RICHMOND, Va. — In late July, Norman Otey was rushed by ambulance to Richmond Community Hospital. The 63-year-old was doubled over in pain and babbling incoherently. Blood tests suggested septic shock, a grave emergency that required the resources and expertise of an intensive care unit.
But Richmond Community, a struggling hospital in a predominantly Black neighborhood, had closed its I.C.U. in 2017.
It took several hours for Mr. Otey to be transported to another hospital, according to his sister, Linda Jones-Smith. He deteriorated on the way there, and later died of sepsis. Two people who cared for Mr. Otey said the delay had most likely contributed to his death.
the hospital’s financial data.
More than half of all hospitals in the United States are set up as nonprofits, a designation that allows them to make money but avoid paying taxes. Although Bon Secours has taken a financial hit this year like many other hospital systems, the chain made nearly $1 billion in profit last year at its 50 hospitals in the United States and Ireland and was sitting on more than $9 billion in cash reserves. It avoids at least $440 million in federal, state and local taxes every year that it would otherwise have to pay, according to an analysis by the Lown Institute, a nonpartisan think tank.
In exchange for the tax breaks, the Internal Revenue Service requires nonprofit hospitals to provide a benefit to their communities. But an investigation by The New York Times found that many of the country’s largest nonprofit hospital systems have drifted far from their charitable roots. The hospitals operate like for-profit companies, fixating on revenue targets and expansions into affluent suburbs.
borrowing tricks from business consultants, have trained staff to squeeze payments from poor patients who should be eligible for free care.
John M. Starcher Jr., made about $6 million in 2020, according to the most recent tax filings.
“Our mission is clear — to extend the compassionate ministry of Jesus by improving the health and well-being of our communities and bring good help to those in need, especially people who are poor, dying and underserved,” the spokeswoman, Maureen Richmond, said. Bon Secours did not comment on Mr. Otey’s case.
In interviews, doctors, nurses and former executives said the hospital had been given short shrift, and pointed to a decade-old development deal with the city of Richmond as another example.
In 2012, the city agreed to lease land to Bon Secours at far below market value on the condition that the chain expand Richmond Community’s facilities. Instead, Bon Secours focused on building a luxury apartment and office complex. The hospital system waited a decade to build the promised medical offices next to Richmond Community, breaking ground only this year.
‘Glorified Emergency Room’
founded in 1907 by Black doctors who were not allowed to work at the white hospitals across town. In the 1930s, Dr. Jackson’s grandfather, Dr. Isaiah Jackson, mortgaged his house to help pay for an expansion of the hospital. His father, also a doctor, would take his children to the hospital’s fund-raising telethons.
Cassandra Newby-Alexander at Norfolk State University.
got its first supermarket.
according to research done by Virginia Commonwealth University. The public bus route to St. Mary’s, a large Bon Secours facility in the northwest part of the city, takes more than an hour. There is no public transportation from the East End to Memorial Regional, nine miles away.
“It became impossible for me to send people to the advanced heart valve clinic at St. Mary’s,” said Dr. Michael Kelly, a cardiologist who worked at Richmond Community until Bon Secours scaled back the specialty service in 2019. He said he had driven some patients to the clinic in his own car.
Richmond Community has the feel of an urgent-care clinic, with a small waiting room and a tan brick facade. The contrast with Bon Secours’s nearby hospitals is striking.
At the chain’s St. Francis Medical Center, an Italianate-style compound in a suburb 18 miles from Community, golf carts shuttle patients from the lobby entrance, past a marble fountain, to their cars.
after the section of the federal law that authorized it, allows hospitals to buy drugs from manufacturers at a discount — roughly half the average sales price. The hospitals are then allowed to charge patients’ insurers a much higher price for the same drugs.
The theory behind the law was that nonprofit hospitals would invest the savings in their communities. But the 340B program came with few rules. Hospitals did not have to disclose how much money they made from sales of the discounted drugs. And they were not required to use the revenues to help the underserved patients who qualified them for the program in the first place.
In 2019, more than 2,500 nonprofit and government-owned hospitals participated in the program, or more than half of all hospitals in the country, according to the independent Medicare Payment Advisory Commission.
in wealthier neighborhoods, where patients with generous private insurance could receive expensive drugs, but on paper make the clinics extensions of poor hospitals to take advantage of 340B.
to a price list that hospitals are required to publish. That is nearly $22,000 profit on a single vial. Adults need two vials per treatment course.
work has shown that hospitals participating in the 340B program have increasingly opened clinics in wealthier areas since the mid-2000s.
were unveiling a major economic deal that would bring $40 million to Richmond, add 200 jobs and keep the Washington team — now known as the Commanders — in the state for summer training.
The deal had three main parts. Bon Secours would get naming rights and help the team build a training camp and medical offices on a lot next to Richmond’s science museum.
The city would lease Bon Secours a prime piece of real estate that the chain had long coveted for $5,000 a year. The parcel was on the city’s west side, next to St. Mary’s, where Bon Secours wanted to build medical offices and a nursing school.
Finally, the nonprofit’s executives promised city leaders that they would build a 25,000-square-foot medical office building next to Richmond Community Hospital. Bon Secours also said it would hire 75 local workers and build a fitness center.
“It’s going to be a quick timetable, but I think we can accomplish it,” the mayor at the time, Dwight C. Jones, said at the news conference.
Today, physical therapy and doctors’ offices overlook the football field at the training center.
On the west side of Richmond, Bon Secours dropped its plans to build a nursing school. Instead, it worked with a real estate developer to build luxury apartments on the site, and delayed its plans to build medical offices. Residents at The Crest at Westhampton Commons, part of the $73 million project, can swim in a saltwater pool and work out on communal Peloton bicycles. On the ground floor, an upscale Mexican restaurant serves cucumber jalapeño margaritas and a Drybar offers salon blowouts.
have said they plan to house mental health, hospice and other services there.
a cardiologist and an expert on racial disparities in amputation, said many people in poor, nonwhite communities faced similar delays in getting the procedure. “I am not surprised by what’s transpired with this patient at all,” he said.
Because Ms. Scarborough does not drive, her nephew must take time off work every time she visits the vascular surgeon, whose office is 10 miles from her home. Richmond Community would have been a five-minute walk. Bon Secours did not comment on her case.
“They have good doctors over there,” Ms. Scarborough said of the neighborhood hospital. “But there does need to be more facilities and services over there for our community, for us.”
In 2018, senior executives at one of the country’s largest nonprofit hospital chains, Providence, were frustrated. They were spending hundreds of millions of dollars providing free health care to patients. It was eating into their bottom line.
The executives, led by Providence’s chief financial officer at the time, devised a solution: a program called Rev-Up.
Rev-Up provided Providence’s employees with a detailed playbook for wringing money out of patients — even those who were supposed to receive free care because of their low incomes, a New York Times investigation found.
nonprofits like Providence. They enjoy lucrative tax exemptions; Providence avoids more than $1 billion a year in taxes. In exchange, the Internal Revenue Service requires them to provide services, such as free care for the poor, that benefit the communities in which they operate.
But in recent decades, many of the hospitals have become virtually indistinguishable from for-profit companies, adopting an unrelenting focus on the bottom line and straying from their traditional charitable missions.
focused on investments in rich communities at the expense of poorer ones.
And, as Providence illustrates, some hospital systems have not only reduced their emphasis on providing free care to the poor but also developed elaborate systems to convert needy patients into sources of revenue. The result, in the case of Providence, is that thousands of poor patients were saddled with debts that they never should have owed, The Times found.
provide. That was below the average of 2 percent for nonprofit hospitals nationwide, according to an analysis of hospital financial records by Ge Bai, a professor at the Johns Hopkins Bloomberg School of Public Health.
Ten states, however, have adopted their own laws that specify which patients, based on their income and family size, qualify for free or discounted care. Among them is Washington, where Providence is based. All hospitals in the state must provide free care for anyone who makes under 300 percent of the federal poverty level. For a family of four, that threshold is $83,250 a year.
In February, Bob Ferguson, the state’s attorney general, accused Providence of violating state law, in part by using debt collectors to pursue more than 55,000 patient accounts. The suit alleged that Providence wrongly claimed those patients owed a total of more than $73 million.
Providence, which is fighting the lawsuit, has said it will stop using debt collectors to pursue money from low-income patients who should qualify for free care in Washington.
But The Times found that the problems extend beyond Washington. In interviews, patients in California and Oregon who qualified for free care said they had been charged thousands of dollars and then harassed by collection agents. Many saw their credit scores ruined. Others had to cut back on groceries to pay what Providence claimed they owed. In both states, nonprofit hospitals are required by law to provide low-income patients with free or discounted care.
“I felt a little betrayed,” said Bev Kolpin, 57, who had worked as a sonogram technician at a Providence hospital in Oregon. Then she went on unpaid leave to have surgery to remove a cyst. The hospital billed her $8,000 even though she was eligible for discounted care, she said. “I had worked for them and given them so much, and they didn’t give me anything.” (The hospital forgave her debt only after a lawyer contacted Providence on Ms. Kolpin’s behalf.)
was a single room with four beds. The hospital charged patients $1 a day, not including extras like whiskey.
Patients rarely paid in cash, sometimes offering chickens, ducks and blankets in exchange for care.
At the time, hospitals in the United States were set up to do what Providence did — provide inexpensive care to the poor. Wealthier people usually hired doctors to treat them at home.
wrote to the Senate in 2005.
Some hospital executives have embraced the comparison to for-profit companies. Dr. Rod Hochman, Providence’s chief executive, told an industry publication in 2021 that “‘nonprofit health care’ is a misnomer.”
“It is tax-exempt health care,” he said. “It still makes profits.”
Those profits, he added, support the hospital’s mission. “Every dollar we make is going to go right back into Seattle, Portland, Los Angeles, Alaska and Montana.”
Since Dr. Hochman took over in 2013, Providence has become a financial powerhouse. Last year, it earned $1.2 billion in profits through investments. (So far this year, Providence has lost money.)
Providence also owes some of its wealth to its nonprofit status. In 2019, the latest year available, Providence received roughly $1.2 billion in federal, state and local tax breaks, according to the Lown Institute, a think tank that studies health care.
a speech by the Rev. Dr. Martin Luther King Jr.: “If it falls your lot to be a street sweeper, sweep streets like Michelangelo painted pictures.”
Ms. Tizon, the spokeswoman for Providence, said the intent of Rev-Up was “not to target or pressure those in financial distress.” Instead, she said, “it aimed to provide patients with greater pricing transparency.”
“We recognize the tone of the training materials developed by McKinsey was not consistent with our values,” she said, adding that Providence modified the materials “to ensure we are communicating with each patient with compassion and respect.”
But employees who were responsible for collecting money from patients said the aggressive tactics went beyond the scripts provided by McKinsey. In some Providence collection departments, wall-mounted charts shaped like oversize thermometers tracked employees’ progress toward hitting their monthly collection goals, the current and former Providence employees said.
On Halloween at one of Providence’s hospitals, an employee dressed up as a wrestler named Rev-Up Ricky, according to the Washington lawsuit. Another costume featured a giant cardboard dollar sign with “How” printed on top of it, referring to the way the staff was supposed to ask patients how, not whether, they would pay. Ms. Tizon said such costumes were “not the culture we strive for.”
financial assistance policy, his low income qualified him for free care.
In early 2021, Mr. Aguirre said, he received a bill from Providence for $4,394.45. He told Providence that he could not afford to pay.
Providence sent his account to Harris & Harris, a debt collection company. Mr. Aguirre said that Harris & Harris employees had called him repeatedly for weeks and that the ordeal made him wary of going to Providence again.
“I try my best not to go to their emergency room even though my daughters have gotten sick, and I got sick,” Mr. Aguirre said, noting that one of his daughters needed a biopsy and that he had trouble breathing when he had Covid. “I have this big fear in me.”
That is the outcome that hospitals like Providence may be hoping for, said Dean A. Zerbe, who investigated nonprofit hospitals when he worked for the Senate Finance Committee under Senator Charles E. Grassley, Republican of Iowa.
“They just want to make sure that they never come back to that hospital and they tell all their friends never to go back to that hospital,” Mr. Zerbe said.
The Everett Daily Herald, Providence forgave her bill and refunded the payments she had made.
In June, she got another letter from Providence. This one asked her to donate money to the hospital: “No gift is too small to make a meaningful impact.”
Following a Script ‘Like Robots’
In 2019, Vanessa Weller, a single mother who is a manager at a Wendy’s restaurant in Anchorage, went to Providence Alaska Medical Center, the state’s largest hospital.
She was 24 weeks pregnant and experiencing severe abdominal pains. “Let this just be cramps,” she recalled telling herself.
Ms. Weller was in labor. She gave birth via cesarean section to a boy who weighed barely a pound. She named him Isaiah. As she was lying in bed, pain radiating across her abdomen, she said, a hospital employee asked how she would like to pay. She replied that she had applied for Medicaid, which she hoped would cover the bill.
After five days in the hospital, Isaiah died.
Then Ms. Weller got caught up in Providence’s new, revenue-boosting policies.
The phone calls began about a month after she left the hospital. Ms. Weller remembers panicking when Providence employees told her what she owed: $125,000, or about four times her annual salary.
She said she had repeatedly told Providence that she was already stretched thin as a single mother with a toddler. Providence’s representatives asked if she could pay half the amount. On later calls, she said, she was offered a payment plan.
“It was like they were following some script,” she said. “Like robots.”
Later that year, a Providence executive questioned why Ms. Weller had a balance, given her low income, according to emails disclosed in Washington’s litigation with Providence. A colleague replied that her debts previously would have been forgiven but that Providence’s new policy meant that “balances after Medicaid are being excluded from presumptive charity process.”
Ms. Weller said she had to change her phone number to make the calls stop. Her credit score plummeted from a decent 650 to a lousy 400. She has not paid any of her bill.
Susan C. Beachy and Beena Raghavendran contributed research.
The ruling means the state’s abortion clinics will have to shut down and anyone seeking an abortion will have to go out of state.
Arizona can enforce a near-total ban on abortions that has been blocked for nearly 50 years, a judge ruled Friday, meaning clinics statewide will have to stop providing the procedures to avoid the filing of criminal charges against doctors and other medical workers.
The judge lifted a decades-old injunction that blocked enforcement of the law on the books since before Arizona became a state. The only exemption to the ban is if the woman’s life is in jeopardy.
The ruling means the state’s abortion clinics will have to shut down and anyone seeking an abortion will have to go out of state. The ruling takes effect immediately, although an appeal is possible. Planned Parenthood and two other large providers said they were halting abortions.
Abortion providers have been on a roller coaster since the U.S. Supreme Court in June overturned the landmark 1973 Roe v. Wade decision guaranteeing women a constitutional right to an abortion. At first providers shut down operations, then re-opened, and now have to close again.
Planned Parenthood had urged the judge not to allow enforcement, and its president declared that the ruling “takes Arizonans back to living under an archaic, 150-year-old law.”
“This decision is out of step with the will of Arizonans and will cruelly force pregnant people to leave their communities to access abortion,” said Alexis McGill Johnson, Planned Parenthood Federation of America’s president and CEO, said in a statement.
Republican Attorney General Mark Brnovich, who had urged the judge to lift the injunction so the ban could be enforced, cheered.
“We applaud the court for upholding the will of the Legislature and providing clarity and uniformity on this important issue,” Brnovich said in a statement. “I have and will continue to protect the most vulnerable Arizonans.”
The ruling comes amid an election season in which Democrats have seized on abortion rights as a potent issue. Sen. Mark Kelly, under a challenge from Republican Blake Masters, said it “will have a devastating impact on the freedom Arizona women have had for decades” to choose an abortion. Democrat Katie Hobbs, who is running for governor, called it the product of a decadeslong attack on reproductive freedom by Republicans that can only be fended off by voters in November.
Masters and Kari Lake, the Republican running against Hobbs, both back abortion restrictions. Their campaigns had no immediate comment.
Pima County Superior Court Judge Kellie Johnson ruled more than a month after hearing arguments on Brnovich’s request to lift the injunction.
The near-total abortion ban was enacted decades before Arizona secured statehood in 1912. Prosecutions were halted after the injunction was handed down following the Roe decision. Even so, the Legislature reenacted the law in 1977.
Assistant Attorney General Beau Roysden told Johnson at an Aug. 19 hearing that since Roe has been overruled, the sole reason for the injunction blocking the old law is gone and she should allow it to be enforced. Under that law, anyone convicted of performing a surgical abortion or providing drugs for a medication abortion could face two to five years in prison.
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An attorney for Planned Parenthood and its Arizona affiliate argued that allowing the pre-statehood ban to be enforced would render more recent laws regulating abortion meaningless. Instead, she urged the judge to let licensed doctors perform abortions and let the old ban only apply to unlicensed practitioners.
The judge sided with Brnovich, saying that because the injunction was issued in 1973 only because of the Roe decision, it must be lifted in its entirety.
“The Court finds an attempt to reconcile fifty years of legislative activity procedurally improper in the context of the motion and record before it,” Johnson wrote. “While there may be legal questions the parties seek to resolve regarding Arizona statutes on abortion, those questions are not for this Court to decide here.”
In overturning Roe on June 24, the high court said states can regulate abortion as they wish.
A physician who runs a clinic providing abortions said she was dismayed but not surprised by the decision.
“It kind of goes with what I’ve been saying for a while now –- it is the intent of the people who run this state that abortion be illegal here,” Dr. DeShawn Taylor said. “Of course we want to hold onto hope in the back of our minds, but in the front of my mind I have been preparing the entire time for the total ban.”
Republicans control the Legislature, and GOP Gov. Doug Ducey is an abortion opponent who has signed every abortion law that reached his desk for the past eight years.
Johnson, the judge, said Planned Parenthood was free to file a new challenge. But with Arizona’s tough abortion laws and all seven Supreme Court justices appointed by Republicans, the chances of success appear slim.
What’s allowed in each state has shifted as legislatures and courts have acted since Roe was overturned. Before Friday’s ruling, bans on abortion at any point in pregnancy were in place in 12 Republican-led states.
In another state, Wisconsin, clinics have stopped providing abortions amid litigation over whether an 1849 ban is in effect. Georgia bans abortions once fetal cardiac activity can be detected. Florida and Utah have bans that kick in after 15 and 18 weeks gestation, respectively.
The ruling came a day before a new Arizona law banning abortions after 15 weeks of pregnancy takes effect. Signed by Ducey in March, the law was enacted in hopes that the Supreme Court would pare back limits on abortion regulations. Instead, it overturned Roe.
Ducey has argued that the new law he signed takes precedence over the pre-statehood law, but he did not send his attorneys to argue that before Johnson.
The old law was first enacted among a set of laws known as the “Howell Code” adopted by 1st Arizona Territorial Legislature in 1864. Arizona clinics have been performing about 13,000 abortions a year.
As the number of people dealing with mental health challenges increases, it’s putting a strain on psychiatrists and mental health professionals.
More American adults are seeking resources for help in getting treatment for mental health. A new CDC survey finds the trend is higher among adults 18 to 44.
But with an increase in patients comes a new strain on mental health professionals, on psychiatrists.
The Association of American Medical Colleges says the current shortfall is at 6%. That’s expected to be between 14,000 and 32,000 psychiatrists by 2024.
Forensic psychiatry specialist Dr. Abdi Tinwalla, as president of the Illinois Psychiatric Society, has seen how the shortage of psychiatrists has reached a crisis point.
“The prevalence of mental illness in the population is increasing, the American population is increasing. So year over year so far we have more doctors going into retirement than doctors coming into the workforce,” said Tinwalla.
Another factor in the shortage, he says, is feeding the pipeline — as in residencies. These take place after medical school in a hospital or clinic and provide doctors with crucial hands-on training.
Dr. Tinwalla says there’s growing interest in the field but financial barriers are posing steep challenges.
“This year itself there were twice the number of people wanting to go in than the seats they had available. The biggest barrier for that is funding and, you know, the government funding for these programs has not increased in the last couple of years,” said Tinwalla.
It’s actually been decades. The Balanced Budget Act of 1997 capped the number of residents each teaching hospital is eligible to receive Medicare-funded reimbursements for.
Individual institutions are responsible for any additional slots. Though there is a new federal push to bolster the medical workforce. The “Resident Physician Shortage Reduction Act”, which Democratic Senator Bob Menendez introduced in 2021, would expand Medicare funding for thousands of residency positions.
But despite support from medical groups and organizations, the bill’s future is uncertain, with minimal movement since introduced.
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The demands of the job are also pushing some psychiatrists to rethink their careers.
A 2022 meta-analysis published in the Journal of Affective Disorders found that nearly half of psychiatrists experience burnout.
It cited lack of resources and lack of autonomy as contributors to feelings of professional exhaustion.
“Part of us experience it in our lives, if we don’t deal with it appropriately it does lead to shortage in our careers so I definitely think burnout so if you ask me if it’s a real phenomenon? It’s a yes,” said Tinwalla.
Despite the reasons for the shortage, Dr. Tinwalla say he sees solutions including collaborative care which involves a team approach.
“Collaborative care has been popular in the last decade, its the care in which is given by the primary care physician in his office, in collaboration with a behavioral care manager and a psychiatrist is a consultant over the phone or video or whatever,” he said.
He also says technology is opening doors for treatment with telemedicine. And he’s encouraged insurers are more likely to cover mental health appointments than in years past.
“Well I’m hoping with the collaborative care model and hopefully with the telepsychiatry we are doing we are going to bridge some of those care gaps that we are having right now,” he said.
California workers won’t have to worry about being fired, or not hired, for off-the-clock marijuana use.
A new phase of California’s weed legalization begins, as the state prepares to make it illegal for a company to fire, or not hire, someone simply for their off-the-clock marijuana use.
California is the seventh state to do it, but a potentially pivotal one for the national attitude toward weed.
At the very least it’s an emboldening step for the millions of California adults who report using marijuana.
At a cannabis store near San Diego, it could mean a tax boom.
The elimination of job risk helps boost usage numbers.
“There were a lot of myths and stigma associated with cannabis and with having a cannabis store in the community. So it’s nice to see that none of those myths came true and a lot of that stigma is starting to disappear,” said David Dallal, a California cannabis store manager.
Cannabis industry insiders and even some law enforcement hope that destigmatizing weed will push more weed users to shop at legitimate dispensaries.
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It could be a potentially life-saving choice as fentanyl-laced drugs flow over the southern border and end up on the black market.
But the stigma around marijuana is still a challenge for people like Dr. David Berger, who’s trying to battle a new restriction in Florida that limits the amount of medical marijuana a person can get in a day.
“Some of my patients for instance, because of their medical needs, they might need to have more milligrams than what the state is allowing for,” said Berger.
Florida is allowing doctors to appeal the limit for those who need it. But that takes time — a potentially-serious wait for users who need the drug.
“If a person is out of their medicine they could be out of their medicine for a good week or almost two and really have no way of accessing it,” said Berger.
It’s a deep contrast to the new reality in California, where lawmakers hope making marijuana irrelevant to employability will set a new standard for the country.
Disability experts say it’s common for doctors to misunderstand bodily autonomy, which can impact a person’s mental health.
CDC data shows about 26% of Americans live with a disability, whether it’s physical or mental.
Conditions like anxiety, spinal injury, ADHD, amputation, depression, cerebral palsy — these are just some examples.
Advocates say there’s a lot of misunderstanding about a person who has a disability. And that stigma not only runs deep — it can also have a huge impact on that individual’s mental health.
Twenty-eight-year-old New Yorker Chloé Valentine Toscano knows beauty, from walking in fashion week to her Instagram reels to publishing in magazines like Allure.
“I’m a writer. I’m someone who likes the color pink. I like butterflies. I like learning a lot about anyone and anything,” she said. “I think we all have differences, and I want to understand differences. … For me, beauty is just being open-minded,” she said.
She also has fought face-to-face with ugly mental health struggles caused by doctors who didn’t understand disability.
“It is a journey,” Valentine Toscano said.
She lost motor function from her elbow down in 2014. She adapted and spent years living with — as she calls it — dead weight. She got into paralypmic swimming and started her career.
Then, after years of researching and soul searching, she chose to amputate her arm.
“I know amputation can be very traumatic because some people, a lot of people,will experience it through trauma,” she said. “But that wasn’t where I was in my case. So, it wasn’t traumatic talking about it, but it was traumatic playing a game with the yeses and the nos.”
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Valentine Toscano spent three years fighting to get her procedure. She says some surgeons told her any elective amputation was too risky, even though she was healthy. Other rejections came after her surgery had been approved and scheduled.
“The answer I got from one, he said, ‘Well, some people just need to learn to live with what they’ve got.’ That made me feel like someone else who wasn’t in my body was telling me what was better for me,” she said. “It felt very frustrating to have it and very offensive to have someone say that.”
Bodily autonomy — or the right to control what happens to your body — is a common struggle in the disability community. And disability experts say misunderstanding that is common, and can cause undue stress as well as impact a person’s mental well-being.
In Valentine Toscano’s story, it happened a few times.
She recounted that in one appointment: “I cried, I broke down and I felt like the minute I expressed that emotion, he sent me in for a psych evaluation, which felt like I was being punished for expressing emotion.” And then she described the examination, saying: “She was asking me, she said, ‘Do you find that you’re unattractive because of your arm and that you would be more attractive without it?’ And I was like, ‘It’s not about that at all. It’s never been about that.’ … I felt angry and belittled and just, not heard, because I was asking for one thing and being evaluated for something that wasn’t even remotely there.”
Clinical Psychologist Dr. Linda Mona has spent the past two decades working on disability and how it relates to health care.
“If you haven’t been exposed to it personally — you have not been exposed to it through being a family friend, a lover, whoever that might be — And you’re not called to do it professionally and you don’t see it around you, you don’t think about it.”
She says, unfortunately, Valentine Toscano’s experience is all too common. Mental health experts with lived experience or expertise in disability are rare.
“It can be quite challenging to find somebody,” Mona said. “The other thing to think about is the steps that come before that, which is that it’s very hard for people to access education if they have disability, let alone graduate school. And internship and fellowship…”
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Sixty-one million U.S. adults, which is about one in 4, have some type of disability, according to the CDC.
A 2021 anonymous survey of graduating medical students showed 7.6% identified as having a disability. But data collected directly from medical schools show that only about 4% of medical students disclosed their disability.
That stigma against disability —physical or mental — runs deep.
From 1867 to 1974 U.S. cities had laws governing who could be in public. Codes included fining or jailing those deemed “diseased, maimed, mutilated, or anyway deformed.”
Mona says it’s federal bias favoring able-bodied people.
“You’re best at home. You’re best tucked away. Or, you’re best institutionalized out of the way of anybody else who is displeased with the way that you look,” she said.
She adds structural stigmas fueled misconceptions about disabled people’s decision-making about their own bodies.
NEWSY’S LINDSEY THEIS: When we talk about bodily autonomy, what type of impact cannot have long term on someone’s mental well-being?
LINDA MONA: Trying to bring that in and make your choices can have a huge effect on your mental health in the long run. … It also happens a lot with pregnancy and people with disabilities. Right? So, you know, somebody has some kind of cognitive mental difference or physical difference. There’s, you know, constant questioning about, you know, ‘you want to be pregnant? You know what that’s going to do to your body?’ … I don’t think anybody thinks those types of decisions are a simple decision. They’re complex. But you have to trust that somebody has made that made that decision with that context in mind and not assume that they’re uninformed.
In summer 2021, Valentine Toscano had her amputation surgery. She calls it a dream come true.
“I just felt happy,” she said. “I was like, ‘Oh my gosh.’ I got this is like a huge step in my life. It just felt like one of those, like, huge dreams. I got there. I got a huge part of my personality back immediately.”
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Valentine Toscano uses a prosthetic, as needed. It’s bright pink and purple with a lot of glitter.
“If I could have decided to have been born with an arm with butterflies and sparkles on it, like right out of the womb, I would have picked that,” she said.
Valentine Toscano said her prosthetic cost $13,000.
“It’s something that’s very expensive,” she said. “I was fortunate to have it covered by health insurance. But that’s not something everyone has.”
Valentine Toscano continues to advocate and write, sharing her experience now from two different sides of disability. She’s also writing a book on the side.
She says the ability to share those stories in her voice and having others listen is not only good for her well-being, it’s truly beautiful.
Studies show 30% of COVID patients report brain fog a few months after they’re sick. It’s 65 to 85% for long-haulers sick beyond that.
COVID-related brain fog is a condition that can feel very defeating and overwhelming.
Newsy’s Lindsey Theis has COVID-related brain fog herself. And it’s a topic she’s covered since 2020. She says each person she’s spoken with tells her it’s a dramatic change that impacts how they think and move throughout their lives. For this story, Theis met a family dealing with what she says is one of the worst cases she’s ever seen.
On a bright, sunny day in rural Rensselaer, Indiana, 45-year-old Kari Lentino’s mind is a slow-moving storm.
“I feel like a brain blizzard half the time,” she said.
Lentino is immunocompromised. She’s had COVID twice. Since June 2021, it’s left her with several neurological setbacks. She says her brain fog is among the worst of it.
“I couldn’t remember passwords to get into certain systems. I worked at the library and I would forget what I was doing while I was doing it,” Lentino said.
Her conversations now go at a snail’s pace as she searches for words.
The mother of four and grandmother of two had to quit work and file for disability.
She can’t watch her grandkids. She won’t run errands or drive. Now, her time is spent mothering her brain.
Dr. Igor Koralnik is chief of neuro-infectious diseases and co-director of the Northwestern Medicine Comprehensive COVID-19 Center, where he also runs a lab.
He says 70% of his COVID brain fog patients are like Lentino — women in their early 40s.
“We see that attention is their main cognitive problem,” he said. “Problem with attention, problem with memory, problem with multitasking and briefly, problems getting through their daily life and working in their current job capacity. … We have people who have been infected back in March 2020 and still have decreased quality of life because of those symptoms and decreased cognitive function.”
Scientists think COVID cognitive dysfunction is from brain inflammation — but what causes it is still itself foggy.
One leading theory is that long COVID is an autoimmune disorder, where the immune system attacks healthy cells in the body, including the brain.
“We find that the virus has confused the immune system, and we think that it’s driving the immune system towards autoimmunity,” Koralnik explained.
Studies show 30% of COVID patients report brain fog a few months after they’re sick. It’s 65 to 85% for long-haulers sick beyond that.
Researchers haven’t found brain fog treatments yet, so they tackle someone’s symptoms.
But even diagnosing brain fog is tricky. It’s invisible. There’s no set case definition but it can include trouble focusing, struggling to remember names, places, or words, reacting slowly, confused judgment, losing a train of thought often and fatigue or exhaustion from concentrating.
Back in Rensselaer, Lentino’s husband helps her prepare her pills. She takes eight medications and two vitamins daily, plus a handful more as needed. That’s in addition to her therapies and memory aids like calendars and post it notes. Those cues share spots in the Lentino home near the signs of her former creative and vibrant self. Prescription bottles near her paintings. Reminders near her Star Wars string art.
“It’s frustrating and depressing. It takes so long to do anything,” she said.
In the spot where she used to stand to paint, brushes and acrylics wait patiently.
Lentino is waiting too, like so many brain fog sufferers. It’s a long, draining wait and the ultimate test of patience.
On a hopeful note, research shows many brain fog patients recover memory and attention near the 6-to-9-month mark. For treatment, some doctors prescribe medicine, like steroids or antihistamines, plus therapies like speech or cognitive rehabilitation therapy. If you have brain fog yourself, experts say you can try memory games and puzzles, and focus on quality sleep and healthy eating.
Michelle Hammer is a New York resident with schizophrenia, a serious mental disorder. She shares her journey.
Michelle Hammer wants you to know schizophrenia. To know the illness is to know her.
“I go, ‘listen, no couches were harmed in the making of this video.’… People with schizophrenia can have a job or actually speak to people or can do things themselves,” said Hammer.
Schizophrenia is a brain disease and patients’ symptoms run a spectrum. They can include negative symptoms like social withdrawal or psychosis, when someone is detached from reality. Usually it looks like hallucinations: Seeing or hearing something that isn’t there; or delusions: Fixed false beliefs that a person can’t change.
For Michelle it began in her teens with paranoid thoughts about her mother. And again at age 18 with her college roommate.
It would be three more years before she was diagnosed as schizophrenic.
“Things were up, things were down. And I ended up in the psych ward twice my freshman year and once my sophomore year,” Hammer said.
“Schizophrenia is a very serious psychiatric illness, but we can do a lot to help these people function and have a normal life,” said Dr. René Kahn, the head of psychiatry at Mount Sinai’s Icahn School of Medicine in New York.
He says Michelle’s experience is more common for female patients.
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RENE KAHN: Women in general have a better prognosis than men.
NEWSY’S LINDSEY THEIS: Why?
KAHN: One of the reasons may be that in women, it starts about five years later than men, meaning that their brain may have developed more and they may have matured more than in men.
THEIS: What are some of the biggest questions, right now, that are still out there? What are the unknowns that you’re trying to answer, you know, in the immediate future, the next couple of years?
KAHN: The biggest question still is ‘what is the cause or what are the causes of schizophrenia?’ Because we don’t know, and we really need to find out if we really want to cure the disease or prevent the disease.
With neither a cure nor prevention, doctors say medication is key for patients. That process is complicated.
Antipsychotic drugs are available to counter psychosis. But that is only one part of the illness.
“Finding the right meds probably took me about ten years, and I’ve probably tried about 20 different medications,” said Hammer.
Today Michelle’s life includes daily meds and frequent psychiatrist televisits to make sure they work and she’s still taking them. It also includes her partner, Carolyn. They married last year. And most recently, a new puppy.
“People kind of like treat people with schizophrenia — they’re always wondering, ‘who’s your support team?'” said Hammer. “They don’t think you’re independent at all.”
THEIS: So no caregiver?
THEIS: Just you.
HAMMER: I can take care of myself. I can do that. I’m a big girl, you know? I’m a big girl. I can do things, you know. I can do things.
THEIS: Does the schizophrenia diagnosis impact how you guys are as a couple in marriage?
CAROLYN HAMMER: If we’re talking and then like I say something and then I’m like waiting for her to respond, but she’s talking to like somebody else instead, it’s like, not bad it’s just like annoying. And I’m like, okay, I guess I’m going to say what I have to say again.
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Schizophrenia is rare. About 1% of U.S. adults have the mental illness. Compare that to one in five people who have an anxiety disorder.
But it reportedly shows up more often in the media. It;’s portrayed negatively and falsely, according to research.
THEIS: Was that ‘Violence and a dangerous person’ — is that common or is that more of the exception?
KAHN: It’s absolutely the exception.
Since 2019 Michelle’s recorded and shared video of her schizophrenic episodes. She wants to debunk the stigma that people with her illness are violent.
In them, she appears to speak to someone off camera — except no one is there. She describes this as being in another world.
“I am currently under seven medications and I’m still doing that. So if I wasn’t on any medication, I’d be doing that constantly, all the time,” she says.
She’s also started a business called Schizophrenic NYC. She sells original activist-minded clothing and art. They include colorful rorschach prints and t-shirts with hopeful slogans.
“I saw a guy on the F train and he was talking to himself in the same mannerisms in which I talked to myself and I was like, you know, what’s the difference between me and him? And the difference is that I have my support team of a family, friends and doctor, and if I didn’t have that, I would totally be in his position,” said Hammer.
Michelle says it’s a way to give a voice to her community, especially those who otherwise could not.
Newsy’s mental health initiative “America’s Breakdown: Confronting Our Mental Health Crisis” brings you deeply personal and thoughtfully told stories on the state of mental health care in the U.S. Click here to learn more.
Research shows that when used in a controlled clinical environment, ketamine can have healing benefits.
Over the past 50 years, research on psychedelics has come a long way from a time when psychedelic albums ruled the charts and psychedelic drugs influenced American counterculture.
Today, research shows some of those same drugs are being used to help people escape a dark place.
“I mean, it’s pretty profound,” said Katy Parr, who sought ketamine therapy.
Parr, of Houston, has long struggled with depression, and says for years she’s been prescribed several different anti-depressants. When the pills failed her, she turned to talk therapy as the only treatment that helped; until she saw a documentary on psychedelic healing.
“I couldn’t sit through the episode; I did watch the whole thing, but it took me two hours because I had to pause so often to sob. Watching their stories was very affirming. I thought, ‘OK, I am sick,'” said Parr.
From there, Parr was recommended by her therapist as a candidate for ketamine therapy and says she’s been benefiting from the sessions ever since.
“There were some moments with some emotional trauma that I have, and I was able to let that go during a ketamine session,” said Parr.
Parr receives treatment at Field Trip Health in Houston, a Toronto-based psychedelic therapy company that has expanded in recent years with clinics in cities across the U.S.
“If the goal is to explore trauma, each session has its own value,” said Dr. Michael Muench, who leads the Field Trip Health clinic in Atlanta.
During sessions, Dr. Muench administers the ketamine injections and checks the patient’s vital signs, while a therapist helps ease the experience.
“So much about psychedelic therapy is about creating a container that feels safe. Part of feeling safe is feeling like what you’re doing is legitimate, supported, and a good and healthy thing,” said Dr. Muench.
The guided experience takes patients on a journey or “trip.” In a dimly lit room, patients wear an eye mask and headphones; it’s a comfortable space for them to address trauma and experience somatic release — something Parr says she experienced during her fourth session.
“It can be extreme laughing, extreme crying; it’s a release of energy and feeling from the body,” said Parr.
In 1999, ketamine became a schedule III non-narcotic substance with accepted medical uses. In 2019, the FDA approved a ketamine nasal spray for treatment-resistant depression, and now doctors and therapists use it regularly in a clinical setting. And while the DEA restricts many other psychedelics, researchers have found great benefits of substances like MDMA and psilocybin, or magic mushrooms.
The Johns Hopkins psychedelic research unit found psilocybin is effective in easing anxiety and depression, even treating veterans with post-traumatic stress disorder (PTSD).
Ketamine results may not be the same for everyone who struggles with depression, and while Parr says she will likely fight depressive symptoms for the rest of her life, the ketamine treatments, along with seeing a regular therapist, have given her a new outlook on life.
“It allowed me to find the pathway to such fulfillment in life and enrichment in my life,” said Parr.
Dr. Muench says the benefits of four to six ketamine sessions can last about a month, with patients returning less frequently for maintenance treatments.
Researchers found ketamine is anywhere from 50% to 80% effective in improving a patient’s mental health.
Currently, CDC recommends the vaccine to people who are a close contact of someone who has monkeypox or who believes they were exposed to the virus.
U.S. officials are considering broadening recommendations for who gets vaccinated against monkeypox, possibly to include many men with HIV or those recently diagnosed with other sexually transmitted diseases.
Driving the discussion is a study released Thursday showing that a higher-than-expected share of monkeypox infections are in people with other sexually transmitted infections.
Dr. John T. Brooks, chief medical officer for the Centers for Disease Control and Prevention’s monkeypox outbreak response, said the report represents a “call to action.”
Brooks told The Associated Press on Thursday that he expected vaccine recommendations to expand and that “the White House, together with CDC, are working on a plan for what that will look like.”
Currently, the CDC recommends the vaccine to people who are a close contact of someone who has monkeypox; people who know a sexual partner was diagnosed in the past two weeks; and gay or bisexual men who had multiple sexual partners in the last two weeks in an area with known virus spread.
Shots are also recommended for health care workers at high risk of exposure.
The vast majority of monkeypox cases are in men who have sex with men who reported close contact with an infected person during sex. But the new CDC report suggested infections in people with HIV and other STDs may be a bigger issue than previously realized.
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The report looked at about 2,000 monkeypox cases from four states and four cities from mid-May to late July.
It found 38% of those with monkeypox infections had been diagnosed with HIV, far higher than their share of the population among men who have sex with men.
The study also found that 41% of monkeypox patients had been diagnosed with an STD in the preceding year. And about 10% of those patients had been diagnosed with three or more different STDs in the prior year.
There were racial differences. More than 60% of Black Americans with monkeypox had HIV, compared with 41% of Hispanic people, 28% of White people and 22% of Asian Americans.
Jason Farley, an infectious disease expert at the Johns Hopkins School of Nursing, said men of color who have sex with men should be at the front of the line for monkeypox vaccine doses. Within those racial and ethnic groups, the next priority should be anyone living with HIV or was recently diagnosed with a STD, he said.
The study has several limitations, including that the data may not be nationally representative, the authors said.
Brooks said the findings could lead to vaccines being recommended for people with recent STD infections, people with HIV, people taking pre-exposure prophylaxis (PrEP) medications to prevent HIV infection and, possibly, prostitutes.
Discussions of expanding eligibility will have to take into account supply of the two-dose vaccine. And any substantial expansion of monkeypox vaccination recommendations may also be subject to review by CDC’s outside vaccine advisers, health officials say.
Also on Thursday, the CDC sent a letter to state and local health departments that said federal funds for HIV and STD prevention can also now be used against monkeypox. Cases in the U.S. seem to be declining, officials say.
Additional reporting by The Associated Press.
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