Dan Weissmann
Tue, 30 Apr 2024 09:00:00 +0000

When Change Healthcare, a subsidiary of UnitedHealth Group, got hit by a cyberattack this winter, a big chunk of the nation's doctors, pharmacists, hospitals, and therapists stopped getting paid. The hack also limited health providers' ability to share medical records and other information critical to patient care.

The cyberattack revealed an often overlooked part of how health care is paid for in the United States and raised concerns for antitrust advocates about how large UnitedHealth has grown.

Host Dan Weissmann speaks with reporters Brittany Trang of Stat News and Maureen Tkacik of The American Prospect about their reporting on the hack and what it says about antitrust enforcement of health care companies.

Dan Weissmann

@danweissmann

Host and producer of “An Arm and a Leg.” Previously, Dan was a staff reporter for Marketplace and Chicago's WBEZ. His work also appears on All Things Considered, Marketplace, the BBC, 99 Percent Invisible, and Reveal, from the Center for Investigative Reporting.

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Transcript: The Hack

Note: “An Arm and a Leg” uses speech-recognition software to generate transcripts, which may contain errors. Please use the transcript as a tool but check the corresponding audio before quoting the podcast.

Dan: Hey there. 

Brittany Trang is a reporter at STAT News– that's a health care news outlet. We talked with Brittany's colleague Bob Herman in our last episode. Like Bob, she's been covering the business of health care. 

And for Brittany, this story starts with Bob flagging a story to their team. He… 

Brittany Trang: Dropped a link in the chat that said like, hey guys, I think we should write about this, question mark, and nobody replied, 

Dan: The story was about a cyber-attack against a company called Change Healthcare. 

Brittany Trang: I was like that sounds like a startup and I was like who cares about some sort of health tech startup 

Dan: But Bob kept bringing it up. 

Brittany Trang: And I finally clicked on the link, and I was like, oh no, this is a big deal. This touches most of the American healthcare system. 

Dan: Yeah, and it's no joke. Change Healthcare is what's called a data clearinghouse. And it's a big one. It's an important part of health care's financial plumbing. Someone had gone in and basically hijacked their computer system and said, Unless we get $22 million dollars, we're not giving it back. So Change went offline, and a huge chunk of the country's Pharmacists, doctors, therapists, hospitals just stopped getting paid. And Change Healthcare stayed offline for weeks and weeks. As we record this, seven weeks in, big parts of it remain offline. And here's this other thing: Change Healthcare is not a startup. It's been around for like 20 years. And in late 2022, Change got purchased by another company– a company that's starting to become a real recurring character on this show: UnitedHealth Group.

You may remember: They're the country's biggest insurance company AND they've got their hands in just about every other part of health care, in a big way. For instance, they're the very biggest employer of physicians in the country, by a huge margin. They've got their own bank, which– among other things– offers payday loans to doctors. And they have a huge collection of companies that do back-end services. In our last episode we heard about Navi Health— and how, under United's ownership, insurance companies have been using NaviHealth's algorithm to cut off care for people in nursing homes. [Boy, yeah– that was a fun story…] And as we've been learning: When one company like this gets so big, their problems– like this cyber-attack– become everybody's problem. And in this case, everybody's problem seems to create an opportunity for United. We'll break down how THAT could possibly work, but obviously it doesn't seem like the way a lot of us would WANT things to work.. And we'll end up talking about what we can maybe do about it. Not “we” as in a bunch of individuals trying to tackle an opponent this big. Good luck with that. But “we” as in the “We the people” of the United States Constitution. We may already be on the case. 

This is An Arm and a Leg– a show about why health care costs so freaking much, and what we can maybe do about it. I'm Dan Weissmann. I'm a reporter, and I like a challenge. So our job on this show is to take one of the most enraging, terrifying, depressing parts of American life, and bring you a show that's entertaining, empowering, and useful. 

We'll start with an attempt to answer what you'd think would be a simple question: What does Change Healthcare do?

Here's Brittany Trang from STAT News again. 

Brittany Trang: It's kind of like Visa or Mastercard or something. Like, when you go to the grocery store and you pay with a credit card, you are not putting your money directly into the pockets of the grocery store. There's a middleman in there and change is that middleman, but for a ton of different things.

Dan: Like insurance claims. Brittany says hospitals and doctors offices often don't submit claims directly to insurance companies. They send the claim to a middleman like Change. And then Change figures out where that claim needs to go next. Like: I'm sending a bunch of mail– I put it all in one mailbox, and the post office figures out how to get it where it goes. Except of course, there's no paper here, no envelopes, no physical packages: All those claims are basically data. Which is why a company like Change is called a data clearinghouse. And even if a given provider uses some other clearinghouse– and of course there are others– Change may still be involved. Because INSURANCE companies like Aetna also use Change as a place to COLLECT claims from providers. On that side, Change is kind of like a post-office box. But claims are just one of the types of data that Change handles. For instance… 

Brittany Trang: when you went to the pharmacy counter or when you would check in at the doctor's office and they take your insurance information and figure out like what you're going to pay for this visit. Both of those processes were messed up. 

Dan: Yeah, and there's more! Prior authorizations– like when your doctor checks in advance to make sure your insurance company is OK with paying for whatever. Those all go through companies like Change. So, if change is offline, do they do your MRI, or your surgery– and just hope it doesn't get denied when Change comes back? And once claims get approved, data for payments goes through Change too. So payments– a lot of payments– just stopped going out. Here's Brittany Trang. 

Brittany Trang: it's just kind of flabbergasting how big this is. This collapsed most of healthcare in some way or another. 

Dan: Overall, the numbers are wild: Change reportedly processes 1.5 trillion dollars a year in claims. Maybe a third of everything that happens in healthcare. According to the American Hospital Association, 94 percent of hospitals said they were affected. Some more than others. Not all providers use Change as their primary clearinghouse. But lots do. And for them, everything just stopped. 

Brittany Trang: I talked to one provider she's like, Oh, I can, I can talk. I'm, here today and tomorrow before we close. And I was like, before we close for spring break. And she said, no, we have 3 and 13 cents left in our bank account. Brittany says that provider got a last minute reprieve– an emergency loan from United. There have been two or three rounds of these loans so far, plus some advance payments from Medicare. But as the outage has dragged on– it started in February, and we're recording this seven weeks later– it's hard to know if those are going to be enough. At the end of March, I talked with Emily Benson. She runs a therapy practice in a Minneapolis suburb. Eight clinicians, mostly treating kids. She says the practice does maybe 70 or 80 thousand dollars worth of business a month. But then in February… Emily Benson: essentially everything went dark for us. 

Dan: United publicly acknowledged the Change hack on February 21st. But Emily Benson says she didn't actually get a heads-up until almost a week later. 

Emily Benson: a lot of alarm bells went off, that was the end of the month. And so a lot of payments came due 

Dan: Her rent. Paychecks for her colleagues, and herself. 

Emily Benson: I mean, I was in a panic. Y'know, I didn't know where I was going to go. 

Dan: She says she usually gets two payments a week from insurance, with everything passing through Change. But it's not just the payments from insurance. Change also provides the documents that say how much an insurance company is GOING to pay for any given claim. 

Emily Benson: That's a critical document because that tells me what does the family owe us. And then the beneficiary is also going to get that information. So they're not surprised by what we charge them. So now every week we're stacking up and stacking up these amounts that the family's going to owe us. 

Dan: By the time we talked, Emily Benson had gotten two loans from United. About 40,000 each: maybe a month's worth of billing for her, between the two loans. 

Emily Benson: That first one was wiped out. Pretty quickly because now we're on week five I'm working on the second, um, installment that I got from united. But, you know, that's half gone now too. So I don't know what the next step is. We're nowhere near. Getting claims processing yet and so. I'm kind of panicking Yeah. 

Emily Benson: it looks like the terms are within 45 days. You have to pay back that temporary loan. How am I going to do that if I don't have claims coming? 

Dan: God. 

Emily Benson: I'm still panicking. 

Dan: I'll bet. Oh my God. You're very, you're very calm for somebody in this situation. 

Emily Benson: Well, you know, I've had a lot of therapy of my own. That's how you become a therapist. So panicking doesn't help anyone. 

Dan: I guess that's, I'll take that under advisement. 

Dan: So, to pay back those loans– which are supposed to be repaid within 45 days– Emily Benson is gonna have to start getting paid again. As we spoke, she'd had been living without systems for filing claims and getting paid for five weeks. And even when those systems get moving again, she's not gonna see all that money right away.

Emily Benson: Imagine the backlog and the clog. Five weeks worth of insurance claims I mean, we're looking at a major traffic jam.

Dan: Oh myGod.Andif everybody were to work double time for the next five weeks, then it would be 10 weeks. But people can't really work double time. 

Emily Benson: When you say that out loud, 

Dan: Sorry. 

Emily Benson: I don't feel as grounded, 

Dan: I'm so sorry. 

Emily Benson: but, but, but it's probably realistic. 

Dan: Other news outlets are talking to providers like Emily Benson all over the country. We're recording this in mid-April. United hasn't responded to our questions on this story, but their website says “We're determined to make this right.” It says they've put out 4 point 7 billion dollars in emergency loans to providers so far. And it says that for the vast majority of Change Healthcare's services, a restoration date is “still pending.” We have no idea what's going to happen. What it'll mean for our doctors, our therapists, our local hospitals. And look, there are elements of this story that go beyond health care. How many of us have personal health information– maybe financial information– that got seized by who the heck knows who in this? And yes, United's getting some heat. They got a list of pointed questions from U.S. Representative Jamie Raskin. Their CEO is supposed to testify in a Senate hearing at the end of April. But as we'll get into in a minute, this disaster– United's disaster– could turn out to have a silver lining– for United: An opportunity to keep on growing. And that opportunity arises precisely because they're so big, and doing so much business in so many parts of the medical-industrial complex. Which doesn't sound great. It raises questions about the, uh, potential downsides for a lot of people, when individual companies get this freaking big. And it raises questions about what we can maybe do about it. And the answer is: Maybe more than we think. That's all coming right up. 

This episode of An Arm and a Leg is produced in partnership with KFF Health News. That's a nonprofit newsroom covering health care in America. Their reporters do amazing work, and we're honored to be in cahoots with them. So, as we've seen, a company like United is so big that their problems become everybody's problem. And at least in one case that I've seen so far, everybody's problem can become United's opportunity. That's what happened in Oregon, and a reporter from Washington, DC, was in a position to make it a national story. 

Maureen Tkacik: My name is Maureen Tkacik, but you can call me Mo and I am the Investigations Editor at the American Prospect, and a Senior Fellow at the American Economic Liberties Project. 

Dan: The Prospect is a politically-progressive news magazine, and the Economic Liberties Project is a non-profit that pushes an anti-monopoly agenda. A lot of Mo's reporting looks at how financial behemoths are looking like monopolists– especially in health care. So… 

Maureen Tkacik: have come to know United Healthcare, pretty well, over past, year or so, 

Dan: Looking at, for instance, how they gobble up medical practices. And as we mentioned, that kind of gobbling has made United the biggest employer of physicians in the country– by huge margins– in just the last few years. About one doc in ten now works for them, as employees or “affiliates.” As we've reported before, big players– like United, like big hospital systems, and like private equity groups– have been gobbling up medical practices for years. And: that kind of consolidation often leads to us paying more– and often for lousier healthcare. Moe Tkacik has been reporting on that kind of gobbling– and recently, she'd been looking at how the state of Oregon had been trying to slow it down. Then, in January 2024, a good-size medical group in Corvallis, Oregon said they were ready for United to gobble them up. The group is called the Corvallis Clinic, and it's got more than a hundred docs. But United and the Clinic would have to go through a whole process to get approval from state regulators. That process includes: regulators asking the public for comments on the transaction. And in this case… 

Maureen Tkacik: they were. inundated with comments. 

Dan: Like 378 of them in just a few weeks. And the comments were overwhelmingly AGAINST the sale. In February, the regulators sent United and Corvallis a 5-page list of conditions under which they might approve a deal. A source of Moe's sent me the document, which he got through a public-records request. The conditions are like, to not reduce service levels in the community for at least 10 years. To keep accepting non-United insurance. And to submit to a lot of monitoring. Then, as negotiations were starting, Change Healthcare went offline. And in early March, Moe got a tip: The clinic and United were gonna make an end run around this process. She talked with an anonymous insider at the clinic. Who told her: It turns out that all of the clinic's billing had been connected to Change. 

Maureen Tkacik: So we're talking about just a calamitous cash crunch. Their revenue came to a standstill 

Dan: And by the time Moe's insider source learned what was up– this had been going on for two weeks. 

Maureen Tkacik: this source said that , Thursday, they all had a meeting and they were not sure they were going to be able to open their doors the following Monday. 

Dan: That was Thursday March 7. The next day, March 8th, lawyers for Corvallis Clinic filed an application for an emergency exemption from the normal review process. A week later, they got that exemption. And this time regulators had not demanded any conditions. As Moe's story laid out, United's problem– the Change Healthcare hack– became everybody's problem, including Corvallis. And their problem seemed to have become United's opportunity. To gobble up the practice without having to agree to any conditions from pesky regulators. And a postscript to the Corvallis Clinic story: Shortly after regulators approved that deal, United sent notices to thousands of patients at another clinic it had taken over in nearby Eugene, saying basically: We don't have a doctor for you anymore. Goodbye and good luck. News reports said that clinic had lost more than 30 doctors since United took over. And among the public comments urging regulators to kibosh the Corvallis clinic, a bunch of people cited lousy experiences at that Eugene clinic under United's ownership. This is the kind of thing that Moe Tkacik and her colleagues at the American Economic Liberties Project– and what's become a kind of anti-monopoly movement– want to change. And here's where this episode becomes maybe just a little less of a horror story, and maybe a little more of an action movie. Because the anti-monopoly movement has gotten a big backer in the last three years: The Biden Administration. In 2017, a woman named Lina Khan made a name for herself in legal circles when she published a paper arguing that Amazon had become the kind of super-dominant company that antitrust laws were designed to constrain. Lina Khan was a law student when she published that paper. In 2021, Joe Biden appointed her to lead the Federal Trade Commission. The FTC and the Department of Justice split the job of antitrust enforcement, and they've both become super-aggressive. They've filed big lawsuits against Google, Amazon, and– in March of this year– Apple. And gotten a fair amount of attention. As we were writing up this episode, Jon Stewart interviewed Lina Khan on “The Daily Show.” And here's how she described her approach in that conversation. 

LK: We've really focused on how companies are behaving. Are they behaving in ways that suggest they can harm their customers, harm their suppliers, harm their workers, and get away with it? And that type of too big to care type approach is really what ends up signaling that a company has monopoly power because they can start mistreating you, but they know you're stuck. 

Dan: Earlier this year, the Wall Street Journal reported that Lina Khan's allies– antitrust folks at the Department of Justice are investigating United. Neither the Justice Department nor United has commented on that report. Meaning: Nobody's denied it. So far, some of the Biden administration's antitrust lawsuits have pan out, and some haven't. Actually, in 2021, the Justice Department sued to prevent UnitedHealth Group from buying Change Healthcare. That one, they lost. But when the sued to block Penguin Random House from buying another giant publisher, Simon and Schuster, they won. And as Lina Khan told Jon Stewart, she and her colleagues aren't just suing to prevent mergers. They sued to get infamous Pharma Bro Martin Skhreli banned for life from the pharma trade. And they won. And they're looking at other ways big companies, especially in health care, screw people. 

LK: Just to give you one example, inhalers. They've been around for decades, but they still cost hundreds of dollars. So our staff took a close look and we've realized the, some of the patents that had been listed for these inhalers were improper. There were bogus. And so we sent hundreds of warning letters around these patents. And in the last few weeks, we've seen companies deal list these patents and three out of the four major manufacturers have now said, Within a couple of months, they're going to cap how much Americans pay to just 35. 

Dan: I think we should start paying a lot more attention to what Lina Khan and her colleagues are up to– and what their chances are. I've started reading up, and getting in touch with folks who are in this fight, and who are watching it closely. Because this is looking like the kind of action movie I kind of like. Meanwhile, I'm posting a link to Jon Stewart's interview with Lina Khan wherever you're listening to this. I'll have a few other links for you in our newsletter– you can sign up for that at arm and a leg show dot com, slash, newsletter. And I'll catch you in a few weeks. Till then, take care of yourself. 

This episode of an arm and a leg was produced by me, Dan Weissmann, with help from Emily Pisacreta, and edited by Ellen Weiss. Big thanks this time to the novelist, journalist and activist Cory Doctorow, who has been writing about the antitrust revival for years, breaking down complex, technical stories in clear, accessible ways. Thanks to professor Spencer Waller from the Loyola University Chicago law school for talking about antitrust with me. And thanks to Dr. John Santa in Oregon– for sharing material he got via a public-records request to the state, and for his observations. Adam Raymonda is our audio wizard. Our music is by Dave Weiner and blue dot sessions. Extra music in this episode from Epidemic Sound. Gabrielle Healy is our managing editor for audience. She edits the first aid kit newsletter. Bea Bosco is our consulting director of operations. Sarah Ballama is our operations manager. And Armand a Leg is produced in partnership with KFF Health News. That's a national newsroom producing in depth journalism about healthcare in America and a core program at KFF, an independent source of health policy research, polling and journalism. Zach Dyer is senior audio producer at KFF Health News. He's editorial liaison to this show. And thanks to the Institute for Nonprofit News for serving as our fiscal sponsor, allowing us to accept tax exempt donations. You can learn more about INN at INN. org. Finally, thanks to everybody who supports this show financially– you can join in any time at arm and a leg show dot com, slash, support– and thanks for listening.

“An Arm and a Leg” is a co-production of KFF Health News and Public Road Productions.

To keep in touch with “An Arm and a Leg,” subscribe to the newsletter. You can also follow the show on Facebook and the social platform X. And if you've got stories to tell about the health care system, the producers would love to hear from you.

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And subscribe to “An Arm and a Leg” on Spotify, Apple Podcasts, Pocket Casts, or wherever you listen to podcasts.

——————————
By: Dan Weissmann
Title: An Arm and a Leg: The Hack
Sourced From: kffhealthnews.org/news/podcast/the-hack/
Published Date: Tue, 30 Apr 2024 09:00:00 +0000

Did you miss our previous article…
https://www.biloxinewsevents.com/what-floridas-new-6-week-abortion-ban-means-for-the-south-and-traveling-patients/

Christopher O'Donnell, Tampa Bay Times
Mon, 29 Apr 2024 09:00:00 +0000

Monica Kelly was thrilled to learn she was expecting her second child.

The Tennessee mother was around 13 weeks pregnant when, according to a lawsuit filed against the state of Tennessee, doctors gave her the devastating news that her baby had Patau syndrome.

The genetic disorder causes serious developmental defects and often results in miscarriage, stillbirth, or death within one year of birth. Continuing her pregnancy, doctors told her, could put her at risk of infection and complications that include high blood pressure, organ failure, and death.

But they said they could not perform an abortion due to a Tennessee law banning most abortions that went into effect two months after the repeal of Roe v. Wade in June 2022, court records show.

So Kelly traveled to a northwestern Florida hospital to get an abortion while about 15 weeks pregnant. She is one of seven women and two doctors suing Tennessee because they say the state's near-total abortion ban imperils the lives of pregnant women.

More than 25,000 women like Kelly traveled to Florida for an abortion over the past five years, state data shows. Most came from states such as Alabama, Louisiana, and Mississippi with little or no access to abortion, data from the Centers for Disease Control and Prevention shows. Hundreds traveled from as far as Texas.

But a recent Florida Supreme Court ruling paved the way for the Sunshine State to enforce a six-week ban beginning in May, effectively leaving women in much of the South with little or no access to abortion clinics. The ban could be short-lived if 60% of Florida voters in November approve a constitutional amendment adding the right to an abortion.

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In the meantime, nonprofit groups are warning they may not be able to meet the increased demand for help from women from Florida and other Southeastern states to travel for an abortion. They fear women who lack the resources will be forced to carry unwanted pregnancies to term because they cannot afford to travel to states where abortions are more available.

That could include women whose pregnancies, like Kelly's, put them at risk.

“The six-week ban is really a problem not just for Florida but the entire Southeast,” said McKenna Kelley, a board member of the Tampa Bay Abortion Fund. “Florida was the last man standing in the Southeast for abortion access.”

Travel Bans and Stricter Limits

Supporters of the Florida restrictions aren't backing down. Some want even stricter limits. Republican state Rep. Mike Beltran voted for both the 15-week and six-week bans. He said the vast majority of abortions are elective and that those related to medical complications make up a tiny fraction.

State data shows that 95% of abortions last year were either elective or performed due to social or economic reasons. More than 5% were related to issues with either the health of the mother or the fetus.

Beltran said he would support a ban on travel for abortions but knows it would be challenged in the courts. He would support measures that prevent employers from paying for workers to travel for abortions and such costs being tax-deductible, he said.

“I don't think we should make it easier for people to travel for abortion,” he said. “We should put things in to prevent circumvention of the law.”

Both abortion bans were also supported by GOP state lawmaker Joel Rudman. As a physician, Rudman said, he has delivered more than 100 babies and sees nothing in the current law that sacrifices patient safety.

“It is a good commonsense law that provides reasonable exceptions yet respects the sanctity of life for both mother and child,” he said in a text message.

Last year, the first full year that many Southern states had bans in place, more than 7,700 women traveled to Florida for an abortion, an increase of roughly 59% compared with three years ago.

The Tampa Bay Abortion Fund, which is focused on helping local women, found itself assisting an influx of women from Arkansas, Georgia, Mississippi, Louisiana, and other states, Kelley said.

In 2023, it paid out more than $650,000 for appointment costs and over $67,000 in other expenses such as airplane tickets and lodging. Most of those who seek assistance are from low-income families including minorities or disabled people, Kelley said.

“We ask each person, ‘What can you contribute?'” she said. “Some say zero and that's fine.” 

Florida's new law will mean her group will have to pivot again. The focus will now be on helping people seeking abortions travel to other states.

But the destinations are farther and more expensive. Most women, she predicted, will head to New York, Illinois, or Washington, D.C. Clinic appointments in those states are often more expensive. The extra travel distance will mean help is needed with hotels and airfare.

North Carolina, which allows abortions through about 12 weeks of pregnancy, may be a slightly cheaper option for some women whose pregnancies are not as far along, she said.

Keeping up with that need is a concern, she said. Donations to the group soared to $755,000 in 2022, which Kelley described as “rage donations” made after the U.S. Supreme Court ended half a century of guaranteeing the federal right to an abortion.

The anger didn't last. Donations in 2023 declined to $272,000, she said.

“We're going to have huge problems on our hands in a few weeks,” she said. “A lot of people who need an abortion are not going to be able to access one. That's really scary and sad.”

Gray Areas Lead to Confusion

The Chicago Abortion Fund is expecting that many women from Southeastern states will head its way.

Illinois offers abortions up until fetal viability — around 24 to 26 weeks. The state five years ago repealed its law requiring parents to be notified when their children seek an abortion.

About 3 in 10 abortions performed in Illinois two years ago — almost 17,000 — involved out-of-state residents, up from fewer than a quarter the previous year, according to state records.

The Chicago nonprofit has prided itself on not turning away requests for help over the past five years, said Qudsiyyah Shariyf, a deputy director. It is adding staffers, including Spanish-language speakers, to cope with an anticipated uptick in calls for help from Southern states. She hopes Florida voters will make the crisis short-lived.  

“We're estimating we'll need an additional $100,000 a month to meet that influx of folks from Florida and the South,” she said. “We know it's going to be a really hard eight months until something potentially changes.”

Losing access to abortion, especially among vulnerable groups like pregnant teenagers and women with pregnancy complications, could also increase cases of mental illness such as depression, anxiety, and even post-traumatic stress disorder, said Silvia Kaminsky, a licensed marriage and family therapist in Miami.

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Kaminsky, who serves as board president of the American Association for Marriage and Family Therapy, said the group has received calls from therapists seeking legal guidance about whether they can help a client who wants to travel for an abortion.

That's especially true in states such as Alabama, Georgia, and Missouri that have passed laws granting “personhood” status to fetuses. Therapists in many states, including Florida, are required to report a client who intends to harm another individual.

“It's creating all these gray areas that we didn't have to deal with before,” Kaminsky said.

Deborah Dorbert of Lakeland, Florida, said that Florida's 15-week abortion limit put her health at risk and that she was forced to carry to term a baby with no chance of survival.

Her unborn child was diagnosed with Potter syndrome in November 2022. An ultrasound taken at 23 weeks of pregnancy showed that the fetus had not developed enough amniotic fluid and that its kidneys were undeveloped.

Doctors told her that her child would not survive outside the womb and that there was a high risk of a stillbirth and, for her, preeclampsia, a pregnancy complication that can result in high blood pressure, organ failure, and death.

One option doctors suggested was a pre-term inducement, essentially an abortion, Dorbert said.

Dorbert and her husband were heartbroken. They decided an abortion was their safest option.

At Lakeland Regional Health, she said, she was told her surgery would have to be approved by the hospital administration and its lawyers since Florida had that year enacted its 15-week abortion restriction.

Florida's abortion law includes an exemption if two physicians certify in writing that a fetus has a fatal fetal abnormality and has not reached viability. But a month elapsed before she got an answer in her case. Her doctor told her the hospital did not feel they could legally perform the procedure and that she would have to carry the baby to term, Dorbert said.

Lakeland Regional Health did not respond to repeated calls and emails seeking comment.

Dorbert's gynecologist had mentioned to her that some women traveled for an abortion. But Dorbert said she could not afford the trip and was concerned she might break the law by going out of state.

At 37 weeks, doctors agreed to induce Dorbert. She checked into Lakeland Regional Hospital in March 2023 and, after a long and painful labor, gave birth to a boy named Milo.

“When he was born, he was blue; he didn't open his eyes; he didn't cry,” she said. “The only sound you heard was him gasping for air every so often.”

She and her husband took turns holding Milo. They read him a book about a mother polar bear who tells her cub she will always love them. They sang Bob Marley and The Wailers' “Three Little Birds” to Milo with its chorus that “every little thing is gonna be alright.”

Milo died in his mother's arms 93 minutes after being born.

One year later, Dorbert is still dealing with the anguish. The grief is still “heavy” some days, she said.

She and her husband have discussed trying for another child, but Florida's abortion laws have made her wary of another pregnancy with complications.

“It makes you angry and frustrated. I could not get the health care I needed and that my doctors advised for me,” she said. “I know I can't go through what I went through again.”

——————————
By: Christopher O'Donnell, Tampa Bay Times
Title: What Florida's New 6-Week Abortion Ban Means for the South, and Traveling Patients
Sourced From: kffhealthnews.org/news/article/florida-6-week-abortion-ban-patient-travel-south/
Published Date: Mon, 29 Apr 2024 09:00:00 +0000

Did you miss our previous article…
https://www.biloxinewsevents.com/exposed-to-agent-orange-at-us-bases-veterans-face-cancer-without-va-compensation/

Hannah Norman, KFF Health News and Patricia Kime
Mon, 29 Apr 2024 09:00:00 +0000

As a young GI at Fort Ord in Monterey County, California, Dean Osborn spent much of his time in the oceanside woodlands, training on soil and guzzling water from streams and aquifers now known to be contaminated with cancer-causing pollutants.

“They were marching the snot out of us,” he said, recalling his year and a half stationed on the base, from 1979 to 1980. He also remembers, not so fondly, the poison oak pervasive across the 28,000-acre installation that closed in 1994. He went on sick call at least three times because of the overwhelmingly itchy rash.

Mounting evidence shows that as far back as the 1950s, in an effort to kill the ubiquitous poison oak and other weeds at the Army base, the military experimented with and sprayed the powerful herbicide combination known colloquially as Agent Orange.

While the U.S. military used the herbicide to defoliate the dense jungles of Vietnam and adjoining countries, it was contaminating the land and waters of coastal California with the same chemicals, according to documents.

The Defense Department has publicly acknowledged that during the Vietnam War era it stored Agent Orange at the Naval Construction Battalion Center in Gulfport, Mississippi, and the former Kelly Air Force Base in Texas, and tested it at Florida's Eglin Air Force Base.

According to the Government Accountability Office, however, the Pentagon's list of sites where herbicides were tested went more than a decade without being updated and lacked specificity. GAO analysts described the list in 2018 as “inaccurate and incomplete.”

Fort Ord was not included. It is among about four dozen bases that the government has excluded but where Pat Elder, an environmental activist, said he has documented the use or storage of Agent Orange.

According to a 1956 article in the journal The Military Engineer, the use of Agent Orange herbicides at Fort Ord led to a “drastic reduction in trainee dermatitis casualties.”

“In training areas, such as Fort Ord, where poison oak has been extremely troublesome to military personnel, a well-organized chemical war has been waged against this woody plant pest,” the article noted.

Other documents, including a report by an Army agronomist as well as documents related to hazardous material cleanups, point to the use of Agent Orange at the sprawling base that 1.5 million service members cycled through from 1917 to 1994.

‘The Most Toxic Chemical'

Agent Orange is a 50-50 mixture of two ingredients, known as 2,4-D and 2,4,5-T. Herbicides with the same chemical structure slightly modified were available off the shelf, sold commercially in massive amounts, and used at practically every base in the U.S., said Gerson Smoger, a lawyer who argued before the Supreme Court for Vietnam veterans to have the right to sue Agent Orange manufacturers. The combo was also used by farmers, forest workers, and other civilians across the country.

The chemical 2,4,5-T contains the dioxin 2,3,7,8-tetrachlorodibenzo-p-dioxin or TCDD, a known carcinogen linked to several cancers, chronic conditions and birth defects. A recent Brown University study tied Agent Orange exposure to brain tissue damage similar to that caused by Alzheimer's. Acknowledging its harm to human health, the Environmental Protection Agency banned the use of 2,4,5-T in the U.S. in 1979. Still, the other weed killer, 2,4-D is sold off-the-shelf today.

“The bottom line is TCDD is the most toxic chemical that man has ever made,” Smoger said.

For years, the Department of Veteran Affairs has provided vets who served in Vietnam disability compensation for diseases considered to be connected to exposure to Agent Orange for military use from 1962 to 1975.

Decades after Osborn's military service, the 68-year-old veteran, who never served in Vietnam, has battled one health crisis after another: a spot on his left lung and kidney, hypothyroidism, and prostate cancer, an illness that has been tied to Agent Orange exposure.

He says many of his old buddies from Fort Ord are sick as well.

“Now we have cancers that we didn't deserve,” Osborn said.

The VA considers prostate cancer a “presumptive condition” for Agent Orange disability compensation, acknowledging that those who served in specific locations were likely exposed and that their illnesses are tied to their military service. The designation expedites affected veterans' claims.

But when Osborn requested his benefits, he was denied. The letter said the cancer was “more likely due to your age,” not military service.

“This didn't happen because of my age. This is happening because we were stationed in the places that were being sprayed and contaminated,” he said.

Studies show that diseases caused by environmental factors can take years to emerge. And to make things more perplexing for veterans stationed at Fort Ord, contamination from other harmful chemicals, like the industrial cleaner trichloroethylene, have been well documented on the former base, landing it on the EPA's Superfund site list in 1990.

“We typically expect to see the effect years down the line,” said Lawrence Liu, a doctor at City of Hope Comprehensive Cancer Center who has studied Agent Orange. “Carcinogens have additive effects.”

In February, the VA proposed a rule that for the first time would allow compensation to veterans for Agent Orange exposure at 17 U.S. bases in a dozen states where the herbicide was tested, used, or stored.

Fort Ord is not on that list either, because the VA's list is based on the Defense Department's 2019 update.

“It's a very tricky question,” Smoger said, emphasizing how widely the herbicides were used both at military bases and by civilians for similar purposes. “On one hand, we were service. We were exposed. On the other hand, why are you different from the people across the road that are privately using it?”

The VA says that it based its proposed rule on information provided by the Defense Department.

“DoD's review found no documentation of herbicide use, testing or storage at Fort Ord. Therefore, VA does not have sufficient evidence to extend a presumption of exposure to herbicides based on service at Fort Ord at this time,” VA press secretary Terrence Hayes said in an email.

The Documentation

Yet environmental activist Elder, with help from toxic and remediation specialist Denise Trabbic-Pointer and former VA physician Kyle Horton, compiled seven documents showing otherwise. They include a journal article, the agronomist report, and cleanup-related documents as recent as 1995 — all pointing to widespread herbicide use and experimentation as well as lasting contamination at the base.

Though the documents do not call the herbicide by its colorful nickname, they routinely cite the combination of 2,4-D and 2,4,5-T. A “hazardous waste minimization assessment” dated 1991 reported 80,000 pounds of herbicides used annually at Fort Ord. It separately lists 2,4,5-T as a product for which “substitutions are necessary to minimize the environmental impacts.”

The poison oak “control program” started in 1951, according to a report by Army agronomist Floyd Otter, four years before the U.S. deepened its involvement in Vietnam. Otter detailed the use of these chemicals alone and in combination with diesel oil or other compounds, at rates generally between “one to two gallons of liquid herbicide” per acre.

“In conclusion, we are fairly well satisfied with the methods,” Otter wrote, noting he was interested in “any way in which costs can be lowered or quicker kill obtained.”

An article published in California Agriculture more than a decade later includes before and after photos showing the effectiveness of chemical brush control used in a live-oak woodland at Fort Ord, again citing both chemicals in Agent Orange. The Defense Department did not respond to questions sent April 10 about the contamination or say when the Army stopped using 2,4,5-T at Fort Ord.

“What's most compelling about Fort Ord is it was actually used for the same purpose it was used for in Vietnam — to kill plants — not just storing it,” said Julie Akey, a former Army linguist who worked at the base in the 1990s and later developed the rare blood cancer multiple myeloma.

Akey, who also worked with Elder, runs a Facebook group and keeps a list of people stationed on the base who later were diagnosed with cancer and other illnesses. So far, she has tallied more than 1,400 former Fort Ord residents who became sick.

Elder's findings have galvanized the group to speak up during a public comment period for the VA's proposed rule. Of 546 comments, 67 are from veterans and others urging the inclusion of Fort Ord. Hundreds of others have written in regarding the use of Agent Orange and other chemicals at their bases.

While the herbicide itself sticks around for only a short time, the contaminant TCDD can linger in sediment for decades, said Kenneth Olson, a professor emeritus of soil science at the University of Illinois Urbana-Champaign.

A 1995 report from the Army's Sacramento Corps of Engineers, which documented chemicals detected in the soil at Fort Ord, found levels of TCDD at 3.5 parts per trillion, more than double the remediation goal at the time of 1.2 ppt. Olson calls the evidence convincing.

“It clearly supports the fact that 2,4,5-T with unknown amounts of dioxin TCDD was applied on the Fort Ord grounds and border fences,” Olson said. “Some military and civilian personnel would have been exposed.”

The Department of Defense has described the Agent Orange used in Vietnam as a “tactical herbicide,” more concentrated than what was commercially available in the U.S. But Olson said his research suggests that even if the grounds maintenance crew used commercial versions of 2,4,5-T, which was available in the federal supply catalog, the soldiers would have been exposed to the dioxin TCDD.

The half dozen veterans who spoke with KFF Health News said they want the military to take responsibility.

The Pentagon did not respond to questions regarding the upkeep of the list or the process for adding locations.

In the meantime, the Agency for Toxic Substances and Disease Registry is studying potential chemical exposure among people who worked and lived on Fort Ord between 1985 and 1994. However, the agency is evaluating drinking water for contaminants such as trichloroethylene and not contamination or pollution from other chemicals such as Agent Orange or those found in firefighting foams.

Other veterans are frustrated by the VA's long process to recognize their illnesses and believe they were sickened by exposure at Fort Ord.

“Until Fort Ord is recognized by the VA as a presumptive site, it's probably going to be a long, difficult struggle to get some kind of compensation,” said Mike Duris, a 72-year-old veteran diagnosed with prostate cancer four years ago who ultimately underwent surgery.

Like so many others, he wonders about the connection to his training at Fort Ord in the early '70s — drinking the contaminated water and marching, crawling, and digging holes in the dirt.

“Often, where there is smoke, there's fire,” Duris said.

——————————
By: Hannah Norman, KFF Health News and Patricia Kime
Title: Exposed to Agent Orange at US Bases, Veterans Face Cancer Without VA Compensation
Sourced From: kffhealthnews.org/news/article/agent-orange-us-bases-veterans-face-cancer-without-va-compensation/
Published Date: Mon, 29 Apr 2024 09:00:00 +0000

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