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U.S. health officials said Friday that their investigation into an outbreak of severe vaping-related illnesses is increasingly focused on products that contain the marijuana compound THC. Most of the 800 people who got sick vaped THC, the ingredient in marijuana that causes a high, according to the Centers for Disease Control and Prevention. But officials said they didn’t know if the THC is the problem or some other substance added to the vaping liquid, such as thickeners. (Stobbe, 9/27)

The Centers for Disease Control and Prevention said of 514 injured patients who reported details on their use of vaping devices and e-liquids, 77% used products that contained THC, alone or combined with nicotine. Only 16% of injured vapers said they used nicotine-only products. (Alltucker, 9/27)

Health officials in two states say that many patients sickened by vaping-associated lung illness vaped THC and used pre-packaged, pre-filled cartridges — often acquired from informal sources like friends or dealers. The new report, published Friday by the Centers for Disease Control and Prevention, comes from interviews with 86 confirmed and probable patients with the illness in Illinois and Wisconsin, the states which first reported the cases. The report underscores the difficulty in parsing the exact products that might be involved in the illnesses. Interviewees reported using 234 different products across 87 different brands. (Thielking, 9/27)

Health officials said on Friday that the products include THC-filled vaping cartridges labeled “Dank Vapes,” as well as some other illicit brands that people bought from friends or family or on the street. But officials said Dank Vapes appeared to be a label that THC sellers can slap on any product and is not a specific formulation or a single product. THC is the psychoactive ingredient in marijuana. “Dank Vapes appears to be the most prominent in a class of largely counterfeit brands, with common packaging that is easily available online and that is used by distributors to market THC-containing cartridges with no obvious centralized production or distribution,” said a report published on Friday by state health officials from Illinois and Wisconsin, and from the federal Centers for Disease Control and Prevention. (Grady, 9/27)

Other brands identified by people with the lung injury include TKO, Off White, Moon Rocks, Chronic Carts and others. Industry experts said many THC products on the black market come from distributors who buy empty cartridges, fill them with THC mixtures, then purchase packaging with those brand labels. (Sun and McGinley, 9/27)

Authorities have urged people to stop using electronic cigarettes and other vaping products while they continue to investigate the illness. The Food and Drug Administration and the Trump administration recently said they would pull e-cigarette flavored products off the market. (Ansari, 9/27)

The CDC has been warning since the outbreak began about the risks of buying products "off the street," and Friday's update highlighted the risks of the black market. Sometimes young consumers don't even realize that they're buying unregulated or illicit products. "THC-based products were most often acquired from informal sources such as down the street from friends or from a dealer," said Jennifer Layden of the Illinois Department of Public Health at the press briefing. (Aubrey, 9/27)

Vaping related illnesses are on the rise, and it appears to be related to a black market of THC vapes. WSJ’s Daniela Hernandez sat down with doctors and experts to understand what’s happening with the outbreak. (9/30)

Public health experts are cautioning that the coming flu season could complicate attempts to diagnose new cases of a mysterious vaping-related illness — and, in turn, make it more difficult to track down the cause. The issue, experts say, is that flu and other respiratory viruses can, in many ways, look strikingly similar to a case of vaping-related illness: Symptoms include shortness of breath, night sweats, low oxygen levels, and hazy spots on a lung X-ray. (Thielking, 9/27)

After years of grinding through the bureaucratic process and fending off litigation, the US Food and Drug Administration in 2016 declared that it was finally able to regulate electronic cigarettes. But it would still be years before the agency would require e-cigarette makers to provide information on the health effects of their products, so the FDA could determine whether they should stay on the market. The first deadline for that information was 2018, but the FDA moved it back to 2022. (Martin, 9/28)

In a lounge at the Sundance Film Festival last year, Juul Labs Inc. doled out $1 bundles of e-cigarettes to guests passing through. A-listers, including Elijah Wood, Nicolas Cage and Black Eyed Peas frontman will.i.am, stopped in front of a Juul-branded backdrop and posed for photographs. On its face this was standard marketing practice, cozying up to celebrities to lend cachet to the brand. But by this time, Juul was already aware of teen use of its products, having learned about it in local media reports. (Maloney and McKay, 9/28)

Beginning Tuesday, businesses will no longer be able to sell cigarettes, cigars, chewing and pipe tobacco and vaping products to people younger than 21. The General Assembly in May threw its support behind the effort, with the Senate approving the measure 33-3 and the House backing it by a vote of 124-22. (Carlesso, 9/30)

In an effort to prevent young people from getting hooked on tobacco and nicotine, Maryland is raising the age to buy cigarettes, cigars and vaping products to 21, effective Tuesday. ...Under the law, the minimum age for buying tobacco and nicotine products jumps from 18 to 21. The only exception is for members of the military, who can still buy at age 18 by showing a military identification — a concession that anti-smoking advocates made to get the law passed. (Wood, 9/30)

Nearly all teenagers will be barred from buying e-cigarettes or their analog counterparts in Maryland after Tuesday, when hundreds of new laws — including a higher smoking age — take effect. Maryland joins the District and 14 other states that restrict nicotine sales in an effort to curb an alarming surge in teen vaping. (Cox, 9/29)

More than 300 operators of vaping shops across Massachusetts are reeling in the wake of a state order that they immediately cease operations for four months as U.S. health officials rush to determine the cause of a lung ailment that’s killed 12 people and sickened 805 others. ...Governor Charlie Baker’s emergency decree last week was the most aggressive action yet taken by officials seeking to contain the illness and a nationwide surge in the use of nicotine and marijuana vaporizers by minors. The impact on the fledgling industry in Massachusetts may provide a window into how consumers and businesses might cope with similar moves planned by other states, as the prospect of tighter federal regulations looms. (Moroney and Moore, 9/29)

The recent numbers of vaping-related illness are alarming, at best; at worst, in the eyes of federal officials, the U.S. is embroiled in a deadly, mysterious and "ongoing outbreak" across the country. ... But in Massachusetts, where Gov. Charlie Baker earlier this week declared a public health emergency, some store owners fear the severity of state officials' response as much as the outbreak itself. One vape store owner, Behram Agha, filed a lawsuit Thursday against officials at the Massachusetts Department of Public Health, seeking an injunction to lift Baker's immediate four-month ban on the sale of all vaping products in the state. (Dwyer, 9/27)

Chris Kippes, director of epidemiology, surveillance and infomatics at the Cuyahoga County Board of Health, said electronic-cigarette users who develop breathing problems should be honest when reporting their vaping habits to health officials, even if that means confessing to using THC. Every bit of information will help researchers pinpoint the cause of the mysterious, pneumonia-like illness, Kippes said. (Washington, 9/27)

As the nationwide toll for vaping-related deaths hit 13 and the number of illnesses exceeded 800, state health officials said Friday that more cases have been recorded in Connecticut. The public health department has now logged 18 incidents of vaping-related lung disease, an increase of five since the office last shared data a week ago. All of the patients have been discharged from the hospital. Half required treatment in an intensive care unit. (Carlesso, 9/27)

The recent surge of lung illnesses and deaths linked to vaping, an increasingly entrenched habit among many youths, largely caught school authorities flat-footed, and educators are urgently mobilizing anti-vaping efforts against what they see as a dangerous teen epidemic. (Blume, Kohli and Agrawal, 9/30)

Kaiser Health News: States Target Vaping With Bans. In California, The Action Is Local.

States are piling on. Michigan took the first statewide shot at vaping early this month when it announced a ban on the sale of flavored e-cigarette products. It was soon joined by New York, and Rhode Island jumped in Wednesday. Massachusetts went further, announcing Tuesday that it would prohibit the sale of all vaping flavors and devices for four months. But in California — which prides itself on progressive policies — lawmakers this year punted on a proposal for a statewide ban on flavored tobacco products. (Ibarra, 9/30)

[Speak Nancy] Pelosi has already advised the newest members of her caucus — the ones who secured the majority last year — that they will have to execute a careful balancing act in the coming weeks, to show voters in their districts that they can continue to pass important legislation. She is said to be particularly focused on a proposal to lower prescription drug prices that she unveiled last week, before the Ukraine saga began. But even before impeachment, House Democrats were gaining little traction with policy bills that withered in the Republican-controlled Senate. Polls have shown their proposals to be popular, but they have been routinely overshadowed in the news by Mr. Trump. (Burns and Corasaniti, 9/28)

Major legislation to reduce prescription drug costs for millions of people may get sidelined now that House Democrats have begun an impeachment inquiry of President Donald Trump. Proposals had been moving in Congress, but there are more ways for the process to break down than to succeed. Still, nobody says they’re giving up. Some questions and answers about the legislation and its uncertain prospects. (Alonso-Zaldivar, 9/29)

In the past six months, dozens of members of Congress and their aides have descended upon the southwestern border in an effort to see what is happening there. To witness the visits is to understand the nub of the deep divide over how to repair the nation’s broken immigration system. The fact-finding tours, detailed in interviews with more than two dozen lawmakers and aides, are sometimes sanitized for the V.I.P.s who take them, as the Trump administration works to put the best face on an often inhumane situation. But they have yielded moments of raw emotion and glimpses of human suffering that have prompted passionate testimony, viral videos of lawmakers on their tours, new legislative proposals and, in one case, a book. (Cochrane, 9/28)

Americans need to know more before they can make up their minds about proposed overhauls to the nation’s health care system, according to a survey released Thursday. When asked if they wanted to wipe out private health insurance for a so-called Medicare for All public insurance program, 40 percent of U.S. adults between the ages of 19 to 64 said they did not know enough to offer an opinion. (Santhanam, 9/27)

A Trump administration plan to make hospitals disclose their negotiated prices is spurring a battle between industry and patient advocates that could determine how far the White House will go with its initiative. Friday marks the end of a public input period that has seen more than 750 comments on a proposed rule that would include upending the secret negotiations that determine how much insurers pay for treatments and care. The administration is expected to release a final rule in November. It would take effect Jan. 1, 2020. (Armour, 9/27)

The Trump administration is taking major political heat for opposing Obamacare in a high-stakes legal challenge, which a federal appeals court could rule on any day now. But that wasn’t always the plan. It turns out the administration originally intended to embrace all of the Affordable Care Act — including its protections for patients with preexisting conditions — until an influential trio of conservative advisers convinced President Trump earlier this year to do exactly the opposite. The reversal of course has not previously been reported and sheds new light on how the Trump administration has struggled to uphold and message its health-care plans following Congress's failure to repeal and replace Obamacare in summer 2017. It also suggests at least some Republicans close to Trump are concerned about the potential political backlash and likely chaos if the court rules to strike down the ACA. (Winfield Cunningham, 9/27)

Do a quick search for health insurance, and you'll find plenty of ads for "Trumpcare" plans that cost $59 or less per month. But there's a catch: Trumpcare doesn't exist, and many of these advertised plans offer bare-bones coverage. (Herman, 9/30)

The CMS on Friday released a new tool designed to help employers decide if they should offer their workers individual coverage health reimbursement arrangements. Earlier this year, the CMS finalized a rule that allows employers to give their employees tax-free money to buy health insurance on the individual market through an HRA beginning in January 2020. The tool offers employers access to health insurance premium data based on location. It also provides rate information for the cheapest plan in a category like the lowest-cost silver plan, which depends on a worker's age and location. (Brady, 9/27)

The Food and Drug Administration released new guidelines clarifying which types of medical software systems do—and do not—fall under the agency's regulatory oversight. Under a set of companion guidelines released Thursday, the FDA outlined a plan to focus its regulatory oversight on clinical-decision support software meant to help providers and patients manage "serious or critical conditions," said Dr. Amy Abernethy, the FDA's principal deputy commissioner. (Cohen, 9/27)

Although Oliver would not need a visa, many families from abroad need special permission to enter the United States for medical care. But a recent policy change by the US Citizenship and Immigration Services threatened to severely limit the stay for many children granted special immigration status to receive longer term, lifesaving medical care at hospitals such as Boston Children’s. In August, the agency said it would no longer renew stays through its “medical deferred action” program, which allows people in dire need to remain in the US for two-year periods. The families of at least a dozen children in Boston received notices from the agency denying their extended stays and warning that they could face deportation, The Boston Globe reported. (Salahi, 9/27)

Idaho officials on Friday submitted a work-requirement waiver to the U.S. Department of Health and Human Services for Medicaid expansion, and they say four other waivers will likely be submitted by December. The Idaho Department of Health & Welfare is also taking public comments on another waiver, taking steps to fix problems with a rejected waiver, and is negotiating with the federal agency. (Ridler, 9/27)

Democratic Gov. Laura Kelly’s new council on expanding Medicaid is scheduled to have its first meeting Monday at the Statehouse. The agenda for the meeting includes a welcome from Kelly and briefings about other states’ experiences in expanding Medicaid health coverage for low-income residents. (9/28)

Control of a unit that fights Medicaid fraud in West Virginia is being transferred this week. The fraud unit is moving from the Department of Health and Human Resources to the state attorney general’s office on Tuesday. The transfer was approved by the Legislature earlier this year. (9/30)

Minnesota’s attorney general’s office says it has charged 11 people with defrauding the state’s Medicaid program of more than $800,000. Attorney General Keith Ellison said in a statement Friday that the charges involve nine different cases. The announcement comes on the heels of an investigation into a northern Minnesota care center that bilked Medicaid out of nearly $2.2 million. (9/27)

The federal government is allowing Ohio more flexibility in what services it can provide to Medicaid patients addicted to opioids. The expanded options are coming through a substance use disorder demonstration waiver that the Centers for Medicare and Medicaid Services recently approved. (9/30)

Rhode Island has been awarded nearly $3.5 million in federal funding for addiction treatment. The state’s congressional delegation announced the grant from the Centers for Medicare and Medicaid Services. It’s meant to increase the treatment capacity of Medicaid providers for substance use disorder treatment and recovery services. (9/29)

Connecticut will receive $2.9 million in federal funding over 18 months to develop a plan to provide more substance abuse services to Medicaid recipients. The goal of the Centers for Medicare and Medicaid Services grant is to ultimately increase the capacity of Medicaid providers to deliver substance abuse disorder treatment or recovery services. (9/28)

In announcing a crackdown Friday on companies it says were involved in fraudulent genetic testing, the U.S. Department of Justice brought charges against 35 individuals associated with dozens of telemarketing companies and testing labs. The federal investigation, called Operation Double Helix, went after schemes that allegedly targeted people 65 and older. According to the charges, the schemes involved laboratories paying illegal kickbacks and bribes to medical professionals who were working with fraudulent telemarketers, in exchange for the referral of Medicare beneficiaries. (Neighmond, 9/27)

In what U.S. law-enforcement officials are calling one of the biggest health-care frauds in history, the Justice Department said that Medicare was fraudulently billed $2.1 billion after seniors were enticed to take unnecessary genetic tests for cancer. The Justice Department and the Department of Health and Human Services said on Friday that 35 defendants associated with dozens of telemedicine companies and cancer genetic testing laboratories had been charged with fraud. Those charged included nine doctors. (Brown, 9/27)

Federal agents took down an alleged Medicare scam Friday that exploited seniors’ curiosity about genetic medicine by enticing them to get their cheeks swabbed for unneeded DNA tests. Medicare was billed $2.1 billion. Dubbed “Operation Double Helix,” the crackdown targeted telemedicine companies, doctors and labs, in a joint effort by the Justice Department , the FBI, U.S. attorneys’ offices, and the Health and Human Services inspector general. Thirty-five people were charged around the country. (Alonso-Zaldivar, 9/27)

A new online Medicare Plan Finder tool could make it more time-consuming and difficult for seniors to research and enroll in a Medicare prescription drug plan this year, advocates say. "I have people on the margins," said Julie Hine, a prescription analyst for the Senior Benefits Group, which is a state-licensed independent insurance broker and works with about 7,000 people each Medicare open enrollment period. Some of them are seniors who are homebound. Others don't have Internet access. She recalled one man who makes his prescription drug list on the back of a previously used envelope to save money on paper. (Shamus, 9/29)

As a graying population confronts the limited options for senior housing, seeking ways to maintain independence without the isolation that can accompany so-called aging in place, various grassroots alternatives are gaining footholds. Shared housing, cohousing and village organizations appeal to those hoping to avoid the high costs and institutional nature of assisted-living and nursing homes, or at least stave them off for as long as possible. (Span, 9/27)

The president of the national union for nurses at the University of Cincinnati Medical Center says the hospital system is being “so stupid and so tone deaf” in dealing with its nurses and their concerns about patient safety.“ There are some people in this management here who are being very Trumpian in trying to bully and silence and tell lies about who these nurses are,” said Randi Weingarten, president of the American Federation of Teachers. (Saker, 9/28)

Delaney’s updates, every 90 minutes, might seem like the oldest, simplest kind of medical care — but they were the product of a gradual shift, an innovation that swept from hospital to hospital alongside midcentury advances in surgery that meant procedures ran longer. Children’s started its surgical liaison program in 1963, well before such positions became ubiquitous. Even as the role spread in the 1970s, more hands-on nurses viewed them with a combination of jealousy and disdain. (Boodman, 9/27)

In many cases, the nurses are stretched so thin that some of those complicated responsibilities are handed off to staff members with little or no medical training. Meanwhile, preliminary research from the Minnesota Department of Health, which is surveying school districts about their health care staffing, found that more than a quarter of Minnesota school districts have no nurses at all. (Golden, 9/29)

The 77-year-old business owner experienced multiple complications from the transplant, and UH wouldn’t discharge him unless he could get daily infusions for hydration while at home.Gecsi turned to Julie Wenzinger, owner of the Sandusky-based Advocacy Healthcare Concepts and a board-certified patient advocate, for help. Gecsi credits Wenzinger as one of the people who saved his life.Wenzinger, who also is a registered nurse, is part of a growing profession that helps guide patients and their families through the health care maze. (Washington, 9/29)

Modern medicine can now keep alive children born after just 23 or 24 weeks in the womb. In babies that young, their developing brains will be compromised, which can lead to developmental disabilities and long-term physical and mental health problems. ...Als showed that such care also leads to noticeably different brain structures and measurably improved brain function: By the time they are 8, babies who received kangaroo care can concentrate, organize their thoughts, remember more, and function better than those who didn’t. (Weintraub, 9/27)

Alvar is part of a wave of women in Minnesota choosing home births over hospitals. It’s a shift that’s brought new demand for midwives and fresh questions about why Minnesota — a state that requires a license for pretty much any business — lets midwives practice unregulated. (Richert, 9/30)

Immigrants, already essential to California health care, will become even more important to its future. Today, 1 in 6 medical professionals, and nearly one-third of physicians, are foreign-born, and many are bringing not just their labor but their ideas. Immigrants are responsible for one-fifth of all biomedical research and clinical trials. (Mathews, 9/29)

Three Texas doctors have been charged in Dallas with ordering expensive and medically unnecessary cancer screening tests as part of a nationwide crackdown on fraudulent genetic testing schemes, federal court records show. The Justice Department on Friday announced a coordinated operation targeting "fraudulent genetic cancer testing" that produced charges against 35 people in several states including Florida and Georgia. A total of $2.1 billion was billed to Medicare for the bogus DNA tests, Justice officials said. (Krause, 9/27)

In the latest fallout from the EpiPen pricing scandal, Mylan agreed to pay $30 million to settle charges by the Securities and Exchange Commission for failing to disclose to investors a Department of Justice probe into allegations of overcharging Medicaid for the allergy-relief device. The settlement, which the company had indicated last July was being finalized, comes two years after the company paid $465 million for shortchanging the government health care program. At the time, the Justice Department had been investigating Mylan for knowingly classifying EpiPen as a generic product for nearly a decade in order to avoid paying the appropriate rebates owed to Medicaid. (Silverman, 9/27)

Prosecutors had accused the company of wrongly classifying the EpiPen, its best known product used for treating allergic reactions, as a generic product, when it should have been considered a brand product. The generic classification allowed Mylan to pay a smaller rebate on EpiPen sales to Medicaid programs, regulators said. Drugmakers are required by law to pay rebates for sales to patients insured by Medicaid, which is funded jointly by states and the federal government. (Thomas, 9/27)

Mylan NV misled investors for at least a year about a Justice Department investigation into the allergy shot EpiPen that would eventually cost the company nearly $500 million, the U.S. Securities and Exchange Commission said Friday. The settlement appears to close one part of a long-running saga over a product that boosted Mylan’s sales but also brought controversy. Under the agreement with the SEC, first disclosed as a settlement in principle by Mylan in July, the drugmaker will pay $30 million. (Griffin and Robinson, 9/27)

Mylan has agreed to pay $30 million in a settlement tied to its failure to tell investors about a Justice Department investigation into whether the company overcharged Medicaid for the EpiPen. The Securities and Exchange Commission said Friday that Mylan NV classified the EpiPen as a “generic” drug under the Medicaid drug rebate program. This led to the pharmaceutical company paying much lower rebates to the government than if the EpiPen had been classified as a “branded” drug. (9/27)

Pfizer Inc. said Ian Read, its executive chairman, will retire at the end of the year, with Chief Executive Albert Bourla set to assume the additional post on Jan. 1. ... Mr. Read, who joined Pfizer in 1978 as an operational auditor, has been chairman since 2011 and served as CEO of the drugmaker from 2010 to 2018. Mr. Bourla, who joined Pfizer’s animal-health division in 1993, succeeded Mr. Read as chief executive earlier this year. (Sebastian and Kellaher, 9/27)

Two different pills reduce the risk of ovarian cancer coming back after surgery and chemotherapy, according to studies presented at the annual meeting of the European Society for Medical Oncology in Barcelona Saturday. The results represent a step forward in treating a cancer that is diagnosed in 28,000 women annually in the U.S. and kills 14,000 women a year. Currently, women are treated with surgery to remove their tumors, followed with a type of chemotherapy. But in 85% of cases, the cancer comes back. (Herper and Garde, 9/28)

GlaxoSmithKline PLC has reported positive results from a study of a cancer drug in a clinical trial that a senior figure in the company said justified the decision to acquire cancer specialist Tesaro for $4.16 billion. Axel Hoos, head of oncology research at the drugmaker, said Saturday the results of the phase 3 Prima study could change how women with ovarian cancer are treated. (Martuscelli, 9/29)

Drugmakers have embraced artificial intelligence — using computers to analyze reams of data and then make predictions or recommendations. Germany’s Bayer has been testing how the technology can help diagnose complex or rare conditions, hasten drug development and more. The aspirin-creator has partnered with startups and other tech companies to develop software and apps to speed diagnosis and guide treatment. The company is working with hospitals, academic researchers and others to compile everything the AI software needs to “learn” before it analyzes a patient’s condition. (Johnson, 9/29)

CVS Health Corp. has stopped selling Zantac products at its drugstores, citing a recent alert by the U.S. Food and Drug Administration that the popular heartburn drug could contain low levels of a probable human carcinogen. CVS said Saturday that it is taking the action “out of an abundance of caution.” There is no recall of the product, but customers who purchased these products at CVS can return them for a refund. (Stahl and Burton, 9/29)

In Ohio, PBMs have been accused of overbilling taxpayers, anti-competitive practices and interfering with cancer patients’ access to medication. Now, similar complaints are surfacing about the exclusive contract that one of them, Express Scripts, has with Tricare, the program that provides health care to active-duty military and to veterans. (Schladen, 9/28)

Congressman Gus Bilirakis from Palm Harbor has proposed a federal bill that would direct the Department of Veteran Affairs to carry out a new pilot program for dental services. He said the VA only offers dental services to veterans who are 100% disabled and who have a combat-related injury to the mouth. (Miller, 9/27)

The Manchester VA Medical Center broke ground on its new 16,000-square-foot addition to include urgent care and mental health services Friday morning. The two-story addition will enhance services by offering a direct entrance to the urgent care center, according to the organization. ...The addition will free up about 5,000 square feet in the hospital for other services. Construction being done by Eckman Construction in Bedford is set to start next month.(Phelps, 9/27)

In the U.S., the opioid crisis is about too many opioids. In some other parts of the world, the opioid problem is about the exact opposite — a lack of access to powerful pain management drugs. As pharmaceutical companies are being sued in the U.S. for flooding the market with opioids, doctors in West Africa say they can't even get hold of those painkillers. (Beaubien, 9/27)

Mitchell Yeaton is battling a wave of opioid addiction from his counseling center in New Hampshire ski country, just a short drive from two winter resorts that are engines of the local economy, Atti­tash and Wildcat. In this tourist mecca, jarring contrasts between well-to-do visitors and impoverished families shattered by addiction are part of the job, Yeaton said. But even so, a ski area deal unfolding here is rankling Yeaton and some other community leaders. Some members of the billionaire Sackler family — the owners of Purdue Pharma, the company widely blamed for fueling America’s opioid crisis — will reap about $60 million in financial gains from the sale of 17 ski resorts in the Northeast and Midwest, according to financial disclosure filings. (Rowland, 9/29)

The city’s families have been living with the trauma of gun violence for decades. This year, the number of grieving families has grown as deadly shootings claimed more than 150 lives. (Fentem, 9/30)

Mental health took center stage as law enforcement officers, county attorneys, elected officials and other community leaders gathered Saturday in Mankato for the second meeting of a state working group on police use of deadly force. (Roth, 9/28)

President Trump met in the White House on Friday with Wayne LaPierre, the chief executive of the National Rifle Association, and discussed prospective gun legislation and whether the N.R.A. could provide support for the president as he faces impeachment and a more difficult re-election campaign, according to two people familiar with the meeting. During the meeting, Mr. LaPierre asked that the White House “stop the games” over gun control legislation, people familiar with the meeting said. It was not clear whether Mr. Trump asked Mr. LaPierre for his support, or what that support would look like. (Haberman and Karni, 9/27)

The National Rifle Association confirmed that CEO Wayne LaPierre met with President Donald Trump at the White House on Friday but denied any discussions took place about "special arrangements" involving the group's ongoing support of the president. The response came after The New York Times reported on the meeting Friday, stating Trump and LaPierre "discussed prospective gun legislation and whether the N.R.A. could provide support for the president" amid upcoming impeachment proceedings and his reelection campaign. (Semones, 9/27)

In the medical desert that has become rural America, nothing is more basic or more essential than access to doctors, but they are increasingly difficult to find. The federal government now designates nearly 80 percent of rural America as “medically underserved.” It is home to 20 percent of the U.S. population but fewer than 10 percent of its doctors, and that ratio is worsening each year because of what health experts refer to as “the gray wave.” Rural doctors are three years older than urban doctors on average, with half over 50 and more than a quarter beyond 60. Health officials predict the number of rural doctors will decline by 23 percent over the next decade as the number of urban doctors remains flat. (Saslow, 9/28)

Not since 2006 has Bigfork Valley Hospital taken in more money than it spent providing care. Despite the nonstop financial woes, it continues on and even makes expensive improvements. The hospital recently built a memory care wing called Aspen Circle. (Zdechlik, 9/30)

Kaiser Health News: Listen: Five Oklahoma Hospitals Collapsed – What Happened?

KHN Midwest correspondent Lauren Weber joined StateImpact Oklahoma reporter Jackie Fortiér to discuss why a series of rural hospitals collapsed, leaving hundreds of residents without jobs and their communities without lifesaving emergency medical care. (9/27)

As Congress approved another delay to $4 billion in planned cuts to Medicaid disproportionate-share hospital payments, hospitals are gearing up to rally support for a longer-term solution. The latest continuing resolution would postpone the funding reduction until Nov. 21 and awaits President Donald Trump’s signature. The reprieve came just days before DSH changes were supposed to go into effect with a CMS final rule slashing $44 billion in funding over six years. (Johnson, 9/27)

A whistleblower claim brought a $530,000 settlement from a Louisiana hospital. A news release from U.S. Attorney David Joseph on Thursday says the claim targeted owners and operators of University Health Hospital in Shreveport. The statement says Biomedical Research Foundation of Northwest Louisiana and Louisiana State University got Medicare payments for devices to treat abnormal heart rhythms without making required reports to a qualified registry. (9/27)

Cleveland Clinic and the Sisters of Charity Health System are exploring the possibility of Mercy Medical Center in Canton becoming a full member of the Clinic system while it maintains its Catholic identity through sponsorship by the Sisters of Charity of St. Augustine, according to a news release. The Sisters of Charity Health System, which is the sole member of Mercy Medical Center, and Cleveland Clinic signed a nonbinding letter of intent and will work toward finalizing a definitive agreement. (Coutré, 9/27)

An upcoming antitrust trial will decide whether one of California's biggest health systems’ hardball negotiating tactics amounted to anti-competitive behavior that sharply drove up prices, in a case with big implications in an era of major health care consolidation. The class-action lawsuit brought by the state of California and unions has made Sacramento-based Sutter Health a poster child for big hospital chains that require insurers to access their networks on an all-or-nothing basis and make it harder for plans to steer patients to lower-cost competitors. Jury selection wrapped up Wednesday in San Francisco Superior Court, with arguments set to begin Oct. 7. (Colliver, 9/27)

Health officials announced late Friday that they had resumed elective surgeries at Los Angeles County-USC Medical Center, following a temporary halt to the operations that began earlier this week after the discovery of mold in a room used to sterilize surgical equipment. The L.A. County Department of Health Services said in a statement that the hospital had “begun to ramp up elective surgeries” and was expected to be at full capacity soon. (Dolan and Mejia, 9/27)

Community health has always been part of the mission at Boston Children’s, says Dr. Shari Nethersole, executive director for the hospital’s community health efforts. In its first decades, Children’s Hospital of Boston, as it was known at its founding in 1869, provided free care to orphans and the children of indigent families. That was easier to do when the average hospital visit cost $1.50, as was true through the 1930s. By the hospital’s 1969 centennial, however, regular deficits driven in part by innovation, plus the advent of Medicaid, altered the way the hospital would offer care to low-income patients. (Samuel, 9/27)

An Atlanta Journal-Constitution investigation uncovered cases in which seniors were left in urine-soaked briefs, emergency calls for help went unanswered for hours, and residents with dementia wandered away unnoticed. Others fell repeatedly, suffering bruises, bloody faces and broken bones. Some suffered in pain for days without treatment. (Schrade and Teegardin, 9/29)

It is one of the hidden risks in Georgia assisted living and personal care homes. In more than 50 cases over the past four years, residents reportedly physically or sexually assaulted others living at the facilities, The Atlanta Journal-Constitution found. Most of the assaults involve residents with dementia, who can suddenly become aggressive. But homes are supposed to train staff to spot warning signs of aggressive behavior, and if abuse occurs are required to take steps to ensure a safe environment, such as increasing supervision or seeking medical assessments. Facilities are also required to immediately transfer residents whose continuing behavior threatens other residents. (Schrade and Teegardin, 9/30)

Georgia’s regulators and public safety agencies know quite a lot about problems at the state’s private-pay senior care facilities. Reports of abuse and unexpected deaths and injuries. Fire safety violations. Missing dementia patients. Thefts. Outbreaks of contagious disease. Dirty dining areas. But even if you are looking for this information, you might not find it. Families facing the gut-wrenching process of placing a loved one in a personal care or assisted living home in Georgia are up against a tremendous disadvantage: a haphazard system of accountability that gives low priority to transparency and informing the public. (Teegardin and Schrade, 9/30)

Abortion cases are coming to the U.S. Supreme Court, and they’re only getting harder for the justices to avoid. The court next week starts a new term that will give the clearest indication yet of how eager the justices are to roll back the right to end a pregnancy. ... Abortion opponents are likely to get a more receptive audience now that Justice Brett Kavanaugh has replaced the retired Justice Anthony Kennedy. The eventual goal is to overturn the 1973 Roe v. Wade ruling, which legalized the procedure nationwide. (Stohr, 9/30)

The suicide rate inside California prisons, long one of the highest among the nation’s largest prison systems, jumped to a new peak in 2018 and remains elevated in 2019, despite decades of effort by federal courts and psychiatric experts to fix a system they say is broken and putting lives at risk, a Chronicle investigation has found. Last year, an average of three California inmates killed themselves each month in state cells — 34 total suicides in a system with 129,000 inmates. That amounts to an annual rate of 26.3 deaths per 100,000 people, the highest rate in California since at least 2006. (Fagone and Cassidy, 9/29)

Nashville knows a lot about health care, but for the past two decades, the city hasn't known enough about it's own health. Now, hopefully, that will change. Nashville officials publicized results and data from a landmark health survey conducted in city over the past year. The Nashville Community Health + Well-being Survey, which gathered data from 1,805 respondents spread throughout Davidson County, is the most detailed study of city health since at least 2000. (Kelman, 9/30)

The U.S. liver donation system hasn’t decided whether to start its redistribution of the organs, a proposal that is likely to mean fewer livers for Georgia patients and more for states such as New York.But it could, at least for now. A federal appeals court has ruled that while the court fight goes on, the new liver distribution system can begin. (Hart, 9/27)

A key issue in the contract dispute between General Motors and the United Auto Workers is health benefits. Workers have had famously great health plans, paying just 3% of costs. (Simmons-Duffin, 9/28)

The Minnesota Department of Commerce will publish the final individual and small group health insurance rates for next year on Tuesday. The insurance companies selling health plans for next year proposed average price changes ranging from a 10 percent decrease to a nearly 5 percent increase over this year’s rate. (Zdechlik, 9/29)

Thousands of Washington K-12 students still haven’t met their vaccination requirements — and because they’re not compliant with a new state law, schools could soon ban them from classes. The measure, approved by state lawmakers this year, stops families from citing personal or philosophical beliefs to excuse their students from the measles-mumps-rubella (MMR) vaccine. (Takahama, 9/29)

Pennsylvania is in the grip of a medical marijuana drought, according to multiple dispensary owners from Philadelphia to Pittsburgh. Some dispensaries are rationing dried flower. At Restore Integrative Health Care, a dispensary in Fishtown, there’s a seven-gram limit per patient per day. At Keystone Shops in South Philadelphia there’s a 14 gram a day maximum while TerraVida Holistic Centers in Abington caps it at an ounce (about 28 grams). (Wood, 9/29)

A Baltimore judge has reduced the $229.6 million awarded by a jury to a 16-year-old Prince George’s County mother whose baby suffered a brain injury at birth, but the sum still exceeds $200 million. The move this week by a Baltimore City Circuit Court judge was expected because Maryland has a cap on non-economic damages. That portion of the award was reduced to $740,000 from $25 million. (Cohn, 9/27)

In the past five years, more transgender people have been killed in Texas than any other state, according to a list kept by the LGBTQ advocacy group the Human Rights Campaign. More than California, which has a higher population. More than New York, with its highly visible LGBTQ community. And more than Florida, which dealt with a spate of murders just last year. (McGaughy, 9/29)

Tyler Perry said he cannot “just up and leave” filming in Georgia despite Hollywood’s backlash against the state’s “heartbeat” abortion law. The actor-director-writer made the remarks to The Associated Press on Friday while discussing the upcoming opening of his massive Atlanta-based studio. Some celebs have urged TV and film companies to abandon the state after Republican Gov. Brian Kemp signed the restrictive abortion bill in May. (Landrum Jr., 9/27)

The parents all needed a therapist who could help their children with behavioral and mental health issues. Glenn Payne, 60, appeared to fit the bill. He said he was a neuropsychologist with advanced degrees from the University of California, Los Angeles, affiliations with two Brooklyn hospitals and years of experience. But those credentials were a lie, the Brooklyn district attorney’s office said. (Gold, 9/29)

There’s more than a small argument over whether Sen. Bernie Sanders’s Medicare-for-all plan would raise the taxes of Americans. Moderators ask about it at presidential debates. Vice President Joe Biden uses the talking point to argue against the idea, as does Pete Buttigieg. Sen. Elizabeth Warren (D-Mass.), on the other hand, is repeatedly taken to task by everyone from Democratic debate moderators to Stephen Colbert for refusing to give a straight answer on the topic. This tax issue is supposed to be a telling, damning point. I don’t think it is, but I get that the United States is a country with a long history of successfully portraying higher taxes — even when they would pay for such things as, say, your children’s education — as a boogeyman to be avoided at all costs. In that spirit, I am offering another, more helpful way to think about our nation’s out-of-control medical costs: They’re a form of taxation without representation. (Helaine Olen, 9/27)

Among the many patients of mine who suffer from chronic illness, nearly all tell me they value choice above all else in their health care decisions. Some spend much of their day crippled by weakness, the side effects of medications and the resulting depression that can so easily take root. The last thing they want is to compromise on what they hope to retain some control over: choice of provider, the ability to seek a second opinion or to get an appointment within a desired time frame. The sickest crave simplicity, and while nothing is perfect in American life, the private health insurance industry gives people choices they otherwise would not have. (Vin Gupta, 9/30)

The news behind Amazon Care — the digital retail giant’s telehealth pilot program for its employees — is not the technology. The news is that Jeff Bezos’ company, and others like it, don’t need anyone’s permission to start building and paying for their own parallel health care systems, little by little. The trick will be whether Amazon can go beyond this pilot and build something that provides more of the things we need from health care without blowing everything up. (Vik Panda, 9/27)

Now that GM is making record profits, workers are on strike to demand the company limit the number of lower-paid temporary workers, provide workers with affordable quality health care, and carry on production at four U.S. plants it has targeted for closure. The question is not whether the companies should get government help. The question is how cities and states hold corporations accountable and create high-quality jobs with good benefits that strengthen communities. (Alaa Milbes, 9/27)

Can you judge a nation by the company it keeps? President Trump’s administration spearheaded a declaration at the United Nations this week calling for the elimination of allegedly “ambiguous” expressions in the body’s documents — primarily, “sexual and reproductive health.” These terms are often used to promote pro-abortion policies, the officials claimed, and “there is no international right to an abortion.” Joining the land of the free? Some of the least-free nations on the planet, from Russia to Saudi Arabia, Sudan, Yemen, Egypt, Libya and 12 more. (9/27)

In the U. S., thousands of young women are selling their eggs and serving as gestational surrogates, “renting” their wombs for cash. In India, Nepal, Ukraine and elsewhere, large markets have grown for buying and selling human eggs and renting wombs.Yet media stories about these technologies generally celebrate the creation of new lives – smiling, innocent babies — rather than probing the dilemmas involved. A few years ago, a major national network’s morning news show filmed me, commentating on India’s surrogacy industry. (Robert Klitzman, 9/27)

In 1980, measles caused 2.6 million deaths worldwide. Widespread use of the two-shot measles vaccine over the past four decades changed that. By 2000, routine immunization was preventing 80 million cases of the infection each year. That year, the World Health Organization declared measles “eliminated” in the United States. There was no longer continuous circulation of the virus here. All measles cases could be traced to unvaccinated people catching the disease outside the country or infected people from abroad bringing it in. Now, that is changing. (David Brown, 9/28)

It happened a few weeks ago, when many readers responded angrily to a brief, flippant letter asking why it’s acceptable for dogs but not humans to relieve themselves in public. This week it’s happening again, only the topic is far weightier: In response to a three-sentence letter asking what the difference is between the freedom to choose on abortion and the freedom to choose on childhood vaccination, several readers wrote forceful responses. (Paul Thornton, 9/28)

Most of us rely on vetted experts, brand names, seals of approval, and other signals of trust to help us decide on matters ranging from how to treat a dental abscess to which automobile is most fuel efficient. The resources needed to distinguish trustworthy scientific findings from those that are biased, irreproducible, or even fabricated are more elusive. That’s a problem, because the ability to make such distinctions is essential, given how relevant science is to everyday decisions such as when to vaccinate your child or whether it is safe to consume genetically engineered foods, especially in this age of misinformation. We believe that scientists and the journals that publish their work should do more to clearly and consistently signal to one another — as well as to the public who rely on their findings — which studies have satisfied standards that convey trustworthiness. (Marcia McNutt and Kathleen Hall Jamieson, 9/30)

In 2011, I began a professional and personal journey to understand my profession’s abandonment of our sickest patients. I had been trained as a psychiatrist at an Ivy League medical center on the East Coast. Like most of my colleagues in my generation, I did not end up treating those with schizophrenia and severe bipolar disorder. Also, like many people in my field, I had a personal connection to the disease that I kept to myself. When I was 14, Merle, my beautiful and kind 20-year-old sister, developed schizophrenia. My older sister, Gail, eventually took Merle to the hospital in Philadelphia, our hometown. After two weeks of failed treatment, my parents promptly took her out. (Kenneth Paul Rosenberg, 9/29)

A patient admitted to a Florida mental health facility under the Baker Act is vulnerable, judged to be a threat to himself or others -- or in self-neglect -- and unable to make decisions regarding his own care. In allowing a person’s liberty to be denied for up to 72 hours pending an evaluation, the state carries an immense burden of ensuring proper treatment and that no person is held a minute longer than medically necessary. A troubling Times investigation about North Tampa Behavioral Health calls for more vigorous state oversight to ensure patients’ rights are fully respected. (9/27)

Up to 80 percent of Americans die in hospitals or nursing homes, and a third spend at least 10 days in an intensive care unit before they die, many of them comatose or on a ventilator. A week after his sudden diagnosis of widespread metastatic disease, my father was lucky enough to get a bed in our town’s only hospice, a homey facility staffed with attentive and experienced caregivers. ... But his death was not the peaceful drifting away I’d always imagined, where you floated into a calm, morphine-induced sleep, your breath came slower and slower and then simply stopped. (Harriet Brown, 9/29)

Patients’ stories — what doctors call patient histories — are the bedrock of medicine. “Listen to your patient; they are telling you the diagnosis,” an aphorism attributed to Dr. William Osler, the founder of modern medicine, still holds true today. The disappearance of patients’ stories from electronic health records could be one reason that artificial intelligence and machine learning have so far failed to deliver their promised revolution of health care. (Blake McKinney, 9/30)

Francine’s case demonstrates how, even with all the advances in modern medicine, time remains one of the most important tools in any doctor’s medical kit. That time is precious and limited. That’s why, to prevent further constraints, physicians in the Contra Costa County health system are now poised to go on strike for the first time in our union’s history. (Scott Karpowicz, 9/26)