Tagged Courts

Abortion Rights Advocates Decry Oklahoma Judge’s ‘Rogue’ Decision To Allow Ban On Second-Trimester Procedure To Stand

However, Oklahoma has agreed not to enforce the ban until the state Supreme Court considers an emergency motion from the plaintiffs. Meanwhile, U.S. senators are asking Google to make sure its maps are accurately pointing users to abortion providers rather than crisis pregnancy centers. Abortion news comes out of Texas and Indiana, as well.

Advocates For Low-Wage Immigrants Are Latest To File Suit Against Trump Administration’s ‘Public Charge’ Rule

The “public charge” rule makes it more likely that a legal immigrant who uses benefits such as Medicaid, food stamps and housing assistance will be identified as a “public charge,” jeopardizing their potential to get a green card and become a U.S. citizen. The Trump administration policy has already drawn legal challenges from nearly 20 states.

Longtime Crusader Against OxyContin Begins To See The Fruits Of Her Struggle

In the 15 years since she lost her son to a single OxyContin pill, Barbara Van Rooyan has had but one up-close look at the people representing the company that made it.

It was in a small courthouse in Abingdon, Va., where Van Rooyan and other relatives of OxyContin victims gathered for a sentencing hearing in 2007. Three executives of Purdue Pharma had pleaded guilty to federal charges related to their misbranding and marketing of the powerful opioid. The company had pleaded guilty as well.

Van Rooyan and the others in her group spoke during the sentencing, giving voice to their grief and their pain. They wanted the executives sent to jail for knowingly expanding an opioid crisis fast engulfing the country.

Instead, Purdue paid fines totaling $634 million. The executives served no time. The company was allowed to continue aggressively marketing its product, and the following year, sales of OxyContin reached $2 billion.

From 1999 to 2017, more than 700,000 people in the U.S. died of drug overdoses, according to the Centers for Disease Control and Prevention. In 2017, nearly 68% of the more than 70,000 recorded overdose deaths involved opioids.

“I never really thought a whole lot about evil before this all happened,” Van Rooyan said recently, seated on a couch in the living room of her Irvine, Calif., home. “But to see this kind of malevolence or disregard for human life — I don’t know what else to call it but evil.”

The outcome in that Virginia courthouse was a far cry from last week’s news of a tentative mass settlement of many of the 2,000-plus lawsuits against the company, which could total upward of $12 billion and result in Purdue’s dissolution.

The potential settlement amount would include $3 billion from the Sackler family, owners of Purdue, whose fortune is estimated at $13 billion. The family has amassed that money over the past two decades, largely by selling OxyContin, an opioid painkiller.

Van Rooyan’s Purdue experience is a story of deception, sadness and frustration — yet when she tells it now, she emits a surprising spark of energy. That’s because Van Rooyan, part of the unlikely group of citizens who repeatedly took flailing swings at Purdue Pharma, is watching the giant fall.

Van Rooyan, who has studied the cases against Purdue closely, sees the paradox in the proffered settlement: Much of the payout would be financed by profits from the continued sale of OxyContin, under a new company that would be formed following a Chapter 11 bankruptcy.

Van Rooyan says she treasures this photo of herself holding son Patrick shortly after he was born.  (Ana Venegas for KHN)

But in some regard, she said, Purdue Pharma’s complicity in the opioid crisis has finally emerged into the general public’s view. “The world really knows now. They get it,” she said. “The lid is off, and all this stuff is bubbling out.”

That wasn’t the case on the night of July 4, 2004, when Van Rooyan and her husband, Kirk, got the call that changed their world. Barbara, then a professor of counseling at Folsom Lake College near Sacramento, was told that her son, Patrick Stewart, lay in a San Diego hospital, in a medically induced coma from which he was unlikely to emerge.

Patrick, a graduate of Oak Ridge High School in El Dorado Hills, Calif., and San Diego State University, died at age 24. His friends told Barbara they had attended an Independence Day party at which someone offered her son an OxyContin pill, telling him it “was kind of like a muscle relaxant and it was FDA approved, so it was safe,” she said. Patrick, who had also consumed a couple of beers, was opioid intolerant and suffered respiratory failure in his sleep.

“At the time,” Van Rooyan said, “all I knew about Oxy was that Rush Limbaugh had been addicted to it.”

She was about to learn a lot more.

Van Rooyan channeled her grief through intense research into Oxy’s vast potential for damage despite the company’s sales pitches to the contrary. A slow-release pain treatment with a heavy dose of the narcotic oxycodone, it could be easily crushed or dissolved for a more intense and addictive high. Rampant abuse already had begun to be reported, particularly in the Appalachian area, author Beth Macy wrote in her national bestseller “Dopesick.”

Later in 2004, Van Rooyan found Ed Bisch, a Philadelphia man who had begun a website to expose Oxy abuse in the wake of his teenage son’s death. The following year, Van Rooyan and her husband, a plastic surgeon, petitioned the Food and Drug Administration to require that OxyContin be made more abuse-resistant, and that its use be strictly limited to severe pain.

“This was an exhausting process, which she and Kirk did as a labor of love to try to save others,” Bisch recalled.

Van Rooyan became the California arm of a grassroots movement known as RAPP — Relatives Against Purdue Pharma. The group, originally just four in number, protested at physician meetings funded by pharmaceutical companies and testified before Congress. Van Rooyan enlisted the help of U.S. Sen. Dianne Feinstein (D-Calif.), who wrote the FDA on her behalf and later sent Van Rooyan a letter of commendation.

In the 15 years since she lost her son, Van Rooyan has since channeled her grief into intense research about Oxy’s vast potential for damage and has become one of the trailblazers of the anti-OxyContin movement.  (Ana Venegas for KHN)

But most members of Congress did not reply to Van Rooyan’s letters, she said. The FDA said its review needed more time — which turned out to be eight years. By then, Purdue already had reformulated OxyContin to make it more abuse resistant and to renew its patent, but the FDA declined to restrict its use to managing severe pain.

Van Rooyan pressed on, but for a long while, the opioid crisis felt to her like a topic hiding in plain sight. And fighting Purdue while still grieving the loss of son Patrick was taking a toll.

“Her determination was tireless,” Bisch said, “but eventually the frustration burned us out.”

And then came the turn.

A rash of high-profile opioid overdoses and deaths, from actor Heath Ledger to Tom Petty to Prince, put the topic squarely in the public eye — and 15 years after the death of Van Rooyan’s son, Purdue Pharma and other drugmakers were suddenly on the run.

Van Rooyan tracks every development related to Purdue, including a lawsuit in New York that alleges members of the Sackler family have been offloading their fortunes into private or offshore accounts to shield them from a settlement.

But she’s not out for vengeance. Her goals have changed.

“Do I want the records to be public? Do I want these people to have their business shut down? Yes, I do,” she said. “But more than vindictiveness, I want that money of theirs to go to treatment and rehab. If that happens, something good can come out of it.”

Van Rooyan touches a painting she co-created with artist Nick Simon in memory of Patrick. She says art is part of what saved her in the aftermath of her son’s death.  (Ana Venegas for KHN)

If she has a regret, it is that the case in Virginia ended in 2007 with no more than a fine. “If that result had been different — if people had gone to jail — it could have changed the trajectory of this,” she said.

But momentum finally appears to be gathering, and Van Rooyan finds herself identified as one of the trailblazers of the anti-OxyContin movement. She spends little time dwelling on that. Instead, she quotes her younger son, Andrew, who told her, “We didn’t want any of this — this is just the hand we were dealt. We need to play the cards the best we can.”

“She’s just a really strong person,” said Kirk Van Rooyan, who has been with Barbara throughout the ordeal, though he is not Patrick’s biological father. “There have been times when I’d think to myself, ‘How would I be doing if I were in her shoes?’ And the answer usually is, ‘Not as well as she’s doing.’”

Van Rooyan, a longtime artist, now spends much of her time volunteering with veterans in Orange County, Calif., helping them get back into the workforce and using art therapy to help them express themselves.

The art is special to Van Rooyan, she said, because it is part of what saved her in the aftermath of her son’s death.

“Patrick was the one who suggested I take my first class,” she said. After a few delays, she finally enrolled. It was about a month before that Fourth of July in 2004.


This KHN story first published on California Healthline, a service of the California Health Care Foundation.

At-Home Rape Kits Now Off The Market

Two companies who were advertising at-home sexual assault evidence collection kits appear to have halted selling and marketing the products after widespread objections and two state attorneys general threatened the companies with legal action.

The PRESERVEkit, which was previously being sold on Amazon, is now listed as “currently unavailable.” On Friday, the website for the PRESERVEkit stated that “we will not be selling this product while we review the legal concerns.”

The manufacturer of the kits, the Preserve Group, did not respond to a request for comment by publication time.

On Wednesday, New York Attorney General Letitia James sent letters to both MeToo Kits and the Preserve Group telling them to “cease and desist” either selling or marketing their kits to New York consumers.

Oklahoma Attorney General Mike Hunter followed suit, sending “cease and desist” letters to the two companies on Thursday.

Cecilia Fan, an Amazon spokeswoman, said that when an item is listed as “currently unavailable” it means the seller took down the product. She said when Amazon removes a product, the whole webpage is removed. As of Friday afternoon, the PRESERVEkit’s page remained. Amazon declined further comment.

MeToo Kits, another company that had advertised an at-home sexual assault evidence collection kit, apparently suspended its website as of Friday afternoon. The company was not yet selling its kits but did have them available for preorder on its website. MeToo Kits also did not respond to a request for comment.

Julie Valentine, a forensic nurse and assistant professor of nursing at Brigham Young University, told Kaiser Health News that she emailed Jeff Bezos, the CEO of Amazon, directly on Tuesday with a link to a KHN article in which she was quoted opposing the rape kits because the evidence collected would be useless in court and expose an alleged victim to medical risks.

She said she asked him to remove the product from Amazon listings. “I kept it short, saying I believed the product is harmful to your customers and this is why. The next morning, one of his assistants called me and asked some additional questions.”

Valentine received a message from Amazon’s executive customer relations department on Wednesday stating it had forwarded her request to the correct internal team. She also said she asked other forensic nurses and colleagues to contact Amazon with their concerns about the PRESERVEkit.

Other attorneys general — in Michigan, North Carolina and Virginia — had spoken out against the kits, warning consumers to avoid the product and saying it’s unlikely the kits would be admissible as evidence in court.

Advocates for sexual assault victims have also opposed the use of at-home kits. They say survivors of sexual assault would miss out on other crucial aspects of a sexual assault exam, including treatment for physical injuries, a mental health evaluation, referral to other resources and medication to prevent pregnancy and sexually transmitted infections.

Valentine said it’s important to keep getting the word out about the potential harm of these at-home sexual assault collection kits. As soon as she heard about the products, she alerted the Utah sexual assault crisis lines so workers there could be prepared.

“And good thing that we did, because it happened,” said Valentine. “We had a victim call the crisis line who was thinking about doing the at-home kit. So, I’m hoping all states are educating their crisis line workers about this.”

UVA Will Cut Back On Lawsuits Against Patients In Wake Of KHN Investigation

UVA Health System, which sues thousands of patients each year, seizing wages and home equity to collect on overdue medical bills, said Friday it would increase financial assistance, give bigger discounts to the uninsured and “reduce our reliance on the legal system.”

“This will have a huge impact on patients to the good,” Doug Lischke, the health system’s chief financial officer, said in an interview. The changes will “positively, drastically reduce the legal process” of lawsuits, garnishments and property liens.

“We believe this is much more generous than what we’re doing now.”

Lischke called the new policy “a first step” that could later include financial assistance beyond what was announced Friday. UVA also plans to ask the Virginia General Assembly to change a state law requiring state agencies, including health systems, to “aggressively collect” unpaid bills and charge 6% interest on the balance, he said.

But independent experts said the new UVA policy, which comes on the heels of a Kaiser Health News investigation detailing UVA’s aggressive collection practices, still leaves numerous patients exposed to lawsuits and crippling bills. KHN found that UVA sued patients more than 36,000 times over six years for more than $106 million, sending many families into bankruptcy. And it routinely billed uninsured patients for far more than what a typical insurance company would have paid.

By leaving family assets vulnerable and not fully discounting sticker-price charges, the new UVA guidelines remain “very tough on the poor and near-poor who have managed to amass anything of value that will help them with the daily costs of life,” said Sara Rosenbaum, a health policy professor at George Washington University.

The amended policy loosens qualifications for financial assistance, awarding aid to families with income of up to 400% of the federal poverty level, or $103,000 for a family of four. Until now, families making more than half that much were ineligible for assistance — the most restrictive rules of any major hospital system in Virginia, KHN found. Except in “unusual circumstances,” UVA won’t sue patients unless balances are more than $1,000 and families make more than 400% of the poverty guidelines, the health system said in a written statement.

“While these changes represent a step in the right direction, it’s unfortunate that UVA, a public institution, insists on still suing patients,” said Dr. Marty Makary, a surgeon and researcher at Johns Hopkins Medicine who studies hospital debt collection. “In my conversations with UVA surgeons, they are appalled by the practice of their center in suing patients and want it to stop.”

The changes take effect Jan. 1 but a UVA statement said the health system is “committed to working with anyone who currently has an outstanding balance or debt that they are struggling to pay.”

UVA has not decided what to do about patient lawsuits in the pipeline, Lischke said. Online court records show there are hearings scheduled for hundreds of UVA Medical Center cases over the next few weeks.

Mary Washington Healthcare of Fredericksburg, criticized earlier this summer for a far smaller number of lawsuits, said it would suspend suing patients and try to eliminate current garnishments. Methodist Le Bonheur Healthcare in Memphis, another on a growing list of hospitals called out for aggressive collections, said it would suspend all court activity for a month.

UVA will apply the new financial assistance and charging policies to patients treated in July 2017 or later, Lischke said. That means patients on current payment plans or with judgments against them could have bills eliminated or adjusted. But there will be no refunds of payments already made, he said.

The policies also apply to patients treated after July 2017 with judgments against them but no payment plan, he said. But there will be no refunds of payments already made, he said.

Taken together the changes will cost UVA “millions to tens of millions,” he said declining to give a more precise figure.

UVA began revising its billing and collections policies after being informed of KHN’s findings in August. It examined policies of neighboring hospitals such as Mary Washington as well as other major academic medical centers, Lischke said.

Previously just $4,000 in a retirement account could bar UVA patients from financial help, no matter how low their income. Now patients can have at least $50,000 in savings beyond the value of their home and car and still get assistance as long as they meet the income test, UVA said.

The nonprofit health system, a taxpayer-supported state agency, also said it would grant discounts of 40% to the uninsured to better reflect lower rates negotiated and paid by insurance companies. Previously, uninsured patients got only 20% off the sticker price plus another 10% to 15% if they paid promptly, which few could.

Shaving 40% from “chargemaster” prices used as a starting point for insurer negotiations puts bills to the uninsured in line with what a commercial health plan would pay, Lischke said.

That’s not enough, Rosenbaum said. She recommended they be lowered further to Medicare levels, which can be 75% off or more.  The total of UVA’s cash revenue from all health plans and government programs is 70% below chargemaster, financial forms filed with the Department of Health and Human Services show.

“Even a 40% write-off of charges remains a brutal exposure” for the uninsured, she said. “How could they possibly remain tied to their chargemaster and keep a straight face?”

As part of its ongoing review of billing and collections, UVA will consider further lowering charges to the uninsured — perhaps to Medicare levels, Lischke said.

The new policy also does nothing for those who were sued and garnished for treatment before July 2017.

So far the health system’s announcement doesn’t help the 20 UVA students reported by KHN to have “active holds” on their enrollment this semester because they owe money to the UVA Medical Center. UVA treats unpaid hospital bills the same as unpaid tuition.

UVA has not approached legislators yet about changing billing laws but hoped to have next year’s General Assembly consider it.

“I am hopeful that we are able to influence a change to not only the Debt Collection Act” requiring aggressive collection “but also the state indigent care guidelines,” Lischke said.

Gov. Ralph Northam, a physician who is close to Dr. L.D. Britt, a Norfolk surgeon and professor who is chairman of the health system’s board, has said nothing publicly beyond his Monday statement that “I am glad to hear the UVA Health System is in the process of changing their policies and practices.”

Purdue Pharma Nixed Plans To Support Opioid-Addiction Treatment As Barrage Of Lawsuits Flooded In

Purdue Pharma and the Sackler family would have donated $50 million a piece to fund the foundation, but the idea got derailed when it began contemplating bankruptcy and working out court settlements with states. Meanwhile, historians are asking that any opioid settlements being worked out be made public so they can be preserved for the future. News on the crisis comes out of North Carolina as well.

UVA Suspends Medical Lawsuits In Wake Of KHN Investigation

CHARLOTTESVILLE, Va. — Under pressure after Kaiser Health News reported Monday that it sues thousands of patients a year and sends many into bankruptcy, University of Virginia Health System suspended about a dozen patient lawsuits Thursday and said it will announce changes to its billing and collections policy Friday.

At a weekly session at the Albemarle County Courthouse often dominated by UVA hospital litigation, UVA lawyer Melissa Riley said cases due to be heard Thursday would be withdrawn while the system takes a broader look at its long-standing practice of aggressive debt collection.

The move affects only those cases and changes nothing for thousands of patients who have already lost court judgments to UVA or face other pending lawsuits. And those cases could be refiled later.

“The university is conducting a review and may announce changes to its policies tomorrow,” Riley said.

Several patients in the courtroom and District Court Judge William Barkley said they had no comment.

UVA sued more than 36,000 patients over six years for unpaid bills for more than $106 million, KHN found.

It also seized some $22 million in patients’ state tax refunds, mostly outside the judicial process, as part of a program to help state and local governments collect debts. And it frequently billed uninsured patients for far more than what a typical insurance company would have paid.

Top officials at the health system’s quarterly board meeting Thursday morning were set to discuss billing and collections in a closed session but had little to say about the matters beforehand.

“I’m very concerned” about what KHN reported “and I’m very sympathetic” to patients caught in litigation, said James Murray, a venture capitalist who as rector serves as the head of the UVA Board of Visitors, its governing body.

As usual, the board met in UVA’s classical Rotunda, designed by Thomas Jefferson. UVA is taxpayer- and state-funded. A KHN reporter objected to the closed session, arguing that matters potentially affecting hundreds of thousands of UVA patients should be discussed publicly.

“We’re not going to discuss it in open session,” said Pamela Sutton-Wallace, the UVA Medical Center CEO who will step down in November, the university disclosed Tuesday.

Instead the board, led by L.D. Britt, a surgeon and professor at Eastern Virginia Medical School in Norfolk, celebrated a profitable fiscal year and UVA Medical Center ranking again as U.S. News & World Report’s top hospital in Virginia.

Unaudited results presented Thursday showed UVA Medical Center, the core of UVA Health, made an $87 million operating profit on revenue of $1.7 billion in the fiscal year ending in June and held stocks, bonds and other investments worth about $1 billion.

As part of its investigation into billing practices, KHN reported that UVA has the least generous patient financial assistance guidelines of any major hospital system in Virginia. Savings of only a few thousand dollars in a 401(k) account can disqualify even families with very low incomes from UVA aid.

CEO Sutton-Wallace is moving to New York-Presbyterian Hospital in November to become a senior vice president, UVA Health announced Tuesday. Her departure “is in no way related” to the billing and collections problems, UVA President James Ryan said in a message to employees.

New York-Presbyterian did not respond to multiple requests for comment.

Data editor Elizabeth Lucas contributed to this report. 

FDA Defends Framework As It Dismisses Advocacy Group’s Petition To Put Moratorium On Opioid Approvals

Public Citizen says the agency displayed “dangerously deficient oversight” when it approved opioids during a growing crisis. The FDA denied the request for a moratorium, pointing to the framework and guidance it has developed in the years since. In addition, the FDA argued that it is not permitted under federal law to impose a moratorium on approving new medicines. In other news: a judge knocks down Purdue Pharma’s efforts to dismiss public nuisance claims and the AMA is urging states to be proactive on opioid abuse treatment.

Hospital Giant Sutter Health Faces Legal Reckoning Over Medical Pricing

SAN FRANCISCO — Economists and researchers long have blamed the high cost of health care in Northern California on the giant medical systems that have gobbled up hospitals and physician practices — most notably Sutter Health, a nonprofit chain with 24 hospitals, 34 surgery centers and 5,000 physicians across the region.

Now, those arguments will have their day in court: A long-awaited class-action lawsuit against Sutter is set to open Sept. 23 in San Francisco Superior Court.

The hospital giant, with $13 billion in operating revenue in 2018, stands accused of violating California’s antitrust laws by leveraging its market power to drive out competition and overcharge patients. Health care costs in Northern California, where Sutter is dominant, are 20% to 30% higher than in Southern California, even after adjusting for cost of living, according to a 2018 study from the Nicholas C. Petris Center at the University of California-Berkeley cited in the complaint.

The case was initiated in 2014 by self-funded employers and union trusts that pay for worker health care. It since has been joined with a similar case brought last year by California Attorney General Xavier Becerra. The plaintiffs seek up to $900 million in damages for overpayments that they attribute to Sutter; under California’s antitrust law, the award can be tripled, leaving Sutter liable for up to $2.7 billion.

The case is being followed closely by industry leaders and academics alike.

“This case could be huge. It could be existential,” said Glenn Melnick, a health care economist at the University of Southern California. If the case is successful, he predicted, health care prices could drop significantly in Northern California. It also could have a “chilling effect” nationally for large health systems that have adopted similar negotiating tactics, he said.

The case already has proved controversial: In November 2017, San Francisco County Superior Court Judge Curtis E.A. Karnow sanctioned Sutter after finding it had intentionally destroyed 192 boxes of documents sought by plaintiffs, “knowing that the evidence was relevant to antitrust issues.” He wrote: “There is no good explanation for the specific and unusual destruction here.”

Antitrust enforcement is more commonly within the purview of the Federal Trade Commission and U.S. Department of Justice. “One of the reasons we have such a big problem [with consolidation] is that they’ve done very little. Enforcement has been very weak,” said Richard Scheffler, director of the Nicholas C. Petris Center. From 2010 to 2017, there were more than 800 hospital mergers, and the federal government has challenged just a handful.

“We feel very confident,” said Richard Grossman, lead counsel for the plaintiffs. “Sutter has been able to elevate their prices above market to the tune of many hundreds of millions of dollars.”

Or, as Attorney General Becerra put it at a news conference unveiling his 2018 lawsuit: “This is a big ‘F’ deal.”

Sutter vigorously denies the allegations, saying its large, integrated health system offers tangible benefits for patients, including more consistent high-quality care. Sutter also disputes that its prices are higher than other major health care providers in California, saying its internal analyses tell a different story.

“This lawsuit irresponsibly targets Sutter’s integrated system of hospitals, clinics, urgent care centers and affiliated doctors serving millions of patients throughout Northern California,” spokeswoman Amy Thoma Tan wrote in an emailed statement. “While insurance companies want to sell narrow networks to employers, integrated networks like Sutter’s benefit patient care and experience, which leads to greater patient choice and reduces surprise out-of-network bills to our patients.”

There’s no dispute that for years Sutter has worked aggressively to buy up hospitals and doctor practices in communities throughout Northern California. At issue in the case is how it has used that market dominance.

According to the lawsuit, Sutter has exploited its market power by using an “all-or-none” approach to contracting with insurance companies. The tactic — known as the “Sutter Model” — involves sitting down at the negotiating table with a demand: If an insurer wants to include any one of the Sutter hospitals or clinics in its network, it must include all of them. In Sutter’s case, several of its 24 hospitals are “must-haves,” meaning it would be almost impossible for an insurer to sell an insurance plan in a given community without including those facilities in the network.

“All-or-none” contracting allows hospital systems to demand higher prices from an insurer with little choice but to acquiesce, even if it might be cheaper to exclude some of the system’s hospitals that are more expensive than a competitor’s. Those higher prices trickle down to consumers in the form of higher premiums.

The California Hospital Association contends such negotiations are crucial for hospitals struggling financially. “It can be a great benefit to small hospitals and rural hospitals that don’t have a lot of bargaining power to have a larger group that can negotiate on their behalf,” said Jackie Garman, the CHA’s legal counsel.

Sutter also is accused of preventing insurers and employers from tiering benefits, a technique used to steer patients to more cost-effective options. For example, an insurer might charge $100 out-of-pocket for a procedure at a preferred surgery center, but $200 at a more expensive facility. In addition, the lawsuit alleges that for years Sutter restricted insurers from sharing information about its prices with employers and workers, making it nearly impossible to compare prices when selecting a provider.

Altogether, the plaintiffs allege, such tactics are anti-competitive and have allowed Sutter to drive up the cost of care in Northern California.

Hospitals in California and other regions across the country have watched the success of such tactics and taken note. “All the other hospitals want to emulate [Sutter] to get those rates,” said Anthony Wright, executive director of the advocacy group Health Access.

A verdict that finds such tactics illegal would “send a signal to the market that the way to compete is not to be the next Sutter,” said Wright. “You want them to compete instead by providing better quality service at a lower price, not just by who can get bigger and thus leverage a higher price.”

Along with damages, Becerra’s complaint calls for dismantling the Sutter Model. It asks that Sutter be required to negotiate prices separately for each of its hospitals — and prohibit officials at different hospitals from sharing details of their negotiations. While leaving Sutter intact, the approach would give insurers more negotiating room, particularly in communities with competing providers.

Consolidation in the health care industry is likely here to stay: Two-thirds of hospitals across the nation are part of larger medical systems. “It’s very hard to unscramble the egg,” said Melnick.

California legislators have attempted to limit the “all or nothing” contracting terms several times, but the legislation has stalled amid opposition from the hospital industry.

Now the courts will weigh in.

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! I come bearing bad news for anyone enjoying the slight decrease in D.C. traffic: Congress is back in full force next week. Although we have not had even a slight decrease in health news, I’m sure lawmakers will kick it up even further with gun control, surprise medical bills and, perennially, high drug costs on the expected docket.

For now, here’s what’s been going on during their final week of recess.

President Donald Trump has been coy about what exactly he’s put in his gun violence proposal, but one thing that seems likely: Both parties will be unhappy. (That, at least, seems a sure bet in these divided times.) What you can probably expect to see: an expedited death penalty process, changes to how troubled teens’ sealed records are shielded, and regulations — like “red flag” laws — centered on mental health.

Politico: Trump Prepares to Pitch Gun Proposals Few Really Want

Senate Majority Leader Mitch McConnell is sitting pretty on the sidelines at the moment, waiting to see what the president comes up with.

The Associated Press: McConnell Says He’s Waiting on Trump to Chart Path on Guns

Corporations, though, are taking matters into their own hands. Walgreens and CVS followed in Walmart’s footsteps this week in asking customers not to carry firearms openly in their stores. Walmart — which often tries to stay above the political fray — went further in announcing that it would stop selling ammunition for military-style assault rifles.

The New York Times: Walmart to Limit Ammunition Sales and Discourage ‘Open Carry’ of Guns in Stores

Reuters: Walgreens, CVS, Wegmans Ask Shoppers to Not Openly Carry Firearms

And in a bit of poor optics luck for Texas, a series of laws loosening gun regulations happened to take effect just a day after the state’s latest mass shooting.

Politico: Hours After Shooting Rampage, Texas Gun Laws Loosened

Also, if you want to terrify the bejesus out of yourself, dig into this piece about online forums with a toxic culture of hate that have become breeding grounds for mass shooters and where the inherent anonymity of the internet protects them from law enforcement.

The Wall Street Journal: ‘So What’s His Kill Count?’: The Toxic Online World Where Mass Shooters Thrive


In New York, health officials are eyeing vitamin E oil as a possible culprit in the mysterious vaping-related lung illness sweeping the country. The feds, however, aren’t putting their eggs in that particular basket and said that people should keep an “open mind” about the roots of the outbreak. “People need to realize that it is very probable that there are multiple causes,” said CDC Director Robert Redfield. But with a second death confirmed, officials are scrambling for answers.

Politico: Vitamin E Named as Primary Culprit in Vaping Illness, But Feds Urge Caution


An HHS internal watchdog report detailed the extent of psychological damage suffered by children affected by the “zero tolerance” separation policy. For children so young, it was hard for them to describe their emotional trauma. They were often reduced to complaints about their chest hurting, like “every heartbeat hurts” or “I can’t feel my heart.”

The Associated Press: ‘Can’t Feel My Heart:’ IG Says Separated Kids Traumatized


Crushing medical debt seems to be shaping the future of the country, and 2020 hopeful Sen. Bernie Sanders (I-Vt.) wants to change that. With a proposal that he only hinted at (i.e. did not give any solid details about how to pay for it), he said he would cancel $81 billion worth of medical debt for Americans.

The Washington Post: Sen. Bernie Sanders Teases Plan to Cancel $81 Billion in Americans’ Medical Debt

Meanwhile, despite the attention Sanders and the other progressive front-runners are giving proposals like “Medicare for All,” state lawmakers see defending the health law as the ace up their sleeves in tough elections. Virginia will be a major testing ground for that strategy as Democrats recently secured a big win on expanding Medicaid in the state. They could, however, be vulnerable to Republican messaging on high health care costs because the governor vetoed extensions for short-term plans.

Politico: Democrats Bet Big on Obamacare to Win Virginia Statehouse


So far, the implementation of Medicaid work requirements has been more crash and burn than the graceful transition many Republicans had likely hoped for. But Indiana seems on the path to becoming a model for other states as they add more restrictions to the program. I can explain it no better than Paige Winfield Cunningham at The Washington Post, who wrote: “If Arkansas and Kentucky were heavy-handed in imposing their work requirements, Indiana’s program is more like a tap on the shoulder, advocates argue.”

The Washington Post: Indiana Seeks to Impose Slower, Kinder Work Requirements on Medicaid Recipients

Meanwhile, over in Missouri, expansion advocates are hoping to follow the success of other states by getting the issue in front of voters rather than lawmakers.

The Hill: Advocates Launch Petition to Place Medicaid Expansion on 2020 Ballot in Missouri


The “Guaranteed to Make Everyone’s Blood Boil” award of the week goes to the article about how the Sacklers (the family that founded Purdue Pharma) could emerge from the opioid trials with their personal fortune intact.

The Washington Post: Sacklers Could Hold On to Most of Personal Fortune in Proposed Purdue Settlement

A cluster of HIV cases in West Virginia could be the canary in the coal mine that public health officials monitoring the opioid epidemic have been on the watch for. “This is the nightmare everyone is worried about,” said one expert about the outbreak that appears to be among the largest since one in Indiana’s Scott County four years ago.

Politico: ‘The Nightmare Everyone Is Worried About’: HIV Cases Tied to Opioids Spike in West Virginia County


In the miscellaneous file for the week:

• Reeling from persistent political attacks, Planned Parenthood has announced it will utilize telemedicine and a new app to reach young and rural patients who may have been affected by attempts to chip away at the organization.

The Wall Street Journal: Planned Parenthood to Expand App-Based Health Services to All 50 States

• We as a country are hooked on fast deliveries from Amazon, but there’s a human toll that flies under the radar that goes beyond workers’ pay. This ProPublica-New York Times story starts with the tragedy of a 9-month-old who died in an accident involving an Amazon delivery vehicle and doesn’t get any less heartbreaking as it goes on.

ProPublica/The New York Times: How Amazon Hooked America on Fast Delivery While Avoiding Responsibility for Crashes

• Be sure to check out this fantastic series about how America’s sick, poor and vulnerable will be the ones most affected by the growing climate crisis because they live in urban heat islands.

Howard Center for Investigative Journalism: Code Red: Baltimore’s Climate Divide

• On a much lighter note, scientists may have discovered a gene for left-handedness, which I just find fascinating and may make approximately 10% of my readers happy to know (mostly because it’s linked to having better verbal skills).

CNN: Scientists Identify the Genes Linked to Left-Handedness

• After millions of dollars, thousands of hours of manpower, tons of public outrage and a countless number of headlines from yours truly, the NYC measles outbreak has been declared officially over. The outbreaks in upstate New York still threaten the United States’ status as having eliminated the disease but, for now, public health officials are taking victories where they can get them.

The Washington Post: New York City Declares End to Largest Measles Outbreak in Nearly 30 Years


That’s it for me! Have a great weekend!

KHN’s ‘What The Health?’: Waiting For The Trump Health Plan


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President Donald Trump has been promising to reveal a new health plan since early this year. That hasn’t happened yet. Now, there is a debate about whether having a plan for Democrats to criticize would help or hurt the president’s campaign.

Meanwhile, among the Democrats vying to take on Trump next November, Sen. Bernie Sanders (I-Vt.) is proposing a plan to forgive billions of dollars of medical debt owed by patients.

Other drama playing out this fall: What will happen to the federal family planning program now that Planned Parenthood has dropped out over Trump administration rules it says violate medical ethics, and what will a multimillion-dollar verdict against opioid manufacturer Johnson & Johnson mean for the funding of programs to help those with addiction?

This week’s panelists are Julie Rovner of Kaiser Health News, Stephanie Armour of The Wall Street Journal, Alice Miranda Ollstein of Politico and Kimberly Leonard of the Washington Examiner.

Among the takeaways from this week’s podcast:

  • We are still waiting to see what a Trump health care plan might look like. Conventional wisdom suggests it will likely take the form of a collection of goals and ideas — many of which have already been announced or launched, such as the administration’s efforts on health price transparency. The rollout of a legislative package is increasingly unlikely.
  • One variable that could change that: Incentives for Republicans and the administration might be different if the lower-court ruling invalidating the Affordable Care Act is upheld on appeal.
  • Democratic presidential candidate Sen. Bernie Sanders (I-Vt.) has teased out a plan to cancel an estimated $81 billion worth of medical debt. There’s no talk about how this concept would be funded. One point that could create a lot of interest among voters: Medical debt would no longer affect consumers’ credit scores.
  • Planned Parenthood has, for now, dropped out of the Title X family planning program. More states and organizations could follow suit in the weeks ahead, especially as these entities now must file plans with the administration outlining how they will comply with new requirements.
  • The first verdict in favor of a state lawsuit against an opioid manufacturer, with Oklahoma suing Johnson & Johnson, brought a verdict of more than half a billion dollars. But that was so much less than the state was seeking ($17.5 billion) that the company’s stock rose after the decision. That makes it unclear what impact this test case will have as other states sue other opioid makers to recover damages caused by their products.

Also this week, Rovner interviews KHN’s Rachel Bluth, who wrote the latest KHN-NPR “Bill of the Month” feature about a patient who did everything right to prepare financially for an elective surgical procedure — and still got billed more than he expected. If you have an outrageous medical bill you would like to share with us, you can do that here.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: Kaiser Health News’ “Beset By Lawsuits And Criticism In U.S., Opioid Makers Eye New Market In India,” and “In India’s Slums, ‘Painkillers Are Part Of The Daily Routine,” by Sarah Varney

Alice Miranda Ollstein: The New York Times Magazine’s “Why Doesn’t the United States Have Universal Health Care? The Answer Has Everything to Do With Race,” by Jeneen Interlandi

Kimberly Leonard: Vox.com’s “She Spent More Than $110,000 on Drug Rehab. Her Son Still Died,” by German Lopez

Stephanie Armour: The Atlantic’s “L.A.’s Health-Care Reform Is a Lesson for Democrats,” by Ronald Brownstein

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