares to as much as $30,000 or more per conventional incubators, she said.
Chen estimates some 15,000 babies benefited from Embrace incubators in 2022.
Dr. Leah Seaman has been using Embrace incubators for three years in Zambia. Seaman is a doctor working in pediatrics for the last 12 years, including six years focusing on neonatal care at the Kapiri Mposhi District Hospital in the Central Province of Zambia.
Seaman has also been busy setting up a new specialized neonatal ward in the rural district hospital. “When I first came to Zambia, we had one old incubator that would draw a lot of power,” she said. “We often struggle with power cuts here, so even the voltage can be too low for the incubator to function well. Having enough space to set up conventional incubator was an issue as well.”
So she reached out to Chen in late 2020 after researching solutions that would work for the specific conditions in Zambia.
“In Zambia, 13% of births are premature, and that’s not even including low-birth-weight babies born at term,” she said. “We needed an effective solution.”
Embrace Global donated 15 incubators to the hospital. The new neonatal ward, set to open this month, is built around the Embrace incubator stations with Kangaroo mother care, or skin to skin contact between mother and baby.
“Last year we had 800 babies through the ward and maybe half of them used the Embrace incubator,” said Seaman. “This year we’ve had over 800 already. We haven’t asked for any conventional incubators because from 1 kg (2.2 lbs) and above, the Embrace incubator does the work.”
Because of their heavy use, Seaman said the main challenge with the incubators is making sure that the heating pad is kept warm and reheated in a timely manner. “We’ve built a mattress station where we will be teaching the new mothers how to do that,” she said.
“Why do we keep babies warm? It’s not just a nice thing. It literally does save lives,” Seaman said.
A surgical tool the size of a dinner plate was found inside a woman’s abdomen 18 months after her baby was delivered by cesarean section, according to a report by New Zealand’s Health and Disability Commissioner.
An Alexis retractor, or AWR, which can measure 17 centimeters (6 inches) in diameter, was left inside the mother’s body following the birth of her baby at Auckland City Hospital in 2020.
The AWR is a retractable cylindrical device with a translucent film used to draw back the edges of a wound during surgery.
The woman suffered months of chronic pain and went for several checkups to find out what was wrong, including X-rays that showed no sign of the device. The pain got so severe that she visited the hospital’s emergency department and the device was discovered on an abdominal CT scan and removed immediately in 2021.
New Zealand’s Health and Disability Commissioner, Morag McDowell, found Te Whatu Ora Auckland – the Auckland District Health Board – in breach of the code of patient rights, in a report released on Monday.
The health board initially claimed that a nurse, who was in her 20s, attending to the woman during the cesarean had failed to exercise reasonable skill and care towards the patient.
“As set out in my report, the care fell significantly below the appropriate standard in this case and resulted in a prolonged period of distress for the woman,” McDowell said. “Systems should have been in place to prevent this from occurring.”
The report explained that the woman had a scheduled C-section because of concerns about placenta previa, a problem during pregnancy when the placenta completely or partially covers the opening of the uterus.
During the operation in 2020, a count of all surgical instruments used in the procedure did not include the AWR, the commission report found. This was possibly “due to the fact that the Alexis Retractor doesn’t go into the wound completely as half of the retractor needs to remain outside the patient and so it would not be at risk of being retained,” a nurse told the commission.
McDowell recommended the Auckland District Health Board make a written apology to the woman and revise its policies by including AWRs as part of the surgical count.
The case has also been referred to the director of proceedings, an official who will determine whether any further action should be taken.
Dr Mike Shepherd, Te Whatu Ora Health New Zealand group director of operations for Te Toka Tumai Auckland, apologized for the error in a statement.
“On behalf of our Women’s Health service at Te Toka Tumai Auckland and Te Whatu Ora, I would like to say how sorry we are for what happened to the patient, and acknowledge the impact that this will have had on her and her whānau [family group].”
“We would like to assure the public that incidents like these are extremely rare, and we remain confident in the quality of our surgical and maternity care.”
When Dr. Janelle Cooper, an OB/GYN, pulled into the parking garage of the hospital where she works in Annapolis, Maryland, and walked toward the building, she saw a man running and thought, “Oh, that’s unusual.”
She noticed “a truck that was parked in the middle of the street, and the doors were flung open,” Cooper told CNN.
And then, she heard a cry from the backseat that pieced everything together.
“I’d know those screams anywhere,” Cooper said.
The running man was the grandfather of Elsa Antunez. He had rushed her to the Luminis Health Anne Arundel Medical Center.
He stopped the truck in the parking garage by an entrance which would have put Artunez only a few feet from the front desk, where she would have been transported by a wheelchair to the delivery unit.
But by the time the car was in park, it was too late. The baby was coming.
When Cooper reached the truck, the baby’s head was already out.
“My instinct took over and I just jumped into action and delivered the baby,” Copper said.
Jean Andres, the hospital’s labor and delivery director, arrived at work a few moments later.
Andres heard the “very distinct scream” delivery room teams recognize instantly.
“I put my lunch bag down, called the team to let them know we had a delivery in the garage,” Andres told CNN. “And I proceeded to assist Dr. Cooper with the delivery that she had performed.”
Artunez gave birth to a healthy baby girl, Yesenia Patricia, and surprisingly for a first-time mother, the doctor noted, it went quickly. “She did really well.”
Once Yesenia was born, Andres dried her off and kept her warm until the medical team came and took the family to a maternity room in the hospital.
“The fact that it was in a garage was very unconventional, but it was not chaotic,” Andres said. “It was actually a very beautiful birth,” she recalled.
And although Cooper has delivered thousands of babies, she said this time was different.
“I’ve delivered in different places around the hospital before, but never in the back of a pickup truck,” she said.
Baby Yesenia isn’t the first to be born in the medical center’s parking garage, Andres and Cooper noted, nonplussed.
“We delivered a baby in the elevator this week,” Cooper told CNN.
Newly released police body camera footage shows an officer firing through the windshield of a pregnant woman’s car after she was accused of shoplifting at a grocery store in a Columbus, Ohio, suburb last week.
Ta’kiya Young, 21, was later pronounced dead at a hospital.
The video shows a Blendon Township police officer approaching Young’s driver’s side window outside a Kroger in Westerville and repeatedly telling her to get out of the car.
A second officer, who is also wearing a body camera, then steps in front of the vehicle.
“They said you stole something….get out of the car,” the officer at the window says, telling Young not to leave.
“I didn’t steal sh*t,” Young can be heard saying as the two argue back and forth with her window slightly ajar.
Police previously said a grocery store employee had notified police officers a woman who had stolen bottles of alcohol was in a car parked outside the store.
“Get out of the f**king car,” the officer standing in front of the car says, with his gun drawn and his left hand braced on the hood of the car, the video shows.
Young can then be seen turning the wheel of the car as the officer next to her window continues to urge her to exit the vehicle.
“Get out of the f**king car,” the officer in front of the car repeats as the vehicle begins to move slowly forward, the video shows.
A few seconds elapse and then the officer standing in front of the hood fires into the vehicle.
After the shot is fired, the officers run alongside the car yelling at the driver to stop.
The car rolls onto a sidewalk between two brick columns and into a building.
Police then call for backup and work to break the window to get to the driver, who appears to be slumped over to one side.
The body camera footage released by the Blendon Township Police Department blurred the faces of the officers. The footage is also edited and spliced together.
Young was pregnant at the time of her death and the fetus did not survive, the Franklin County Coroner’s Office previously said. Her cause of death is pending.
Police say the Ohio Bureau of Criminal Investigation is conducting an independent investigation of the incident.
The BCI probe could take “several weeks or months,” according to Steve Irwin, the press secretary for the Ohio Attorney General’s Office, which includes BCI. After investigators finish the examination, their findings will be forwarded to the county prosecutor who will make a decision on pursuing any potential charges, he said.
“Having viewed the footage in its entirety, it is undeniable that Ta’Kiya’s death was not only avoidable, but also a gross misuse of power and authority,” lawyers representing Young’s family said in a news release.
“After seeing the video footage of her death, this is clearly a criminal act and the family demands a swift indictment of this officer for the killings of both Ta’Kiyah and her unborn daughter,” they said.
Police say the officers haven’t “waived their rights as victims” in this incident and are withholding their identities, according to a news release from Blendon Township police.
“When Ms. Young drove her car directly at Officer #1, striking him, Officer #1 became a victim of attempted vehicular assault,” police said in a news release.
“When Ms. Young pulled away from Officer #2 while his hand and part of his arm was still in the driver’s side window, Officer #2 became a victim of misdemeanor assault,” they said in the news release.
Authorities said the officers worked quickly to help Young after the shooting, saying EMS was called 10 seconds after she was taken out of the car. The officer who fired the shot also grabbed a trauma kit and applied a chest seal to her wound in under two minutes after she was removed from the vehicle.
The officer who fired his weapon is still on administrative leave, but the second officer who was at the window is back at work. Chief John Belford said after he reviewed the videos, he didn’t see a reason to keep the second officer on leave.
“I returned him to duty, as our staffing is already very limited,” he said, noting both officers would still be subject to a “full administrative review” after the BCI investigation.
“Last week, there was a tragedy in our community,” Belford said in a statement. Due to potential pending litigation, he says the department is “very limited in what we can say.”
“We’re being as transparent and forthcoming as we can, given these significant legal constraints.” He cited an ongoing BCI investigation and potential “personnel actions” regarding the officer who opened fire.
The local police union said others would make any decisions regarding whether either officer is charged in the incident. But, Brian Steel, executive vice president of Fraternal Order of Police Capital City Lodge #9, noted “a weapon is not just a firearm. A weapon is also a 2000-pound vehicle that somebody puts in gear and is driving at you.”
“I understand why it could be justified but, again, I don’t make that decision,” Steel said at a news conference Friday, adding he was assuming the officer believed he could not get out of the way of the vehicle quickly enough.
The Blendon Township Police Department’s use of force policy says when it’s “feasible,” officers should take “reasonable steps” to get out of the way of an approaching vehicle instead of firing a weapon.
“An officer should only discharge a firearm at a moving vehicle or its occupants when the officer reasonably believes there are no other reasonable means available to avert the imminent threat of the vehicle, or if deadly force other than the vehicle is directed at the officer or others,” the policy says.
Zookeepers at the Columbus Zoo and Aquarium arrived to a pair of unexpected discoveries Thursday morning: a newborn baby gorilla and the news that its mother wasn’t a male gorilla.
The gorilla, Sully, has lived at the facility with her mother since 2019 and was thought to be male until “the gorilla care team discovered her holding the unexpected baby gorilla early Thursday,” the zoo announced in a news release.
But how could the facility not know 8-year-old Sully was actually a female? And that she was pregnant?
Well, gorillas “don’t have prominent sex organs” and males and females look mostly alike until around age 8, the zoo said in the release, noting it’s only later in life that males develop their large size, silver backs and distinctive head bumps.
Along with the hard-to-distinguish features, veterinarians at the zoo where the gorilla was born took a “hands-off approach” with their care and allowed the primate to be cared for by its mother, the Columbus Zoo noted.
When Sully arrived in Columbus, she was a “young and healthy animal” and didn’t require any medical procedures that would have led to the discovery sooner, the zoo said.
The pregnancy was also missed because “gorillas rarely show outward signs” they are carrying because “newborns are smaller than human babies and gorillas naturally have large abdomens,” the release notes.
With the gestation period for gorillas being eight and a half months, the zoo estimates Sully became pregnant in the fall.
The zoo says the adorable infant appears to be a healthy female. “The veterinary and animal care teams have not yet approached the infant, giving them time to bond with one another and with the rest of the troop, but will conduct a wellness exam soon,” the facility said in the release.
A DNA test will be performed later to determine the newborn’s father.
The new mother and baby will be on display for guests at the zoo’s gorilla habitat starting Friday, according to the release.
Western lowland gorillas – the subspecies that lives at the Columbus Zoo – are critically endangered, according to the International Union for the Conservation of Nature. There are an estimated 100,000 left in the wild across central Africa, says the Columbus Zoo. Their population has been depleted due to habitat loss, deforestation and hunting for bushmeat.
The surprise discovery builds on a history of gorilla conservation at the Columbus Zoo. The facility “was the first zoo in the world to welcome the birth of a baby gorilla” in 1956, according to the release.
Sully’s yet-to be named infant is the 34th gorilla born at the zoo, says the release. “She’s an important part of our work to conserve these magnificent animals,” the facility wrote.
Democratic Sen. Amy Klobuchar said Sunday she would support allowing limitations on abortion in the third trimester of pregnancy, breaking with many Democrats in Congress who have been hesitant to offer specifics on abortion limitations.
“I support allowing for limitations in the third trimester that do not interfere with the life or health of the women,” Klobuchar told CNN’s Dana Bash on “State of the Union” Sunday.
The third trimester in a pregnancy begins at 27 weeks. Less than 1% of abortions are performed at 21 weeks or later, according to a 2020 report from the US Centers for Disease Control and Prevention.
Abortion has become an especially potent political topic in the year since the monumental US Supreme Court decision one year ago to overturn Roe v. Wade and eliminate the federal constitutional right to abortion nationwide. More than a dozen US states have banned or severely restricted access to the procedure since the ruling.
“What I support – and I will be very clear about this – is Roe v. Wade, which does allow for limitations, but it also protects the life of the woman and the health of the woman,” Klobuchar said Sunday.
“I think that is the best way to go. But you look at what they are doing, their leading Republican candidates, Dana, are asking for abortion bans. Trump was on just last night gloating about how he had put these Supreme Court justices in place that had reversed Roe v. Wade.”
Klobuchar has long articulated the need for some restrictions on late-term abortions, telling Bloomberg in 2019 “there are limits there in the third trimester that are very important – about – except for the health of the woman.”
In the 2022 midterms, abortion was a crucial motivator for many voters, as CNN exit polls showed that 46% of people said that abortion was the most important issue to their vote. Abortion is also likely to be a cornerstone of President Joe Biden’s reelection campaign, as administration officials highlight what Democrats have done to protect access to abortion.
“MAGA Republicans made clear that they don’t intend to stop with the Dobbs decision. No, they won’t, until they get a national ban on abortion,” Biden said this week, promising to issue a veto if a national ban is ever passed by Congress.
The reality star and Poosh founder revealed she was pregnant in a video on Instagram Saturday in which she’s seen in the audience at a Blink 182 concert holding a sign that read, “Travis I’m pregnant.”
Kardashian posted more behind-the-scenes photos from the concert on Sunday, showcasing her growing baby bump.
“Overwhelmed with gratitude and joy for God’s blessing and plan,” she captioned the post, which features a photo of Barker playfully holding his drumsticks over Kardashian’s belly.
Kardashian and Barker got engaged in October 2021 and wed last year in multiple ceremonies.
Following a not-technically-legal walk down the aisle in Las Vegas after the Grammy Awards in April 2022, the pair exchanged vows at the Santa Barbara Courthouse in May and wrapped up the wedding festivities with a lavish Italian ceremony at Dolce & Gabbana designers Domenico Dolce and Stefano Gabbana’s private villa.
This will be Kardashian and Barker’s first child together, but they each have children from previous relationships.
Kardashian shares three children – Mason, Penelope and Reign – with her former longtime partner Scott Disick. Barker is father to Landon, daughter Alabama and stepdaughter Atiana, whom he shares with ex-wife Shanna Moakler.
The two have shared a bit about their fertility journey on Hulu’s reality series, “The Kardashians.”
Kardashian told The Wall Street Journal in September 2022 she had paused in vitro fertilization treatments leading up to getting married because it was “a lot” and she wanted to focus on planning her wedding ceremony.
On Sunday, Barker added to the chorus in the joyous comment section of Kardashian’s post with his own message of gratitude, saying, “God is great.”
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.”
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.”
The U.S. Food and Drug Administration amended the terms of its emergency use authorizations for the Pfizer and Moderna bivalent vaccines on Tuesday, allowing people ages 65 and older and certain people with weakened immunity to get additional doses before this fall’s vaccination campaigns.
The bivalent vaccines made by Pfizer and Moderna carry instructions for fighting both the original strain of the Covid-19 virus as well as Omicron and its spinoffs.
They have been available in the United States since September under emergency use authorizations, or EUAs, which tightly restrict how the vaccines may be given.
On Tuesday, the FDA changed the terms of the authorizations for those vaccines so that certain individuals could get an additional dose ahead of most others.
Namely, adults ages 65 and older who have received a single dose of a bivalent vaccine may receive an additional dose at least four months following their first dose.
Most individuals with certain degrees of immunocompromise who have received a first dose of a bivalent vaccine can get a second at least 2 months later. Additional doses may be administered at the discretion of their healthcare provider.
Dr. Peter Hotez, who co-directs the Center for Vaccine Development at Texas Children’s Hospital, has been calling on the FDA to increase access to the bivalent boosters for those who want them. He says for the most part, today’s guidance from the agency makes sense.
“My only question is why the 65 year age cutoff? What was that based on? Ordinarily I would have preferred that it be brought down to 60 or even 50,” Hotez said in an email to CNN.
“For those Americans who understand its importance, we should make second bivalent boosters available. Finally, we’ll soon need guidance about another annual fall booster. Presumably that information comes sometime this summer,” he added.
For immunocompromised children ages 6 months through 4 years, eligibility for additional bivalent doses will depend on the vaccine previously received, the FDA said in a news release.
Another big change is that most unvaccinated individuals may now receive a single dose of a bivalent vaccine, rather than mutiple doses of the original single-strain vaccines, the agency said. The FDA simplified its recommendation for unvaccinated individuals after recognizing that most Americans now have some immunity against Covid-19, even if its just through past infections.
“Evidence is now available that most of the U.S. population 5 years of age and older has antibodies to SARS-CoV-2, the virus that causes COVID-19, either from vaccination or infection that can serve as a foundation for the protection provided by the bivalent vaccines. COVID-19 continues to be a very real risk for many people, and we encourage individuals to consider staying current with vaccination, including with a bivalent COVID-19 vaccine. The available data continue to demonstrate that vaccines prevent the most serious outcomes of COVID-19, which are severe illness, hospitalization, and death,” said Dr. Peter Marks, head of FDA’s Center for Biologics Evaluation and Research, in a news release.
Children ages 6 months through 5 years who have not yet been vaccinated may now receive a two-dose series of the Moderna bivalent vaccine as their primary series, or a three-dose series of the Pfizer-BioNTech bivalent vaccine if they are 6 months through 4 years of age. Children who are age 5 may receive two doses of the Moderna bivalent or a single dose of the Pfizer-BioNTech bivalent vaccine.
Children ages 6 months through 5 years who got started on their monovalent vaccines, can now get a dose of a bivalent vaccine, but the number of doses they qualify for will depend on the number of doses they’ve already had and what kind of vaccine they got.
The agency stressed that most people who have gotten one dose of a bivalent vaccine are not currently eligible for a second dose.
And they encouraged everyone who hasn’t yet gotten their first dose of a bivalent vaccine to do so, and many Americans are still in that bucket.
Only about 17% of those eligible, less than 1 in 5 Americans, has gotten a recommended dose.
As time has passed, adults with reduced immune function because of their age or an underlying health problem have been asking doctors whether they need another dose of the bivalent vaccines.
The United States Center for Disease Control and Prevention has reported early data showing that the effectiveness of the bivalent vaccines, even against emergency room visits and hospitalizations, has already started to wane.
But the agency has not been free to make what’s known as a “permissive use” recommendation about the boosters, which would allow doctors to offer additional doses to vulnerable patients because of the terms of the EUA.
The updated terms give the CDC and its Advisory Committee on Immunization Practices (ACIP) greater freedom to recommend additional doses of the bivalent vaccines. The ACIP is holding a meeting on the Covid-19 vaccines Wednesday and is expected to endorse the FDA’s changes.
For everyone not covered by today’s changes, the FDA says it intends to make decisions about future vaccinations after receiving recommendations on the fall strain composition from its advisory committee in June.
Both Canada and the United Kingdom have offered another round of bivalent boosters to those at highest risk from Covid-19 this spring.
Editor’s Note: Roxanne Jones, a founding editor of ESPN The Magazine and former vice president at ESPN, has been a producer, reporter and editor at the New York Daily News and The Philadelphia Inquirer. Jones is co-author of “Say it Loud: An Illustrated History of the Black Athlete.” She talks politics, sports and culture weekly on Philadelphia’s 900AM WURD. The views expressed here are solely hers. Read more opinion on CNN.
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The ruling earlier this month by a Texas federal judge to suspend the US Food and Drug Administration’s approval of a drug that is used frequently for medication abortions, is very personal for me.
That’s because I took mifepristone years ago during a miscarriage, and it saved my life.
When I was prescribed mifepristone, it had not yet taken center stage in America’s abortion wars. I did not have to make a rushed road trip across state lines to get my medicine, unlike many women who need the drug but live in one of the many states that have restricted access to medication abortion or passed near-total bans on abortion.
I was not forced to set up a secret meet-up with a stranger in order to buy my medicine on the black market, as several women I spoke to recently said they planned to do. Nor did I have to order mifepristone online and find myself navigating the many scammers taking advantage of the current patchwork of state abortion laws in the US.
Mifepristone is one of two drugs used in a medication abortion and the other, misoprostol, was not subject to the ruling by the Texas judge. The two drugs can be administered to someone having a miscarriage, allowing them to terminate the pregnancy when the fetus is not viable.
It happened some years ago: After experiencing more than a day of hemorrhaging during the first trimester of my pregnancy, I visited my ob-gyn, who explained after examining me that my blood pressure was dropping rapidly and the heavy bleeding I was experiencing was an unmistakable sign of a miscarriage.
For many women, being prescribed mifepristone is part of their routine medical care. Not so in my case: As my doctor explained, I was facing a dire medical emergency. I was grateful for the medication that saved my life.
My miscarriage took me by surprise. I had loved being pregnant the first time around, about a decade earlier. And as a healthy woman, I had no reason for fear when I became pregnant again. By the time I was administered mifepristone, I was losing a life that I had already begun to love. And like many other women, despite my level of education or economic status, I could not outrun the statistics that put Black women at higher risk.
Up to one in four known pregnancies will end in a miscarriage. And for Black women, the numbers are alarmingly higher. According to an analysis of 4.6 million pregnancies in seven countries, the risk of a miscarriage for Black women is 43% higher than for White women.
In the Black community, women have traditionally been taught to bear their burdens silently — keep your business to yourself — even after something as devastating as pregnancy loss. We are conditioned to do as I did back then, and keep it moving as we try to outrun the long list of statistics that tell us our lives are in danger from every direction, whether it be from health care risks to societal injustices or other stressors.
During my miscarriage, I was a woman who was afraid, hemorrhaging and in excruciating pain, in desperate need of safe, emergency medical care. Thanks to the administration of mifepristone, I was allowed dignity during my miscarriage. It’s what every woman deserves — whether it be facing a potentially life-threatening miscarriage or seeking an abortion.
I learned from my experience that every miscarriage matters. Women must have access to whatever medicines and counseling we need to help us heal and that includes mifepristone. What we don’t need is to be criminalized by politicians and punitive reproductive laws that have long been out of step with public opinion. Despite the continuing political attacks on women’s reproductive rights, more than 61% of US adults say abortion should be legal in all or most cases, according to Pew Research Center.
After the US Justice Department asked the Supreme Court to intervene, Justice Samuel Alito issued a temporary order to preserve the status quo, ensuring access to the drug while giving the justices more time to study the issue.
I am hoping the justices can put politics aside and focus on the science surrounding the safety of mifepristone, a drug that, thankfully, I had access to when my life was in danger. Mifepristone, a synthetic steroid, is even safer than common prescription drugs including penicillin and Viagra.
Following the science demands that, regardless of where you stand on the issue of abortion, consideration must be made for cases like mine and the millions of other women who for years have safely used this medication for complications surrounding miscarriages.
We do not know how the legal fight over medication abortion will unfold. But women across the nation – in blue and red states alike – are watching. Punitive laws like the one signed last week by Florida Gov. Ron DeSantis seek to criminalize reproductive care providers. And worse, they are stripping us of rights that men take for granted – it’s unlikely they will be prohibited by the law from making health care decisions about their own bodies.
It must end. And I’m betting that whether it be with our voice or our votes, women will have the last word.
A pair of conflicting federal court rulings on Friday created arguably the most contentious and chaotic legal flashpoint over abortion access since the Supreme Court’s ruling last summer that overturned Roe v. Wade and ended the right to an abortion nationwide.
Within less than an hour, two major rulings came down in separate, closely watched cases concerning medication abortion – in lawsuits that are completely at odds with each other.
In one case, filed by anti-abortion activists in Texas, a judge said the FDA’s 2000 approval of mifepristone – one of the drugs used to terminate a pregnancy – should be halted. But the court paused its ruling for a week so that it can be appealed, and that appeal is already under way.
In the second case, where Democratic-led states had sued in Washington to expand access to abortion pills, a judge ordered the federal government to keep the drug available in the 17 states, plus the District of Columbia, that brought the lawsuit.
On their face, both cases deal with the administrative law that controls how the US Food and Drug Administration goes about regulating mifepristone. The disputes did not rely directly on the question of whether there is a right to an abortion – the question that was at the center of the Supreme Court’s ruling last June. But tucked in the Texas ruling, by US District Judge Matthew Kacsmaryk, was the idea that embryos could have individual rights that courts can consider in their rulings.
Both cases emerge from a political environment that was unleashed by the Supreme Court’s Roe v. Wade reversal and a willingness to push the legal envelope that the Supreme Court ruling created. The abortion issue is now on a path back to the Supreme Court, as higher courts are asked to sort out the contradictory commands of Friday night’s decisions.
Because the Texas judge has paused his ruling, it has no immediate impact on the availability of medication abortion drugs. But the next several days stand to be a dramatic and combustible legal fight over the order – a fight ratcheted up by the rival ruling in Washington.
Besides pausing his ruling for one week, Kacsmaryk – an appointee of former President Donald Trump who sits in Amarillo, Texas – seemed to hold nothing back as he ripped apart the FDA’s approval of mifepristone and embraced wholeheartedly the challengers’ arguments the drug’s risks weren’t adequately considered.
Kacsmaryk, whose anti-abortion advocacy before joining the federal bench was documented by a recent Washington Post profile, showed a striking hostility to medication abortion, which is the method used in a majority of the abortions in the United States.
Leading medical organizations have already condemned his opinion and pushed back at the judge’s analysis of the safety of medication abortion.
The judge said that the FDA failed to consider “the intense psychological trauma and post-traumatic stress women often experience from chemical abortion,” in what was a repeated invocation of “chemical abortion,” the term preferred by abortion opponents. Kacsmaryk suggested that the FDA’s data was downplaying the frequency with which the drug being mistakenly administered to someone who had an ectopic pregnancy, i.e. a pregnancy outside the cavity of the uterus. He repeated the challengers’ accusations that the FDA’s approval process had been the subject of improper political pressure.
He said the FDA’s refusal to impose certain restrictions on the drug’s use “resulted in many deaths and many more severe or life-threatening adverse reactions.”
“Whatever the numbers are, they likely would be considerably lower had FDA not acquiesced to the pressure to increase access to chemical abortion at the expense of women’s safety,” he said.
Jack Resneck Jr., the president of the American Medical Association, said in a statement that Kacsmaryk’s ruling “flies in the face of science and evidence and threatens to upend access to a safe and effective drug.”
“The court’s disregard for well-established scientific facts in favor of speculative allegations and ideological assertions will cause harm to our patients and undermines the health of the nation,” the AMA president said.
Kacsmaryk’s opinion paid no heed to the argument made by the FDA’s defenders that cutting off access to medication abortion would put the health of pregnant people at risk and that it would force abortion seekers to terminate their pregnancies through a surgical procedure instead.
Instead, the judge wrote that a ruling in the challengers’ favor would ensure “that women and girls are protected from unnecessary harm and that Defendants do not disregard federal law.”
As he explained why the preliminary injunction – which was being handed down before the case could proceed to a trial – was justified, he said that embryos had their own rights that could be part of the analysis. That assertion goes farther than what the Supreme Court said in its June ruling, known as Dobbs v. Jackson Women’s Health.
“Parenthetically, said ‘individual justice’ and ‘irreparable injury’ analysis also arguably applies to the unborn humans extinguished by mifepristone — especially in the post-Dobbs era,” Kacsmaryk said Friday.
Whereas Kacsmaryk had been asked by the challengers in Texas to block medication abortion, US District Judge Thomas Owen Rice, who sits in Spokane, Washington, was considering whether abortion pills should be easier to obtain.
Rice, an Obama appointee, granted the Democratic attorneys general who brought the lawsuit a partial win.
They had asked Rice to remove certain restrictions – known as REMS or Risk Evaluation and Mitigation Strategy – the FDA has imposed on mifepristone, with the blue states arguing the drug was safe and effective enough to make those restrictions unnecessary.
While Rice is rejecting that bid for now, he granted a request the states also made that the FDA be ordered to keep the drugs on the market. But Rice’s ruling only applies in the 17 plaintiff states and the District of Columbia.
His decision maintains the status quo for the availability of abortion pills in those places and he specifically is blocking the agency from “altering the status quo and rights as it relates to the availability of Mifepristone under the current operative January 2023 Risk Evaluation and Mitigation Strategy.”
Rice’s opinion was a striking split screen to Kacmsaryk’s. While the Texas judge said the FDA did not adequately take into account the drug risks, Rice showed sympathy to the arguments that the rules for mifepristone’s use were too strict and that the agency should be taking a more lenient approach to how the abortion pill is regulated.
Ultimately, he said he would not grant the Democratic states’ request that he remove some of the drug restrictions at this preliminary stage in the proceedings, because that would go well beyond maintaining the status quo while the case advances. He noted that if he had granted that request, it would also undo a new FDA rule that allows pharmacies to dispense abortion pills. That would reduce its availability and would run “directly counter to Plaintiffs’ request.”
If Kacsmaryk’s ruling halting mifepristone’s approval is allowed to go into effect, it will run headlong into Rice’s order that mifepristone remain available in several states. Kacsmaryk’s ruling is a nationwide injunction.
The Justice Department and Danco, a mifepristone manufacturer that intervened in the case to defend the approval, both filed notices of appeal. Both Attorney General Merrick Garland and Danco said in statements that in addition to the appeals, they will seek “stays” of the ruling, meaning emergency requests that the decision is frozen while the appeal moves forward.
They’re appealing to the US 5th Circuit Court of Appeals, which is sometimes said to be the country’s most conservative appeals court. Yet some legal scholars were skeptical that the 5th Circuit, as conservative as it is, would let Kacmsaryk’s order take effect.
Washington, where the blue states’ lawsuit was filed, is covered under the 9th Circuit, a liberal appellate court. But it’s unclear if the ruling from Rice will be appealed. Garland said the Justice Department was still reviewing the decision out of Washington. A so-called circuit split would increase the odds that the Supreme Court would intervene. But given how the practical impact of the two district court rulings contradict each other, the Supreme Court may have no choice but to get involved.
The lawyer for the challengers in the Texas case, anti-abortion medication associations and doctors, said Friday evening that he had not reviewed the Washington decision, so he could not weigh in on how it impacted Kacsmaryk’s order that the drug’s approval be halted.
“I’m not sure whether there’s a direct conflict yet and with the Washington state decision just because I haven’t read it yet, but there may not be a direct conflict,” Erik Baptist, who is an attorney with Alliance Defending Freedom, said. “But if there is a direct conflict then there may be – it may be inevitably going to the Supreme Court, but I’m not convinced that it’s necessary at this point to make that conclusion.”
Florida’s state Senate on Monday passed a bill that would ban most abortions in the state after the gestational age of six weeks, or about four weeks of pregnancy.
The bill’s advance, which still needs to pass the state’s GOP-led House, comes one year after Gov. Ron DeSantis signed a 15-week ban into law. The new legislation likely further burnishes the conservative credentials of DeSantis, a potential 2024 presidential candidate, and it was met with outrage by state Democrats, two of whom were arrested during a protest near the state Capitol Monday night.
The current bill would impose restrictions on telehealth abortions and medication. It would include exemptions for women facing life-threatening harm while pregnant and victims of rape, incest and human trafficking.
The bill targets both physicians who perform abortions and those who “actively participate in” them, and should the bill become law, any person who violates it could be charged with a third-degree felony.
The “Heartbeat Protection Act” passed the Florida Senate in a 26-13 vote.
A protest over the bill near the state Capitol resulted in the arrests of 11 people who were charged with trespassing after a warning, Tallahassee police said. Florida Democrats said state party Chairwoman Nikki Fried and Florida Senate Minority Leader Lauren Book were among them.
“As the Democratic leader in the Florida Senate, it’s my job to a lead this incredible group of 11 Democrats, other than myself, to fight against these extreme policies,” Book told CNN on Wednesday. ‘Women will die as a consequence of this piece of policy.”
Other abortion rights advocates say the Florida bill unfairly seeks to ban abortions before many even know they are pregnant.
“This bill will unfairly and disproportionately impact people who live in rural communities, people with low incomes, people with disabilities, and people of color,” Kara Gross, the legislative director and senior policy counsel at the American Civil Liberties Union of Florida, said in a statement.
“Hundreds of thousands of pregnant people will be forced to travel out of state to seek the care they need. Many people will not even know they are pregnant by six weeks, and for those who do, it is unlikely they will be able to schedule the legally required two in-person doctor’s appointments before six weeks of pregnancy,” Gross said.
The White House has also criticized the pending bill.
“The President and Vice President believe women should be able to make health care decisions with their doctors and families – free from political interference. They are committed to protecting access to reproductive care, and continue to call on Congress to restore the protections of Roe v. Wade in federal law,” White House press secretary Karine Jean-Pierre said in a statement when the bill was first introduced.
State Sen. Clay Yarborough, one of the bill’s Republican sponsors, said “unborn children deserve the strongest protections possible under our laws.”
The legislation underscores the ongoing efforts across the country to restrict access to abortion in a post-Roe world. Other Republican-led states have also pursued six-week abortion bans that have been met with legal challenges.
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.”
Several women who say Texas’ abortion bans posed significant risks to their health have sued the state this week, opening a new front in the legal battles that have emerged since the Supreme Court overturned national abortion rights protections last year.
Five women allege in the lawsuit that uncertainty around when medical emergency exemptions in Texas’ abortion laws apply exacerbated medical emergencies that put their lives, health and fertility in danger.
“To the extent Texas’s abortion bans bar the provision of abortion to pregnant people to treat medical conditions that pose a risk to the pregnant person’s life or a significant risk to their health,” the lawsuit says, “the Bans violate pregnant people’s” rights under the state constitution’s provisions protecting fundamental rights and the right to equality.
The lawsuit is not seeking to block Texas’ abortion bans outright. Rather, the women – who are joined by two medical providers in the lawsuit – ask the court to clarify that abortions can be performed when a physician makes a “good faith judgment” that “the pregnant person has a physical emergent medical condition that poses a risk of death or a risk to their health (including their fertility).”
The women’s complaint details harrowing stories of being denied abortion care when they faced emergency complications in their pregnancies, which were all wanted. They filed the lawsuit in state court in Austin, Texas.
Texas, its Attorney General Ken Paxton, the Texas Medical Board and its Executive Director Stephen Brint Carlton are listed as defendants in the lawsuit. Neither Paxton’s office nor a spokesperson for the state medical board responded to a request for comment from CNN. Gov. Greg Abbott’s office also did not immediately respond to CNN’s inquiry.
Rihanna didn’t introduce a new song during her Apple Music Super Bowl LVII Halftime Show performance Sunday night but she did introduce a new pregnancy.
The entertainer sang a medley of her biggest hits while visibly pregnant with her second child, her representative has confirmed to CNN.
Online speculation about the pregnancy began as Rihanna opened her performance in Glendale, Arizona, on a floating stage wearing an all-red ensemble that appeared to show off a baby bump.
Last May, Rihanna welcomed her first child with rapper A$AP Rocky.
The singer spoke about motherhood during an interview as she prepared for her halftime show performance, saying becoming a mother made her feel like she can do anything.
“When you become a mom, there is something that just happens where you feel like you can take on the world,” said the musical icon and entrepreneur.
“The Super Bowl is one of the big stages in the world, so as scary as that was – because I haven’t been on stage in seven years – there’s something exhilarating about the challenge of it all,” said Rihanna, who last toured in 2016. “It’s important for me to do this this year. It’s important for representation. It’s important for my son to see that.”
The pregnancy didn’t appear to slow Rihanna down during the performance break from the Kansas City Chiefs and Philadelphia Eagles showdown. She danced and belted out some of her best-known hits, surrounded by a crew of dancers dressed in white. She opened the show with “B**ch Better Have My Money,” before moving on to other entries on her long list of chart toppers, including, “We Found Love,” “Rude Boy,” “Work,” “Only Girl (In the World)” and “Umbrella.”
If you drive down a busy suburban strip mall or walk down a street in a major city, chances are you won’t go long without spotting a Concentra, MedExpress, CityMD or another urgent care center.
Demand at urgent care sites surged during the Covid-19 pandemic as people searched for tests and treatments. Patient volume has jumped 60% since 2019, according to the Urgent Care Association, an industry trade group.
That has fueled growth for new urgent care centers. A record 11,150 urgent care centers have popped up around the United States and they are growing at 7% a year, the trade group says. (This does not include clinics inside retail stores like CVS’ MinuteClinic or freestanding emergency departments.)
Urgent care centers are designed to treat non-emergency conditions like a common cold, a sprained ankle, an ear infection, or a rash. They are recommended if patients can’t get an immediate appointment with their primary care doctor or if patients don’t have one. Primary care practices should always be the first call in these situations because they have access to patients’ records and all of their health care history, while urgent care sites are meant to provide episodic care.
Urgent care sites are often staffed by physician assistants and nurse practitioners. Many also have doctors on site. (One urgent care industry magazine says, in 2009, 70% of its providers were physicians, but that the percentage had fallen to 16% by last year.) Urgent cares usually offer medical treatment outside of regular doctor’s office hours and a visit costs much less than a trip to the emergency room.
Urgent care has grown rapidly because of convenience, gaps in primary care, high costs of emergency room visits, and increased investment by health systems and private-equity groups. The urgent care market will reach around $48 billion in revenue this year, a 21% increase from 2019, estimates IBISWorld.
The growth highlights the crisis in the US primary care system. A shortage of up to 55,000 primary care physicians is expected in the next decade, according to the Association of American Medical Colleges.
But many doctors, health care advocates and researchers raise concerns at the proliferation of urgent care sites and say there can be downsides.
Frequent visits to urgent care sites may weaken established relationships with primary care doctors. They can also lead to more fragmented care and increase overall health care spending, research shows.
And there are questions about the quality of care at urgent care centers and whether they adequately serve low-income communities. A 2018 study by Pew Charitable Trusts and the Centers for Disease Control and Prevention found that antibiotics are overprescribed at urgent care centers, especially for common colds, the flu and bronchitis.
“It’s a reasonable solution for people with minor conditions that can’t wait for primary care providers,” said Vivian Ho, a health economist at Rice University. “When you need constant management of a chronic illness, you should not go there.”
Urgent care centers have been around in the United States since the 1970s, but they were long derided as “docs in a box” and grew slowly during their early years.
They have become more popular over the past two decades in part due to pressures on the primary care system. People’s expectations of wait times have changed and it can be difficult, and sometimes almost impossible, to book an immediate visit with a primary care provider.
Urgent care sites are typically open for longer hours during the weekday and on weekends, making it easier to get an appointment or a walk-in visit. Around 80% of the US population is within a 10-minute drive of an urgent care center, according to the industry trade group.
“There’s a need to keep up with society’s demand for quick turnaround, on-demand services that can’t be supported by underfunded primary care,” said Susan Kressly, a retired pediatrician and fellow at the American Academy of Pediatrics.
Health insurers and hospitals have also become more focused on keeping people out of the emergency room. Emergency room visits are around ten times more expensive than visits to an urgent care center. During the early 2000s, hospital systems and health insurers started opening their own urgent care sites, and they have introduced strategies to deter emergency room visits.
Additionally, passage of the Affordable Care Act in 2010 spurred an increase in urgent care providers as millions of newly insured Americans sought out health care. Private-equity and venture capital funds also poured billions into deals for urgent care centers, according to data from PitchBook.
Urgent care centers can be attractive to investors. Unlike ERs, which are legally obligated to treat everyone, urgent care sites can essentially choose their patients and the conditions they treat. Many urgent care centers don’t accept Medicaid and can turn away uninsured patient,s unless they pay a fee.
Like other health care options, urgent care centers make money by billing insurance companies for the cost of the visit, additional services, or the patient pays out of pocket. In 2016, the median charge for a 30-minute new insured patient visit was $242 at an urgent care center, compared with $294 in a primary care office and $109 in a retail clinic, according to a study by FAIR Health, a nonprofit that collects health insurance data.
“If they can make it a more convenient option, there’s a lot of revenue here,” said Ateev Mehrotra, a professor of health care policy and medicine at Harvard Medical School who has researched urgent care clinics. “It’s not where the big bucks are in health care, but there’s a substantial number of patients.”
Mehrotra research has found that between 2008 and 2015, urgent care visits increased 119%. They became the dominant venue for people seeking treatment for low-acuity conditions like acute respiratory infections, urinary tract infections, rashes, and muscle strains.
Some doctors and researchers worrythat patients with primary care doctors – and those without – are substituting urgent care visits in place of a primary care provider.
“What you don’t want to see is people seeking a lot care outside their pediatrician and decreasing their visits to their primary care provider,” said Rebecca Burns, the urgent care medical director at the Lurie Children’s Hospital of Chicago.
Burns’ research has found that high urgent care reliance fills a need for children with acute issues but has the potential to disrupt primary care relationships.
The National Health Law Program, a health care advocacy group for low-income families and communities, has called for state regulations to require coordination among urgent care sites, retail clinics, primary services, and hospitals to ensure continuity of patients’ care.
And while the presence of urgent care centers does prevent people from costly emergency department visits for low-acuity issues, Mehrotra from Harvardhas found that, paradoxically, they increase health care spending on net.
Each $1,646 visit to the ER for a low-acuity condition prevented was offset by a $6,327 increase in urgent care center costs, his research has found. This is in part because people may be going to urgent care for minor illnesses they would have previously treated with chicken soup.
There are also concerns about the oversaturation of urgent care centers in higher-income areas that have more consumers with private health care and limited access in medically underserved areas.
Urgent care centers selectively tend not to serve rural areas, areas with a high concentration of low-income patients, and areas with a low concentration of privately-insured patients, researchers at the University of California at San Francisco found in a 2016 study. They said this “uneven distribution may potentially exacerbate health disparities.”
A panel of independent experts that advises the US Food and Drug Administration on its vaccine decisions voted unanimously Thursday to update all Covid-19 vaccines so they contain the same ingredients as the two-strain shots that are now used as booster doses.
The vote means young children and others who haven’t been vaccinated may soon be eligible to receive two-strain vaccines that more closely match the circulating viruses as their primary series.
The FDA must sign off on the committee’s recommendation, which it is likely to do, before it goes into effect.
Currently, the US offers two types of Covid-19 vaccines. The first shots people get – also called the primary series – contain a single set of instructions that teach the immune system to fight off the original version of the virus, which emerged in 2019.
This index strain is no longer circulating. It was overrun months ago by an ever-evolving parade of new variants.
Last year, in consultation with its advisers, the FDA decided that it was time to update the vaccines. These two-strain, or bivalent, shots contain two sets of instructions; one set reminds the immune system about the original version of the coronavirus, and the second set teaches the immune system to recognize and fight off Omicron’s BA.4 and BA.5 subvariants, which emerged in the US last year.
People who have had their primary series – nearly 70% of all Americans – were advised to get the new two-strain booster late last year in an effort to upgrade their protection against the latest variants.
The advisory committee heard testimony and data suggesting that the complexity of having two types of Covid-19 vaccines and schedules for different age groups may be one of the reasons for low vaccine uptake in the US.
Currently, only about two-thirds of Americans have had the full primary series of shots. Only 15% of the population has gotten an updated bivalent booster.
Data presented to the committee shows that Covid-19 hospitalizations have been rising for children under the age of 2 over the past year, as Omicron and its many subvariants have circulated. Only 5% of this age group, which is eligible for Covid-19 vaccination at 6 months of age, has been fully vaccinated. Ninety percent of children under the age of 4 are still unvaccinated.
“The most concerning data point that I saw this whole day was that extremely low vaccination coverage in 6 months to 2 years of age and also 2 years to 4 years of age,” said Dr. Amanda Cohn, director of the US Centers for Disease Control and Prevention’s Division of Birth Defects and Infant Disorders. “We have to do much, much better.”
Cohn says that having a single vaccine against Covid-19 in the US for both primary and booster doses would go a long way toward making the process less complicated and would help get more children vaccinated.
Others feel that convenience is important but also stressed that data supported the switch.
“This isn’t only a convenience thing, to increase the number of people who are vaccinated, which I agree with my colleagues is extremely important for all the evidence that was related, but I also think moving towards the strains that are circulating is very important, so I would also say the science supports this move,” said Dr. Hayley Gans, a pediatric infectious disease specialist at Stanford University.
Many others on the committee were similarly satisfied after seeing new data on the vaccine effectiveness of the bivalent boosters, which are cutting the risk of getting sick, being hospitalized or dying from a Covid-19 infection.
“I’m totally convinced that the bivalent vaccine is beneficial as a primary series and as a booster series. Furthermore, the updated vaccine safety data are really encouraging so far,” said Dr. David Kim, director of the the US Department of Health and Human Services’ National Vaccine Program, in public discussion after the vote.
Thursday’s vote is part of a larger plan by the FDA to simplify and improve the way Covid-19 vaccines are given in the US.
The agency has proposed a plan to convene its vaccine advisers – called the Vaccines and Related Biological Products Advisory Committee, or VRBPAC – each year in May or June to assess whether the instructions in the Covid-19 vaccines should be changed to more closely match circulating strains of the virus.
The time frame was chosen to give manufacturers about three months to redesign their shots and get new doses to pharmacies in time for fall.
“The object, of course – before anyone says anything – is not to chase variants. None of us think that’s realistic,” said Jerry Weir, director of the Division of Viral Products in the FDA’s Office of Vaccines Research and Review.
“But I think our experience so far, with the bivalent vaccines that we have, does indicate that we can continue to make improvements to the vaccine, and that would be the goal of these meetings,” Weir said.
In discussions after the vote, committee members were supportive of this plan but pointed out many of the things we still don’t understand about Covid-19 and vaccination that are likely to complicate the task of updating the vaccines.
For example, we now seem to have Covid-19 surges in the summer as well as the winter, noted Dr. Michael Nelson, an allergist and immunologist at the University of Virginia. Are the surges related? And if so, is fall the best time to being a vaccination campaign?
The CDC’s Dr. Jefferson Jones said that with only three years of experience with the virus, it’s really too early to understand its seasonality.
Other important questions related to the durability of the mRNA vaccines and whether other platforms might offer longer protection.
“We can’t keep doing what we’re doing,” said Dr. Bruce Gellin, chief of global public health strategy at the Rockefeller Foundation. “It’s been articulated in every one of these meetings despite how good these vaccines are. We need better vaccines.”
The committee also encouraged both government and industry scientists to provide a fuller picture of how vaccination and infection affect immunity.
One of the main ways researchers measure the effectiveness of the vaccines is by looking at how much they increase front-line defenders called neutralizing antibodies.
Neutralizing antibodies are like firefighters that rush to the scene of an infection to contain it and put it out. They’re great in a crisis, but they tend to diminish in numbers over time if they’re not needed. Other components of the immune system like B-cells and T-cells hang on to the memory of a virus and stand ready to respond if the body encounters it again.
Scientists don’t understand much about how well Covid-19 vaccination boosts these responses and how long that protection lasts.
Another puzzle will be how to pick the strains that are in the vaccines.
The process of selecting strains for influenza vaccines is a global effort that relies on surveillance data from other countries. This works because influenza strains tend to become dominant and sweep around the world. But Covid-19 strains haven’t worked in quite the same way. Some that have driven large waves in other countries have barely made it into the US variant mix.
“Going forward, it is still challenging. Variants don’t sweep across the world quite as uniform, like they seem to with influenza,” the FDA’s Weir said. “But our primary responsibility is what’s best for the US market, and that’s where our focus will be.”
Eventually, the FDA hopes that Americans would be able to get an updated Covid-19 shot once a year, the same way they do for the flu. People who are unlikely to have an adequate response to a single dose of the vaccine – such as the elderly or those with a weakened immune system – may need more doses, as would people who are getting Covid-19 vaccines for the first time.
At Thursday’s meeting, the advisory committee also heard more about a safety signal flagged by a government surveillance system called the Vaccine Safety Datalink.
The CDC and the FDA reported January 13 that this system, which relies on health records from a network of large hospital systems in the US, had detected a potential safety issue with Pfizer’s bivalent boosters.
In this database, people 65 and older who got a Pfizer bivalent booster were slightly more likely to have a stroke caused by a blood clot within three weeks of their vaccination than people who had gotten a bivalent booster but were 22 to 42 days after their shot.
After a thorough review of other vaccine safety data in the US and in other countries that use Pfizer bivalent boosters, the agencies concluded that the stroke risk was probably a statistical fluke and said no changes to vaccination schedules were recommended.
At Thursday’s meeting, Dr. Nicola Klein, a senior research scientist with Kaiser Permanente of Northern California, explained how they found the signal.
The researchers compared people who’d gotten a vaccine within the past three weeks against people who were 22 to 42 days away from their shots because this helps eliminate bias in the data.
When they looked to see how many people had strokes around the time of their vaccination, they found an imbalance in the data.
Of 550,000 people over 65 who’d received a Pfizer bivalent booster, 130 had a stroke caused by a blood clot within three weeks of vaccination, compared with 92 people in the group farther out from their shots.
The researchers spotted the signal the week of November 27, and it continued for about seven weeks. The signal has diminished over time, falling from an almost two-fold risk in November to a 47% risk in early January, Klein said. In the past few days, it hasn’t been showing up at all.
Klein said they didn’t see the signal in any of the other age groups or with the group that got Moderna boosters. They also didn’t see a difference when they compared Pfizer-boosted seniors with those who were eligible for a bivalent booster but hadn’t gotten one.
Further analyses have suggested that the signal might be happening not because people who are within three weeks of a Pfizer booster are having more strokes, but because people who are within 22 to 42 days of their Pfizer boosters are actually having fewer strokes.
Overall, Klein said, they were seeing fewer strokes than expected in this population over that period of time, suggesting a statistical fluke.
Another interesting thing that popped out of this data, however, was a possible association between strokes and high-dose flu vaccination. Seniors who got both shots on the same day and were within three weeks of those shots had twice the rate of stroke compared with those who were 22 to 42 days away from their shots.
What’s more, Klein said, the researchers didn’t see the same association between stroke and time since vaccination in people who didn’t get their flu vaccine on the same day.
The total number of strokes in the population of people who got flu shots and Covid-19 boosters on the same day is small, however, which makes the association a shaky one.
“I don’t think that the evidence are sufficient to conclude that there’s an association there,” said Dr. Tom Shimabukuro, director of the CDC’s Immunization Safety Office.
Nonetheless, Richard Forshee, deputy director of the FDA’s Office of Biostatistics and Pharmacovigilance, said the FDA is planning to look at these safety questions further using data collected by Medicare.
The FDA confirmed that the agency is taking a closer look.
“The purpose of the study is 1) to evaluate the preliminary ischemic stroke signal reported by CDC using an independent data set and more robust epidemiological methods; and 2) to evaluate whether there is an elevated risk of ischemic stroke with the COVID-19 bivalent vaccine if it is given on the same day as a high-dose or adjuvanted seasonal influenza vaccine,” a spokesperson said in a statement.
The FDA did not give a time frame for when these studies might have results.
