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Fallen pinecones covered 16-year-old Leslie Keiser’s cheap amoxil canada fresh grave at the edge of Wolf Point, a small community on the Fort Peck Indian Reservation on the eastern Montana plains. Leslie, whose father is a member of the Fort Peck Assiniboine and Sioux Tribes, is one of at least two teenagers on the reservation who died by suicide this summer. A third teen’s death cheap amoxil canada is under investigation, authorities say.

Leslie’s mother, Natalie Keiser, was standing beside the grave recently when she received a text with a photo of the headstone she ordered. She looked at her phone and then back at the grave of the girl who took her own life in September. €œI wish cheap amoxil canada she would have reached out and let us know what was wrong,” she said.

Youth suicide rates have been increasing in the U.S. Over the past decade. Between 2007 and 2017, the rate nearly tripled for children aged 10 to 14, and cheap amoxil canada rose 76% among 15- to 19-year-olds, according to the U.S.

Centers for Disease Control and Prevention. Mental health experts fear the amoxil could make things worse, particularly for kids who cheap amoxil canada live on rural native American reservations like Fort Peck. In a typical year, Native American youth die by suicide at nearly twice the rate of their white peers in the U.S.

Among those are vulnerable children on remote reservations who are cut off from their larger families and communities by buy antibiotics-caused restrictions. €œIt has put a really heavy cheap amoxil canada spirit on them, being isolated and depressed and at home with nothing to do,” says Carrie Manning, a project coordinator at the Fort Peck Tribes’ Spotted Bull Recovery Resource Center. Other Native American leaders are also sounding an alarm.

On South Dakota’s Pine Ridge Reservation, Oglala Sioux Tribe President Julian Bear Runner declared a state of emergency in August. In his declaration, Bear Runner wrote that the measures imposed to prevent the amoxil’s spread has added to the strain on a population already struggling with poverty, addiction, high crime and the trauma of generations of being the target cheap amoxil canada of racism. €œThese necessary measures and the threat of the amoxil and the threat of the amoxil are taking a toll on the mental health needs of our population, requiring a response that we are inadequately prepared for due to lack of resources,” Bear Runner wrote.

It’s not clear what connection the amoxil has to the youth suicides on the cheap amoxil canada Fort Peck reservation. Leslie had attempted suicide once before several years ago, but she had been in counseling and seemed to be feeling better, her mother says, though she also notes that Leslie’s therapist canceled her counseling sessions before the amoxil hit. €œProbably with the amoxil it would have been discontinued anyway,” Keiser says.

€œIt seems like things that were important were kind of set to the wayside.” Tribal members cheap amoxil canada typically lean on one another in times of crisis, but this time is different. The reservation is a buy antibiotics hot spot. In remote Roosevelt County, which encompasses most of the reservation, more than 10% of the population has been infected with the antibiotics.

The resulting social distancing has led tribal officials to worry the community will fail to cheap amoxil canada see mental health warning signs among at-risk youth. So officials are focusing suicide prevention efforts on finding ways to help those kids remotely. €œOur people have been through hardships cheap amoxil canada and they’re still here, and they’ll still be here after this one as well,” says Don Wetzel, tribal liaison for the Montana Office of Public Instruction and a member of the Blackfeet Nation.

€œI think if you want to look at resiliency in this country, you look at our Native Americans.” Poverty, high rates of substance abuse, limited health care and crowded households elevate both physical and mental health risks for residents of reservations. €œIt’s those conditions where things like suicide and amoxils like buy antibiotics are able to just decimate tribal people,” says Teresa Brockie, a public health researcher at Johns Hopkins University and a member of the White Clay Nation from Fort Belknap, Montana. Montana has seen 231 suicides this year, with the highest rates occurring cheap amoxil canada in rural counties.

Those numbers aren’t much different from a typical year, says Karl Rosston, suicide prevention coordinator for the state’s Department of Public Health and Human Services. The state has had one of the highest suicide rates in the country each year for decades. As social distancing drags on, fatality numbers climb and the economic impacts of the amoxil start to take hold of cheap amoxil canada families, Rosston says, and he expects to see more suicide attempts in December and January.

€œWe’re hoping we’re wrong in this, of course,” he said. For rural teenagers, in particular, the isolation caused by school closures and curtailed or canceled sports seasons can tax their mental health. €œPeers are a cheap amoxil canada huge factor for kids.

If they’re cut off, they’re more at risk,” Rosston says. Furthermore, teen suicides tend to cluster, especially in rural areas cheap amoxil canada. Every suicide triples the risk that a surviving loved one will follow suit, Rosston says.

On average, every person who dies by suicide has six survivors who are affected deeply by the loss. €œWhen talking about small tribal communities, that jumps to 25 cheap amoxil canada to 30,” he says. Maria Vega, a 22-year-old member of the Fort Peck Tribes, knows this kind of contagious grief.

In 2015, after finding the body of a close friend who had died by suicide, Vega attempted suicide as well. She is now a youth cheap amoxil canada representative for a state-run suicide prevention committee that organizes conferences and other events for young people. Vega is a nursing student who lives six hours away from her family, making it difficult to travel home.

She contracted buy antibiotics in cheap amoxil canada October and was forced to isolate, increasing her sense of removal from family. While isolated, Vega was able to attend therapy sessions through a telehealth system set up by her university. €œI really do think therapy is something that would help people while they’re alone,” she says.

But Vega points out cheap amoxil canada that this is not an option for many people on rural reservations who don’t have computers or reliable internet access. The therapists who do offer telehealth services have long waitlists. Frederick Lee presents a suicide prevention program called QPR (Question, Persuade, Refer) in Scobey, Montana.

Organizations offering youth suicide intervention and prevention initiatives are cheap amoxil canada struggling to sustain the same level of services during the amoxil. Sara Reardon Other prevention programs are having difficulties operating during the amoxil. Brockie, who studies health delivery in disadvantaged populations, has twice had to delay the cheap amoxil canada launch of an experimental training program for Native parents.

In this project, local workers will meet individually with 120 parents with young children and teach resiliency, cultural knowledge and parenting skills. Brockie hopes that by strengthening family and community connections through this novel method, the program will lower these children’s risk of substance abuse and suicide later in life. At Fort Peck, the reservation’s mental health center has had to scale down its youth events that teach leadership skills and traditional practices like horseback riding and archery, cheap amoxil canada as well as workshops on topics like coping with grief.

The cultural events, which Manning says usually draw 200 people or more, are intended to take teenagers’ minds away from depression and allow them to have conversations about suicide, a taboo topic in many Native cultures. The few events, such as coping skills, that can go forward are limited now to a handful of people at a time. Tribes, rural states and other organizations running youth suicide intervention and prevention initiatives are struggling to sustain the cheap amoxil canada same level of services.

Using money from the federal CARES Act and other sources, Montana’s Office of Public Instruction ramped up online suicide prevention training for teachers, while Rosston’s office has beefed up counseling resources people can access via the phone. On the national level, the Center for Native American Youth in Washington, D.C., hosts biweekly webinars for young people to talk about their hopes and concerns. Executive Director Nikki Pitre says that on average around 10,000 young cheap amoxil canada people log in each week.

In the CARES Act, the federal government allocated $425 million for mental health programs, $15 million of which was set aside for Native health organizations. Pitre hopes the amoxil will bring attention to the historical inequities that the led to lack of health care cheap amoxil canada and resources on reservations, and how they enable the twin epidemics of buy antibiotics and suicide. €œThis amoxil has really opened up those wounds,” she says.

€œWe’re clinging even more to the resiliency of culture.” In Wolf Point, Natalie Keiser experienced that resiliency and support firsthand. The Fort Peck community has come together to pay for cheap amoxil canada Leslie’s funeral. €œThat’s a miracle in itself,” she says.

If you or someone you know may be contemplating suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 or text HOME to 741741 to reach the Crisis Text Line. In emergencies, call 911, cheap amoxil canada or seek care from a local hospital or mental health provider. KHN (Kaiser Health News) is a nonprofit news service covering health issues.

It is an editorially independent program of KFF (Kaiser Family Foundation) that is not cheap amoxil canada affiliated with Kaiser Permanente. Most Popular on TIME 1 1996. Ruth Bader Ginsburg 2 1971.

Angela Davis cheap amoxil canada 3 1938. Frida Kahlo The antibiotics Brief. Everything you need to know about the global spread of buy antibiotics Please enter a valid email address.

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SHARE THIS STORYSuicide prevention efforts usher promise of help for all Americans Dec. 21, 2020, cheap amoxil canada 08:19:00 AM Printable Version Need Viewer Software?. WASHINGTON — The U.S.

Department of Veterans Affairs (VA) announced today the completion of all 2020 priorities established under the President’s Roadmap to Empower Veterans and End a National Tragedy of Suicide (PREVENTS) to end suicide through seamless access to care, a connected research ecosystem and robust community engagement aimed at changing the culture around mental health care and ultimately preventing suicide among Veterans and all Americans. President Trump released the PREVENTS roadmap in June 2020 and to date, PREVENTS has cheap amoxil canada accomplished all nine priorities for the year, including. Launching REACH as a national public health campaign aimed at empowering all Americans to play a critical role in preventing suicide.

Garnering signatures from cheap amoxil canada 42 States and one U.S. Territory on a PREVENTS State Proclamation outlining agreed-upon practices and steps to engage their citizens in suicide prevention. Partnering with VA and the U.S.

Chamber of Commerce Foundation’s Hiring Our Heroes to create a Wellbeing in the Workplace Pledge and Guide to encourage companies cheap amoxil canada to prioritize the mental health and wellness of their employees. More than 50 major U.S. Companies and organizations have already signed the pledge.

€œWe have adopted a public-health cheap amoxil canada approach to suicide prevention that enlists all Americans to recognize the signs of those who are vulnerable and connect them to resources that can help,” said VA Secretary Robert Wilkie. €œI want every Veteran to know that VA is here for you, and we will not relent in our efforts to reach those who are struggling and connect them with lifesaving support.” Achieving the 2020 milestones is fulfilled by the launch of the Suicide Prevention Grand Challenge under a partnership among PREVENTS and the VA Innovation Center in collaboration with the VA Office of Mental Health and Suicide Prevention — who will host a summit in February 2021 with experts in technology, mental health, suicide prevention and related fields to help guide the planning and implementation for the challenge. The summit cheap amoxil canada will build upon success and lessons learned from The White House Summit on Veterans Suicide held in September 2019, and guide efforts for launching, running, judging, and selecting winners of individual competitions in the Suicide Prevention Grand Challenge.

For inquiries on the summit, please contact VASPGChallenge@va.gov. ### If you or someone you know is having thoughts of suicide, contact the Veterans Crisis Line to receive free, confidential support and crisis intervention available 24 hours a day, 7 days a week, 365 days a year. Call 1-800-273-8255 and Press 1, text to 838255 or chat online cheap amoxil canada at VeteransCrisisLine.net/Chat.

Media covering this issue can download VA’s Safe Messaging Best Practices fact sheet or visit www.ReportingOnSuicide.org for important guidance on how to communicate about suicide. Disclaimer of HyperlinksThe appearance of external hyperlinks does not constitute endorsement by the Department of Veterans Affairs of the linked web sites, or the information, products or services contained therein. For other than authorized VA activities, the Department does not exercise any editorial control over the information you may find at cheap amoxil canada these locations.

All links are provided with the intent of meeting the mission of the Department and the VA website. Please let us know about existing external links which you believe are inappropriate and about specific additional external links which you believe ought to be included by emailing newmedia@va.gov..

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In 2021, more than 880 of you submitted ideas amoxil for urinary tract for KHN-NPR’s Bill of the Month investigative series, trusting us with two of the most personal topics in life. Your health and your money. We are amoxil for urinary tract deeply grateful. Our trove of bills and stories — building steadily to nearly 5,000 since February 2018 — tells us that American health care’s financial toll is a burden for far too many people, and that our health system is often better at promoting its own financial interests than protecting the public. The stories we told in 2021 illuminate some practices that have been happening for decades and others that are new.

We met Kyunghee Lee, who wanted to know why the amoxil for urinary tract bill for her arthritis injection was suddenly 10 times more when her doctor’s office moved one floor up. And we met the Salerno family, who helped us discover how “obstetric emergency departments” mean supersized bills for even the healthiest, most routine births. In case you missed any, take time to read about and listen to each of our Bill of the Month episodes from this year — and help protect yourself from sticker shock. We head into 2022 with a new federal law against surprise medical bills, which takes effect amoxil for urinary tract Jan. 1.

Though it is far from a perfect law, it is an answer to a conversation our Bill of the Month patient, Drew Calver, helped start in 2018 when he wrote in about the $109,000 bill he owed after his heart attack, despite insurance. We embark on the fifth year of our crowdsourced investigation with more federal legislation introduced as amoxil for urinary tract a result of a Bill of the Month feature — it would be great if that fix for the arbitrary “birthday rule” that can ensnare new parents in red tape took less than four years to remedy. Click on the people below to hear their stories. Bill of the Month is a crowdsourced investigation by KHN and NPR that dissects and amoxil for urinary tract explains medical bills. Do you have an interesting medical bill you want to share with us?.

Tell us about it!. Related Topics Contact Us Submit a Story amoxil for urinary tract TipAfter Amanda Wilson lost her son, Braden, 15, to buy antibiotics in early 2021, she tried to honor his memory. She put up a lending library box in his name. She plans to give the money she saved for his college education to other teens who love the arts and technology. But in amoxil for urinary tract one area, she hit a brick wall.

Attempting to force change at the California hospital where she believes her son contracted buy antibiotics in December 2020. While seeking treatment for a bleeding cyst, Braden was surrounded for hours by coughing patients in the emergency room, Wilson said. Yet, she said, she has been unable to amoxil for urinary tract get the hospital to show her improvements it told her it made or get a lawyer to take her case. €œI was pretty shocked,” Wilson said. €œThere’s truly amoxil for urinary tract no recourse.” Throughout the amoxil, lawmakers from coast to coast have passed laws, declared emergency orders or activated state-of-emergency statutes that severely limited families’ ability to seek recourse for lapses in buy antibiotics-related care.

Under such liability shields, legal advocates say, it’s nearly impossible to seek the legal accountability that can pry open information and drive systemic improvements to the -control practices that make hospitals safer for patients. €œLawsuits are there for accountability and truth to be exposed,” said Kate Miceli, state affairs counsel for the American Association for Justice, which advocates for plaintiff lawyers. €œThese laws are absolutely preventing that.” A amoxil for urinary tract previous KHN investigation documented that more than 10,000 people tested positive for buy antibiotics after they were hospitalized for something else in 2020. Yet many others, including Braden Wilson, are not counted in those numbers because they were discharged before testing positive. Still, the KHN findings are the only nationally publicly available data showing rates of patients who tested positive for buy antibiotics after admission into individual U.S.

Hospitals. Those who have lost a family member say hospitals need to be held more accountable. €œMy mom is not like one of those people who would say ‘Go sue them,’” said Kim Crail, who believes her 79-year-old mom contracted buy antibiotics during an eight-day stay at a hospital in Edgewood, Kentucky, because she tested positive less than 48 hours after leaving. €œBut she just wouldn’t want it to happen to anyone else.” ‘You Put Your Trust in the Hospital’ At age 89, Yan Keynigshteyn had begun to fade with dementia. But he was still living at home until he was admitted to Ronald Reagan UCLA Medical Center in Los Angeles for a urological condition, according to Terry Ayzman, his grandson.

Keynigshteyn, a Soviet Union emigrant who did not understand English, found himself in an unfamiliar place with masked caregivers. The hospital confined him to his bed, Ayzman said. He did not understand how to navigate the family’s Zoom calls and, eventually, stopped talking. He was tested regularly for buy antibiotics during his two-week-plus stay, Ayzman said. On Keynigshteyn’s way home in an ambulance, his doctor got test results showing he had tested positive for buy antibiotics.

It can take two to 14 days from exposure to buy antibiotics for patients to start showing symptoms such as a fever, though the average is four to five days. His grandson believes that because Keynigshteyn was in the hospital for over two weeks before testing positive, he contracted buy antibiotics at Ronald Reagan UCLA Medical Center. As the ambulance doors opened and Keynigshteyn finally saw his wife and other family members, he smiled for the first time in weeks, Ayzman said. Then the crew slammed the doors shut and took him back to the hospital. Yan Keynigshteyn ― pictured with his wife, Yanina — died of buy antibiotics in February 2021, according to grandson Terry Ayzman.

(Terry Ayzman) A few days later, Keynigshteyn died. €œYou put your trust in the hospital and you get the short end of the stick,” Ayzman said. €œIt wasn’t supposed to be like that.” Ayzman wanted to find out more from the hospital, but he said officials there refused to give him a copy of its investigation into his grandfather’s case, saying it was an internal matter and the results were inconclusive. Hospital spokesperson Phil Hampton did not answer questions about Keynigshteyn. €œUCLA Health’s overriding priority is the safety of patients, employees, visitors and volunteers,” he said, adding that the health system has been consistent with or exceeded -control protocols at the local, state and federal level throughout the amoxil.

Ayzman reached out to five lawyers, but he said none would take the case. He said they all told him courts were unsympathetic to cases against health care institutions at the time. €œI don’t believe that a state of emergency should give a license to hospitals to get away with things scot-free,” Ayzman said. Terry Ayzman says his grandfather Yan Keynigshteyn tested positive for buy antibiotics over two weeks after being admitted to Ronald Reagan UCLA Medical Center in Los Angeles for treatment of a urological condition.(Terry Ayzman) The Current State of Legal Play The avalanche of liability shield legislation was pitched as a way to prevent a wave of lawsuits, Miceli said. But it created an “unreasonable standard” for patients and families, she said, since a state-of-emergency raises the bar for filing medical malpractice cases and already makes many lawyers hesitant to take such cases.

Almost every state put extra liability shield protections in place during the amoxil, Miceli said. Some of them broadly protected institutions such as hospitals, while others were more focused on shielding health care workers. Corporate-backed groups, including the American Legislative Exchange Council, the U.S. Chamber of Commerce Institute for Legal Reform, American Tort Reform Association and the National Council of Insurance Legislators, helped pass a range of liability shield bills across the country through lobbying, working with state partners or drafting forms of model legislation, a KHN review has found. William Melofchik, general counsel for NCOIL, said member legislators drafted their model bill because they felt it was important to guard against a never-ending wave of litigation and to be “better safe than sorry.” Nathan Morris, vice president of legislative affairs for the Chamber’s Institute for Legal Reform, said his group’s work had influenced states across the country to implement what he called timely and effective protections for hospitals that were trying to do the right thing while working through a harrowing amoxil.

€œNothing that we advocated for would slam the courthouse door in the face of someone who had a claim that was clearly legitimate,” he said. The other two organizations did not answer questions about their involvement in such work by deadline. Braden Wilson was passionate about the arts and technology. His mother, Amanda Wilson, plans to give the money she saved for his college education to teens with similar interests. (Amanda Wilson) Joanne Doroshow, executive director of the Center for Justice &.

Democracy at New York Law School, said such powerful corporate lobbying interests used the broader “health care heroes” moment to push through lawsuit protections for institutions like hospitals. She believes they will likely worsen patient outcomes. €œThe fact that the hospitals were able to get immunity under these laws is pretty offensive and dangerous,” she said. Some of the measures were time-limited or linked to public emergencies that have since expired, but, Miceli said, more than half of states still have some form of expanded liability laws and executive orders in place. Florida legislators are currently working to extend its protections to mid-2023.

Doctors’ groups and hospital leaders say they must have legal immunity in times of crisis. €œLiability protections can be incredibly important because they do encourage providers to continue working and to continue actually providing care in incredibly troubling emergency circumstances,” said Jennifer Piatt, a deputy director of the Western Region Office for the Network for Public Health Law. Akin Demehin, director of policy for the American Hospital Association, said it’s important to remember the severe shortages in testing and personal protective equipment at the start of the amoxil. He added that the health care workforce faced tremendous strain as it had to juggle new roles amid personnel shortages, along with ever-evolving federal guidance and understanding of how the antibiotics spreads. Piatt cautioned that appropriately calibrating liability shields is delicate work, as protections that are too broad can deprive patients of their ability to seek recourse.

Those wanting to learn more about how buy antibiotics spreads within a U.S. Hospital have few resources. Dr. Abraar Karan, now an infectious diseases fellow at Stanford, and other researchers examined buy antibiotics transmission rates among roommates at Brigham and Women’s Hospital in Boston. But few hospitals have dug deep on the topic, he said, which could reflect the stretched-thin resources in hospitals or a fear of negative media coverage.

€œThere should be dialogue from the lessons learned,” Karan said. €˜Do Not Put Anything in Writing’ Crail and Kelly Heeb lost their mother, Sydney Terrell, to buy antibiotics early in 2021. The sisters believe she caught it during her more-than-weeklong stay at St. Elizabeth Edgewood Hospital outside Cincinnati following a hernia repair surgery. Sydney Terrell died Jan.

8, 2021, after a tough battle with buy antibiotics, according to her daughters. Kim Crail and Kelly Heeb believe their 79-year-old mother caught the antibiotics at St. Elizabeth Edgewood Hospital in Kentucky during an eight-day stay following a hernia repair surgery. (Kim Crail) They said she spent hours in an ER separated from other patients only by curtains and did not wear a mask in her patient room while she recovered. She was discharged from the hospital complaining about tightness in her chest, the sisters said.

Within 24 hours, she spiked a fever. The next day, she was back in the ER, where she tested positive for buy antibiotics on Christmas Eve 2020, they said. After a difficult bout with the amoxil, Terrell died Jan. 8. When Crail attempted to file a complaint detailing their concerns, she said a hospital risk management employee told her.

€œâ€˜No, do not put anything in writing.’” Crail filed cursory paperwork anyway. She received the hospital’s conclusion in the mail in an envelope postmarked Dec. 1, more than seven months after the April 27 date typed at the top of the letterhead. The letter stated the St. Elizabeth Healthcare oversight committee determined it was “unable to substantiate” that their mother contracted buy antibiotics in the hospital due to high community transmission rates, incubation timing and unreliable buy antibiotics tests.

The letter did note that despite the hospital system’s extensive protocols, “the risks of transmission will always exist.” Guy Karrick, a spokesperson for the hospital, did not comment on the sisters’ specific case but said “we have not and would not tell any patient or family not to put their concerns in writing.” He added that the hospital has been following all federal and state guidelines to protect its patients. Braden’s mom, Amanda Wilson, had far more dialogue with the hospital where she thinks her son got buy antibiotics. But it still left her with doubts that she made an impact. When her son was in the Adventist Health Simi Valley ER in December 2020 in a bed separated by curtains, they could hear staffers periodically reminding coughing patients around them to keep on their masks. She and Braden kept their own masks on for the vast majority of their several-hours-long stay, she said, but staffers in their bay didn’t always have their own masks pulled up.

Hospital spokesperson Alicia Gonzalez said staffers “track s that may occur in our facilities and we have no verified of any patient or visitor of buy antibiotics in our facility,” adding that the hospital is “dedicated to serving our community and ensuring the safety of all who are cared for at our hospital.” After losing her 15-year-old son, Braden, to buy antibiotics, Amanda Wilson says she hopes to “leave little pieces of him out in the world.” (Amanda Wilson) Wilson, a mathematician who works in the aerospace industry, expected the hospital to be able to show her evidence of some of the changes she discussed with hospital officials, including its president. For one, she hoped the staffers would get trained by a physician with direct experience treating the buy antibiotics complication that made her son fatally ill, called MIS-C, or multisystem inflammatory syndrome. She also had hoped to see proof that the hospital installed no-touch faucets in the ER bathroom, which would help limit the spread of s. Gonzalez said that hospital executives listened to Wilson’s concerns and met with her on more than one occasion and that the hospital has improved its internal processes and procedures as it has learned about transmissibility and best practices. But Wilson said they wouldn’t send her photos or let her see the changes for herself.

The hospital declined to list or provide evidence of the changes to KHN as well. €œIt made me more angry,” Wilson said. €œHere I tried to make it better for people. I couldn’t make it better for Braden, but for people who’d come to this hospital — it is the only hospital in our town.” She said she reached out to a lawyer, who told her there would be no way to prove how Braden caught buy antibiotics. She had no other way to force more of a reckoning over her son’s death.

So, she said, she has turned to other ways to “leave little pieces of him out in the world.” Lauren Weber. LaurenW@kff.org, @LaurenWeberHP Christina Jewett. ChristinaJ@kff.org, @by_cjewett Related Topics Contact Us Submit a Story TipERLANGER, Ky. €” The sleek corporate offices of one of Amazon’s air freight contractors looms over Villaspring of Erlanger, a stately nursing home perched on a hillside in this Cincinnati suburb. Amazon Prime Air cargo planes departing from a recently opened Amazon Air Hub roar overhead.

Its Prime semi-trucks speed along the highway, rumbling the nursing home’s windows. This is daily life in the shadow of Amazon. €œWe haven’t even seen the worst of it yet,” said John Muller, chief operating officer of Carespring, Villaspring’s operator. €œThey are still finishing the Air Hub.” Amazon’s ambitious expansion plans in northern Kentucky, including the $1.5 billion, 600-acre site that will serve as a nerve center for Amazon’s domestic air cargo operations, have stoked anxieties among nursing home administrators in a region where the unemployment rate is just 3%. Already buckling from an exodus of amoxil-weary health care workers, nursing homes are losing entry-level nurses, dietary aides and housekeepers drawn to better-paying jobs at Amazon.

The average starting pay for an entry-level position at Amazon warehouses and cargo hubs is more than $18 an hour, with the possibility of as much as $22.50 an hour and a $3,000 signing bonus, depending on location and shift. Full-time jobs with the company come with health benefits, 401(k)s and parental leave. By contrast, even with many states providing a temporary buy antibiotics bonus for workers at long-term care facilities, lower-skilled nursing home positions typically pay closer to $15 an hour, often with minimal sick leave or benefits. Nursing home administrators contend they are unable to match Amazon’s hourly wage scales because they rely on modest reimbursement rates set by Medicaid, the government program that pays for long-term care. Across the region, nursing home administrators have shut down wings and refused new residents, irking families and making it more difficult for hospitals to discharge patients into long-term care.

Modest pay raises have yet to rival Amazon’s rich benefits package or counter skepticism about the benefits of a nursing career for a younger generation. €œAmazon pays $25 an hour,” said Danielle Geoghegan, business manager at Green Meadows Health Care Center in Mount Washington, Kentucky, a nursing home that has lost workers to the Amazon facility in Shepherdsville. The alternative?. “They come here and deal with people’s bodily fluids.” The nursing home industry has long employed high school graduates to feed, bathe, toilet and tend to dependent and disabled seniors. But facilities that sit near Amazon’s colossal distribution centers are outgunned in the bidding war.

€œChick-fil-A can raise their prices,” said Betsy Johnson, president of the Kentucky Association of Health Care Facilities. €œWe can’t pass the costs on to our customer. The payer of the service is the government, and the government sets the rates.” And while gripes about fast-food restaurants having to close indoor dining because of a worker shortage have ricocheted around Kentucky, Johnson said nursing homes must remain open every day, every hour of the year. €œWe can’t say, ‘This row of residents won’t get any services today,’” she said. Reaching Upstream Nationwide, long-term care facilities are down 221,000 jobs since March 2020, according to a recent report from the American Health Care Association and National Center for Assisted Living, an organization that represents 14,000 nursing homes and assisted living communities caring for 5 million people.

While many hospitals and physicians’ offices have managed to replenish staffing levels, the report says long-term care facilities are suffering a labor crisis worse “than any other health care sector.” Industry surveys show 58% of nursing homes have limited new admissions, citing a dearth of employees. Kentucky and other states are relying on free or low-cost government-sponsored training programs to fill the pipeline with new talent. Luring recruits falls to teachers like Jimmy Gilvin, a nurse’s aide instructor at Gateway Community and Technical College in Covington, Kentucky, one of the distressed River Cities tucked along the Ohio River. On a recent morning, Gilvin stood over a medical dummy tucked into a hospital bed, surrounded by teenagers and young adults, each toting a “Long-Term Care Nursing Assistance” textbook. Gilvin held a toothbrush and toothpaste, demonstrating how to clean a patient’s dentures — “If someone feels clean, they feel better,” he said — and how to roll unconscious patients onto their side.

The curriculum covers the practical aspects of working in a nursing home. Bed-making, catheter care, using a bedpan and transferring residents from a wheelchair to a bed. €œIt takes a very special person to be a certified nursing assistant,” Gilvin said. €œIt’s a hard job, but it’s a needed job.” Over the past five years, Gilvin has noticed sharp attrition. €œMost of them are not even finishing, they’re going to a different field.” In response, nursing schools are reaching further upstream, recruiting high school students who can attend classes and graduate from high school with a nurse’s aide certificate.

€œWe’re getting them at a younger age to spark interest in the health care pathways,” said Reva Stroud, coordinator of the health science technology and nurse’s aide programs at Gateway. Stroud has watched, with optimism, the hourly rate for nurse’s aides rise from $9 an hour to around $15. But over the years that she’s directed the program, she said, fewer students are choosing to begin their careers as aides, a position vital to nursing home operations. Instead, they are choosing to work at Walmart, McDonald’s or Amazon. €œThere is a lot of competition for less stress,” Stroud said.

A staunch believer in the virtue of nursing, she is disheartened by the responses from students. €œâ€˜Well, I could go pack boxes and not have to worry about someone dying and make more money.’” Even for those who want a career in nursing, becoming a picker and packer at Amazon carries strong appeal. The company covers 100% of tuition for nursing school, among other fields, and has contracted with community colleges to provide the schooling. Amazon is putting Kayla Dennis, 30, through nursing school. She attended a nursing assistant class at Gateway but decided against a career as a nurse’s aide or certified nursing assistant.

Instead, she works at the Amazon fulfillment center in Hebron, Kentucky, for $20.85 an hour with health insurance and retirement benefits while attending school to become a registered nurse, a position requiring far more training with high earning potential. €œAmazon is paying 100% of my school tuition and books,” Dennis said. €œOn top of that, they work around my school schedule.” Waiting for a Rising Tide The nursing home workforce shortages are not a top concern for the state and local economic development agencies that feverishly pursue deals with Amazon. Cities nationwide have offered billions of dollars in tax breaks, infrastructure upgrades and other incentives to score a site, and the spoils abound. Amazon has opened at least 250 warehouses this year alone.

Amazon has been a prominent force in northern Kentucky, resurfacing the landscape with titanic warehouses and prompting pay bumps at Walmart, fast-food franchises and other warehouse companies. The company has “made significant investments in our community,” said Lee Crume, chief executive officer of Northern Kentucky Tri-County Economic Development Corp. €œI’m hard-pressed to say something negative.” Amazon representatives did not respond to interview requests for this story. Some labor experts said Amazon’s “spillover effect” — the bidding up of wages near its hubs — suggests companies can afford to compensate workers at a higher rate without going out of business. Clemens Noelke, a research scientist at Brandeis University, said that is true — to a point.

Because Amazon draws workers indiscriminately from across the low-wage sector, rather than tapping into a specific skill profile, it is hitting sectors with wildly different abilities to adapt. Industries like nursing homes, home health care agencies and even public schools that rely on government funding and are hampered in raising wages are likely to lose out. €œThere are some employers who are at the margin, and they will be pushed out of business,” Noelke said. A survey conducted in November by the Kentucky Association of Health Care Facilities found 3 in 5 skilled nursing facilities, assisted living communities and care homes were concerned about closing given the number of job vacancies. The solutions proffered by state legislators rely largely on nurse training programs already offered by community colleges like Gateway.

Republican Rep. Kimberly Poore Moser, a registered nurse who chairs the state’s Health and Family Services Committee, said that while legislators must value health care jobs, “we have a finite number of dollars. If we increase salaries for one sector of the health care population, what are we going to cut?. € Moser said Kentucky’s bet on Amazon will pay off, eventually. €œThe more we inject into our economy, the more our Medicaid budget will grow,” she said.

That confidence in a rising-tide-lifts-all-boats approach frustrates Johnson, president of the Kentucky Association of Health Care Facilities. Lawmakers have difficulty grasping the complexity of financing a nursing home, she said, noting that Kentucky’s Medicaid reimbursement rates stagnated at a one-tenth of 1% increase for five years, before receiving a larger increase to offset inflation the past two years. The Biden administration’s Build Back Better Act, still before Congress, would infuse billions of dollars into in-home care and community-based services for seniors, largely through federal Medicaid payments. It includes funding aimed at stimulating recruitment and training. But the measure is focused largely on expanding in-home care, and it’s not clear yet how it might affect nursing home pay rates.

For now, the feeding frenzy continues. Just off Interstate 65 in Shepherdsville, Wendy’s, White Castle and Frisch’s Big Boy dangle offers of “work today, get paid tomorrow.” FedEx signs along the grassy medians that once advertised $17 an hour are stickered over with a higher offer of $23. The colossal Amazon warehouse bustles with workers in yellow safety vests. And in nearby Mount Washington, Sherrie Wathen, administrator of the Green Meadows nursing home, strains to fill a dozen vacancies, knowing she can’t match Amazon’s package for her entry-level slots. Instead, Wathen, who began her own nursing career at 18, tells prospective employees to consider life at a factory.

€œYou’re going to have the same day over and over.” At the nursing home, she said, “I am the only family this lady has. I get to make an impact rather than packing an item in a box.” Sarah Varney. svarney@kff.org, @SarahVarney4 Related Topics Contact Us Submit a Story TipSTATENVILLE, Ga. €” Georgia’s Echols County, which borders Florida, could be called a health care desert. It has no hospital, no local ambulances.

A medical provider comes to treat patients at a migrant farmworker clinic but, other than a small public health department with two full-time employees, that’s about the extent of the medical care in the rural county of 4,000 people. In an emergency, a patient must wait for an ambulance from Valdosta and be driven to a hospital there, or rely on a medical helicopter. Ambulances coming from Valdosta can take up to 20 minutes to arrive, said Bobby Walker, county commission chairman. €œThat’s a pretty good wait for an ambulance,” he added. Walker tried to establish an ambulance service based in Statenville, the one-stoplight county seat in Echols, but the cost of providing one was projected at $280,000 a year.

Without industry to prop up the tax base, the county couldn’t come up with that kind of money. In many ways, Echols reflects the health care challenges faced in rural areas nationwide, such as limited insurance coverage among residents, gaps in medical services and shortages of providers. Dr. Jacqueline Fincher, an internal medicine physician who practices in rural Thomson, in eastern Georgia, said such communities have a higher share of people 65 and older, who need extensive medical services, and a much higher incidence of poverty, including extreme poverty, than the rest of the country. About 1 in 4 Echols residents has no health insurance, for example, and almost one-third of the children live in poverty, according to the County Health Rankings and Roadmaps program from the University of Wisconsin’s Population Health Institute.

Like Echols, several Georgia counties have no physician at all. It’s difficult to recruit doctors to a rural area if they haven’t lived in such an environment before, said Dr. Tom Fausett, a family physician who grew up and still lives in Adel, a southern Georgia town. About 20% of the nation lives in rural America, but only about 10% of U.S. Physicians practice in such areas, according to the National Conference of State Legislatures.

And 77% of the country’s rural counties are designated as health professional shortage areas. About 4,000 additional primary care practitioners are needed to meet current rural health care needs, the Health Resources and Services Administration has estimated. €œMany physicians haven’t experienced life in a rural area,” said Dr. Samuel Church, a family medicine physician who helps train medical students and residents in the northern Georgia mountain town of Hiawassee. €œSome of them thought we were Alaska or something.

I assure them that Amazon delivers here.” Rural hospitals also have trouble recruiting nurses and other medical personnel to fill job vacancies. €œWe’re all competing for the same nurses,” said Jay Carmichael, chief operating officer of Southwell Medical, which operates the hospital in Adel. Even in rural areas that have physicians and hospitals, connecting a patient to a specialist can be difficult. €œWhen you have a trauma or cardiac patient, you don’t have a trauma or cardiac team to take care of that patient,” said Rose Keller, chief nursing officer at Appling Healthcare in Baxley, in southeastern Georgia. Access to mental health care is also a major problem, said Dr.

Zita Magloire, a family physician in Cairo, a city in southern Georgia with about 10,000 residents. €œIt’s almost nonexistent here.” Dr. Zita Magloire, a family physician in Cairo, Georgia, says access to mental health treatment for patients is a major problem in rural areas. €œIt’s almost nonexistent here,” she says.(Andy Miller/KHN) A map created at Georgia Tech shows wide swaths of rural counties without access to autism services, for example. One factor behind this lack of health care providers is what rural hospital officials call the “payer mix.” Many patients can’t pay their medical bills.

The CEO of Emanuel Medical Center in Swainsboro, Damien Scott, said 37% of the hospital’s emergency room patients have no insurance. And a large share of rural hospitals’ patients are enrolled in Medicaid or Medicare. Medicaid typically pays less than the cost of providing care, and although Medicare reimbursements are somewhat higher, they’re lower than those from private insurance. €œThe problem with rural hospitals is the reimbursement mechanisms,” said Kirk Olsen, managing partner of ERH Healthcare, a company that manages four hospitals in rural Georgia. Georgia is one of 12 states that have not expanded their Medicaid programs under the Affordable Care Act.

Doing so would make additional low-income people eligible for the public insurance program. Would that help?. “Absolutely,” said Olsen, echoing the comments of almost everyone interviewed during a monthslong investigation by Georgia Health News. €œIf Medicaid was expanded, hospitals may become more viable,” said Dr. Joe Stubbs, an internist in Albany, Georgia.

€œSo many people go into a hospital who can’t pay.” Echols County isn’t the only place where ambulance service is spotty. Ambulance crews in some rural areas have stopped operating, leaving the remaining providers to cover greater distances with limited resources, said Brock Slabach, chief operations officer of the National Rural Health Association. It’s difficult for a local government to afford the cost of the service when patient volumes in sparsely populated rural areas are very low, he said. €œIf people aren’t careful, they’re going to wake up and there’s not going to be rural health care,” said Richard Stokes, chief financial officer of Taylor Regional Hospital in Hawkinsville, Georgia. €œThat’s my big worry.” Andy Miller.

amiller@kff.org, @gahealthnews Related Topics Contact Us Submit a Story TipOwen Loney’s surprise bill resulted from an emergency appendectomy in 2019 at a Richmond, Virginia, hospital. Insurance covered most of the cost of the hospital stay, he said. He didn’t pay much attention to a bill he received from Commonwealth Anesthesia Associates and expected his insurance to cover it. A few months ago, he got a notice that Commonwealth was suing him in Richmond General District Court for $1,870 for putting him under during the surgery, court records show. €œWow, seriously?.

€ the 30-year-old information technology manager recalled thinking after getting the court summons. Loney didn’t have that kind of money at hand. His plan was to try to negotiate down the amount or “take out another credit card to pay for it.” Loney’s is a classic, notorious type of surprise bill that Congress and activists have worked for years to eliminate. An out-of-network charge not covered by insurance even though the patient had an emergency procedure or sought care at an in-network hospital thinking insurance would cover most charges. Commonwealth said it was in-network for Loney’s insurer, UnitedHealthcare.

But the insurer rejected the anesthesiology charge because it said his primary care doctor was out of network, claims records show. The federal No Surprises Act, passed at the end of 2020, has been hailed by consumer advocates for prohibiting such practices. Starting Jan. 1, medical companies in most cases cannot bill patients more than in-network amounts for any emergency treatment or out-of-network care delivered at an in-network hospital. But as much as the legislation is designed to protect millions of patients from unexpected financial consequences, it will hardly spare all consumers from medical billing surprises.

€œIt’s great that there will be surprise billing protections … but you’re still going to see lawsuits,” said Zack Cooper, an economist and associate professor at the Yale School of Public Health. €œThis is by no means going to get rid of all of the problems with billing.” The law will kick in too late for Loney and many others saddled with surprise out-of-network bills in states that don’t already ban the practice. €œIt doesn’t prohibit surprise bills that are happening now in states that don’t have protections” against them, said Erin Fuse Brown, a law professor at Georgia State University who studies hospital billing. €œAnd it doesn’t prohibit collection activity for surprise bills that arose prior to January.” Virginia’s surprise-bill protection law took effect only this year and doesn’t apply to self-insured employer health plans, which cover a large portion of residents. The federal legislation also does nothing to reduce another kind of unpleasant, often surprising bill — large, out-of-pocket payments for in-network medical care that many Americans can’t afford and might not have realized they were incurring.

Two substantial changes in recent years shifted more risk to patients. Employers and other payers narrowed their provider networks to exclude certain high-cost hospitals and doctors, making them out of network for more patients. They also drastically increased deductibles — the amount patients must pay each year before insurance starts contributing. The No Surprises Act addresses the first change. It does nothing to address the second.

For a snapshot of the past and future of surprise and disputed medical bills, KHN examined Commonwealth’s lawsuits against patients in central Virginia and attended court hearings where patients contested their bills. €œThe whole thing with insurance not covering my bills is a headache,” said Melissa Perez-Obregon, a Richmond-area dance teacher whom Commonwealth sued for $1,287 over services she received during the 2019 birth of her daughter, according to court records. Her insurance paid most but not all of a $5,950 anesthesia charge, billing records show. €œI’m a teacher,” she said, standing in the lobby at Chesterfield County General District Court. €œI don’t have this kind of extra money.” Commonwealth is one of the more active creditors seeking judgments in the Richmond area, court records show.

From 2019 through 2021, it filed nearly 1,500 cases against patients claiming money owed for treatment, according to the KHN analysis of court filings. In numerous cases, it initiated garnishment proceedings, in which creditors seize a portion of patients’ wages. Describing itself as “the largest private anesthesiology practice in Central Virginia,” Commonwealth said it employs more than 100 clinicians who care for roughly 55,000 patients a year in hospitals and surgery centers, mostly in the Richmond area. Commonwealth said more than 99% of the patients it treats are members of insurance plans it accepts. It garnishes wages only as a “last resort” and only if the patient has the ability to pay, Michael Williams, Commonwealth’s practice administrator, said in a written statement.

€œOver the past three years we have filed suit to collect from just over 1% of our patients,” mostly for money owed for in-network deductibles or coinsurance, Williams said. Nearly half the bills are settled before the court date, he said. Gwendolyn Peters, 67, said she was shocked to receive a court summons this summer. Commonwealth was suing her for $1,000 for anesthesia during a lumpectomy for breast cancer in 2019, according to court records. €œThis is the first time I have ever been in this situation,” she said, sitting in the Chesterfield court with half a dozen other Commonwealth defendants.

Because patients typically have little or no control over who puts them under, Brown said, anesthesiologists face less risk to their businesses and reputations than other medical specialists do in using aggressive collections tactics. The specialty is often “one of the worst offenders because they don’t depend on their reputation to get patients,” she said. €œThey’re not going to lose business because they engage in these really aggressive practices that ruin their patients’ finances.” The average annual deductible for single-person coverage from job-based insurance has soared from $303 to $1,434 in the past 15 years, according to KFF. Deductibles for family coverage in many cases exceed $4,000 a year. Coinsurance — the patient’s responsibility after the deductible is met — can add thousands of additional dollars in expenses.

That means millions of patients are essentially uninsured for care that might cost them a substantial portion of their income. Surveys have repeatedly found that many consumers say they would have trouble paying an unexpected bill of even a few hundred dollars. Loney’s insurer, UnitedHealthcare, agreed to pay the bill from Commonwealth for his emergency appendectomy after being contacted by KHN and saying it “updated” information on the claim. Otherwise, Loney said, he couldn’t have paid it without borrowing money. In Richmond-area courthouses, hearings for Commonwealth lawsuits take place every few months.

A lawyer for the anesthesiology practice attends, sometimes making payment arrangements with patients. Many defendants don’t show up, which often means they lose the case and might be subject to garnishment. Commonwealth sued retiree Ronda Grimes, 66, for $1,442 for anesthesia claims her insurance didn’t cover after a 2019 surgery, billing and legal records filed in Richmond General District Court show. €œThat’s a lot of money, especially when you have health insurance,” she said. New research by Cooper and colleagues examining court cases in Wisconsin shows that medical lawsuits are disproportionately filed against people of color and people living in low-income communities.

€œPhysicians are entitled to get paid like everyone else for their services,” Cooper said. But unaffordable, out-of-pocket medical costs are “a systemic issue. And this systemic issue generally falls on the backs of the most vulnerable in our population.” For uninsured patients, Commonwealth matches any financial assistance given by the hospital and will be “enhancing” its financial assistance program in 2022, Williams said. Two of the nine people being sued by Commonwealth and interviewed by KHN at courthouse hearings were Hispanic. Four were Black.

One was Darnetta Jefferson, 61, who underwent a double mastectomy in early 2020 and came to court wearing a cancer-survivor shirt. Commonwealth sued her for $836 it said she owed in coinsurance for anesthesia she was given during the surgery. Commonwealth’s lawyer agreed to drop the lawsuit if she agreed to pay $25 a month toward the balance until it’s paid, she said. €œIf I ever have some extra money to pay it off someday, I will,” said Jefferson, who worked at Ukrop’s supermarket for many years before her cancer forced her to go on disability. €œBut right now, my circumstances are not looking good.” Although she is living on a reduced income, her rent just went up again, said Jefferson, who also survived lung cancer diagnosed in 2009.

Rent now runs close to $1,000 a month. Paying Commonwealth’s bill in monthly $25 increments, she said, means “it’s going to be a long way to go.” Jay Hancock. jhancock@kff.org, @JayHancock1 Related Topics Contact Us Submit a Story Tip.

In 2021, more than 880 of you submitted cheap amoxil canada ideas for KHN-NPR’s Bill of the Month investigative series, trusting us with two of the http://www.massage-energiecenter.at/?slides=header3 most personal topics in life. Your health and your money. We are cheap amoxil canada deeply grateful. Our trove of bills and stories — building steadily to nearly 5,000 since February 2018 — tells us that American health care’s financial toll is a burden for far too many people, and that our health system is often better at promoting its own financial interests than protecting the public. The stories we told in 2021 illuminate some practices that have been happening for decades and others that are new.

We met Kyunghee Lee, who wanted to know why the bill for her arthritis injection was suddenly 10 times more when her doctor’s office moved one floor up cheap amoxil canada. And we met the Salerno family, who helped us discover how “obstetric emergency departments” mean supersized bills for even the healthiest, most routine births. In case you missed any, take time to read about and listen to each of our Bill of the Month episodes from this year — and help protect yourself from sticker shock. We head into 2022 with a new federal law against surprise medical cheap amoxil canada bills, which takes effect Jan. 1.

Though it is far from a perfect law, it is an answer to a conversation our Bill of the Month patient, Drew Calver, helped start in 2018 when he wrote in about the $109,000 bill he owed after his heart attack, despite insurance. We embark on the fifth year of our crowdsourced investigation with more federal legislation introduced as a result of a Bill of the Month feature cheap amoxil canada — it would be great if that fix for the arbitrary “birthday rule” that can ensnare new parents in red tape took less than four years to remedy. Click on the people below to hear their stories. Bill of the Month is a crowdsourced investigation by KHN and cheap amoxil canada NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us?.

Tell us about it!. Related Topics Contact Us Submit a Story TipAfter cheap amoxil canada Amanda Wilson lost her son, Braden, 15, to buy antibiotics in early 2021, she tried to honor his memory. She put up a lending library box in his name. She plans to give the money she saved for his college education to other teens who love the arts and technology. But in one area, cheap amoxil canada she hit a brick wall.

Attempting to force change at the California hospital where she believes her son contracted buy antibiotics in December 2020. While seeking treatment for a bleeding cyst, Braden was surrounded for hours by coughing patients in the emergency room, Wilson said. Yet, she said, she has been unable to get the hospital to show her improvements it told her it made or cheap amoxil canada get a lawyer to take her case. €œI was pretty shocked,” Wilson said. €œThere’s truly no recourse.” Throughout the amoxil, lawmakers from coast to coast have passed laws, declared emergency orders or activated cheap amoxil canada state-of-emergency statutes that severely limited families’ ability to seek recourse for lapses in buy antibiotics-related care.

Under such liability shields, legal advocates say, it’s nearly impossible to seek the legal accountability that can pry open information and drive systemic improvements to the -control practices that make hospitals safer for patients. €œLawsuits are there for accountability and truth to be exposed,” said Kate Miceli, state affairs counsel for the American Association for Justice, which advocates for plaintiff lawyers. €œThese laws are absolutely preventing that.” A previous KHN investigation documented that more cheap amoxil canada than 10,000 people tested positive for buy antibiotics after they were hospitalized for something else in 2020. Yet many others, including Braden Wilson, are not counted in those numbers because they were discharged before testing positive. Still, the KHN findings are the only nationally publicly available data showing rates of patients who tested positive for buy antibiotics after admission into individual U.S.

Hospitals. Those who have lost a family member say hospitals need to be held more accountable. €œMy mom is not like one of those people who would say ‘Go sue them,’” said Kim Crail, who believes her 79-year-old mom contracted buy antibiotics during an eight-day stay at a hospital in Edgewood, Kentucky, because she tested positive less than 48 hours after leaving. €œBut she just wouldn’t want it to happen to anyone else.” ‘You Put Your Trust in the Hospital’ At age 89, Yan Keynigshteyn had begun to fade with dementia. But he was still living at home until he was admitted to Ronald Reagan UCLA Medical Center in Los Angeles for a urological condition, according to Terry Ayzman, his grandson.

Keynigshteyn, a Soviet Union emigrant who did not understand English, found himself in an unfamiliar place with masked caregivers. The hospital confined him to his bed, Ayzman said. He did not understand how to navigate the family’s Zoom calls and, eventually, stopped talking. He was tested regularly for buy antibiotics during his two-week-plus stay, Ayzman said. On Keynigshteyn’s way home in an ambulance, his doctor got test results showing he had tested positive for buy antibiotics.

It can take two to 14 days from exposure to buy antibiotics for patients to start showing symptoms such as a fever, though the average is four to five days. His grandson believes that because Keynigshteyn was in the hospital for over two weeks before testing positive, he contracted buy antibiotics at Ronald Reagan UCLA Medical Center. As the ambulance doors opened and Keynigshteyn finally saw his wife and other family members, he smiled for the first time in weeks, Ayzman said. Then the crew slammed the doors shut and took him back to the hospital. Yan Keynigshteyn ― pictured with his wife, Yanina — died of buy antibiotics in February 2021, according to grandson Terry Ayzman.

(Terry Ayzman) A few days later, Keynigshteyn died. €œYou put your trust in the hospital and you get the short end of the stick,” Ayzman said. €œIt wasn’t supposed to be like that.” Ayzman wanted to find out more from the hospital, but he said officials there refused to give him a copy of its investigation into his grandfather’s case, saying it was an internal matter and the results were inconclusive. Hospital spokesperson Phil Hampton did not answer questions about Keynigshteyn. €œUCLA Health’s overriding priority is the safety of patients, employees, visitors and volunteers,” he said, adding that the health system has been consistent with or exceeded -control protocols at the local, state and federal level throughout the amoxil.

Ayzman reached out to five lawyers, but he said none would take the case. He said they all told him courts were unsympathetic to cases against health care institutions at the time. €œI don’t believe that a state of emergency should give a license to hospitals to get away with things scot-free,” Ayzman said. Terry Ayzman says his grandfather Yan Keynigshteyn tested positive for buy antibiotics over two weeks after being admitted to Ronald Reagan UCLA Medical Center in Los Angeles for treatment of a urological condition.(Terry Ayzman) The Current State of Legal Play The avalanche of liability shield legislation was pitched as a way to prevent a wave of lawsuits, Miceli said. But it created an “unreasonable standard” for patients and families, she said, since a state-of-emergency raises the bar for filing medical malpractice cases and already makes many lawyers hesitant to take such cases.

Almost every state put extra liability shield protections in place during the amoxil, Miceli said. Some of them broadly protected institutions such as hospitals, while others were more focused on shielding health care workers. Corporate-backed groups, including the American Legislative Exchange Council, the U.S. Chamber of Commerce Institute for Legal Reform, American Tort Reform Association and the National Council of Insurance Legislators, helped pass a range of liability shield bills across the country through lobbying, working with state partners or drafting forms of model legislation, a KHN review has found. William Melofchik, general counsel for NCOIL, said member legislators drafted their model bill because they felt it was important to guard against a never-ending wave of litigation and to be “better safe than sorry.” Nathan Morris, vice president of legislative affairs for the Chamber’s Institute for Legal Reform, said his group’s work had influenced states across the country to implement what he called timely and effective protections for hospitals that were trying to do the right thing while working through a harrowing amoxil.

€œNothing that we advocated for would slam the courthouse door in the face of someone who had a claim that was clearly legitimate,” he said. The other two organizations did not answer questions about their involvement in such work by deadline. Braden Wilson was passionate about the arts and technology. His mother, Amanda Wilson, plans to give the money she saved for his college education to teens with similar interests. (Amanda Wilson) Joanne Doroshow, executive director of the Center for Justice &.

Democracy at New York Law School, said such powerful corporate lobbying interests used the broader “health care heroes” moment to push through lawsuit protections for institutions like hospitals. She believes they will likely worsen patient outcomes. €œThe fact that the hospitals were able to get immunity under these laws is pretty offensive and dangerous,” she said. Some of the measures were time-limited or linked to public emergencies that have since expired, but, Miceli said, more than half of states still have some form of expanded liability laws and executive orders in place. Florida legislators are currently working to extend its protections to mid-2023.

Doctors’ groups and hospital leaders say they must have legal immunity in times of crisis. €œLiability protections can be incredibly important because they do encourage providers to continue working and to continue actually providing care in incredibly troubling emergency circumstances,” said Jennifer Piatt, a deputy director of the Western Region Office for the Network for Public Health Law. Akin Demehin, director of policy for the American Hospital Association, said it’s important to remember the severe shortages in testing and personal protective equipment at the start of the amoxil. He added that the health care workforce faced tremendous strain as it had to juggle new roles amid personnel shortages, along with ever-evolving federal guidance and understanding of how the antibiotics spreads. Piatt cautioned that appropriately calibrating liability shields is delicate work, as protections that are too broad can deprive patients of their ability to seek recourse.

Those wanting to learn more about how buy antibiotics spreads within a U.S. Hospital have few resources. Dr. Abraar Karan, now an infectious diseases fellow at Stanford, and other researchers examined buy antibiotics transmission rates among roommates at Brigham and Women’s Hospital in Boston. But few hospitals have dug deep on the topic, he said, which could reflect the stretched-thin resources in hospitals or a fear of negative media coverage.

€œThere should be dialogue from the lessons learned,” Karan said. €˜Do Not Put Anything in Writing’ Crail and Kelly Heeb lost their mother, Sydney Terrell, to buy antibiotics early in 2021. The sisters believe she caught it during her more-than-weeklong stay at St. Elizabeth Edgewood Hospital outside Cincinnati following a hernia repair surgery. Sydney Terrell died Jan.

8, 2021, after a tough battle with buy antibiotics, according to her daughters. Kim Crail and Kelly Heeb believe their 79-year-old mother caught the antibiotics at St. Elizabeth Edgewood Hospital in Kentucky during an eight-day stay following a hernia repair surgery. (Kim Crail) They said she spent hours in an ER separated from other patients only by curtains and did not wear a mask in her patient room while she recovered. She was discharged from the hospital complaining about tightness in her chest, the sisters said.

Within 24 hours, she spiked a fever. The next day, she was back in the ER, where she tested positive for buy antibiotics on Christmas Eve 2020, they said. After a difficult bout with the amoxil, Terrell died Jan. 8. When Crail attempted to file a complaint detailing their concerns, she said a hospital risk management employee told her.

€œâ€˜No, do not put anything in writing.’” Crail filed cursory paperwork anyway. She received the hospital’s conclusion in the mail in an envelope postmarked Dec. 1, more than seven months after the April 27 date typed at the top of the letterhead. The letter stated the St. Elizabeth Healthcare oversight committee determined it was “unable to substantiate” that their mother contracted buy antibiotics in the hospital due to high community transmission rates, incubation timing and unreliable buy antibiotics tests.

The letter did note that despite the hospital system’s extensive protocols, “the risks of transmission will always exist.” Guy Karrick, a spokesperson for the hospital, did not comment on the sisters’ specific case but said “we have not and would not tell any patient or family not to put their concerns in writing.” He added that the hospital has been following all federal and state guidelines to protect its patients. Braden’s mom, Amanda Wilson, had far more dialogue with the hospital where she thinks her son got buy antibiotics. But it still left her with doubts that she made an impact. When her son was in the Adventist Health Simi Valley ER in December 2020 in a bed separated by curtains, they could hear staffers periodically reminding coughing patients around them to keep on their masks. She and Braden kept their own masks on for the vast majority of their several-hours-long stay, she said, but staffers in their bay didn’t always have their own masks pulled up.

Hospital spokesperson Alicia Gonzalez said staffers “track s that may occur in our facilities and we have no verified of any patient or visitor of buy antibiotics in our facility,” adding that the hospital is “dedicated to serving our community and ensuring the safety of all who are cared for at our hospital.” After losing her 15-year-old son, Braden, to buy antibiotics, Amanda Wilson says she hopes to “leave little pieces of him out in the world.” (Amanda Wilson) Wilson, a mathematician who works in the aerospace industry, expected the hospital to be able to show her evidence of some of the changes she discussed with hospital officials, including its president. For one, she hoped the staffers would get trained by a physician with direct experience treating the buy antibiotics complication that made her son fatally ill, called MIS-C, or multisystem inflammatory syndrome. She also had hoped to see proof that the hospital installed no-touch faucets in the ER bathroom, which would help limit the spread of s. Gonzalez said that hospital executives listened to Wilson’s concerns and met with her on more than one occasion and that the hospital has improved its internal processes and procedures as it has learned about transmissibility and best practices. But Wilson said they wouldn’t send her photos or let her see the changes for herself.

The hospital declined to list or provide evidence of the changes to KHN as well. €œIt made me more angry,” Wilson said. €œHere I tried to make it better for people. I couldn’t make it better for Braden, but for people who’d come to this hospital — it is the only hospital in our town.” She said she reached out to a lawyer, who told her there would be no way to prove how Braden caught buy antibiotics. She had no other way to force more of a reckoning over her son’s death.

So, she said, she has turned to other ways to “leave little pieces of him out in the world.” Lauren Weber. LaurenW@kff.org, @LaurenWeberHP Christina Jewett. ChristinaJ@kff.org, @by_cjewett Related Topics Contact Us Submit a Story TipERLANGER, Ky. €” The sleek corporate offices of one of Amazon’s air freight contractors looms over Villaspring of Erlanger, a stately nursing home perched on a hillside in this Cincinnati suburb. Amazon Prime Air cargo planes departing from a recently opened Amazon Air Hub roar overhead.

Its Prime semi-trucks speed along the highway, rumbling the nursing home’s windows. This is daily life in the shadow of Amazon. €œWe haven’t even seen the worst of it yet,” said John Muller, chief operating officer of Carespring, Villaspring’s operator. €œThey are still finishing the Air Hub.” Amazon’s ambitious expansion plans in northern Kentucky, including the $1.5 billion, 600-acre site that will serve as a nerve center for Amazon’s domestic air cargo operations, have stoked anxieties among nursing home administrators in a region where the unemployment rate is just 3%. Already buckling from an exodus of amoxil-weary health care workers, nursing homes are losing entry-level nurses, dietary aides and housekeepers drawn to better-paying jobs at Amazon.

The average starting pay for an entry-level position at Amazon warehouses and cargo hubs is more than $18 an hour, with the possibility of as much as $22.50 an hour and a $3,000 signing bonus, depending on location and shift. Full-time jobs with the company come with health benefits, 401(k)s and parental leave. By contrast, even with many states providing a temporary buy antibiotics bonus for workers at long-term care facilities, lower-skilled nursing home positions typically pay closer to $15 an hour, often with minimal sick leave or benefits. Nursing home administrators contend they are unable to match Amazon’s hourly wage scales because they rely on modest reimbursement rates set by Medicaid, the government program that pays for long-term care. Across the region, nursing home administrators have shut down wings and refused new residents, irking families and making it more difficult for hospitals to discharge patients into long-term care.

Modest pay raises have yet to rival Amazon’s rich benefits package or counter skepticism about the benefits of a nursing career for a younger generation. €œAmazon pays $25 an hour,” said Danielle Geoghegan, business manager at Green Meadows Health Care Center in Mount Washington, Kentucky, a nursing home that has lost workers to the Amazon facility in Shepherdsville. The alternative?. “They come here and deal with people’s bodily fluids.” The nursing home industry has long employed high school graduates to feed, bathe, toilet and tend to dependent and disabled seniors. But facilities that sit near Amazon’s colossal distribution centers are outgunned in the bidding war.

€œChick-fil-A can raise their prices,” said Betsy Johnson, president of the Kentucky Association of Health Care Facilities. €œWe can’t pass the costs on to our customer. The payer of the service is the government, and the government sets the rates.” And while gripes about fast-food restaurants having to close indoor dining because of a worker shortage have ricocheted around Kentucky, Johnson said nursing homes must remain open every day, every hour of the year. €œWe can’t say, ‘This row of residents won’t get any services today,’” she said. Reaching Upstream Nationwide, long-term care facilities are down 221,000 jobs since March 2020, according to a recent report from the American Health Care Association and National Center for Assisted Living, an organization that represents 14,000 nursing homes and assisted living communities caring for 5 million people.

While many hospitals and physicians’ offices have managed to replenish staffing levels, the report says long-term care facilities are suffering a labor crisis worse “than any other health care sector.” Industry surveys show 58% of nursing homes have limited new admissions, citing a dearth of employees. Kentucky and other states are relying on free or low-cost government-sponsored training programs to fill the pipeline with new talent. Luring recruits falls to teachers like Jimmy Gilvin, a nurse’s aide instructor at Gateway Community and Technical College in Covington, Kentucky, one of the distressed River Cities tucked along the Ohio River. On a recent morning, Gilvin stood over a medical dummy tucked into a hospital bed, surrounded by teenagers and young adults, each toting a “Long-Term Care Nursing Assistance” textbook. Gilvin held a toothbrush and toothpaste, demonstrating how to clean a patient’s dentures — “If someone feels clean, they feel better,” he said — and how to roll unconscious patients onto their side.

The curriculum covers the practical aspects of working in a nursing home. Bed-making, catheter care, using a bedpan and transferring residents from a wheelchair to a bed. €œIt takes a very special person to be a certified nursing assistant,” Gilvin said. €œIt’s a hard job, but it’s a needed job.” Over the past five years, Gilvin has noticed sharp attrition. €œMost of them are not even finishing, they’re going to a different field.” In response, nursing schools are reaching further upstream, recruiting high school students who can attend classes and graduate from high school with a nurse’s aide certificate.

€œWe’re getting them at a younger age to spark interest in the health care pathways,” said Reva Stroud, coordinator of the health science technology and nurse’s aide programs at Gateway. Stroud has watched, with optimism, the hourly rate for nurse’s aides rise from $9 an hour to around $15. But over the years that she’s directed the program, she said, fewer students are choosing to begin their careers as aides, a position vital to nursing home operations. Instead, they are choosing to work at Walmart, McDonald’s or Amazon. €œThere is a lot of competition for less stress,” Stroud said.

A staunch believer in the virtue of nursing, she is disheartened by the responses from students. €œâ€˜Well, I could go pack boxes and not have to worry about someone dying and make more money.’” Even for those who want a career in nursing, becoming a picker and packer at Amazon carries strong appeal. The company covers 100% of tuition for nursing school, among other fields, and has contracted with community colleges to provide the schooling. Amazon is putting Kayla Dennis, 30, through nursing school. She attended a nursing assistant class at Gateway but decided against a career as a nurse’s aide or certified nursing assistant.

Instead, she works at the Amazon fulfillment center in Hebron, Kentucky, for $20.85 an hour with health insurance and retirement benefits while attending school to become a registered nurse, a position requiring far more training with high earning potential. €œAmazon is paying 100% of my school tuition and books,” Dennis said. €œOn top of that, they work around my school schedule.” Waiting for a Rising Tide The nursing home workforce shortages are not a top concern for the state and local economic development agencies that feverishly pursue deals with Amazon. Cities nationwide have offered billions of dollars in tax breaks, infrastructure upgrades and other incentives to score a site, and the spoils abound. Amazon has opened at least 250 warehouses this year alone.

Amazon has been a prominent force in northern Kentucky, resurfacing the landscape with titanic warehouses and prompting pay bumps at Walmart, fast-food franchises and other warehouse companies. The company has “made significant investments in our community,” said Lee Crume, chief executive officer of Northern Kentucky Tri-County Economic Development Corp. €œI’m hard-pressed to say something negative.” Amazon representatives did not respond to interview requests for this story. Some labor experts said Amazon’s “spillover effect” — the bidding up of wages near its hubs — suggests companies can afford to compensate workers at a higher rate without going out of business. Clemens Noelke, a research scientist at Brandeis University, said that is true — to a point.

Because Amazon draws workers indiscriminately from across the low-wage sector, rather than tapping into a specific skill profile, it is hitting sectors with wildly different abilities to adapt. Industries like nursing homes, home health care agencies and even public schools that rely on government funding and are hampered in raising wages are likely to lose out. €œThere are some employers who are at the margin, and they will be pushed out of business,” Noelke said. A survey conducted in November by the Kentucky Association of Health Care Facilities found 3 in 5 skilled nursing facilities, assisted living communities and care homes were concerned about closing given the number of job vacancies. The solutions proffered by state legislators rely largely on nurse training programs already offered by community colleges like Gateway.

Republican Rep. Kimberly Poore Moser, a registered nurse who chairs the state’s Health and Family Services Committee, said that while legislators must value health care jobs, “we have a finite number of dollars. If we increase salaries for one sector of the health care population, what are we going to cut?. € Moser said Kentucky’s bet on Amazon will pay off, eventually. €œThe more we inject into our economy, the more our Medicaid budget will grow,” she said.

That confidence in a rising-tide-lifts-all-boats approach frustrates Johnson, president of the Kentucky Association of Health Care Facilities. Lawmakers have difficulty grasping the complexity of financing a nursing home, she said, noting that Kentucky’s Medicaid reimbursement rates stagnated at a one-tenth of 1% increase for five years, before receiving a larger increase to offset inflation the past two years. The Biden administration’s Build Back Better Act, still before Congress, would infuse billions of dollars into in-home care and community-based services for seniors, largely through federal Medicaid payments. It includes funding aimed at stimulating recruitment and training. But the measure is focused largely on expanding in-home care, and it’s not clear yet how it might affect nursing home pay rates.

For now, the feeding frenzy continues. Just off Interstate 65 in Shepherdsville, Wendy’s, White Castle and Frisch’s Big Boy dangle offers of “work today, get paid tomorrow.” FedEx signs along the grassy medians that once advertised $17 an hour are stickered over with a higher offer of $23. The colossal Amazon warehouse bustles with workers in yellow safety vests. And in nearby Mount Washington, Sherrie Wathen, administrator of the Green Meadows nursing home, strains to fill a dozen vacancies, knowing she can’t match Amazon’s package for her entry-level slots. Instead, Wathen, who began her own nursing career at 18, tells prospective employees to consider life at a factory.

€œYou’re going to have the same day over and over.” At the nursing home, she said, “I am the only family this lady has. I get to make an impact rather than packing an item in a box.” Sarah Varney. svarney@kff.org, @SarahVarney4 Related Topics Contact Us Submit a Story TipSTATENVILLE, Ga. €” Georgia’s Echols County, which borders Florida, could be called a health care desert. It has no hospital, no local ambulances.

A medical provider comes to treat patients at a migrant farmworker clinic but, other than a small public health department with two full-time employees, that’s about the extent of the medical care in the rural county of 4,000 people. In an emergency, a patient must wait for an ambulance from Valdosta and be driven to a hospital there, or rely on a medical helicopter. Ambulances coming from Valdosta can take up to 20 minutes to arrive, said Bobby Walker, county commission chairman. €œThat’s a pretty good wait for an ambulance,” he added. Walker tried to establish an ambulance service based in Statenville, the one-stoplight county seat in Echols, but the cost of providing one was projected at $280,000 a year.

Without industry to prop up the tax base, the county couldn’t come up with that kind of money. In many ways, Echols reflects the health care challenges faced in rural areas nationwide, such as limited insurance coverage among residents, gaps in medical services and shortages of providers. Dr. Jacqueline Fincher, an internal medicine physician who practices in rural Thomson, in eastern Georgia, said such communities have a higher share of people 65 and older, who need extensive medical services, and a much higher incidence of poverty, including extreme poverty, than the rest of the country. About 1 in 4 Echols residents has no health insurance, for example, and almost one-third of the children live in poverty, according to the County Health Rankings and Roadmaps program from the University of Wisconsin’s Population Health Institute.

Like Echols, several Georgia counties have no physician at all. It’s difficult to recruit doctors to a rural area if they haven’t lived in such an environment before, said Dr. Tom Fausett, a family physician who grew up and still lives in Adel, a southern Georgia town. About 20% of the nation lives in rural America, but only about 10% of U.S. Physicians practice in such areas, according to the National Conference of State Legislatures.

And 77% of the country’s rural counties are designated as health professional shortage areas. About 4,000 additional primary care practitioners are needed to meet current rural health care needs, the Health Resources and Services Administration has estimated. €œMany physicians haven’t experienced life in a rural area,” said Dr. Samuel Church, a family medicine physician who helps train medical students and residents in the northern Georgia mountain town of Hiawassee. €œSome of them thought we were Alaska or something.

I assure them that Amazon delivers here.” Rural hospitals also have trouble recruiting nurses and other medical personnel to fill job vacancies. €œWe’re all competing for the same nurses,” said Jay Carmichael, chief operating officer of Southwell Medical, which operates the hospital in Adel. Even in rural areas that have physicians and hospitals, connecting a patient to a specialist can be difficult. €œWhen you have a trauma or cardiac patient, you don’t have a trauma or cardiac team to take care of that patient,” said Rose Keller, chief nursing officer at Appling Healthcare in Baxley, in southeastern Georgia. Access to mental health care is also a major problem, said Dr.

Zita Magloire, a family physician in Cairo, a city in southern Georgia with about 10,000 residents. €œIt’s almost nonexistent here.” Dr. Zita Magloire, a family physician in Cairo, Georgia, says access to mental health treatment for patients is a major problem in rural areas. €œIt’s almost nonexistent here,” she says.(Andy Miller/KHN) A map created at Georgia Tech shows wide swaths of rural counties without access to autism services, for example. One factor behind this lack of health care providers is what rural hospital officials call the “payer mix.” Many patients can’t pay their medical bills.

The CEO of Emanuel Medical Center in Swainsboro, Damien Scott, said 37% of the hospital’s emergency room patients have no insurance. And a large share of rural hospitals’ patients are enrolled in Medicaid or Medicare. Medicaid typically pays less than the cost of providing care, and although Medicare reimbursements are somewhat higher, they’re lower than those from private insurance. €œThe problem with rural hospitals is the reimbursement mechanisms,” said Kirk Olsen, managing partner of ERH Healthcare, a company that manages four hospitals in rural Georgia. Georgia is one of 12 states that have not expanded their Medicaid programs under the Affordable Care Act.

Doing so would make additional low-income people eligible for the public insurance program. Would that help?. “Absolutely,” said Olsen, echoing the comments of almost everyone interviewed during a monthslong investigation by Georgia Health News. €œIf Medicaid was expanded, hospitals may become more viable,” said Dr. Joe Stubbs, an internist in Albany, Georgia.

€œSo many people go into a hospital who can’t pay.” Echols County isn’t the only place where ambulance service is spotty. Ambulance crews in some rural areas have stopped operating, leaving the remaining providers to cover greater distances with limited resources, said Brock Slabach, chief operations officer of the National Rural Health Association. It’s difficult for a local government to afford the cost of the service when patient volumes in sparsely populated rural areas are very low, he said. €œIf people aren’t careful, they’re going to wake up and there’s not going to be rural health care,” said Richard Stokes, chief financial officer of Taylor Regional Hospital in Hawkinsville, Georgia. €œThat’s my big worry.” Andy Miller.

amiller@kff.org, @gahealthnews Related Topics Contact Us Submit a Story TipOwen Loney’s surprise bill resulted from an emergency appendectomy in 2019 at a Richmond, Virginia, hospital. Insurance covered most of the cost of the hospital stay, he said. He didn’t pay much attention to a bill he received from Commonwealth Anesthesia Associates and expected his insurance to cover it. A few months ago, he got a notice that Commonwealth was suing him in Richmond General District Court for $1,870 for putting him under during the surgery, court records show. €œWow, seriously?.

€ the 30-year-old information technology manager recalled thinking after getting the court summons. Loney didn’t have that kind of money at hand. His plan was to try to negotiate down the amount or “take out another credit card to pay for it.” Loney’s is a classic, notorious type of surprise bill that Congress and activists have worked for years to eliminate. An out-of-network charge not covered by insurance even though the patient had an emergency procedure or sought care at an in-network hospital thinking insurance would cover most charges. Commonwealth said it was in-network for Loney’s insurer, UnitedHealthcare.

But the insurer rejected the anesthesiology charge because it said his primary care doctor was out of network, claims records show. The federal No Surprises Act, passed at the end of 2020, has been hailed by consumer advocates for prohibiting such practices. Starting Jan. 1, medical companies in most cases cannot bill patients more than in-network amounts for any emergency treatment or out-of-network care delivered at an in-network hospital. But as much as the legislation is designed to protect millions of patients from unexpected financial consequences, it will hardly spare all consumers from medical billing surprises.

€œIt’s great that there will be surprise billing protections … but you’re still going to see lawsuits,” said Zack Cooper, an economist and associate professor at the Yale School of Public Health. €œThis is by no means going to get rid of all of the problems with billing.” The law will kick in too late for Loney and many others saddled with surprise out-of-network bills in states that don’t already ban the practice. €œIt doesn’t prohibit surprise bills that are happening now in states that don’t have protections” against them, said Erin Fuse Brown, a law professor at Georgia State University who studies hospital billing. €œAnd it doesn’t prohibit collection activity for surprise bills that arose prior to January.” Virginia’s surprise-bill protection law took effect only this year and doesn’t apply to self-insured employer health plans, which cover a large portion of residents. The federal legislation also does nothing to reduce another kind of unpleasant, often surprising bill — large, out-of-pocket payments for in-network medical care that many Americans can’t afford and might not have realized they were incurring.

Two substantial changes in recent years shifted more risk to patients. Employers and other payers narrowed their provider networks to exclude certain high-cost hospitals and doctors, making them out of network for more patients. They also drastically increased deductibles — the amount patients must pay each year before insurance starts contributing. The No Surprises Act addresses the first change. It does nothing to address the second.

For a snapshot of the past and future of surprise and disputed medical bills, KHN examined Commonwealth’s lawsuits against patients in central Virginia and attended court hearings where patients contested their bills. €œThe whole thing with insurance not covering my bills is a headache,” said Melissa Perez-Obregon, a Richmond-area dance teacher whom Commonwealth sued for $1,287 over services she received during the 2019 birth of her daughter, according to court records. Her insurance paid most but not all of a $5,950 anesthesia charge, billing records show. €œI’m a teacher,” she said, standing in the lobby at Chesterfield County General District Court. €œI don’t have this kind of extra money.” Commonwealth is one of the more active creditors seeking judgments in the Richmond area, court records show.

From 2019 through 2021, it filed nearly 1,500 cases against patients claiming money owed for treatment, according to the KHN analysis of court filings. In numerous cases, it initiated garnishment proceedings, in which creditors seize a portion of patients’ wages. Describing itself as “the largest private anesthesiology practice in Central Virginia,” Commonwealth said it employs more than 100 clinicians who care for roughly 55,000 patients a year in hospitals and surgery centers, mostly in the Richmond area. Commonwealth said more than 99% of the patients it treats are members of insurance plans it accepts. It garnishes wages only as a “last resort” and only if the patient has the ability to pay, Michael Williams, Commonwealth’s practice administrator, said in a written statement.

€œOver the past three years we have filed suit to collect from just over 1% of our patients,” mostly for money owed for in-network deductibles or coinsurance, Williams said. Nearly half the bills are settled before the court date, he said. Gwendolyn Peters, 67, said she was shocked to receive a court summons this summer. Commonwealth was suing her for $1,000 for anesthesia during a lumpectomy for breast cancer in 2019, according to court records. €œThis is the first time I have ever been in this situation,” she said, sitting in the Chesterfield court with half a dozen other Commonwealth defendants.

Because patients typically have little or no control over who puts them under, Brown said, anesthesiologists face less risk to their businesses and reputations than other medical specialists do in using aggressive collections tactics. The specialty is often “one of the worst offenders because they don’t depend on their reputation to get patients,” she said. €œThey’re not going to lose business because they engage in these really aggressive practices that ruin their patients’ finances.” The average annual deductible for single-person coverage from job-based insurance has soared from $303 to $1,434 in the past 15 years, according to KFF. Deductibles for family coverage in many cases exceed $4,000 a year. Coinsurance — the patient’s responsibility after the deductible is met — can add thousands of additional dollars in expenses.

That means millions of patients are essentially uninsured for care that might cost them a substantial portion of their income. Surveys have repeatedly found that many consumers say they would have trouble paying an unexpected bill of even a few hundred dollars. Loney’s insurer, UnitedHealthcare, agreed to pay the bill from Commonwealth for his emergency appendectomy after being contacted by KHN and saying it “updated” information on the claim. Otherwise, Loney said, he couldn’t have paid it without borrowing money. In Richmond-area courthouses, hearings for Commonwealth lawsuits take place every few months.

A lawyer for the anesthesiology practice attends, sometimes making payment arrangements with patients. Many defendants don’t show up, which often means they lose the case and might be subject to garnishment. Commonwealth sued retiree Ronda Grimes, 66, for $1,442 for anesthesia claims her insurance didn’t cover after a 2019 surgery, billing and legal records filed in Richmond General District Court show. €œThat’s a lot of money, especially when you have health insurance,” she said. New research by Cooper and colleagues examining court cases in Wisconsin shows that medical lawsuits are disproportionately filed against people of color and people living in low-income communities.

€œPhysicians are entitled to get paid like everyone else for their services,” Cooper said. But unaffordable, out-of-pocket medical costs are “a systemic issue. And this systemic issue generally falls on the backs of the most vulnerable in our population.” For uninsured patients, Commonwealth matches any financial assistance given by the hospital and will be “enhancing” its financial assistance program in 2022, Williams said. Two of the nine people being sued by Commonwealth and interviewed by KHN at courthouse hearings were Hispanic. Four were Black.

One was Darnetta Jefferson, 61, who underwent a double mastectomy in early 2020 and came to court wearing a cancer-survivor shirt. Commonwealth sued her for $836 it said she owed in coinsurance for anesthesia she was given during the surgery. Commonwealth’s lawyer agreed to drop the lawsuit if she agreed to pay $25 a month toward the balance until it’s paid, she said. €œIf I ever have some extra money to pay it off someday, I will,” said Jefferson, who worked at Ukrop’s supermarket for many years before her cancer forced her to go on disability. €œBut right now, my circumstances are not looking good.” Although she is living on a reduced income, her rent just went up again, said Jefferson, who also survived lung cancer diagnosed in 2009.

Rent now runs close to $1,000 a month. Paying Commonwealth’s bill in monthly $25 increments, she said, means “it’s going to be a long way to go.” Jay Hancock. jhancock@kff.org, @JayHancock1 Related Topics Contact Us Submit a Story Tip.

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Molly Walker is an associate editor, amoxil cost who covers infectious diseases for MedPage Today. She has amoxil cost a passion for evidence, data and public health. Follow Disclosures IDWeek is jointly sponsored by the Infectious Diseases amoxil cost Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists.The authors disclosed no conflicts of interest..

"You need to Buy ventolin online without prescription listen to them cheap amoxil canada to understand the disease. The patients know more than the doctors." -- Paul Garner, MD, of Liverpool School of Tropical Medicine in England, discussing symptoms that may accompany so-called long buy antibiotics, which he has."The Sacklers may literally be getting away with not murder, but mass manslaughter." -- Andrew Kolodny, MD, of Brandeis University, discussing cheap amoxil canada the Department of Justice's $8 billion plea deal with Purdue Pharma, which included no jail time."It's important to treat every clinical encounter as an opportunity to vaccinate." -- Elizabeth La, PhD, of RTI Health Solutions in Research Triangle Park, North Carolina, on her study of adolescent immunizations."Be prepared to have a plan A, a plan B, and a plan C." -- David Ferraro, MD, of National Jewish Health in Denver, on lessons learned from the first wave of the amoxil for treating critically ill buy antibiotics patients."There was finally someone like me that was actually giving birth to a child, from a uterus that wasn't hers." -- Kayla Edwards, a patient with Mayer-Rokitansky-Küster-Hauser syndrome who later gave birth to a healthy girl after a uterus transplant."We really weren't expecting this result." -- Sung Choi, MD, of Rutgers New Jersey Medical School, on finding an association between lungs transplanted from obese donors and better survival among recipients."How do you improve something that you cannot even measure?. " -- Zubaid Rafique, MD, of Baylor College of Medicine in Houston, on the difficulties of identifying severe hyperkalemia in the emergency department.Comprehensive contact tracing efforts in one New Jersey city worked to drive buy antibiotics cases down, even with limited resources, a researcher said.From a mid-April peak of 263 cases, contact tracers in the city of Paterson brought that number down to seven cases, with over 90% of confirmed cases cheap amoxil canada investigated as of June 15, reported Paul Persaud, MD, of Paterson Department of Health in New Jersey, in a presentation from the virtual IDWeek.Moreover, the 4.65% mortality rate in Paterson, the third largest city in New Jersey, was lower than two other towns in the same county, other large cities in New Jersey such as Newark and Jersey City, and in the entire state overall.Through a base of 25 members of a "strike team" first designed to investigate outbreaks of foodborne illnesses, the team expanded to 50 members deployed for contact tracing, including a case coordinator, case investigators, a case/contact monitor, and contact tracers, the authors said."When we first started this, we had no funding from the CARES Act.

We relied on existing staff," said Persaud during a press conference.He detailed the challenge that investigators faced with contact tracing, given that Paterson is a densely populated area with a population of over 150,000 people (60% Hispanic/Latino, 25% Black, 9% white, and 4% Asian), with a median household income of around $39,000.The authors outlined how cheap amoxil canada the team worked. Case coordinators extracted cases from the Communicable Disease Reporting and cheap amoxil canada Surveillance System and assigned them to case investigators, who conducted the epidemiological investigation and determined the isolation/quarantine period. A contact tracer monitored cases and contacts throughout isolation and followed up with daily phone calls, they added."Once we called and said we were calling from the health department, that helped," Persaud said, though he added, "We had cheap amoxil canada our fair share of people hanging up the phone on us." If that happened, another member of the team would try to make contact."We never gave up," he said.As the outbreak evolved, the authors described how some contact tracers were trained to become case investigators, while additional health department employees were then trained as contact tracers to replace them.

The department even enlisted community policing for hard-to-find cases and contacts.The experiment was a success, with the authors cheap amoxil canada showing cases declining from a moving average of 216.3 on April 24 to a current moving average of 7.5 cases as of Oct. 3.Researchers emphasized the importance of buy in from the mayor and city administration, as well as the importance of training, internal reinforcement, and the commitment of the staff to the process."It's not always easy to cross-train employees, especially in institutions where cheap amoxil canada there are limited financial resources," he said.Persaud thought the model outlined could potentially be replicated in a rural setting. However, the authors noted it was unclear cheap amoxil canada how this intervention impacted buy antibiotics case-fatality rates, and called for more research to investigate.

Molly Walker is an associate cheap amoxil canada editor, who covers infectious diseases for MedPage Today. She has a passion for evidence, data and cheap amoxil canada public health. Follow Disclosures IDWeek is jointly sponsored by the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists.The authors cheap amoxil canada disclosed no conflicts of interest..

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A 2870 g male amoxil pill price infant was born at 36+1 weeks’ gestation by cesarean section due to mild polyhydramnios and amoxil suspension 500mg a non-reassuring cardiotocography. An uasound at 31 weeks demonstrated transient hyperechogenic fetal bowel (HFB).At birth, the Apgar scores were 9 and 10. The abdominal examination was unremarkable.He amoxil suspension 500mg spontaneously passed meconium. After 20 hours, he developed left hemiabdominal distension with visible dilated bowel loop sign (figure 1) and bile-stained vomiting.Figure 1 ‘Bowel loop sign’ on abdominal wall due to a segmental intestinal dilatation.Abdominal radiography ….

A 2870 g male cheap amoxil canada infant was born at 36+1 weeks’ gestation by cesarean section due to mild polyhydramnios and a non-reassuring cardiotocography. An uasound at 31 weeks demonstrated transient hyperechogenic fetal bowel (HFB).At birth, the Apgar scores were 9 and 10. The abdominal cheap amoxil canada examination was unremarkable.He spontaneously passed meconium. After 20 hours, he developed left hemiabdominal distension with visible dilated bowel loop sign (figure 1) and bile-stained vomiting.Figure 1 ‘Bowel loop sign’ on abdominal wall due to a segmental intestinal dilatation.Abdominal radiography ….