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A judge in Oklahoma on Monday ruled that Johnson & Johnson had intentionally played down the dangers and oversold the benefits of opioids, and ordered it to pay the state $572 million in the first trial of a drug manufacturer for the destruction wrought by prescription painkillers. The amount fell far short of the $17 billion judgment that Oklahoma had sought to pay for addiction treatment, drug courts and other services it said it would need over the next 20 years to repair the damage done by the opioid epidemic. (Hoffman, 8/26)

Cleveland County District Judge Thad Balkman’s landmark decision is the first to hold a drugmaker culpable for the fallout of years of liberal opioid dispensing that began in the late 1990s, sparking a nationwide epidemic of overdose deaths and addiction. More than 400,000 people have died of overdoses from painkillers, heroin and illegal fentanyl since 1999. “The opioid crisis has ravaged the state of Oklahoma and must be abated immediately,” Balkman said, reading part of his decision aloud from the bench Monday afternoon. “As a matter of law, I find that defendants’ actions caused harm, and those harms are the kinds recognized by [state law] because those actions annoyed, injured or endangered the comfort, repose, health or safety of Oklahomans,” he wrote in the decision. (Bernstein, 8/26)

Kaiser Health News: Judge Cites Opioid ‘Menace,’ Awards Oklahoma $572M In Landmark Case

“Defendants caused an opioid crisis that is evidenced by increased rates of addiction, overdose deaths and neonatal abstinence syndrome in Oklahoma,” Balkman said in the ruling. (Fortier and Mann, 8/26)

Under the abatement plan detailed in the written order, most of the funding — $232,947,710 — would go toward providing assessments and comprehensive treatment and recovery services to all Oklahomans in need of them. Another $103,277,835 would go toward pain management efforts. (Ellis, 8/27)

The judge said in the ruling that Johnson & Johnson’s misleading marketing included unbranded campaigns jointly developed with other companies that suggested pain was undertreated and that higher amounts of opioid prescriptions were the solution. The state said the company’s actions created a “public nuisance” and asked the judge to award as much as $17 billion to abate the costs of the crisis. Analysts followed the Oklahoma trial closely for signs of what might happen in the broader opioid litigation. Attention will turn next to Cleveland, where two counties are set to go to trial in October against an array of drugmakers and distributors. (Randazzo and Hopkins, 8/26)

Oklahoma Attorney General Mike Hunter had claimed that J&J and its pharmaceutical subsidiary Janssen aggressively marketed to doctors and downplayed the risks of opioids as early as the 1990s. The state said J&J’s sales practices created an oversupply of the addictive painkillers and “a public nuisance” that upended lives and would cost the state $12.7 billion to $17.5 billion. The state was seeking more than $17 billion from the company. (Lovelace, 8/26)

"Janssen did not cause the opioid crisis in Oklahoma, and neither the facts nor the law support this outcome," Michael Ullmann, executive vice president and general counsel for Johnson & Johnson, said in a written statement on Monday. "We recognize the opioid crisis is a tremendously complex public health issue and we have deep sympathy for everyone affected. We are working with partners to find ways to help those in need," he said. "This judgment is a misapplication of public nuisance law that has already been rejected by judges in other states." (Howard and Drash, 8/27)

The damages appeared to be smaller than Wall Street was expecting, as stocks of companies involved in opioid litigation spiked upward after the ruling. Wells Fargo analysts earlier said they believed Johnson & Johnson could have faced a payout of more than $2 billion in the Oklahoma lawsuit. “This is not the eye-popping result that some people expected it to be,” said Andrew Pollis, a professor at Case Western Reserve University School of Law, who has tracked the opioid litigation closely. (Demko, 8/26)

Before Oklahoma’s trial began on May 28, the state reached settlements with two other defendant groups — a $270-million deal with OxyContin maker Purdue Pharma and an $85-million settlement with Israeli-owned Teva Pharmaceutical Industries Ltd. Oklahoma argued the companies and their subsidiaries created a public nuisance by launching an aggressive and misleading marketing campaign that overstated how effective the drugs were for treating chronic pain and understated the risk of addiction. Oklahoma Atty. Gen. Mike Hunter says opioid overdoses killed 4,653 people in the state from 2007 to 2017. (Murphy, 8/26)

In response to the ruling, the American Hospital Association jointly with the Oklahoma Hospital Association asked the judge to assign funds to the state's hospitals and health systems. "With additional resources, hospitals can broaden access to post-overdose treatment in emergency departments, increase training of physicians to treat substance use disorders, cover the costs of lengthy stays and follow-up care for infants with neonatal abstinence disorder, and invest in electronic health information systems to improve coordinated care and prevent overprescribing," the groups said. (Luthi, 8/26)

The fact that the state won any money is significant — it's the first ruling to hold a pharmaceutical company responsible for the opioid crisis. But the state had asked for much more: around $17 billion. The judge found the drugmaker liable for only about 1/30 of that. "The state did not present sufficient evidence of the amount of time and costs necessary, beyond year one, to abate the opioid crisis," Judge Thad Balkman wrote in his ruling. (Simmons-Duffin, 8/26)

Some two dozen opioid manufacturers, drug distributors and retailers are now being sued by states, counties, cities and tribes across the nation for their roles in the opioid crisis, yet Johnson & Johnson, the corporate giant, wound up as the only company on trial in Oklahoma despite the fact that its drugs accounted for only about 1 percent of opioid sales in the state. (Hoffman, 8/26)

What's next? The first federal trial, involving claims from Ohio's Cuyahoga and Summit counties, is scheduled for Oct. 21. The Cleveland-based judge in that case, Dan Polster, intends to use that as a bellwether, providing decisions that could apply to other cases. Polster is overseeing most of the opioid cases and is pushing the parties to settle. (Mulvihill, 8/27)

While some Johnson & Johnson investors were relieved that the company’s $572 million penalty for fueling Oklahoma’s opioid epidemic wasn’t as high as feared, lawyers for other U.S. states, cities and counties could hardly contain their glee. That’s because the ruling by Oklahoma Judge Thad Balkman on Monday was the first affirmation in court of a high-risk legal strategy using public-nuisance laws to punish predatory drug marketing. More than 45 other states and 2,000 local governments are hoping to win billions of dollars in verdicts with the same arguments. (Feeley and Griffin, 8/27)

A ruling from a judge in Oklahoma that marketing tactics used by pharmaceutical giant Johnson & Johnson contributed to the opioid crisis could signal what’s ahead for other drug companies facing lawsuits across the country. ...Some experts say it could begin the kind of legal dismantling the tobacco industry experienced in the 1990s. (Santhanam, 8/26)

Effects from the nation’s shift in attitude toward opioid makers are already apparent. In June, Purdue Pharma laid off its entire sales team while fellow opioid manufacturer Insys Therapeutics filed for bankruptcy. Insys had just settled with the U.S. Department of Justice for $225 million after admitting the company bribed doctors to prescribe its potent fentanyl painkiller, Subsys. (Clason, 8/26)

William Brangham talks to StateImpact Oklahoma’s Jackie Fortier about the case's unusual argument and broad impact. (Brangham, 8/26)

Here are key quotes from Cleveland County District Judge Thad Balkman's 42-page judgment in the state's opioid case against Johnson & Johnson and its subsidiaries. (8/27)

After a 3 1/2 year legal battle, secret records about Purdue Pharma’s marketing of its potent opioid painkiller OxyContin will finally be made public. The Kentucky Supreme Court denied a request from Purdue to review lower courts’ decisions to release the documents, according to a one-page order received Monday by the lawyers in the case. The decision is a major victory for STAT, which first filed a motion to unseal the records in March 2016. Purdue has fought to keep the documents out of view, but the Supreme Court’s refusal is final and can’t be appealed. (Joseph and Ross, 8/26)

On Monday, the 17 million pages of documents were being shipped from Frankfort to Pike County, where the case originated. Officials in the Pike County Circuit Court Clerk’s office could not immediately say how and when they would be available. (8/26)

Two decades ago, a new generation of supposedly safer painkillers triggered an epidemic of opioid abuse in the U.S. Since then, opioid overdoses have killed well over 400,000 Americans — more deaths than the country’s military suffered in World War II. The surge in prescription drug abuse was followed by a wave of heroin addiction. Now, more than half of opioid deaths are caused by synthetic versions such as fentanyl, a chemical powerful enough to kill in tiny concentrations. Beyond the death toll, at least 2 million Americans have become addicted. (Edney and Etter, 8/26)

Overdose deaths in New York City declined slightly last year after years of alarming increases, health officials said Monday. There were 1,444 fatal overdoses citywide last year, down 2.6% from 2017, according to data released by the city Health Department. The number had been rising since 2010, when it was a comparatively low 541. (8/26)

Wednesday, the White House announced the federal government will be cracking down on international fentanyl trafficking. Fentanyl is a pain reliever used for treating severe pain, but in recent years the addictive drug has been used recreationally - causing more than 28,000 deaths in 2017. That’s more than half the deaths caused by opioids overall that year. Making it the biggest contributor to the opioid overdose. Fentanyl has taken the lives of thousands of Floridians over the past years. (Gainey, 8/26)

The deaths of three Illinois prisoners over three days from "probable intoxication" of an unknown substance have raised questions about drug use behind bars and whether inmates are watched closely enough, according to a published report. WBEZ reported Monday that documents the Chicago radio station obtained and interviews it conducted suggest lax supervision before at least one of the deaths that occurred in September of last year at Menard Correctional Center in Chester. (8/26)

Nineteen states and the District of Columbia sued on Monday over the Trump administration's effort to alter a federal agreement that limits how long immigrant children can be kept in detention. "We wish to protect children from irreparable harm," California Attorney General Xavier Becerra said as he announced the lawsuit he is co-leading with Massachusetts Attorney General Maura Healey. Both are Democrats. (Ronayne, 8/26)

[California Gov. Gavin] Newsom and the state’s attorney general said officials from coast to coast — all Democrats — plan to file a lawsuit in Los Angeles that aims to prevent the U.S. government from overriding a federal consent decree that has set basic conditions for detaining underage migrants in the United States since 1997. A judge overseeing the decree, known as the Flores Settlement Agreement, issued a ruling in 2015 that limited the amount of time children can be held to 20 days. (Sacchetti, 8/26)

“No child deserves to be left in conditions inappropriate and harmful for their age,” Becerra said Monday. “The actions by this administration are not just morally reprehensible, they’re illegal. Children don’t become subhuman simply because they are migrants.” As the state with the largest immigrant population in the country, including an estimated 2.2 million people in the U.S. illegally, California officials have repeatedly clashed with Trump over his crackdown on migrants, including those seeking asylum. (McGreevy and Luna, 8/26)

Administration officials argue migrants have exploited the Flores agreement and bring children across the border to avoid being held in custody while they await their day in immigration court. The new policy will “restore integrity to our immigration system and eliminates the incentive for children to be used or exploited to enter the United States,” McAleenan said last week when announcing the change. The new rule follows President Donald Trump’s previous attempt to crack down on families bringing children over the border with his family separation policy, which separated at least 2,000 children from their parents. (Bollag, 8/26)

California, along with 18 other states and the District of Columbia, argue the rule would shatter minimum protections for children. President Donald Trump and administration officials are facing intense scrutiny and widespread public backlash for allowing migrant children to be held in unsafe, unsanitary conditions that public and mental health experts say pose extreme harm to their physical and mental well-being. The Trump administration rule risks prolonged detention that would cause irreparable harm to migrant children, their families and California communities accepting children upon release from federal custody, state Attorney General Xavier Becerra argued. (Hart, 8/26)

Kaiser Health News: How And When Immigrants’ Use Of Government Benefits Might Affect Their Legal Status

A new rule to restrict legal immigration, published by the Trump administration this month, is sowing confusion and anxiety even among immigrants not directly affected by it, as fear spreads faster than facts, immigration and health policy experts say. The rule would allow the federal government to more easily deny permanent residency status, popularly known as green cards, or entry visas to applicants who use — or are deemed likely to use — federally funded food stamps, housing assistance and Medicaid. (Ibarra, 8/27)

Migrant children held in rooms so cramped they couldn’t all sit, never mind lie down. Roll calls held at midnight, 3, 6 and 9 in the morning. Food that tasted like dirt, water like chlorine. Cruel guards who in one instance threw food on the floor, instigating fights as hungry kids scrambled to get it. These are some of the experiences described in a declaration based on interviews with children who spent time in border detention facilities and are now living in Washington. (Shapiro, 8/26)

Severely ill immigrants, including children with cancer, cystic fibrosis, and other grave conditions, are facing deportation under a change in Trump administration policy that immigration advocates are calling cruel and inhumane. The policy change will affect at least a dozen children receiving treatment at Boston hospitals and potentially thousands of additional immigrants across the country, according to lawyers and advocates. All had been granted “medical deferred action,” a special status that allows immigrants to remain in the country legally, receive Medicaid, and work while they receive treatment for dire health conditions. (Levenson, 8/26)

The small program known as "medical deferred action" allows people to remain in the U.S. for two-year periods if they can prove extreme medical need. Many of the people affected by the policy change came to the U.S. through a visa or other permitted status and are requesting to stay beyond those terms to receive medical treatment. (Dooling, 8/26)

In Boston alone, the decision could affect about 20 families with children fighting cancer, HIV, cerebral palsy, muscular dystrophy, epilepsy and other serious conditions, said Anthony Marino, head of immigration legal services at the Irish International Immigrant Center, which represents the families. Advocates say similar letters from Citizenship and Immigration Services have been issued to immigrants in California, North Carolina and elsewhere. “Can anyone imagine the government ordering you to disconnect your child from life-saving care — to pull them from a hospital bed — knowing that it will cost them their lives?” Marino said. “This is a new low,” Democratic Sen. Ed Markey said. “Donald Trump is literally deporting kids with cancer.” (Marcelo, 8/26)

To bring down the rising suicide rate in the U.S., Cory Booker wants to appoint a federal coordinator tasked solely with suicide prevention. Amy Klobuchar wants to fund more local programs designed to prevent suicides among farmers and in tribal communities. Pete Buttigieg wants to add more mental health providers to the Department of Veterans Affairs and limit access to guns and other lethal means for people at high risk of suicide. The ideas came in response to a survey sent to 2020 presidential candidates by a new nonpartisan group called Mental Health For US. (Thielking, 8/27)

One in four Americans report that their data has been hacked. And among those who have searched online for health information or products, about the same percentage are very concerned that it might be used to frustrate their efforts to get medical care, a job or health insurance, according to a new POLITICO/Harvard T.H. Chan School of Public Health poll. The poll also showed increasing concern about the safety of e-cigarettes, with about twice as many respondents rating marijuana safer than vaping. (Allen, 8/26)

A federal judge said he will issue a ruling Tuesday that will determine whether Missouri’s new abortion law banning abortions at or after eight weeks of pregnancy will take effect as scheduled this week. During a court hearing on Monday, Planned Parenthood and the American Civil Liberties Union asked U.S. District Judge Howard Sachs to issue a temporary restraining order to stop the law from taking effect on Wednesday until a legal challenge against it is decided. Sachs told attorneys he had a draft of his written ruling ready, but that he wanted to consider Monday’s arguments before issuing it on Tuesday. He did not indicate how he would rule. (Ballentine and Stafford, 8/26)

On a recent sun-shot afternoon outside the Manufactory in downtown Los Angeles, a crowd collected around tables loaded with ornate cakes, decorated with fresh flowers, piped frosting and buttercream slogans that read “mind your own uterus” and “no more hangers.” It was a community action meeting masquerading as a high-end bake sale; Michelle Obama meets Antoine Carême. Around the country, pastry chefs are banding together and throwing old-fashioned bake sales to raise funds for causes they care about. It’s hardly a new model: Folks have been trading cookies for cash and causes — in classrooms, churches and on sidewalks — for decades. (Scattergood, 8/26)

The five contenders who hope to succeed state Sen. Dan Claitor showed wide differences on abortion during a forum Monday at the Press Club of Baton Rouge. ... The clearest split of the forum focused on whether an abortion bill signed by Gov. John Bel Edwards that banned abortion at about six weeks of pregnancy should have included an exception for rape and incest. (Sentell, 8/26)

Shortly before serious data problems surfaced in mid-March at a troubled Novartis (NVS) unit, a Food and Drug Administration report noted the company had recently conducted an “extensive investigation” after finding errors and discrepancies in a preclinical test. The agency apparently believed the difficulties had been rectified. In a February 2019 report, FDA personnel noted that AveXis — the Novartis unit at the center of a scandal over manipulating data for the gene therapy — uncovered problems with a so-called mouse assay. (Silverman, 8/27)

Bristol-Myers Squibb Co. took a major step toward completing its $74 billion acquisition of Celgene Corp., as the two pharmaceutical companies found a buyer for a skin treatment whose sale they hope will address antitrust concerns. Amgen Inc. agreed on Monday to buy Celgene’s psoriasis medicine Otezla for $13.4 billion in cash. The decision comes after the U.S. Federal Trade Commission raised anticompetitive concerns related to anti-inflammatory drugs, of which Otezla is an example. (Hopkins and Kellaher, 8/26)

The American Federation of Teachers (AFT) is calling on Congress to enact a series of proposals the group said would reduce gun violence. AFT President Randi Weingarten promoted a ban on assault weapons, improved background checks and so-called red flag gun legislation in a letter to Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), who lead the Senate Health, Education, Labor and Pensions Committee. (Frazin, 8/26)

From huge rewards to calls for allowing Missouri cities to enact their own gun laws, leaders in St. Louis and Kansas City are grappling with a troubling rise in shooting deaths, especially those involving children. This past weekend was especially violent. In Kansas City, four men were killed Sunday, including two in a drive-by shooting in a popular entertainment district. In St. Louis, six people were killed in shootings, including 8-year-old and 10-year-old girls and a 15-year-old boy. (8/26)

Republican Rep. Steve Watkins got heat Monday from frustrated eastern Kansas constituents who pressed the freshman congressman to publicly endorse tougher gun laws following recent mass shootings. Several people left a Watkins town hall meeting in Topeka unhappy that he didn’t commit himself during the event to backing stronger background checks for firearms purchases or a “red flag” law that would allow authorities to seize guns from people deemed a danger to themselves or others. Members of the audience of about 40 interrupted Watkins when he tried to defend the GOP’s record on gun issues. (Hanna, 8/26)

The country’s largest health insurer is seeking to toss a federal lawsuit that alleges it wrongly denied coverage for a controversial radiation treatment to a Boston woman with cervical cancer. Kate Weissman sued UnitedHealthcare earlier this year after it refused to pay for her $95,000 treatment at Massachusetts General Hospital. The treatment, called proton beam radiation therapy, is designed to precisely target a tumor while protecting the surrounding organs. (Dayal McCluskey, 8/27)

The company told him after a heart attack and open-heart surgery that his health insurance had been cut off because he had worked too few hours. He learned later, only through his own inquiry, that his insurance coverage couldn't be canceled under the Family and Medical Leave Act. Those who work at least 24 hours a week for an employer with more than 50 employees in a 75-mile radius, and have been at their job a year or more, qualify for protection under the federal act. (Rood, 8/26)

Heat-related deaths have increased sharply since 2014 in Nevada and Arizona, raising concerns that the hottest parts of the country are struggling to protect their most vulnerable residents from global warming. In Arizona, the annual number of deaths attributed to heat exposure more than tripled, from 76 deaths in 2014 to 235 in 2017, according to figures obtained from the U.S. Centers for Disease Control and Prevention. Heat-related deaths in Nevada rose almost fivefold during the same period, from 29 to 139. (Flavelle and Popovich, 8/26)

He is a 28-year-old police officer in North Carolina. She is a 39-year-old child-care provider in West Virginia who stopped working because of a debilitating liver disease. The two never met until the March day they were both discharged from a Pittsburgh hospital. Sarah Chambers had just received a liver transplant; the donor was from Zachary Lechette, who volunteered to give a portion of his liver to her, a complete stranger. (Reddy, 8/26)

Researchers found that people who scored higher on an optimism assessment were more likely to live past the age of 85. Those with higher optimism levels at the start of the study were more likely to have advanced degrees and be physically active, and less likely to have health conditions like diabetes or depression. However, when researchers accounted for these variables, they still found that optimism was associated with people living significantly longer. (Corley, 8/26)

Former football players who had experienced more severe concussions were more likely to report erectile dysfunction and low testosterone than other players, according to a team of Harvard researchers. Former athletes were more likely to report that doctors had recommended or prescribed treatments for the sexual health conditions if they had a higher “concussion symptom score,” a measure derived from self-reported head injury symptoms like dizziness and nausea, or if they reported more frequently losing consciousness playing football.  (Facher, 8/26)

Earlier this month when Weight Watchers put out its new Kurbo app, designed for children ages 8 through 17, there was an outcry across social media arguing that weight loss programs for children can lead to eating disorders, low self-esteem and yo-yo weight cycling. Critics expressed concern about the harm to children from “fat-shaming.” Some, including in this newspaper, said that weight loss plans for children never work. (Klass, 8/26)

The scene was the same every day at Deb Shell’s house in Berkeley, Calif. She would send her three children to elementary school with packed lunches, and they would come home with their lunch bags almost completely full. Shell started talking to other parents and learned that the Berkeley Unified School District had cut lunchtime at some schools to add additional instructional minutes to the classroom. Many kids were going through the day hungry. When Shell and other parents went to observe lunch, they saw that the problem was even worse for students who had to stand in line for their meals. The students are supposed to have 20 minutes to eat, but they often have only 15, Shell said. (Ettinger, 8/26)

The older population of the U.S. is skyrocketing, with the number of seniors expected to approximately double in the next few decades – while the population over 85 nearly triples. The aging of the baby boomer generation means millions of job openings for elder care workers, as well as geriatricians, geriatric nurses and other healthcare workers, and soaring health expenses. (Davis, 8/26)

Owning a dog may be good for your cardiovascular health. That is the conclusion of a study of a randomly selected group of 1,769 residents of Brno, in the Czech Republic. None had a history of cardiovascular illness, and 42 percent owned pets. Researchers scored them on the American Heart Association’s seven measures of heart health: blood pressure, cholesterol, blood sugar, physical activity, diet, body mass index and smoking. (Bakalar, 8/26)

Kaiser Health News: Mysterious Vaping Lung Injuries May Have Flown Under Regulatory Radar

It was the arrival of the second man in his early 20s gasping for air that alarmed Dr. Dixie Harris. Young patients rarely get so sick, so fast, with a severe lung illness, and this was her second case in a matter of days. Then she saw three more patients at her Utah telehealth clinic with similar symptoms. They did not have infections, but all had been vaping. When Harris heard several teenagers in Wisconsin had been hospitalized in similar cases, she quickly alerted her state health department. (Lupkin and Barry-Jester, 8/27)

How much marijuana is really in that pot brownie? Chocolate can throw off potency tests so labels aren't always accurate, and now scientists are trying to figure out why. In states where marijuana is legal, pot comes in cookies, mints, gummies, protein bars — even pretzels. These commercial products are labeled with the amount of high-inducing THC. That helps medical marijuana patients get the desired dose and other consumers attune their buzz. (8/26)

New Jersey unveiled a $120 million plan on Monday to speed up the replacement of old lead pipes in Newark in response to mounting alarm about the toxic metal leaching into the drinking water in the state's largest city. Newark officials began handing out bottled water to some residents earlier this month after tests found that some of the water filters they had previously distributed were not working properly. (8/26)

“We are going to do this as swiftly as humanly possible,” Mr. Baraka said at a news conference in Newark, standing with the governor and about two dozen other New Jersey officials. Years of neglect, mismanagement and denials have plunged Newark into one of the largest environmental crises in an American city in years, provoking anger, confusion and frustration among its 285,000 residents. (Corasaniti, 8/26)

An earlier timeline for the massive undertaking put the project about 10 years from completion but on Monday, Essex County Executive Joseph DiVincenzo said the injection of money would reduce it by several years. "As an elected official, I don't want to wait that long. I want this long-term solution to happen sooner rather than later," DiVincenzo said at a news conference, adding that it could be finished in 24 to 30 months. (Romo, 8/26)

The Newark lead crisis, which began nearly three years ago. Since last October, the city has distributed 38,000 PUR filters to residents who have water flowing through lead pipes serviced by a plant in Pequannock, New Jersey. The crisis sparked new interest earlier this month after the Environmental Protection Agency (EPA) said that the city needed to distribute bottled water to residents after tests done by the EPA in three homes using the filters found that two showed lead levels exceeding 15 parts per billion, the federal and state drinking water standard. (Thomas, 8/26)

North Carolina seems like an unlikely laboratory for health care reform. It refused to expand Medicaid coverage under the Affordable Care Act, and ranks in the bottom third among states in measures of overall health. But the state has embarked on one of the country’s most ambitious efforts to transform how health care is defined and paid for. North Carolina is in the early stages of turning away from the traditional fee-for-service model, in which doctors and hospitals are paid for each office visit, test or operation. (Lohr, 8/26)

For the past eight weeks, Gov. Roy Cooper and the General Assembly have been locked in a budget stalemate largely over the governor’s desire to expand the Medicaid program to cover an estimated additional half million people, while the Republican majority in the legislature have staunchly refused to move on the question. State government continues to function on last year’s spending levels, but special projects and new programs lack funding to move forward. (Hoban, 8/26)

Puerto Rico is on alert as Tropical Storm Dorian moves toward the island. But Puerto Rico is still heavily in debt and suffering from infrastructure damage after Hurricane Maria nearly two years ago. Puerto Rico native and University of Connecticut professor Charles Venator-Santiago said people with the means are stocking up on water and canned food in anticipation of the storm. Unfortunately, most Puerto Ricans don’t have the means. (Uhler, 8/26)

Three former nursing-home workers facing criminal charges surrendered to authorities in Florida in connection with the deaths of 12 elderly patients at a sweltering facility after Hurricane Irma in 2017, according to attorneys involved. The three former employees—administrator Jorge Carballo, supervising nurse Sergo Colin and nurse Althia Meggie—presented themselves at Broward County jail in Fort Lauderdale on Monday, said Lawrence Hashish, an attorney for Ms. Meggie. A fourth former employee was taken into custody in Miami-Dade County and will be moved to Broward County, he said. (Campo-Flores, 8/26)

A California union is financing a statewide health reform initiative that would ensure protections for Arizona residents with preexisting conditions. The ballot proposal titled Arizonans Fed Up with Failing Healthcare could appear on the November 2020 election ballot. (Innes, 8/26)

As some districts begin welcoming students for the start of the school year this week, leaders at the state Department of Public Health remain tight-lipped about whether they plan to release the latest assessment of school vaccination rates in Connecticut. Lawmakers in May said they were expecting to see figures from the 2018-19 year that show what percentage of students at each school claimed the religious exemption to mandatory immunizations. But a lawsuit filed later that month put a stop – at least temporarily – to the disclosure of that data. (Carlesso, 8/26)

Tens of thousands of University System of Georgia employees will face average increases in their 2020 health care premiums of 5.5 percent to 7.5 percent. Also starting next year, a university employee will have to pay a $100 monthly surcharge for spousal coverage if the spouse has health insurance offered by an employer but does not take it. (Miller, 8/26)

St. Louis County’s top public health officials want more medical workers at the county jail. The facility needs about 20 more full-time nurses to reach its ideal staffing level of 60, they say. Currently, the jail is relying on nurses hired through short-term contracts to fill the gaps in staffing, said Dr. Emily Doucette, co-director of the county’s public health department. (O'Donoghue, 8/26)

Minnesota must pay back an estimated $48 million to the federal government because it improperly dealt out money to certain state chemical dependency treatment providers. The Centers for Medicare and Medicaid Services told the Minnesota Department of Human Services in May that it must “immediately cease” payments to a group of substance abuse treatment providers formally known as “institutions for mental diseases.” These institutions include hospitals, nursing homes or other facilities that have more than 16 beds and treat people with mental illness or chemical dependency. Federal Medicaid money generally cannot be used to cover treatment in these facilities. (Faircloth, 8/26)

Post-9/11 veterans and their family members now have a new, more affordable option for mental health services. The Steven A. Cohen Military Family Clinic at Aspire Health Partners, which officially opened Monday at a ceremony attended by Gov. Ron DeSantis, U.S. Rep. Kathy Castor and Mayor Jane Castor, offers treatment plans to veterans for conditions such as post-traumatic stress disorder, anxiety and depression. Services also are available to their spouses and children, either on campus or in their homes through telehealth options. (Najarro, 8/26)

A Frisco home health care company is boosting its hospice services with a $130 million cash purchase of a Birmingham, Ala., firm that serves 1,000 patients a day. Addus HomeCare Corp. announced the deal Monday with Hospice Partners of America LLC, which has 21 locations in Texas, Idaho, Kansas, Missouri, Oregon and Virginia. Closing is subject to regulatory approvals. (O'Donnell, 8/26)

Mental illness is a severe problem among Sacramento’s homeless, according to a federally mandated census conducted in January. According to Sacramento Steps Forward, the nonprofit that conducts the point-in-time count every two years, 22 percent of homeless people report having a mental disability, and 21 percent have a psychiatric disability. Experts overwhelmingly agree that homelessness and mental health issues can be intimately linked. According to an informal survey by Loaves & Fishes, the common denominator among homeless people is past experience with trauma – and homelessness is itself a traumatic experience. (Wang and Chalermkraivuth, 8/26)

For nonsmokers like Nelson, it’s easy to find apartments where you shouldn’t catch a whiff of tobacco. Thousands of apartment buildings in Minnesota have declared themselves smoke-free. West Side Flats is owned by Sherman Associates, which has 5,000 apartment units in the Twin Cities. Senior vice president Chris Sherman said the company snuffed out smoking in its buildings about eight years ago. (Moylan, 8/27)

In the latest jolt to hit the Minnesota Department of Human Services, Deputy Commissioner Claire Wilson has resigned for the second time in less than two months. Wilson first submitted her resignation in early July along with Deputy Commissioner Chuck Johnson, an event that sparked a series of unprecedented changes at the top of the $18 billion agency. Both rescinded their resignations the following week, after then-commissioner Tony Lourey announced that he was stepping down. (Howatt, 8/26)

For two years, the state of Oklahoma prepared a case against major pharmaceutical companies, charging that they played a key role in the rise of the opioid problem across the state. This has raised national debates over whether and how private companies selling legal products can be found liable for the damage those products and their business practices inflict. In Monday's ruling in Norman, Oklahoma, Judge Thad Balkman provided his answer, ruling against Johnson & Johnson, and ordered the company to pay the state $572 million to help the state prepare abatement programs. Finally having companies found liable for their actions is cathartic and important. The hard work addressing the issue of addiction, though, clearly still lies ahead. (Holly M. Karibo, 8/26)

Last month, I got an email from a dear old friend from Kentucky with devastating news. Her daughter Kathryn had died of an opioid overdose. I was stunned, though perhaps I shouldn’t have been. I knew she had long struggled with addiction: A talented artist and writer, she was prescribed an opioid for wrist pain at 19, and that’s all it took. Eventually, she began using heroin, and now she had overdosed on fentanyl. It’s the same tragic path tens of thousands of other young Americans have traveled. (Gideon Gil, 8/26)

The ruling Monday by an Oklahoma judge that Johnson & Johnson must pay $572 million for selling opioids will be cheered by everyone who wants a scapegoat for the scourge of addiction. But the ruling could have far larger, and more dangerous, consequences by opening a vast new arena for product-liability suits. More than 2,000 states and municipalities have sued opioid makers and distributors in federal litigation in Ohio. Another 250 or so have filed lawsuits in state courts where they hope local judges and juries will provide a more sympathetic audience. Most like Oklahoma GOP Attorney General Mike Hunter have been aided by private plaintiff attorneys. (8/26)

The public exposé of severe lead contamination in the tap water of Flint, Mich., has prompted national soul-searching, legal battles, some of which are ongoing, and beefed-up state rules governing lead in drinking water. The Environmental Protection Agency is expected to propose an update to the federal Lead and Copper Rule soon, a long-overdue step in strengthening federal regulation of drinking water. (Mekela Panditharatne, 8/26)

The Democratic debate on health care has to date centered around who should be covered and who should pay the bill. That debate, which has been going on for decades, has no clear answers and cannot be easily resolved because of two fundamental realities: Health care is expensive, and Americans are sick. Americans benefit from highly trained personnel, remarkable facilities and access to the newest drugs and technologies. Unless we eliminate some of these benefits, our health care will remain costly. (Dariush Mozaffarian and Dan Glickman, 8/26)

Ten years ago, when I was studying to become a dietitian and public-health professional, the idea of stepping outside of our culture’s weight-centric dieting paradigm was almost unthinkable. Most of us have lived our entire lives in “diet culture” — a belief system that views being thin as a mark of health and moral virtue, promotes weight loss as a means of attaining higher status and better health, demonizes some foods while elevating others and oppresses people who don’t match culture’s image of health and beauty. (Christy Harrison, 8/26)

The Trump administration last week announced a new regulation that would allow the government to indefinitely detain migrant families who cross the border. If it goes into effect, it would terminate an agreement known as the Flores settlement that has been in place since 1997 to ensure that children are kept in the least restrictive setting possible, receive certain standards of care, have access to lawyers, and are generally released within 20 days. The effect would be to extend the well-documented suffering of migrant children in detention centers. (Leah Hibel and Caitlin Patler, 8/27)

Carlos Gregorio Hernandez Vasquez, 16, “is seen lying on the floor, vomiting on the floor, and walks over to the commode, where he sits and later lies back and expires.” This is how Norma Jean Farley, a contract forensic pathologist for Hidalgo County, Tex., described this Guatemalan boy’s last moments in her autopsy report, after she reportedly reviewed a video from the detention facility. The autopsy attributed the death to the virus responsible for 3,000 to 49,000 U.S. deaths each year: influenza. (Saad B. Omer, 8/26)

Renowned economist Robert J. Shapiro is a Democrat. He served in the Clinton administration and advised Hillary Clinton, Barack Obama and Al Gore. The Progressive Policy Institute started in 1989 and still considered in D.C. circles “Bill Clinton’s think tank.” Shapiro’s report for PPI, The Impact of Electronic Cigarettes on Cigarette Smoking by Americans and Its Health and Economic Implications, is objectively and meticulously researched and comes to firm conclusions — vaping is the most effective method for smoking cessation and is not a gateway to cigarette use. Vaping improves health, saves health-care costs and adds to economic productivity. (Kerri Houston Toloczko, 8/25)

The term “type 1 diabetes” generally conjures up images of insulin. That makes sense, because insulin is the main treatment for this common disease. But it isn’t a cure. A type of cell transplant that comes close to a cure for some people with type 1 diabetes, a technique pioneered and tested in the United States, is now available in many countries but is still deemed an experimental procedure in the U.S., making it almost impossible to get. That doesn’t make sense to us. (Camillo Ricordi and Anthony Japour, 8/27)

Unfortunately, many people with Parkinson’s or other chronic diseases have no health insurance, usually because they can no longer work and afford the premiums. Typically, they have not received approval for Social Security disability insurance (SSDI). Initial applications may take six months or longer to consider, and only 36 percent  receive initial approval. Those denied enter a series of lengthy appeal processes. (Allan Hugh Cole Jr., 8/26)

Michael Johnson, a former college athlete convicted in 2015 of not disclosing his H.I.V.-positive status to sexual partners, was released on parole from a Missouri prison last month. Mr. Johnson, who is gay and black, had maintained his innocence, and there was no proof that he had transmitted the virus. And yet that didn’t seem to matter in the court of public opinion, or in the court of law. On Dec. 20, 2016, a Missouri appeals court ruled that Mr. Johnson’s trial had been “fundamentally unfair.” H.I.V. nondisclosure is inherently difficult to prove yet seemingly easy to condemn, as shown time and again by judges and juries worldwide. (Chris Beyrer and Robert Suttle, 8/26)

Congress is notorious for passing legislation without reading it, but the urge to rush legislation reached a new level in Washington this month. Some members of Congress have announced support for gun control bills that haven’t even been written yet! What’s already clear from their vague proposals, however, is that none of these measures would have stopped any recent mass public shooting. For the safety of the general public, perhaps we should have a mandatory waiting period for lawmakers who rush to pass unconstitutional and unhelpful legislation. (Thomas Massie and Jim Jordan, 8/26)