Tag: physicians and surgeons

A Texas family fought for weeks to regain custody of their newborn. Experts say the case shows how Black parents are criminalized. | CNN

CNN
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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.

Black infants also die at more than twice the rate of White infants, according to the Centers for Disease Control and Prevention.

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.”

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April 24, 2023
Why is it difficult for children to get a bed at pediatric hospitals? It’s more complicated than you think | CNN
CNN
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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.

What they didn’t expect was that it would take hours to find a bed for her.

Even though the respiratory surge that overwhelmed doctor’s offices and hospitals last fall is over, some parents like Schnacky are still having trouble getting their children beds in a pediatric hospital or a pediatric unit.

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 now offer 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 July, Tufts Medical Center in Boston converted its 41 pediatric beds to treat adult ICU and medical/surgical patients, citing the need to care for critically ill adults, the health system 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.”

Low insurance reimbursement rates also factor into how hospital administrations make financial decisions.

“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 staying in 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.

“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.”

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.”

So, what can be done to improve access to pediatric care? Much like the reasons behind the difficulties parents and caregivers are experiencing, the solutions are complex:
A lot of it comes down to money
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.”
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March 16, 2023
Romanian doctors investigated for reusing implants from dead patients | CNN

CNN
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Romanian prosecutors said on Saturday they have opened a criminal investigation into five doctors suspected of reusing hundreds of medical implants extracted from dead patients.

One of the five doctors, who was working at a hospital in the eastern Romanian city of Iasi, has been taken into custody pending the investigation on charges of abuse of power and bribe taking, prosecutors said in a statement.

They said the unnamed doctor oversaw a network of four other physicians who provided him with cardiac implants extracted from deceased patients without prior approval from them or their families.

Prosecutors allege the doctor performed 238 surgeries over seven years from 2017, illegally using implants extracted from dead patients or of unknown provenance and putting his patients at risk of serious complications or death.

“A large part of the implants recommended by the doctor…were not necessary and were prompted by fake diagnoses or by previously prescribed medication that would trigger specific symptoms,” the statement said.

Romania’s healthcare system, one of the least developed within the European Union, has been dogged by corruption, inefficiencies and politicized management.

The state has built one hospital in the last three decades and spends the least on healthcare in the EU, with tens of thousands of doctors and nurses having emigrated.

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February 19, 2023
GOP lawmakers escalate fight against gender-affirming care with bills seeking to expand the scope of bans | CNN Politics

Washington
CNN
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A flurry of bills seeking to restrict access to gender-affirming care for trans youth have been introduced by Republican state lawmakers this year, with debates around the issue reaching new heights thanks to proposals that would dramatically expand the scope of bans on such care.

More than 80 bills seeking to restrict access to gender-affirming care have been introduced around the country through February 9, according to data compiled by the American Civil Liberties Union and shared with CNN.

Gender-affirming care is medically necessary, evidence-based care that uses a multidisciplinary approach to help a person transition from their assigned gender – the one the person was designated at birth – to their affirmed gender – the gender by which one wants to be known.

Though many of the bills introduced so far this year target trans youth and their access to gender-affirming care, at least four states saw bills introduced this session that would restrict such care for individuals over the age of 18, including at least two states where proposed bans covered people under the age of 26.

Legislation aimed at trans adults has alarmed LGBTQ advocates, who worry that even if those measures don’t become law, they will make future bills exclusively targeting minors seem like sensible compromises.

The slew of new bills underscores the shifting policy goals of some conservatives seeking to politicize the lives of transgender Americans by imposing restrictions on a small and vulnerable group that, LGBTQ advocates say, are largely misunderstood, making their existence ripe for attacks. A number of GOP-led states have in recent years been successful in banning trans youth from competing on sports teams that match their gender identity, but now it appears the focus has largely turned to gender-affirming care.

“It’s really, I think, a big but important, notable moment that they’re no longer pretending that this is about caring about young folks, and making it very clear that all that they really want to do is prevent trans folks from being able to receive medically necessary, life-saving care basically at any age,” said Cathryn Oakley, state legislative director and senior counsel for the Human Rights Campaign, one of the nation’s largest LGBTQ rights groups.

“They have abandoned women’s sports entirely but doubled down on trying to hurt trans kids,” she added. “So, you know, the through line here is about hurting trans people. And yes, they’re looking for the next discriminatory measure that they can get passed.”

In pushing the health care bans, Republicans have argued that decisions around such care should be made after an individual becomes an adult – a position that is facing intense scrutiny as some lawmakers have moved the age goalpost this year.

Many of the bills likely won’t get far in the legislative process. An HRC report released last month said that of the 315 anti-LGBTQ bills introduced in 2022, only 29 – or less than 10% – became law. Still, the influx of bills this session is already helping to grow the small group of states that previously enacted bans on gender-affirming care.

Last month, Utah became the first state this year to enact a ban on gender-affirming care for trans youth, joining Arkansas, which enacted its ban in 2021, and Alabama, which put a similar ban on its books last year. Arizona also enacted restrictions on gender-affirming care in 2022, though its ban was less sweeping than the others.

Two of those laws have already brought forth a complicated legal landscape around the issue. The ACLU sued Arkansas over its ban and a federal judge temporarily blocked it in 2021, and Alabama’s law was partially blocked by a federal judge last May.

As states consider the dozens of health care bans introduced this year, they’ll do so under threat of federal legal action, with the legislative efforts having caused the US Department of Justice to take notice.

Last year, DOJ’s Civil Rights Division sent a stern warning to state attorneys general on the matter, saying in a letter that it “is committed to ensuring that transgender youth, like all youth, are treated fairly and with dignity in accordance with federal law.”

“Intentionally erecting discriminatory barriers to prevent individuals from receiving gender-affirming care implicates a number of federal legal guarantees,” the letter read in part.

Major medical associations agree that gender-affirming care is clinically appropriate for children and adults with gender dysphoria, which, according to the American Psychiatric Association, is psychological distress that may result when a person’s gender identity and sex assigned at birth do not align.

Though the care is highly individualized, some children may decide to use reversible puberty suppression therapy. This part of the process may also include hormone therapy that can lead to gender-affirming physical change. Surgical interventions, however, are not typically done on children and many health care providers do not offer them to minors.

LGBTQ advocates have long argued that the health care bans further marginalize a vulnerable community and could cause serious harm to a group that suffers from uniquely high rates of suicide.

“LGBTQ youth are not inherently prone to mental health challenges and suicide. They are placed at higher risk by the hostility and discrimination they face because of who they are,” said Kasey Suffredini of the Trevor Project, a nonprofit that works to prevent suicide among LGBTQ youth. “It is on adults to carry young people through this period until we get to the place where lawmakers aren’t attacking these young people anymore.”

At least four states saw bills introduced this year that would restrict gender-affirming care for individuals over the age of 18, dramatically raising the bar in Republicans’ efforts to regulate such care.

Among those bills was one in Mississippi that would have criminalized people who provided or aided in the provision of gender-affirming care for individuals under the age of 21, with violators of the ban facing “the felony crime of ‘gender disfigurement.’” If convicted, a violator could have been sentenced to a maximum of five years in prison and face a fine of at least $10,000. That bill, however, died in committee in late January.

A Kansas bill would prohibit medical professionals from “knowingly performing … or causing to be performed” gender-affirming care on an individual under the age of 21 and would make violations of the ban a felony under state law. The bill makes some exceptions, including in the case of someone born intersex.

A bill in South Carolina, meanwhile, would impose similar restrictions. But the measure, among other things, would require someone older than 21 who is seeking gender-affirming care to first get a referral from their “primary care physician and a referral from a licensed psychiatrist who must certify that the person has been diagnosed with gender dysphoria or a similar condition by the psychiatrist and that the psychiatrist believes that gender transition procedures would be appropriate for the person.”

Two near-identical bills in South Carolina and Oklahoma go a step further, providing that a “physician or other healthcare professional shall not provide gender transition procedures” to anyone under the age of 26. Medical professionals convicted of violating the act would be guilty of a felony, with a conviction in Oklahoma carrying a maximum sentence of five years in prison. The bills also prohibit public funds from being used “directly or indirectly” at organizations that provide such care.

“Surgical and chemical genital mutilation has been occurring in our great state, and it must be stopped,” the bill’s sponsor, Oklahoma GOP state Sen. David Bullard, said in a statement, using incendiary language to describe the clinically appropriate health care he’s trying to restrict.

The statement said Bullard “chose the age of 26 to account for scientific findings that the brain does not fully develop and mature until the mid- to late 20s with the prefrontal cortex, the part responsible for critical skills like planning and controlling urges, developing last.”

Bullard’s bill was later gutted by a Senate committee, with the changes removing the ban on care but maintaining the public funds prohibition.

“These are people who are old enough to enlist in the military, buy guns, buy alcohol, buy tobacco, get married, do a variety of other things that we leave to adults to do,” Oakley said. “And yet we would be forbidding them from being able to receive gender affirming care, as if that is in some way a more permanent decision.”

The push to restrict gender-affirming care has been a central focus for a number of well-funded national right-wing groups, including the conservative American Principles Project.

The group’s president, Terry Schilling, told CNN that it works with states to introduce and pass such bans, saying their overall goal is to eliminate gender-affirming care for all Americans, regardless of age. “The movement to oppose (gender-affirming care) has never said, ‘we only care about children.’ We’ve said, ‘we want to protect children,’” he said.

“And so, we want to protect who we can as quick as possible. And the group of people that we can protect as quick as possible is children,” Schilling added. “And so that’s the thrust of the strategy – is we want to protect everyone from this stuff. But ultimately, we have to start with children because that’s where the vast majority of the American people are right now.”

Lawmakers in Texas have introduced a number of bills that would outlaw gender-affirming care for trans youth, with most of them setting up blanket bans similar to ones being floated elsewhere.

But the state is also attempting to approach the issue in a unique way, with lawmakers there having introduced at least four bills that would expand the definition of child abuse to include providing gender-affirming care to minors.

The bills are seeking to codify a non-legally binding opinion released last year by Texas Attorney General Ken Paxton that said providing gender-affirming surgical procedures and drugs that affect puberty should be considered child abuse under state law.

Paxton’s move prompted the Texas Department of Family and Protective Services to begin investigating parents who provide their children with such care. But LGBTQ advocates sued, and a district judge ruled last September that the state cannot pursue investigations into parents providing such care if their children and those families are part of one of the groups suing the state.

One of the bills states in part that abuse “includes the following acts by a medical professional or mental health professional for the purpose of attempting to change or affirm a child ‘s perception of the child’s sex, if that perception is inconsistent with the child ‘s biological sex.”

When Republican state Rep. Bryan Slaton pre-filed the bill last year, he said in a statement that it “will designate genital removal surgeries, chemical castration, puberty blockers, and other sex change therapies as child abuse.”

Elsewhere, states are pushing ahead with bans similar to the ones in Arkansas and Alabama that are currently in legal jeopardy.

In Utah, the Republican-controlled legislature moved a ban on gender-affirming care for minors through the statehouse in under a month, with Republican Gov. Spencer Cox giving it his stamp of approval in late January.

“More and more experts, states and countries around the world are pausing these permanent and life-altering treatments for new patients until more and better research can help determine the long-term consequences,” Cox said in a statement explaining his decision to sign the bill into law.

“This is a devastating and dangerous violation of the rights and privacy of transgender Utahns, their families, and their medical providers,” said Chase Strangio, deputy director for transgender justice at the ACLU, in a statement. “Claims of protecting our most vulnerable with these laws ring hollow when lawmakers have trans children’s greatest protectors – their parents, providers, and the youth themselves – pleading in front of them not to cut them off from their care.”

LGBTQ advocates hoped Cox would veto the ban, pointing to the governor’s decision last year to veto an anti-trans sports bill in the state. At the time, he questioned the need for it and stressed that it targets a marginalized group that suffers from high rates of suicide. Lawmakers, however, quickly overrode his veto, with the drama underscoring how Republicans are not always in lockstep on matters pertaining to the LGBTQ community.

Last month, Mississippi’s House passed a bill that similarly makes it illegal to “knowingly provide gender transition procedures to any person under” the age of 18. Physicians and other medical professionals found to have violated the ban would have their license to practice health care in the state revoked.

“I just believe a child needs to wait until they’re 18-years-old, then they can make their own decision,” the bill’s sponsor, Republican state Rep. Gene Newman, told CNN. Decisions about the type of care Newman’s bill seeks to limit, however, are made by a mix of people, including a child’s parents and the medical provider.

A South Dakota bill would also prohibit health care professionals in the state from providing gender-affirming care to minors. Like the Mississippi bill, providers found to be in violation of the ban by a professional or occupational licensing board would get their license to practice medicine revoked, according to the bill. The bill cleared South Dakota’s Senate on Thursday and is now headed to Republican Gov. Kristi Noem, who is supportive of the legislation.

South Dakota has been especially hostile to trans youth in recent years, with Noem having signed a bill last year banning transgender women and girls in the state from competing on sports teams consistent with their gender at accredited schools and colleges. That legislation codified an executive order the governor signed in 2021.

As lawmakers continue to debate these bans, advocates like Strangio, who is involved in the ACLU’s legal fight against some of the bans, are vowing to take states to court over any enacted restrictions.

“It will be the government’s burden to defend it in court,” he told a Tennessee House committee last month that went on to approve a ban there. “And Tennessee, like Alabama, like Texas, like Arkansas, will not be able to do so.”

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February 13, 2023
Surgeon General says 13 is ‘too early’ to join social media | CNN

CNN
—

US Surgeon General Vivek Murthy says he believes 13 is too young for children to be on social media platforms, because although sites allow children of that age to join, kids are still “developing their identity.”

Meta, Twitter, and a host of other social media giants currently allow 13-year-olds to join their platforms.

“I, personally, based on the data I’ve seen, believe that 13 is too early … It’s a time where it’s really important for us to be thoughtful about what’s going into how they think about their own self-worth and their relationships and the skewed and often distorted environment of social media often does a disservice to many of those children,” Murthy said on “CNN Newsroom.”

The number of teenagers on social media has sparked alarm among medical professionals, who point to a growing body of research about the harm such platforms can cause adolescents.

Murthy acknowledged the difficulties of keeping children off these platforms given their popularity, but suggested parents can find success by presenting a united front.

“If parents can band together and say you know, as a group, we’re not going to allow our kids to use social media until 16 or 17 or 18 or whatever age they choose, that’s a much more effective strategy in making sure your kids don’t get exposed to harm early,” he told CNN.

Adobe Stock

New research suggests habitually checking social media can alter the brain chemistry of adolescents.

According to a study published this month in JAMA Pediatrics, students who checked social media more regularly displayed greater neural sensitivity in certain parts of their brains, making their brains more sensitive to social consequences over time.

Psychiatrists like Dr. Adriana Stacey have pointed to this phenomenon for years. Stacey, who works primarily with teenagers and college students, previously told CNN using social media releases a “dopamine dump” in the brain.

“When we do things that are addictive like use cocaine or use smartphones, our brains release a lot of dopamine at once. It tells our brains to keep using that,” she said. “For teenagers in particular, this part of their brain is actually hyperactive compared to adults. They can’t get motivated to do anything else.”

Recent studies demonstrate other ways excessive screen time can impact brain development. In young children, for example, excessive screen time was significantly associated with poorer emerging literacy skills and ability to use expressive language.

Democratic Sen. Chris Murphy, who recently published an op-ed in the Bulwark about loneliness and mental health, echoed the surgeon general’s concerns about social media. “We have lost something as a society, as so much of our life has turned into screen-to-screen communication, it just doesn’t give you the same sense of value and the same sense of satisfaction as talking to somebody or seeing someone,” Murphy told CNN in an interview alongside Murthy.

For both Murphy and Murthy, the issue of social media addiction is personal. Both men are fathers – Murphy to teenagers and Murthy to young children. “It’s not coincidental that Dr. Murthy and I are probably talking more about this issue of loneliness more than others in public life,” Murphy told CNN. “I look at this through the prism of my 14-year-old and my 11-year-old.”

As a country, Murphy explained, the U.S. is not powerless in the face of Big Tech. Lawmakers could make different decisions about limiting young kids from social media and incentivizing companies to make algorithms less addictive.

The surgeon general similarly addressed addictive algorithms, explaining pitting adolescents against Big Tech is “just not a fair fight.” He told CNN, “You have some of the best designers and product developers in the world who have designed these products to make sure people are maximizing the amount of time they spend on these platforms. And if we tell a child, use the force of your willpower to control how much time you’re spending, you’re pitting a child against the world’s greatest product designers.”

Despite the hurdles facing parents and kids, Murphy struck a note of optimism about the future of social media.

“None of this is out of our control. When we had dangerous vehicles on the road, we passed laws to make those vehicles less dangerous,” he told CNN. “We should make decisions to make [social media] a healthier experience that would make kids feel better about themselves and less alone.”

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January 29, 2023
Why urgent care centers are popping up everywhere | CNN Business

New York
CNN
—

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 worry that 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 Harvard has 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.”

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January 28, 2023
Why is Britain’s health service, a much-loved national treasure, falling apart? | CNN

London
CNN
—

Most winters, headlines warn that Britain’s National Health Service (NHS) is at “breaking point.” The alarms sound over and over and over again. But the current crisis has set warning bells ringing louder than before.

“This time feels different,” said Peter Neville, a doctor who has worked in the NHS since 1989. “It’s never been as bad as this.”

Scenes that would until recently have been unthinkable have now become commonplace. Hospitals are running well over capacity. Many patients don’t get treated in wards, but in the back of ambulances or in corridors, waiting rooms and cupboards – or not at all. “It’s like a war zone,” an NHS worker at a hospital in Liverpool told CNN.

These stories are borne out by the data. In December, 54,000 people in England had to wait more than 12 hours for an emergency admission. The figure was virtually zero before the pandemic, according to data from NHS England. The average wait time for an ambulance to attend a “category 2” condition – like a stroke or heart attack – exceeded 90 minutes. The target is 18 minutes. There were 1,474 (20%) more excess deaths in the week ending December 30 than the 5-year average.

Ambulance staff and nurses have staged a series of strikes over pay and working conditions, with the latest walkout by ambulance workers happening Monday. More are planned for the coming weeks. The chief executive of the NHS Confederation, which represents NHS organizations in England, wrote to the government on the eve of an ambulance strike last month to warn of NHS leaders’ concerns that they “cannot guarantee patient safety” that day. In response, a government health minister advised the public to avoid “risky activity.”

While the NHS has suffered crises before, this winter has brought a new reality: In Britain, people can no longer rely on getting healthcare in an emergency.

Founded shortly after World War II, the NHS is treated with an almost religious reverence by many. Britons danced for it during the 2012 London Olympics and clapped for it during the pandemic. “Our NHS” is a source of national pride.

Now, it is coming unstuck. There has long been an implicit contract between British people and the state: Pay taxes and National Insurance contributions in return for a health service that is free at the point of use.

But, with the tax burden on track to reach its highest sustained level since the NHS was founded, Britons are paying more and more for a service they increasingly cannot access as quickly as they need.

Some of these strains can be seen elsewhere in Europe. Doctors in both France and Spain have held strikes in recent weeks, as many countries face the same problems of providing care to an increasingly aging population – when inflation is at its highest level in decades.

Yet there are fears that the NHS is in worse shape than its international peers, and CNN spoke with experts who said they fear they’re witnessing the “collapse” of the service.

So how did Britain get here?

When Covid-19 hit, the NHS went into full crisis-fighting mode, diverting staff and resources from across the organization to care for patients with the disease.

But, for many in the NHS, Covid-19 remains a crisis from which they are yet to emerge.

During the height of the pandemic, many ordinary practices were put on hold. Millions of operations were canceled. The NHS “backlog” has ballooned. Data from November showed there were more than 7 million people on a hospital waiting list in England.

This winter, a “twindemic” of Covid and flu continues to put additional strain on capacity.

Explanations for the current crisis “have to start with a consideration of Covid-19,” Ben Zaranko, an economist at the Institute for Fiscal Studies (IFS) whose work focuses on Britain’s health care system, told CNN. “There’s the simple fact that there are beds in hospitals occupied by Covid patients, which means those beds can’t be used for other things.”

Covid also created a strain on the amount of work the NHS can do. “If you add up all the time that staff spend doing infection control measures, donning protective equipment and separating out wards into people with and without Covid … that might impede the overall productivity of the system,” Zaranko said. Rates of NHS staff sickness are also considerably higher than they were pre-pandemic, according to IFS analysis.

But, again, Britain was not alone in battling the pandemic, yet it appears to have suffered a worse hit than comparable nations.

This is despite there being more doctors and nurses in the NHS now than there were before Covid. According to an IFS report, even after adjusting for staff sickness absences, there are 9% more consultants, 15% more junior doctors and 8% more nurses than in 2019.

Yet the NHS is treating fewer patients than before the pandemic.

“It seems to be that bits of the system aren’t fitting together anymore,” Zaranko said. “It’s not just about how much staff there are and how much money there is. It’s how it’s being used.”

Even with the increase in funding since the pandemic, the UK is still playing catchup, after what critics say is more than a decade of underfunding the NHS.

Neville, a consultant in a hospital, judges 2008 the “best” he has seen the NHS in more than 30 years of working in it. By that time, the NHS had enjoyed nearly a decade of hugely increased investment. Waiting lists fell substantially. Some even complained about getting doctor appointments too quickly.

“When the Labour government came in in 1997, they injected considerably more money into the NHS. It enabled us to appoint an adequate number of staff and get on top of our waiting lists,” Neville told CNN.

But this level of investment did not last. In response to the 2007-2008 financial crisis, the Conservatives elected in the coalition government in 2010 embarked on a program of austerity. Budgets were cut and staff salaries frozen. For Neville, the ensuing decade saw a gradual “erosion” of the system: “Slow, subtle, but nonetheless happening.”

According to analysis by health charity the Health Foundation, average day-to-day health spending in the UK between 2010 and 2019 was £3,005 ($3,715) per person per year – 18% below the EU14 [countries that joined the EU before 2004] average of £3,655 ($4,518).

During this period, capital expenditure – the amount spent on buildings and equipment – was especially low, according to the Health Foundation analysis. The UK has far fewer MRI and CT scanners per person than the Organisation for Economic Co-operation and Development (OECD) average, meaning staff often have to wait for equipment to become available.

Hospital beds are particularly scarce. Over the past 30 years the number of beds in England has more than halved, from around 299,000 in 1987 to 141,000 in 2019, according to analysis by the King’s Fund, an independent think tank.

Siva Anandiciva, chief analyst at the King’s Fund, told CNN this decrease was partly attributable to the “changing model of care.” As technology and treatments improved, people spent less time in hospital, reducing the need for beds. The last Labour government, in power from 1997 to 2010, also cut bed numbers, despite increasing investment elsewhere.

“You can keep reducing how long patients stay in hospital,” said Anandaciva, but eventually “you approach a minimum. If you then keep cutting bed numbers … that’s when you start to get into problems like performance.”

During the austerity years, bed numbers continued to be cut, leaving the UK with fewer beds per capita than almost any developed nation, according to OECD data.

“For a long time we knew we just didn’t have the bed capacity,” Anandaciva said. But cuts continued in the name of “efficiency,” he added.

While low bed numbers were seen as a marker of “success” indicating that the NHS was running efficiently, it left the UK woefully underprepared for a shock like Covid-19. The same factors that made the NHS “efficient” in one context made it grossly inefficient when that context changed, in his analysis.

The bed shortage has been made even more acute by the fact that many of those in hospital no longer need to be there – there is simply nowhere else for them to go.

“The longest I had a patient that was physically and medically ready to go home, but was sitting around waiting for discharge, was four weeks,” said Angus Livingstone, a doctor working in the John Radcliffe Hospital in Oxford.

The problem is caused by a crisis in another sector: Social care. Patients that could leave the hospital end up staying there because they cannot access more modest care in a home setting and so cannot be safely discharged.

Health and social care are separate sectors in the UK system. Healthcare is provided by the NHS, whereas social care is provided by local councils. Unlike the NHS, social care is not free at the point of use: It is rationed and means-tested.

There have long been calls to integrate the two systems, since a crisis in one system feeds through into the other.

“If you allow us to regain the enormous number of beds that are currently occupied by people awaiting social care, then I would be very confident that the immediate snarl-up in A&E and ambulances waiting outside would pretty much disappear overnight,” Neville said.

“When people ask me, ‘where do you want the money in the NHS?’ My answer is ‘I don’t want it in the NHS. I want it in social care.’”

With an increasingly aging population – the latest census data show nearly 19% of the population of England and Wales is now 65 or older – demand for social care is increasing. But the sector is struggling to provide it in the face of staffing shortages, rising costs and funding pressures.

Care work can be grueling and underpaid. Most supermarkets offer a better hourly wage, analysis from the King’s Fund found. So, it is perhaps unsurprising that the sector reported 165,000 vacancies in August.

The NHS is also reporting an alarming number of vacancies, with about 133,000 open positions as of September.

This points to a deeper crisis: Morale.

Jatinder Hayre, a doctor completing the foundation program at a hospital in East London, told CNN that morale is “at an all time low.” Staff are “stressed, fatigued, tired,” he said. “There doesn’t seem to be an end to this.”

“When you walk into the hospital in the morning, you’re met with this cacophony of grief and dismay and dissatisfaction from patients, who are lined up in the corridor,” Hayre said.

“You feel awful, but there’s nothing you can do. You’re fighting against a system that’s collapsing.”

Hayre said that most days there are “around 40 to 50 patients lined up in the corridors” as there is no space left in the wards. “It’s not appropriate. It’s not a safe or dignified environment.”

Unable to deliver an acceptable standard of care, many staff are demoralized – and considering their options. At Hayre’s hospital, “the day-to-day workplace talk is, ‘are we going to leave?’”

A junior doctor at a hospital in Manchester, who wished to remain anonymous, told CNN that she had made the decision to join the growing number of NHS doctors who are moving abroad. She plans to move abroad in the summer, to work in a country that offers doctors better pay and working conditions.

Of the eight doctors she lived with at university, six have already left. “They’ve all gone to Australia. They love it,” she said. Only one is planning to stay in the UK.

Medical students are watching in alarm as their future workplace deteriorates.

“For everyone I know, it’s almost a given that at some point they’re going to go to Australia or New Zealand,” said Eilidh Garrett, who studies medicine at Newcastle University. She is considering taking exams to work as a doctor in Canada.

This is a hugely painful decision for many young doctors. “I think about my closest friends. If I go to another country and treat other people’s closest friends, while my friends struggle to see a doctor in the UK – that is really heartbreaking,” Garrett told CNN.

Meanwhile, Britain’s vote to leave the European Union in 2016 has likely not helped the situation. Research by the Nuffield Trust health think tank, published in November, finds that long-standing staff shortages in nursing and social care “have been exacerbated by Brexit.”

The picture is “more complex” for doctors working in the NHS, the researchers found. While overall “EU numbers have remained relatively stable,” the report says, the data suggest a slowdown in the registration of specialists from the EU and European Free Trade Association countries since Brexit, particularly in certain specialties such as anesthetics.

The concern is that these issues get worse the longer they go untreated.

When patients finally get seen, their treatments take more time, forcing those after them to wait even longer as they get sicker.

“In terms of the system performance, it feels like we’re past the tipping point,” Zaranko said. “The NHS has been gradually deteriorating in its performance for some time. But we’ve gone off a cliff in recent months.”

It is unclear how the NHS regains its footing. Some compare this crisis to a period in the 1990s when services were rapidly deteriorating. The NHS was in bad shape, but restored its levels of service after a decade of historically high investment while Labour was in power.

Injections of cash on this scale are unlikely to be replicated. The most recent budget announced by the government in November will see NHS England spending rise by only 2% in real terms on average over the next two years.

“We recognize the pressures the NHS is facing so announced up to £250 million [$309 million] of additional funding to immediately help reduce hospital bed occupancy, alleviate pressures on A&E and unlock much-needed ambulance handovers,” a spokesperson from the Department of Health and Social Care told CNN in a statement.

“This is on top of the £500 million [$618 million] Discharge Fund to speed up the safe discharge of patients and rolling out virtual wards to free up hospital beds and cut waiting cuts,” the statement continued.

Pay negotiations between the government and nursing unions have so far been unsuccessful. British media outlets have reported that Prime Minister Rishi Sunak may be considering offering a one-off hardship payment of £1,000 ($1,236) to attempt to resolve the dispute, but many feel this underestimates the true nature of the crisis.

“All I hear about is sticking plasters,” Neville said. “It depresses us all.”

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January 23, 2023
Opinion: Women don’t have to die from cervical cancer | CNN

Editor’s Note: Dr. Eloise Chapman-Davis is director of gynecologic oncology at NewYork-Presbyterian/Weill Cornell Medical Center and Weill Cornell Medicine. Dr. Denise Howard is chief of obstetrics and gynecology at NewYork-Presbyterian Brooklyn Methodist Hospital and a vice chair of obstetrics and gynecology at Weill Cornell Medicine. The views expressed in this commentary are their own. Read more opinion on CNN.

CNN
—

As doctors who specialize in women’s reproductive health, we are on the front lines of a preventable crisis. Imagine treating a woman with advanced cancer who has a five-year survival rate of 17%, knowing that she should have never developed the deadly disease in the first place.

This is what we are facing with cervical cancer. Yet we have the clinical tools not only to lower but also eliminate nearly all the roughly 14,000 new cases and 4,300 deaths from cervical cancer each year.

We have effective screenings: the traditional Pap smear and the HPV test. If these screening tests are abnormal, additional tests can determine who needs further treatment to prevent the development of cancer. Importantly, we have the HPV vaccine, which protects against high-risk human papillomavirus (HPV) types that cause the majority of cervical cancer cases and is nearly 100% effective, according to the National Cancer Institute.

A report published earlier this month shows the vaccine’s tremendous impact. The US saw a 65% drop in cervical cancer rates from 2012 through 2019 among women ages 20-24, the first to have received the vaccine. The vaccine, combined with screening, could wipe out cervical cancer and make it a disease of the past.

But the percentage of women overdue for their cervical cancer screening is growing, and, alarmingly, late-stage cases are on the rise.

We have had the heartbreaking experience of seeing mothers in the prime of life die from this avoidable disease, leaving small children behind — even women who had an abnormal screening but never received follow-up care. It’s devastating to see an otherwise healthy person slowly die from a preventable cancer.

Simply put, cervical cancer should never occur. This Cervical Cancer Awareness Month, we should commit to making that a reality. Here is what needs to happen.

Eliminating cervical cancer requires commitment at multiple levels, from public awareness campaigns with culturally appropriate messaging that broadcasts the power of the vaccine and screenings to prevent cancer to resources that ensure all women have easy access to routine health exams.

Timely screening reminders and systems to prioritize follow-up care are essential. Too many women with abnormal screenings don’t receive their results, reminders or follow-up instructions they understand and, therefore don’t receive the proper treatment. Barriers also include logistical challenges like transportation and language issues. Studies suggest that 13% to 40% of cervical cancer diagnoses result from lack of follow-up among women with an abnormal screening test.

Gynecology and primary care practices should be vigilant about reaching and monitoring patients with suspicious test findings. Large health systems can leverage the power of the electronic health record to track abnormal tests and ensure these women receive the proper follow-up.

Pediatricians should encourage parents of children 9 and older to get the HPV vaccine and stress its safety. About 60% of teenagers are up to date on their HPV vaccines, according to the US Centers for Disease Control and Prevention. Physicians not recommending the vaccine and parents’ rising concerns about its safety, despite more than 15 years of evidence that it is safe and effective, have been cited as top reasons why more children aren’t receiving this lifesaving vaccine.

College campuses should do large-scale, catch-up vaccination outreach. These students are at high risk for contracting HPV, yet only half report having received the full HPV vaccine series. This service should be provided at no cost to students.

Stark racial disparities also must be addressed. As Black women physicians, we are frustrated that Black women continue to be more likely to die from the disease than any other race, according to the American Cancer Society. The system failures contributing to this tragedy range from Black women receiving less aggressive treatment to barriers around access to affordable routine health care and the high-quality, specialized treatment needed to treat cancer. Everyone deserves access to quality care.

Older patients should be told that approval of the HPV vaccine has been extended up to age 45 and to discuss with their doctor whether it’s right for them. Insurance providers should cover the cost of the vaccine for these older ages.

Women should see a gynecologist on a regular basis well into their older years. We see patients with cervical cancer in their 60s and 70s who haven’t been screened in 20 years. Many people stop seeing a gynecologist after childbearing or menopause, but this shouldn’t be the case. Getting quality gynecological exams throughout a woman’s life is critical to preserving it.

We also need to empower women to be their own advocates through health education. Women should receive their screening result with an explanation of what it means and any next steps clearly delineated. No news after a screening is not good news. In an ideal world, women would see their HPV status as essential information with the power to save their lives.

Education makes a difference. At NewYork-Presbyterian and Weill Cornell Medicine, we produced a series of easy-to-understand, publicly available videos on cervical cancer and the HPV vaccine. We showed several of the vaccine videos to more than 100 parents in one of our pediatric practices that serves mostly low-income families as part of a pilot study. Their knowledge scores on a questionnaire about the vaccine and HPV that they completed before and after watching the videos increased nearly 80%, and roughly 40% of the unvaccinated children received the HPV vaccine within one month. We aim to expand this effort.

We have the tools to prevent cervical cancer but fail to use them effectively. It’s unacceptable, and we can no longer ignore the problem. It’s time for a full-scale offensive focused on all fronts to make cervical cancer a disease of the past.

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January 21, 2023
Opinion: ‘We can barely breathe.’ How did Britain’s treasured NHS get so sick? | CNN

Editor’s Note: Dr. Roopa Farooki is an Internal Medicine Doctor for the NHS in South East England. She is the author of “Everything is True: A Junior Doctor’s Story of Life, Death and Grief,” on the first 40 days of the Covid-19 pandemic. The views expressed in this commentary are her own. Read more opinion on CNN.

CNN
—

I’m writing this towards midnight, having just finished a set of four 13-hour shifts in my small, coastal hospital’s Accident & Emergency (A&E) department.

It’s hard to describe the helplessness we feel, as doctors, every time we walk through the emergency waiting room, packed with patients, knowing we can only review and treat one person at a time.

Knowing that when we see someone really sick, who needs admission, that they might be waiting on that chair or trolley for over 24 hours before a bed on the ward becomes free.

I’m an internal medicine doctor for the UK’s National Health Service – better known as the NHS. I’m currently on the medical on-call team – the majority of patients who come through the front door at A&E are referred to us.

Government-funded and free at the point of care, the NHS is a source of national pride.

And it is in crisis.

There aren’t enough beds for our patients. Trying to include an extra bed on each side of the ward, is akin to trying to make more space in a car park by simply drawing the lines closer together.

And then, there are not enough staff to care for the beds that we do have. When we manage to make a patient well enough to be discharged, we find we cannot, as there is no one in the community to care for them.

No one to help with the non-medical activities of daily living, such as washing and dressing.

We work in hospitals where in the A&E, a consulting room to review and examine a patient is a luxury, and the doctors queue up for them.

I recently had to perform a lumbar puncture – where a needle is inserted into the patient’s spinal canal, to measure and collect cerebrospinal fluid for testing – normally a procedure that you could do at the bedside.

But this patient didn’t have a bed in A&E, even though they clearly needed one, and was just lying down on two chairs pushed together.

I managed to get a consulting room for 30 minutes and did the procedure there, before I was told to leave by the emergency department consultant. It seems I shouldn’t have been allowed to occupy the room for even that long.

My own son came into our A&E not so long ago. He had a dislocated shoulder after falling off his bike, on a day when I happened to be working at a different hospital.

He was treated relatively quickly, with pain relief, his shoulder popped back into place by the emergency department doctor. His X-ray repeated and checked before being discharged.

Still, he was shocked, visibly shocked at the place where I have spent much of my working life.

It’s different when you see your everyday reality though naïve eyes. He saw the elderly patients on the jigsaw of trolleys crammed into the department, pushed against the wall, squeezed in the gap between the bed and nursing stations.

He saw the fluids hanging from rails where we had no stands, lines running into the patient’s forearms. He saw the oxygen fed into their noses from cylinders propped along the bed, the cacophony of beeping machines and alarms.

It doesn’t look like it does on the TV. It doesn’t even look like it does on reality TV.

Sometimes though we can fix a patient’s problem in reasonable time. The patient’s treatment, albeit in an uncomfortable chair, can still be started. And after 24 hours of antibiotics or fluids or other interventions, they can improve enough to be discharged home.

That happened first thing this morning. It was a relief for the patient, their family and me, that I could send him home with oral antibiotics, some two days after he had come into the emergency department.

In this instance, he had not been left in the waiting room the entire time. We had placed him in a small room with five other patients having interventions in their chairs.

In these closeted spaces, informal bonds form. The patients in those rooms look out for each other. If you call out a name, and someone is too hard of hearing to answer, or in the toilet, the others will let you know where they are.

I’m always apologizing to patients. And to their families. I’m humble about the care that we can offer, with the resources and staffing that we have.

I’m always apologizing to patients. And to their families. I’m humble about the care that we can offer, with the resources and staffing that we have.

Dr. Roopa Farooki

I’m always worrying that while we’re managing the medical issues – while I’m monitoring arterial oxygenation by taking regular blood gases from their radial arteries, while our nurses are administering medication, while our radiologists are reporting the imaging – that our patients are suffering socially and psychologically.

I encourage them to call their families when they’re in the emergency department, and plug in their phone.

I urge them to keep up their food and fluid intake, while stuck in the trolley or chair. “Please have a cup of tea, and a snack, and a meal, whenever someone comes round to offer you one,” I say.

“Even if you don’t feel like it now, you might want it a bit later.”

How is this different from the pandemic? In many ways, it’s not. Then, we worked with the understanding that we might walk into a virus, get ill, and maybe even get critically ill. That’s not changed.

Many of the patients I admitted over Christmas, sitting in the same space as other patients, later tested positive for Covid-19 or Influenza A.

When I wrote an account of the first 40 days of the Covid-19 pandemic, from the start of lockdown, I described the unprecedented nature of the situation, the compromise for patients and my health care colleagues.

“Death and deterioration have been impossibly normalized. You’re living in impossible times,” I wrote.

I never thought that almost three years later we would still be working like this. I had hoped to look back at that time with learning and wisdom, knowing that it was extraordinary, that we got through it, and hoping that I had done enough to help.

But now, that egotism, that sense of what we are doing as individual clinicians is in any way significant, seems foolish.

We are caught in a trap of underfunding that means what we can offer patients isn’t enough. In medical terms, this is a chronic condition, like heart failure. We are now suffering an acute exacerbation, so the fluid that should have been pumped around efficiently is now filling our boots and our lungs. We can barely breathe.

The junior doctors, that is any doctor who is not a consultant, have experienced more than a decade’s worth of sub-inflation pay awards, amounting to a 26% decrease in pay since 2008.

Recently it has been reported that as many as 40% of my junior doctor colleagues will leave the NHS next year.

From my personal experience, that seems optimistic. No one that I know wishes to remain in the NHS once their training contract finishes. They are talking about taking a year off, agency work, heading abroad where there is better pay and conditions, having more time to see their families.

They want anything other than what they have experienced for the last three years.

Already this winter we’ve had several strikes from ambulance workers and nurses, with more planned this week.

But next year, every day will be like a strike day, if something isn’t done to prevent our clinical staff from giving up and burning out.

And the tragedy is that this feels orchestrated. This chronic disease, this failure of our hearts, has been deliberately mismanaged; with the decade of persistent underfunding, it is as though the medication that we need has been withheld, to a point of crisis.

And then the political leadership essentially say to us, “Look, you just can’t work anymore. You’re not well.” As though it is our fault.

Our treasured NHS. I still find it extraordinary that I can organize expensive tests and start life-saving treatments and procedures, from the emergency room to the intensive care unit, that would cost hundreds or thousands of pounds, and ask nothing more from a patient, for all of this, than their time in the hospital.

I still feel that being a doctor is the best job in the world, providing care for those who need it. And I have been so proud to be an NHS doctor, giving back to the place which looked after my sister through her breast cancer and chemotherapy, and me through the birth of my children.

The NHS will exist as long as there are those who will fight for it.

But we’re all so tired. People clapped for us during the pandemic, and it felt empty, performative at the time.

It means nothing when we are left to fight for the NHS on our own.

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January 20, 2023
Opinion: I almost died last year from a medical problem that was entirely preventable | CNN

Editor’s Note: Alice Paul Tapper, 15, is a high school sophomore in Washington, DC. She is the daughter of CNN’s Jake Tapper. The opinions expressed in this commentary are solely hers. View more opinions on CNN.

CNN
—

I almost died around Thanksgiving last year, and it was entirely preventable.

It started one weekend in November 2021 with stomach cramping, a low fever, chills and vomiting. Soon it became clear I needed to go to the emergency room. By the time I got there, I had low blood pressure, an elevated heart rate, intense abdominal pain and a high white blood cell count.

I was given IV fluids to combat my dehydration, but I didn’t get better. The doctor and nurses didn’t know what was wrong and stood around me confused, as if they were waiting for me to tell them what to do. The sharp cramping pains and the throbbing feeling in my stomach got worse, so they transferred me to another hospital.

With guidance from my pediatrician, my parents told the doctors to check for appendicitis. But since I was tender all over my abdomen — not just on my right side — the doctors ruled it out. My parents kept pressing, so a doctor told me to stand up and jump. I could barely get an inch off the ground. The doctors concluded that what I had must be a viral infection and would eventually just go away.

It didn’t. I got sicker and my skin started turning a pale green. As Monday turned into Tuesday, I was only given Tylenol for my pain. My mom asked the doctors why I couldn’t get a sonogram to see what was happening inside my abdomen; they said it wasn’t needed. My dad asked why I couldn’t get antibiotics; the doctors said for a viral infection they could do more harm than good. My parents kept pushing for a gastroenterologist who might have more insight about my condition to evaluate me, but one never came.

I felt helpless. My condition wasn’t the only thing that alarmed me; so did the lack of recognition I received from the hospital. I was not being heard; when I described to the doctors how much pain I was in, they responded with condescending looks.

On Tuesday night, my dad went home to be with my brother, but it wasn’t long before my mom called him in tears. I was in agony and was only being treated with a heating pad. My dad got the phone number for the hospital administrator and begged for a gastroenterologist, for imaging — for anything. The phone call worked, and at the hospital administrator’s orders, I was finally taken to get an abdominal X-ray. The imaging showed this was no viral infection.

In the middle of the night, I was rushed to get an ultrasound that revealed I had a perforated appendix that was leaking a poisonous stream of bacteria throughout my internal organs. When I learned my diagnosis, I was almost relieved. At least the doctors now had a plan.

Finally, the surgical team took over. The next couple of hours were a blur. A CT scan was followed by emergency surgery; two laparoscopic drains were inserted in my body to get rid of the toxic leakage. I had sepsis and we would later learn I was going into hypovolemic shock — which can cause organs to stop working. That night was the scariest night of my life.

Once I was well enough to leave the ICU, I stayed in the hospital for another week, bedridden with uncomfortable drains in my body and horribly sharp cramping pains, for which I was given morphine. I could barely walk. I didn’t recognize the helpless, hunchbacked, green, exhausted girl I saw in the hospital mirror.

Why did this all go so horribly wrong?

My mom soon learned about research conducted by Dr. Prashant Mahajan, vice chair of Emergency Medicine and division chief of Pediatric Emergency Medicine at University of Michigan Health C.S. Mott Children’s Hospital. Mahajan’s research notes that, despite being the most common surgical emergency in children, appendicitis can be missed in up to 15% of children at initial presentation. Up to 15%!

This is because there are so many possible reasons for abdominal pain. Appendicitis can mimic several common conditions including constipation and acute gastroenteritis, which my hospital pediatricians mistakenly thought I had. According to Mahajan, up to half of appendicitis patients may not exhibit the classic signs of right lower quadrant pain, fever and vomiting.

Mahajan’s research also shows that appendicitis misdiagnoses are more likely in children under 5 — and in girls. I was disappointed but not surprised to learn that girls can be listened to and taken seriously less often.

Hospitals need to change the way they assess and diagnose appendicitis because it can frequently present in atypical ways. Anupam Kharbanda, pediatric emergency medicine doctor at Children’s Minnesota, came up with what’s called the pARC (pediatric Appendicitis Risk Calculator) score to help assess a child’s probability of appendicitis, using variables such as sex, age, duration of pain, pain migration, white blood cell count and more.

The pARC score could be an important piece of changing diagnostic practices and saving lives.

In 2018, a 5-year-old girl in England, Elspeth Moore, was sent home by a pediatrician even though she complained her stomach “felt like it was on fire.” The doctor diagnosed a viral infection. She died of peritonitis, sepsis and acute appendicitis two days later.

My story has a less tragic ending. Luckily, I wasn’t sent home without monitoring like Elspeth was, and I finally got the care I needed. Months after my first hospitalization, I had an appendectomy at a new hospital — Children’s Hospital of Philadelphia. My health has returned to normal. But I have a new mission to spread awareness about misdiagnoses of appendicitis — because what happened to Elspeth could have happened to me, too.

The X-ray machine was down the hall, the CT machine just a floor below, the sonogram machine just steps away and the antibiotics I needed were just one phone call away. But doctors didn’t utilize these tools to quickly diagnose and treat me and, as a result, I almost died. It breaks my heart to think about the boys and girls who don’t have parents who can get the phone number of the hospital administrator — who can’t make their voices break through.

I still can’t believe this happened to me — and I don’t want it to happen to anyone else.

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December 15, 2022
Desperate for heart surgery for their baby, a family feels the effects of pediatric hospital shortages | CNN

CNN
—

Even before their daughter was born in June, Aaron and Helen Chavez knew she would need heart surgery. Doctors expected her to have an operation around 6 months of age.

When it became apparent in September that it would have to happen much sooner than expected, the Chavezes said, they endured an agonizing monthlong wait for a bed to open at their local children’s hospital so baby MJ could have the procedure she needed.

“They said, ‘Well, we would love to get her in as soon as possible. However, right now, we don’t have beds,’ ” Aaron said.

Space for children in hospitals is at a premium across the country. Data reported to the US government shows that as of Friday, more than three-quarters of pediatric hospital beds and 80% of intensive care beds for kids are full. That’s up from an average of about two-thirds full over the past two years.

Federal data shows that the strain on hospital beds for kids began in August and September, which is right around the start of the school year in many areas.

Hospitals are seeing higher than normal numbers of sick infants and children due to a particularly early and severe season for respiratory infections in kids, including respiratory syncytial virus, or RSV, and influenza.

As of Friday, Golisano Children’s Hospital in Rochester, New York, the facility that treated the Chavezes’ daughter, was over capacity. Federal data shows that it has been consistently more full than the national average over the past few months. Golisano went from having 85% of its beds occupied in August to over 100% now.

Like many other hospitals across the country, Golisano has seen a sharp increase in children who are severely ill with RSV. Dr. Tim Stevens, the chief clinical officer, said 35% of the hospital’s current patients – excluding those in the neonatal intensive care unit – have RSV.

A lack of available beds means patients are sometimes held in the emergency department to wait for a bed to open so they can be admitted, Stevens says.

It may also mean children who have chronic conditions and need procedures or hospital care, but whose conditions are stable, may have to wait.

MJ was born in June with a ventricular septal birth defect – a hole between the pumping chambers of her heart. It’s a relatively common problem affecting about 1 in every 240 infants in the United States, according to the US Centers for Disease Control and Prevention.

Doctors could see the defect on prenatal ultrasounds, but because MJ was never in the right position to get a good image, they weren’t sure of its size.

If they’re small enough, these holes usually close on their own soon after birth. But the hole in MJ’s heart was not small.

It caused the oxygen-rich blood coming from her lungs to mix with oxygen-poor blood returning from the rest of her body. Too much blood got squeezed back into her tiny lungs with each heartbeat, straining her respiratory system.

Everything exhausted her, even nursing or drinking from a bottle. “She would stop eating before she was full and before she got the calories that she needed,” Aaron said.

Typically, babies will take a bottle for 15 to 20 minutes at a time, but MJ would doze off after six or seven minutes, her mother recalls.

They didn’t worry, Helen says, because they were trying hard not to be anxious newbies. “All those websites, they say sometimes you just have a sleepy baby, and it’s OK,” she said.

Other signs that MJ might be hungry could be explained away, too. They mistook her constant fussing for colic. Her scalp started to get dry and flaky, and they thought it might be a common skin condition called cradle cap.

As first-time parents, the Chavezes didn’t realize at first that MJ wasn’t eating enough. Doctors didn’t immediately catch it, either. MJ got three checkups during her first month, one within a few days of coming home from the hospital, the other at two weeks and another at one month.

It’s normal for babies to lose weight after birth, especially if Mom got IV fluids during labor and delivery. They typically return to their birth weights by 2 to 3 weeks of age. And at first, MJ did regain weight, climbing back to her birth weight by 2 weeks old.

But babies with heart conditions like hers can have faster-than-normal metabolisms, and it was between weeks two and four that her parents say the feeding issues really began to cause problems.

“We were frustrated and we were scared, because she looked like she was losing weight, not gaining weight. She was very thin for a baby,” Aaron said.

The doctors had advised them to count the number of wet and dirty diapers she was having each day as a way to judge whether she was eating enough. Her parents didn’t know it was not as much as she should have been.

“One day, I was holding her, sitting in our recliner. I looked down at her and I was like, ‘this baby looks puny. Like, she does not look like she feels good,’ ” Helen said.

She called their pediatrician, who saw them the same day. The pediatrician immediately notified their cardiologist, who arranged for a feeding tube to help MJ get more nutrition.

Helen says they had been told MJ would need surgery to repair the hole in her heart around 6 months of age.

“Once the feeding issues started, though, that I think that we all kind of realized that, OK, she’s probably not going to hit that six-month mark,” she says.

MJ got the feeding tube when she was around 6 weeks old, in August. Her doctors started talking about moving the operation up but advised her parents that she would need to gain some weight first.

The feeding tube helped for a time, but by the time MJ was 3 months old, her condition had deteriorated.

“Every breath came with a grunt,” Aaron said. “She was fairly regularly sweating, no matter the ambient temperature in the room or whether we were holding her or not.”

Every time MJ drew a breath, the skin around her collarbone would suck in and her abdomen would pull under ribcage, a symptom known as a retraction. Retractions are a sign that someone is working very hard to breathe.

“It looked like her chest was almost scooping under her lungs with each breath. The retractions were getting really bad. It was around that point that they told us, ‘Hey, yeah, this is accelerating faster. We’re going to need to get her in for surgery soon,’ ” Aaron said.

Helen said their cardiologist first discussed getting MJ’s case reviewed – a key step her doctors needed to prepare for her surgery – on September 14.

“He said, ‘it might take a couple of weeks to get her in because we’ve been really slammed with emergencies, but we’ll get her in,’ ” Helen said.

Doctors put MJ on medications called diuretics to help drain excess fluid off her lungs and ease her breathing – but then, at the end of September, she caught a cold.

It wasn’t a bad cold, and Helen Chavez, a pharmacist, thinks that if the baby had been healthy, she probably could have fought it off at home with no problems. But Helen was worried, so she took she MJ to the ER.

The doctors checked her, determined she was stable and sent the family home with supportive care.

At a follow-up doctor’s visit, Helen said, she asked again, “Where are we on the surgery?”

Helen said the cardiologist said they had not been able to review MJ’s case.

“And they said, ‘Well, we would love to get her in as soon as possible. However, right now we don’t have beds,’ ” Aaron said.

“Throughout that time, she kept getting worse. More symptoms would pop up in terms of the breathing would get worse, the retractions would get worse, that kind of a thing. Like there was more and more and more piling up,” Aaron said.

Helen said she understood that MJ’s condition was still stable, but she was worried it wouldn’t stay that way.

“I was like, ‘I’m worried she’s going to crash and that’s how we’re going to get in for this surgery is, it’s going to take this kid crashing and burning before we can get her in,’ ” Helen told the doctor, who reassured her.

” ‘No, no, no, she is not going to get to that point before we get her in,’ ” she says they were told.

On October 10, things took a turn.

The baby slept in a bassinet beside her parents’ bed. Helen nudged Aaron awake around midnight to look at their daughter, and his first thought was to reassure his wife that yes, the doctors had told them that her breathing was going to look bad. But then he rolled over and peered at MJ, who was asleep.

“That was the moment that I was wide awake,” Aaron said, and he was terrified.

“It was the raggedness of her breathing and the noise. Every breath, there was a strange sound coming from her. It sounded like she was fighting for, like, struggling for every breath.”

They raced to the hospital.

“We were sitting in the ER, and every other kid in that pediatric ER was hacking, coughing, sneezing,” Helen said. “Clearly, respiratory viruses hit Rochester early and very hard.”

Helen said it was clear by the end of that visit that medications had done all they could do and that MJ would continue to get worse without the operation.

“Our understanding is, it took an extra ER visit to push the timeline,” Helen said.

That visit prompted an emergency appointment with the cardiologist.

“That’s where they were like, ‘OK, we’ve got her in for conference,’ ” Helen said.

The hospital says it can’t comment on the specifics of MJ’s case.

“The Golisano Children’s Hospital cardiology and cardiac surgery teams review the status of all pediatric patients who need heart surgery twice a week,” the hospital said in a statement to CNN. “We cannot comment on a specific case, but once surgery becomes necessary, it is scheduled as quickly as needed based on the medical condition of the child. The current high census of pediatric inpatients at our hospital has not affected our ability to schedule non-elective pediatric cardiac surgeries in a timely way.”

Stevens, the chief clinical officer, says those decisions are made on a case-by-case basis.

“Each of those are reviewed by our medical and surgical team to determine whether or not they’re time-sensitive,” he said. “Things that are time-sensitive or certainly urgent or emergent, they get done.”

When it becomes clear that a child needs to be admitted, Stevens said, hospital officials find ways to open beds, and they try to do it so it doesn’t exhaust their nurses.

Stevens says he’s hopeful the situation will improve, that infections will die down, “because this is not sustainable.”

Aaron Chavez agrees that there was no delay once MJ’s case got the necessary review – but says that review itself kept getting put off.

“We were essentially told that her case review was being delayed because they simply didn’t have the beds,” he said.

The surgical team reviewed MJ’s case on October 13, and she had surgery 12 days later, according to Aaron.

Aaron says the family has no complaints about the quality of care their daughter received, and they’re grateful to the entire team of doctors, nurses and other staff who treated their daughter.

“Once push came to shove, they definitely got her in, but the last four weeks were really, really harrowing,” Helen said. “It was just kind of hard to watch your baby have trouble breathing and know that there’s not a whole lot you can do.”

On the morning of October 25, the Chavezes brought MJ to the hospital, where doctors walked them through the operation. A piece of synthetic material would be sewn into her heart to patch the hole. Over time, the material would allow her own cells to grow on it and cover the defect.

The procedure could take as long as 12 hours. But it went faster than anticipated, and MJ was finished in half that time. The surgeon came out to tell them the good news: The operation had been a success.

“Her surgeon said that it was the biggest hole that he has seen in 2022 and one of the biggest he has ever seen,” Aaron said.

The Chavezes then went to the pediatric intensive care unit to wait for MJ. As soon as they saw her, they could see she was better.

Before the surgery, her skin had been pale and mottled; after, she was a healthy pink.

“Just in that short amount of time, her skin had that pinkness and redness in places that you expect like the nose, and her fingers were proper pink,” he said. “That color you expect out of a healthy baby. It was really nice to see that.”

She was in the hospital for six days, and her recovery amazed her care team.

“She kind of crushed recovery milestones like it was her job,” Aaron said.

Now back home, MJ is playing catch-up with the developmental milestones she missed while she was sick. Her muscles are weak, she can’t sit up or roll over yet, and she may never switch back from the feeding tube to a bottle. A team of occupational and physical therapists comes over to help. They expect she will eventually make up for the time she missed, but it will take some work.

Still, Aaron says the surgery has had an amazing effect.

Before her operation, MJ was very uncomfortable and always tired.

“The baby that I have now, that returned from surgery, is constantly smiling at us. She’s almost laughed three different times in the last couple of days, right? She’s so close to a laugh. She seems like an entirely different baby,” Aaron said.

The Chavezes were nervous about sharing their story, but in the end, they decided it was important to shed light on the effects of the ongoing hospital bed shortage.

“Everybody we have told about the bed shortage, that we have told about the nurses and the staff and the doctors telling us how burnt-out and frustrated they are and how tired they are, everybody’s surprised,” Aaron said.

“Everybody’s shocked. Everybody thinks that this is over. The pandemic is over. Our health care system’s back to normal. ‘What are you talking about? What shortages?’ “

In the end, they felt powerless. What could they – two exhausted working parents with a sick infant – do to solve a national crisis?

After all, after nearly three years of a viral pandemic, doesn’t everyone already know what to do? Stay home if you’re sick. Put on a mask in public places while viral illnesses are running rampant. Get vaccinated.

“I don’t know how I’m supposed to help tell 330 million people, ‘Hey, you should care about each other,’ ” Aaron says.

Their story is one reminder of why all those simple but effective measures are important.

“In the end, we believe the information getting out there is better than not,” Aaron said. “Hopefully, it will help push those in power to do better.”

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November 13, 2022
Opinion: Why pre-sports evaluation forms for girls worry me — and should concern you, too | CNN

Editor’s Note: Megan Ranney, MD, MPH, is the deputy dean at the School of Public Health at Brown University and a professor of emergency medicine at the University’s Warren Alpert Medical School. The views expressed in this commentary are her own. Read more opinion on CNN.

CNN
—

As a physician, a public health professional and a parent of a teenage girl, I’ve been following news about a Florida school district’s decision to digitize kids’ school athletic records with interest – and with concern.

What should be a simple decision about medical best practice has been turned into a Gordian knot of not just health, but also policy, politics, technology and bodily autonomy.

Being active is obviously important for kids, in general. We should do everything we can to encourage all youth to engage in physical activity, whether through organized sports or informal activity. Although, traditionally, women were less likely to be competitive athletes, the number of US high school athletes who identify as female has increased more than 10-fold over the last five decades. This growth deserves to be supported.

For kids of all genders to safely participate in competitive sports, a consortium of medical organizations have agreed on a standardized pre-sports physical screening and exam. The exact rules and regulations differ between states, but the overarching goal of a pre-sports physical is to allow physicians (or other appropriate clinicians) to identify and then mitigate potential harms from youth sports participation.

The pre-sports evaluation form used by the Florida High School Athletic Association, and by extension the Palm Beach County School District, includes screening for everything from family history of cardiac disorders to concussions, depression and eating disorders. These questions are included for good reason. Competitive athletes of all genders are prone to energy deficiency, whether due to disordered eating or due to excessive energy use during practices. This energy deficiency can cause long-lasting harm, especially for adolescents.

When the energy deficiency is accompanied by amenorrhea (lack of a period), it is particularly worrisome, as the metabolic and endocrine side-effects can weaken athletes’ bones, increase the risk of stress fractures and increase the risk of long-term osteoporosis. It is, therefore, medically appropriate to ask athletes about signs of disordered eating, amenorrhea, and other signs of physical danger when deciding whether an athlete is safe to practice and compete. This is also the reason the screening form also includes four questions for “females only” about menstruation.

However, there is a big difference between a physician or other trained healthcare professional asking these questions in private, as part of a clinical assessment, and the physician sharing all the details with third parties.

That some states may share the full physical and screening exam – including information about youth athletes’ menstrual cycles – with school districts, state officials and third-party digital record-keeping companies is, to me, deeply worrisome. The strictures of the post-Dobbs world, the reality of today’s tech world and the suggestive examples of other instances where these intersections have left women and girls vulnerable could put parents and doctors in an untenable position.

From a purely medical perspective, the pre-participation exam forms approved by the American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine, specify that only the final decision (e.g., whether or not a patient is cleared for sports, and whether there are restrictions) should be shared with a school district. They specifically comment that the medical exam and screening questions should remain with the evaluating clinician or physician.

This guidance reflects the tremendous importance of protecting the privacy of the patient-physician relationship. The confidentiality of clinical discussions is important in general, but all the more so for adolescents. And reproductive and gynecologic care, including discussions about menstruation, are appropriately considered to be even more private than, say, a lung or heart or knee exam.

But my concern about the reported sharing of data goes beyond fears of impairing the patient-physician relationship. The current social, political and technological environment creates a perfect storm for this information-sharing to endanger youth in a myriad of ways.

First, laws regarding reproductive health, gender and abortion are quickly being rewritten nationwide. In Texas and Oklahoma, those states effectively offer a bounty to anyone who reports a suspected abortion. In other states, being transgender can result in exclusion from organized sports. One could easily imagine a world in which – if school officials or coaches are expected to follow an athlete’s menstrual cycle – some youth would be reported up the chain (accurately or inaccurately) for missed periods. For some youth, this reporting could result in inappropriate and invasive gynecologic exams. For other youth, this could result in them and their parents being charged with a crime. And knowing about a kid’s periods potentially puts schools in a position of liability.

Second, the security of a third-party software system (such as that being used by districts in Florida) is often dubious. While I can’t judge the level of security particular software program being used in Florida, many of us have previously discussed our concerns about poorly designed, poorly protected “period tracking apps.” Cyber-hacking of electronic health records is on the rise. Even the largest, most security-conscious health care organizations are at risk, and data from reproductive health organizations has been specifically targeted and shared. As soon as we share menstrual data with a digital application, we must also worry about its being accessed by those with nefarious intentions.

I doubt that most school systems are ready for these legal and security risks.

Finally, as a mother of a teenager (and a former high school athlete, myself) I cringe at the thought of a coach – even with the best of intentions! – following a child’s menstrual cycle for signs of missed periods. Even in my state (which protects abortion as healthcare, albeit with parental consent), this kind of tracking would be embarrassing at best and invasive at worst. And my worries would be far greater if I were in a state that limited my own and my children’s reproductive rights.

I am glad that Palm Beach County has reconsidered this dangerous policy and asked that questions about menstrual history be removed from Florida’s pre-sports evaluation form. Here’s hoping the Florida High School Athletic Association listens and does what’s right for the sake of kids, parents, coaches and schools.

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October 30, 2022
Singapore jails man who posed as female gynecologist on Facebook to get intimate photos | CNN

CNN
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A man who fooled dozens of women into sending him photos of their genitalia by posing as a female gynecologist on Facebook has been sentenced to jail in Singapore.

The state courts on Wednesday found Ooi Chuen Wei, 37, from Malaysia, guilty of “cheating by personation” and sentenced him to three years and four months in prison.

Ooi used a fake Facebook profile to contact the women, asking them to fill out surveys that included questions about their genitals and sex lives, according to court documents seen by CNN.

Over a period of four years, he tricked 38 women and received close to 1,000 intimate photos and videos in return.

The offenses came to light last July when a woman, who had grown suspicious of Ooi and realized there was no such doctor, lodged a police report.

The police then raided Ooi’s home and seized his devices. During the course of the police investigation, he admitted tricking the women, according to the court documents.

Deputy public prosecutor R. Arvindren asked for a prison sentence of at least three years and eight months for Ooi, citing the large number of victims and how long Ooi had continued his deception.

“The accused executed a carefully thought out scheme to satisfy his sexual desires,” Arvindren said.

“(He) pretended that he was a female doctor and deceived several victims into sending various compromising photographs and videos of themselves. (He) has abused the trust the public has for doctors and he has exploited social media to commit the crimes,” he added.

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October 26, 2022
RSV in children: Symptoms, treatment and what parents should know | CNN

CNN
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In September, an 8-month-old baby came into Dr. Juanita Mora’s office in Chicago with an infection the doctor hadn’t expected to see for another two months: RSV.

Like her peers across the country, the allergist and immunologist has been treating little ones with this cold-like virus well before the season usually starts.

“We’re seeing RSV infections going rampant all throughout the country,” Mora said.

Almost all children catch RSV at some point before they turn 2, the US Centers for Disease Control and Prevention says. Most adults who catch it have a mild illness; for those who are elderly or who have chronic heart or lung disease or a weakened immune system, it can be dangerous. But RSV can be especially tricky for infants and kids.

Mora, a volunteer medical spokesperson for the American Lung Association, says it’s important for parents, caregivers and daycare workers to know what to watch for with RSV, which stands for respiratory syncytial virus. That way, they know whether a sick child can be treated at home or needs to go to a hospital.

“The emergency department is getting completely flooded with all these sick kids, so we want parents to know they can go to their pediatrician and get tested for RSV, influenza and even Covid-19,” Mora said.

Here’s what else parents need to know amid the surge of respiratory illnesses.

For many, RSV causes a mild illness that can be managed at home.

On average, an infection lasts five days to a couple of weeks, and it will often go away on its own, the CDC says. Sometimes, the cough can linger for up to four weeks, pediatricians say.

Symptoms may look like a common cold: a runny nose, a decreased appetite, coughing, sneezing, fever and wheezing. Young infants may seem only irritable or lethargic and have trouble breathing.

Not every child will have every potential RSV symptom.

“Fevers are really hit or miss with RSV infections, especially in young infants,” said Dr. Priya Soni, assistant professor of pediatric infectious diseases at Cedars Sinai Medical Center.

Parents should watch for any changes in behavior, she said, including taking longer to eat or not being interested in food at all. The child can also develop a severe cough and some wheezing.

It’s also important to watch for signs that your child is struggling to breathe or breathing with their ribs or belly – “symptoms which may kind of overlap with many of the other viruses that we’re seeing a resurgence of,” Soni added.

Since it’s not easy for parents to tell the difference between respiratory illnesses like, say, RSV and flu, it’s good to take a sick child to a pediatrician, who can run tests to pinpoint the cause.

“You may need to take your baby to be evaluated sooner rather than later,” Soni said.

When it comes to RSV, parents should be especially cautious if their children are preemies, newborns, children with weakened immune systems or neuromuscular disorders, and those under age 2 with chronic lung and heart conditions, the CDC says.

“Parents should be really astute to any changes, like in their activity and their appetite, and then pay particular attention to any signs of respiratory distress,” Soni said.

Testing is important because treatment for things like flu and Covid-19 may differ.

There’s no antiviral or specific treatment for RSV like there is for the flu, nor is there a vaccine. But if your child is sick, there are things you can do to help.

Fever and pain can be managed with non-aspirin pain relievers like acetaminophen or ibuprofen. Also make sure your child drinks enough fluids.

“RSV can make kids very dehydrated, especially when they’re not eating or drinking, especially when we’re talking infants,” Mora said. “Once they stop eating or their urine output has decreased, they’re not having as many wet diapers, this is a sign they may have to go to the pediatrician or emergency department.”

Talk to your pediatrician before giving your child any over-the-counter cold medicines, which can sometimes contain ingredients that aren’t good for kids.

Your pediatrician will check the child’s respiratory rate – how fast they’re breathing – and their oxygen levels. If your child is very sick or at high risk of severe illness, the doctor may want them to go to a hospital.

“RSV can be super dangerous for some young infants and younger kids, particularly those that are less than 2 years of age,” Soni said.

Mora said labored breathing is a sign that a child is having trouble with this virus. RSV can turn into more serious illnesses such as bronchiolitis or pneumonia, and that can lead to respiratory failure.

If you see that a child’s chest is moving up and down when they breathe, if their cough won’t let them sleep or if it’s getting worse, “that might be a sign that they need to seek help from their pediatrician or take them to the emergency department, because then they might need a supplemental oxygen, or they may need a nebulization treatment.”

CNN medical analyst Dr. Leana Wen says this respiratory difficulty – including a bobbing head, a flaring nose or grunting – is one of two major trouble signs with any respiratory infection. The other is dehydration. “That particularly applies to babies with stuffy noses. They may not be feeding.”

Much of the care provided by hospital staff will be to help with breathing.

“We provide supportive measures for RSV and these kids with oxygen, IV fluids and respiratory therapies, including suctioning,” Soni said.

A thin tube may need to be inserted into their lungs to remove mucus. A child can get extra oxygen through a mask or through a tube that attaches to their nose. Some children may need to use an oxygen tent. Those who are struggling a lot may need a ventilator.

Some babies might also need to be fed by tube.

The best ways to prevent RSV infections, doctors say, is to teach kids to cough and sneeze into a tissue or into their elbows rather than their hands. Also try to keep frequently touched surfaces clean.

If a caregiver or older sibling is sick, Mora says, they should wear a mask around other people and wash their hands frequently.

And most of all, if anyone is sick – child or adult – they should stay home so they don’t spread the illness.

There is a monoclonal antibody treatment for children who are at highest risk for severe disease. It’s not available for everyone, but it can protect those who are most vulnerable. It comes in the form of a shot that a child can get every month during the typical RSV season. Talk to your doctor about whether your child qualifies.

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October 23, 2022
Prosecutors ask jury to recommend death sentence for Parkland shooter | CNN

CNN
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Prosecutors have called on a Florida jury to recommend the Parkland school shooter be put to death, saying in a closing argument Tuesday he meticulously planned the February 2018 massacre, and that the facts of the case outweigh anything in his background that defense attorneys claim warrant a life sentence.

“What he wanted to do, what his plan was and what he did, was to murder children at school and their caretakers,” lead prosecutor Michael Satz said of Nikolas Cruz, who pleaded guilty to 17 counts of murder and 17 counts of attempted murder for the shooting at Marjory Stoneman Douglas High School, in which 14 students and three school staff members were killed. “That’s what he wanted to do.”

But Cruz “is a brain damaged, broken, mentally ill person, through no fault of his own,” defense attorney Melisa McNeill said in her own closing argument, pointing to the defense’s claim that Cruz’s mother used drugs and drank alcohol while his mother was pregnant with him, saying he was “poisoned” in her womb.

“And in a civilized humane society, do we kill brain damaged, mentally ill, broken people?” McNeill asked Tuesday. “Do we? I hope not.”

With closing arguments, the monthslong sentencing phase of Cruz’s trial is nearing its end, marking prosecutors’ last chance to convince the jury to recommend a death sentence and defense attorneys’ last opportunity to lobby for life in prison without parole.

Prosecutors have argued Cruz’s decision to commit the deadliest mass shooting at an American high school was premeditated and calculated, while Cruz’s defense attorneys have offered evidence of a lifetime of struggles at home and in school.

Each side was allotted two and a half hours to make their closing arguments.

Jury deliberations are expected to begin Wednesday, during which time jurors will be sequestered, per Broward Circuit Judge Elizabeth Scherer.

If they choose to recommend a death sentence, the jurors must be unanimous, or Cruz will receive life in prison without the possibility of parole. If the jury does recommend death, the final decision rests with Judge Scherer, who could choose to follow the recommendation or sentence Cruz to life.

In his remarks, Satz outlined prosecutors’ reasoning, including the preparations Cruz made. For a “long time” prior to the shooting, Satz said, Cruz thought about carrying it out.

Revisiting ground covered in the trial, the prosecutor said Cruz researched mass shootings and their perpetrators, including those at a music festival in Las Vegas; at a movie theater in Aurora, Colorado; at Virginia Tech; and at Colorado’s Columbine High School.

Cruz modified his AR-15 to help improve his marksmanship; he accumulated ammunition and and magazines; and he searched online for information about how long it would take police to respond to a school shooting, Satz said.

Then, the day of, Satz said, Cruz hid his tactical vest in a backpack and took an Uber to the school, wearing a Marjory Stoneman Douglas JROTC polo shirt to blend in. Based on his planning, he told the Uber driver to drop him off at a specific pedestrian gate, knowing it would be open soon before school let out.

“All these details he thought of, and he did,” Satz said.

Satz also detailed a narrative of the shooting, which he called a “systematic massacre,” recounting how the shooter killed or wounded each of his victims, whose families and loved ones filled the courtroom gallery. Prosecutors also showed jurors a video of the shooting, which was not shown to the public.

Cruz, wearing a striped sweater and flanked by his public defenders, looked on expressionless, occasionally looking down at the table in front of him or talking to one of his attorneys.

“The appropriate sentence for Nikolas Cruz is the death penalty,” Satz concluded.

In her own statement, McNeill stressed to jurors that defense attorneys were not disputing that Cruz deserves to be punished for the shooting.

“We are asking you to punish him and to punish him severely,” she said. “We are asking you to sentence him to prison for the rest of his life, where he will wait to die, either by natural causes or whatever else could possibly happen to him while he’s in prison.”

The 14 slain students were: Alyssa Alhadeff, 14; Martin Duque Anguiano, 14; Nicholas Dworet, 17; Jaime Guttenberg, 14; Luke Hoyer, 15; Cara Loughran, 14; Gina Montalto, 14; Joaquin Oliver, 17; Alaina Petty, 14; Meadow Pollack, 18; Helena Ramsay, 17; Alex Schachter, 14; Carmen Schentrup, 16; and Peter Wang, 14.

Geography teacher Scott Beigel, 35; wrestling coach Chris Hixon, 49; and assistant football coach Aaron Feis, 37, also were killed – each while running toward danger or trying to help students to safety.

The lengthy trial – jury selection began six months ago, in early April – has seen prosecutors and defense attorneys present evidence of aggravating factors and mitigating circumstances, reasons Cruz should or should not be put to death.

The state has pointed to seven aggravating factors, including that the killings were especially heinous, atrocious or cruel, as well as cold, calculated and premeditated, Satz said Tuesday. Other aggravating factors include the fact the defendant knowingly created a great risk of death to many people and that he disrupted a lawful government function – in this case, the running of a school.

Together, these aggravating factors “outweigh any mitigation about anything about the defendant’s background or character,” Satz said.

Satz rejected the mitigating circumstances presented during trial by the defense, including that Cruz’s mother smoked or used drugs while pregnant with him. Those factors would not turn someone into a mass murderer, Satz argued, adding it was the jury’s job to weigh the credibility of the defense witnesses who testified to those claims.

Satz cast doubt on the defense’s other proposed mitigators. In response to a claim that Cruz has neurological or intellectual deficits, Satz pointed to the gunman’s ability to carefully research and prepare for the Parkland shooting.

In response to claims Cruz was bullied by his peers, Satz argued Cruz was an aggressor, pointing to testimony that he walked around in high school with a swastika drawn on his backpack, along with the N-word and other explicit language.

“Hate is not a mental disorder,” Satz said.

During trial, prosecutors presented evidence showing the gunman spent months searching online for information about mass shootings and left behind social media comments sharing his express desire to “kill people,” while Google searches illustrated how he sought information about mass shootings. On YouTube, Cruz left comments like “Im going to be a professional school shooter,” and promised to “go on a killing rampage.”

“What one writes,” Satz said, referencing Cruz’s online history Tuesday, “what one says, is a window to someone’s soul.”

Public defenders assigned to represent Cruz have asked the jury to take into account his troubled history, from a dysfunctional family life to serious mental and developmental issues, contending he was born with fetal alcohol spectrum disorder.

On Tuesday, McNeill reiterated the defense’s case, starting with one of the first witnesses called in August, Cruz’s older sister, Danielle Woodard. Woodard testified their mother, Brenda Woodard, used drugs and drank alcohol while pregnant with him.

“Her brother, Nikolas Cruz never recovered from the drugs and the alcohol that Brenda put in her polluted womb,” McNeill said Tuesday.

Several neighbors who knew Cruz when he lived with his late adoptive mother, Lynda Cruz, also testified about watching him grow up, McNeill reminded jurors Tuesday. They shared how they saw him behaving in ways they described as “strange” or “weird,” or saw him being bullied. One neighbor, McNeill said, had told jurors that “from the moment he set eyes on Nikolas, he could tell something was not right with him.”

McNeill also revisited Cruz’s academic struggles throughout his childhood, recounting the “many people” – including educators and school counselors or psychologists – who testified they had concerns about his bad behavior or poor performance in school.

Those struggles continued into adolescence, McNeill said: When he was 15 years old, Cruz’s skills in reading, writing and math were well below the levels they should have been. These academic struggles, along with his anxiety and depression, were indicators, McNeill said, of fetal alcohol spectrum disorder.

Various counselors and psychiatrists also testified, McNeill reminded the jury, offering their observations from years of treating or interacting with Cruz. One, former Broward County school district counselor John Newnham, testified that while Lynda Cruz was a caring mother, after the death of her husband, she was “overwhelmed” and did not take advantage of the support available.

This was a factor in Cruz’s failure to receive the proper help, McNeill told jurors Tuesday.

“Everybody told you that Lynda never truly appreciated what was wrong with Nikolas … But the evidence has shown you that Lynda consistently minimized, enabled, ignored, excused, defended and ultimately lied to the very people that were trying to help Nikolas.”

“Sometimes the people who deserve the least amount of compassion and grace and remorse are the ones who should get it,” she said.

As part of the prosecution’s case, family members of the victims were given the opportunity this summer to take the stand and offer raw and emotional testimony about how Cruz’s actions had forever changed their lives. At one point, even members of Cruz’s defense team were brought to tears.

“I feel I can’t truly be happy if I smile,” Max Schachter, the father of 14-year-old victim Alex Schachter, testified in August. “I know that behind that smile is the sharp realization that part of me will always be sad and miserable because Alex isn’t here.”

The defense’s case came to an unexpected end last month when – having called just 26 of 80 planned witnesses – public defenders assigned to represent Cruz abruptly rested, leading the judge to admonish the team for what she said was unprofessionalism, resulting in a courtroom squabble between her and the defense (the jury was not present).

Defense attorneys would later file a motion to disqualify the judge for her comments, arguing in part they suggested the judge was not impartial and Cruz’s right to a fair trial had been undermined. Prosecutors disagreed, writing “judicial comments, even of a critical or hostile nature, are not grounds for disqualification.”

Scherer ultimately denied the motion.

Prosecutors then presented their rebuttal, concluding last week following a three-day delay attributed to Hurricane Ian.

Their case included footage of Cruz telling clinical neuropsychologist Dr. Robert Denney he chose to carry out the shooting on Valentine’s Day because he “felt like no one loved me, and I didn’t like Valentine’s Day and I wanted to ruin it for everyone.”

Denney, who spent more than 400 hours with the gunman, testified for the prosecution that he concluded Cruz has borderline personality disorder and anti-social personality disorder.

But Cruz did not meet the criteria for fetal alcohol spectrum disorder, as the defense has contended, Denney testified, accusing Cruz of “grossly exaggerating” his “psychiatric problems” in tests Denney administered.

When read the list of names of the 17 people killed and asked if fetal alcohol spectrum disorder explained their murders, Denney responded “no” each time.

Correction: An earlier version of this story misspelled the first name of defense attorney Melisa McNeill.

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October 11, 2022
New York State Legislature passes bill to protect doctors who prescribe abortion pills for out-of-state patients | CNN Politics

CNN
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A bill that would legally protect doctors who prescribe and send abortion pills to patients in states where abortion services are outlawed or restricted is now headed to New York Gov. Kathy Hochul’s desk after the state legislature passed the legislation on Tuesday.

The bill ensures that doctors, medical providers and facilitators in the state will be able to provide telehealth services to patients out of state, according to a news release from the New York State Assembly.

The new legislation also protects New York health providers from out-of-state litigation, meaning the state will not cooperate with cases prosecuting doctors in New York who provide telehealth abortion or reproductive services to people in other states.

“This bill expands protections for telehealth providers by providing them the same protections afforded to doctors in other states with strong reproductive healthcare shield laws,” according to the news release.

The bill also ensures that New York medical providers, complying with their practice, who offer telehealth services are not subject to professional discipline, “solely for providing reproductive health services to patients residing in states where such services are illegal.”

CNN has reached out to the governor’s office to see if she will sign the legislation.

CNN previously reported Hochul has indicated support for a shield law protecting medical providers of out of state abortion and reproductive services.

Assemblymember Karines Reyes, a registered nurse who sponsored the bill, said she was “proud to sponsor this critical piece of legislation to fully protect abortion providers using telemedicine.”

According to the state assembly’s news release, the bill recognizes the common use of medication abortion drugs, stating that 54% of abortions across the country are now medication abortions.

Speaker of the New York State Assembly Carl Heastie said, “It is our moral obligation to help women across the country with their bodily autonomy by protecting New York doctors from litigation efforts from anti-choice extremists. Telehealth is the future of healthcare, and this bill is simply the next step in making sure our doctors are protected.”

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April 12, 2021