California wine country wildfire forces evacuation of hospital, hundreds of homes

By Stephen Lam and Steve Gorman

ST. HELENA, Calif. (Reuters) – A wind-driven wildfire erupted on Sunday in the heart of northern California’s Napa Valley wine country to spread across nearly 2,000 acres (809 hectares), forcing the evacuation of a hospital and hundreds of homes, authorities said.

Fire crews were out in force, scrambling to fend off flames threatening neighborhoods and vineyards at the northern end of the famed wine-growing valley and surrounding hillsides, about 75 miles (120 km) north of San Francisco.

The blaze, dubbed the Glass Fire, broke out before dawn near Calistoga and raced toward the adjacent communities of Deer Park and St. Helena, with flames reaching within a mile of the Adventist Health St. Helena hospital.

All 55 patients there at the time were safely evacuated by ambulance and helicopter over the course of five hours from about 7 a.m., hospital spokeswoman Linda Williams told Reuters.

“We had ambulances lined up from all over the Bay area,” she said, adding that although smoke shrouded the facility, the skies above were clear enough for helicopters’ airlift efforts.

It was the second wildfire-related evacuation of the 151-bed hospital in a month, after a massive cluster of lightning-sparked blazes that swept several counties north of the San Francisco Bay region in August.

Authorities ordered about 600 homes evacuated on Sunday, with residents of 1,400 more warned to be ready to flee at a moment’s notice, said Tyree Zander, a spokesman for the state’s forestry and fire protection department (CalFire). The notices affected at least 5,000 people, he added.

By evening, flames stoked by winds gusting up to 50 mph (80 kph) had scorched about 1,800 acres (728 hectares) of grassy rolling hillsides and oak woodlands, with little or no containment, Zander said.

FIRE AT HARVEST TIME

The cause of the fire is being investigated. There were no immediate reports of injuries, but a Reuters photographer in St. Helena saw some structures that had been burned.

The blaze erupted midway through the traditional grape-harvesting period in the Napa Valley, world renowned as one of California’s premiere wine-producing regions. The area’s 475 wineries account for just 4% of the state’s total annual grape harvest but half of the retail value of all California wines sold, according to the Napa Valley Vintners trade group.

Of Napa’s 16 wine-growing districts, or sub-appellations, the Howell Mountain area may have faced the greatest threat, said Lisa Covey, a spokeswoman for Hall Family Wines, which kept open during the day all its three tasting rooms in the county.

Napa and other wine-growing regions have been hit by wildfires in and around the Bay area for several years. Susan Krausz, co-owner of Arkenstone Estate Vineyards in the Howell Mountain community of Angwin, said it would take days or weeks to assess the impact of the latest blaze on valley vintners.

“Most people have harvested,” she said, but added, “Any time’s a bad time for a fire.”

Tom Kaljian, 78, a realtor who owns a house about halfway between Calistoga and St. Helena, defied evacuation orders to spend the day with his wife hosing down their home and dry brush along a fence line separating their property from the Silverado Trail, a key north-south roadway.

“We were told to get out of here, but I was trying to protect our little abode, so we stayed,” he told Reuters by telephone.

After firefighters told him the house was no longer in danger, he added, “I stopped watering at that point, and came in and took a nap.”

The Glass Fire came as the Pacific Gas and Electric Company said it was temporarily halting power to transmission lines in parts of 16 counties across northern and central California to guard against greater wildfire risks in hot, windy, dry weather.

The public safety power shutoffs were expected to affect about 65,000 regional homes and businesses, said PG&E, the state’s largest electric utility.

A red flag warning for extreme wildfire risks for Napa Valley would run through Monday morning, Zander said.

CalFire said a fire weather watch would start on Monday across much of Southern California, following the forecast return of hot, gusty Santa Ana winds and low humidity.

California wildfires have scorched more than 3.7 million acres in the first nine months of 2020, far exceeding any single year in state history, killing 26 people and destroying more than 7,000 structures.

(Reporting by Stephen Lam in St. Helena; Additional reporting and writing by Steve Gorman in Los Angeles; Editing by Daniel Wallis and Clarence Fernandez)

Gilead remdesivir study finds only marginal benefit for moderate COVID-19 patients

By Deena Beasley

(Reuters) – Moderately ill COVID-19 patients saw their condition improve after a 5-day course of Gilead Sciences Inc’s remdesivir, but the drug did not significantly shorten hospital stays and a 10-day course did not show a benefit, according to new data.

The drug, which was shown in a trial of severely ill COVID-19 patients to shorten their hospital recovery time, has been at the forefront of the battle against the pandemic.

The 600-patient analysis, published on Friday by the Journal of the American Medical Association, found that moderately ill patients treated with the antiviral drug for up to 5 days had significantly higher odds of improvement in certain areas, such as whether or not they needed supplemental oxygen, compared to patients given standard treatment.

Researchers said the clinical importance of the benefit for those patients was uncertain, however.

Remdesivir is currently sold under an emergency use authorization from the U.S. Food and Drug Administration for treating patients hospitalized with severe COVID-19, the disease caused by the new coronavirus. Gilead earlier this month filed an application seeking full FDA approval of the drug.

Differing trial results for remdesivir raise “the question of whether the discrepancies are artifacts of study design choices, including patient populations, or whether the drug is less efficacious than hoped,” according to a JAMA editorial accompanying the study.

The new study in moderately ill COVID-19 patients showed that 11 days after starting treatment, 65% of the 10-day remdesivir patients, 70% of the 5-day patients and 60% of the standard care patients had left the hospital.

Side effects seen more frequently in the remdesivir groups included nausea, low blood potassium levels, and headache.

The JAMA editorial said important questions remain regarding the efficacy of remdesivir, including which patients are most likely to benefit from the drug, the optimal duration of therapy, the drug’s impact on clinical outcomes, and its relative effect if combined with generic steroid treatments.

(Reporting by Deena Beasley; Editing by Nick Tattersall and Sonya Hepinstall)

A day fighting COVID-19: U.S. hospital staff share hardest moments on shift

BALTIMORE, Md. (Reuters) – The shifts are long and the scenes are heartbreaking inside a Maryland hospital where nurses and doctors have been treating coronavirus patients for weeks, unable to let family inside to visit loved ones on their death beds.

One of the hardest moments of a recent work day for registered nurse Julia Trainor was intubating a patient, and then calling the patient’s husband so he could talk to his wife. He was not allowed in the hospital.

“I had to put him on the phone and hold the phone to her ear as he told her that he loved her so much, and then I had to wipe away her tears,” says Trainor, who works in a surgical intensive care unit. “I’m used to seeing very sick patients and I’m used to patients dying, but nothing quite like this.”

The highly infectious COVID-19 disease caused by the novel coronavirus has infected more than 580,000 people across the United States and killed nearly 24,000.

In Maryland, where residents have been ordered to stay at home since March 30 to stem the spread of the disease, around 9,000 have tested positive for the virus and more than 260 have died.

After finishing what for many was a more than 12-hour shift, some nurses and doctors at one hospital shared with Reuters the hardest moments of their days. The hospital asked that it not be named.

The medical workers agreed that one of the toughest parts of the job – more than the exhausting schedule or adjusting to work in a new unit – was witnessing the toll on patients and families.

Because of the hospital’s no-visitor policy, which was implemented to prevent further spread of the virus, the medical staff must care for the patients’ physical needs and offer as much emotional support as they can muster in the absence of the patients’ families.

“The hardest moment during the shift was just seeing COVID patients die helpless and without their family members beside them,” says Ernest Capadngan, a nurse in the hospital’s biocontainment unit.

Communicating with the families has weighed heavily on the hospital staff. Staff cannot bend the no-visit rules, even when a family calls in desperation.

“I had a patient fall out of bed today and I had to call his wife and tell her and she couldn’t come see him, even though she pleaded and begged to come see him,” says Tracey Wilson, a nurse practitioner.

“One of the hardest moments was having to see a family member of a COVID patient say goodbye over an iPad,” says Tiffany Fare, a nurse in the biocontainment unit. “You can’t see your loved one and then they’re gone.”

There are very few opportunities to rest during a shift, although colleagues look out for one another and try to cover for each other when someone needs a break.

Cheryll Mack, a registered nurse in the emergency room, says she tries to get outside for 15 minutes during the day to breathe.

“It has given me relief, just fresh air,” Mack says.

Each shift concludes with a similar decontamination drill. Nurses and doctors must remove their personal protective equipment and shower immediately before coming in contact with their family at home.

“I take a very long, very hot shower. And then I usually sit on the couch and… read a book or watch some mindless reality show in order to destress,” says Martine Bell, a nurse practitioner.

Laura Bontempo, an emergency medicine physician, says she removes her work clothing and gear in a decontamination tent she has set up outside her home, and then wraps herself in a towel and runs inside to shower.

Then she puts the scrubs in the washing machine by themselves to not contaminate any other items.

Meghan Sheehan, 27, a nurse practitioner, says she drives home each night without turning on the radio and uses the quiet time to reflect on her shift and her patients. When she gets home, she tries hard not to dwell on the day.

“I go home, I shower immediately and try to have dinner with family, and try to not talk about it,” she said. “Nighttime is definitely the hardest because you’re constantly thinking about what the next day will brin

(Writing by Gabriella Borter in New York, Editing by Rosalba O’Brien)

Chinese capital battles jump in virus cases as infections ease elsewhere

BEIJING (Reuters) – The number of people who have contracted the coronavirus in the Chinese capital has jumped sharply, including more than 30 in an outbreak at a major hospital, while many other parts of the country are reporting fewer or no new infections.

Officials on Friday reported one new case in Beijing as of Feb. 20, bringing the total in the city to 396, with four dead.

Twenty-three cases were recorded the previous day.

The new cases largely stemmed from a major hospital about 6 k, (3.7 miles) west of Tiananmen Square, and come as China’s leaders decide whether to postpone their annual gathering of parliament, the year’s most important political event, originally set for early March.

Eight health workers, nine care workers and cleaners, and 19 patients and their family members were among the 36 cases confirmed at Fuxing Hospital thus far, Pang Xinghuo, vice head of Beijing’s disease control centre, told reporters on Thursday.

The hospital only had nine cases as of Feb. 3.

“I feel deeply guilty and distressed by the cluster case incident at Fuxing Hospital,” Li Dongxia, the hospital’s director, told the same briefing.

The infections also caught the attention of the Global Times, a tabloid published by the ruling Communist Party’s official People’s Daily, which ran a story under the headline: “Whopping rise in infection at Beijing hospital puts capital on alert.”

The city’s total cases now rank 13th among provincial-level jurisdictions.

To control the spread of the virus, Beijing and other cities have ordered measures including reduced opening hours at shopping malls, temperature checks in public spaces, and disinfection at residential compounds.

Beijing also requires that people arriving from elsewhere in China quarantine at home for 14 days. Migrant workers are steadily returning to the city of more than 20 million after a long Lunar New Year break, which was extended to give authorities more time to try to contain the virus.

“So disappointed! I was brought up in the district and thought it’s the safest bastion because it’s the heart of the country,” one person wrote on the Twitter-like Weibo.

Nationwide, more than 75,400 people have been confirmed infected with the coronavirus and 2,236 have died, mostly in central Hubei province and its capital of Wuhan where the virus emerged in a wildlife market in December.

(Reporting by Ryan Woo and Lusha Zhang; Additional reporting by Yan Zhang, Yawen Chen and Cheng Leng in Beijing; Editing by Tony Munroe and Kim Coghill)

U.S. Justice Ginsburg released from hospital after cancer surgery

FILE PHOTO: U.S. Supreme Court Associate Justice Ruth Bader Ginsburg is seen during a group portrait session for the new full court at the Supreme Court in Washington, U.S., November 30, 2018. REUTERS/Jim Young/File Photo

WASHINGTON (Reuters) – U.S. Supreme Court Justice Ruth Bader Ginsburg, 85, has been released from the hospital after undergoing cancer surgery, a court spokeswoman said on Wednesday.

“Justice Ginsburg was discharged from the hospital yesterday and is recuperating at home,” spokeswoman Kathy Arberg said in a statement.

The liberal justice underwent surgery at Memorial Sloan Kettering Cancer Center in New York on Friday to remove two cancerous nodules in her left lung.

There was no evidence of any remaining disease after the removal of the two nodules, both of which were found to be cancerous, Arberg said on Friday, citing the thoracic surgeon, Dr. Valerie Rusch. No further treatment was planned, she said.

Ginsburg, one of the court’s nine justices, broke three ribs in a fall last month. The nodules were found as part of the tests the justice underwent after the fall, Arberg said.

As the oldest justice, Ginsburg is closely watched for any signs of deteriorating health. Ginsburg, appointed by Democratic President Bill Clinton in 1993, also is the senior liberal member of the court, which has a 5-4 conservative majority.

If she were unable to continue serving, Republican President Donald Trump could replace her with a conservative, further shifting the court to the right. Trump already has put two conservatives on the court since becoming president in January 2017 and a potentially dominant 6-3 conservative majority would have major consequences for issues including abortion, the death penalty, voting rights, gay rights and religious liberty.

Ginsburg has recovered from previous medical issues. She was treated in 1999 for colon cancer and again in 2009 for pancreatic cancer but did not miss any argument sessions either time. In 2014, doctors placed a stent in her right coronary artery to improve blood flow after she reported discomfort following routine exercise. She was released from a hospital the next day.

The justices are scheduled to hear their next round of arguments on Jan. 7.

In recent years she has become something of a cult figure for liberals and known by the nickname “Notorious RBG,” after the late rapper Notorious BIG.

A documentary film, “RBG,” was released earlier this year and a feature film about her life, “On the Basis of Sex,” made its debut in theaters this week.

(Reporting by Lawrence Hurley; Writing by Mohammad Zargham; Editing by Tim Ahmann and Bill Trott)

Trump Jr.’s wife hospitalized after suspicious powder scare: police

Donald Trump Jr. and his wife Vanessa speak with Jared Kushner during inauguration ceremonies for the swearing in of Donald Trump as the 45th president of the United States on the West front of the U.S. Capitol in Washington, U.S., January 20, 2017. REUTERS/Brian Snyder/File Photo

By Jonathan Allen and Peter Szekely

NEW YORK (Reuters) – U.S. President Donald Trump’s daughter-in-law Vanessa Trump was taken to a New York hospital on Monday after she opened a piece of mail containing an unidentified white powder that was later determined to be non-hazardous, officials said.

Vanessa Trump, the wife of the president’s eldest son Donald Jr., was hospitalized after she complained of nausea following her exposure, New York officials said. Two other people who were present were also taken to the hospital.

“The substance had arrived by mail and it was addressed to Donald Trump Jr.,” said New York Police Department spokesman Carlos Nieves.

U.S. authorities have been on alert for mail containing white powder since 2001, when envelopes laced with anthrax were sent to media outlets and U.S. lawmakers, killing five people.

Three patients from the household were transported to the NewYork-Presbyterian/Weill Cornell Medical Center for further evaluation, said Fire Department spokeswoman Sophia Kim.

The three included Vanessa Trump’s mother, although she had not complained of symptoms, the police spokesman said.

The package had a Boston postmark, ABC News and the New York Post reported, citing unnamed law enforcement sources. NYPD officials declined to comment on that detail.

“Thankful that Vanessa and my children are safe and unharmed after the incredibly scary situation that occurred this morning,” Trump Jr. said on Twitter. “Truly disgusting that certain individuals choose to express their opposing views with such disturbing behavior.”

The U.S. Secret Service, which is charged with protecting members of the president’s family, confirmed it was involved in the investigation, said spokesman Jeffrey Adams.

Trump Jr. in September briefly gave up his Secret Service protection, normally provided to the immediate families of all sitting presidents, the New York Times reported at the time, citing unnamed administration officials. His protective detail was restored after about a week, CNN reported, also citing unnamed sources.

Trump Jr. has been in the public eye for his role in a 2016 meeting in Trump Tower with a Russian attorney and others after the Trump campaign was offered potentially damaging information about Democratic rival Hillary Clinton.

Congress has held probes into that meeting and whether it was part of a Russian campaign to influence the 2016 U.S. presidential election.

Russia denies trying to influence the election. Trump dismisses any talk of collusion.

In 2016, white powder, which also proved harmless, was sent to the home of Eric Trump, Trump Jr.’s brother.

(Reporting by Peter Szekely and Jonathan Allen; Additional reporting by Roberta Rampton in Washington; Writing by Scott Malone; Editing by Peter Cooney, Alistair Bell and Cynthia Osterman)

South Korean hospital blaze kills at least 37, fleeing patients brave flames

Smoke rises from a burning hospital in Miryang, South Korea, January 26, 2018.

By Christine Kim

MIRYANG, South Korea (Reuters) – Once famous for an award-winning film of the same name, the South Korean city of Miryang became a scene of horror on Friday as flames and toxic smoke swept through a hospital, killing at least 37 people and injuring more than 140.

South Korea’s deadliest fire in almost a decade followed one last month that killed 29 people, reviving concern over safety standards, as the hospital director said current law did not require the building to have a sprinkler system.

“So many lives were sacrificed and the people of our city, as well as those throughout the country, have fallen into deep grief,” the city’s mayor, Park Il-ho, told reporters, appearing visibly distressed.

Many patients “walked though fire and smoke” to escape from the Sejong Hospital as the main exit was on the first floor, which was ablaze, a city official told Reuters.

Those on upper floors used ladders and plastic escape slides to flee, while firefighters carried some who could not walk.

“I saw the elderly patients scrambling out through the windows and had to help,” said Woo Young-min, 25, as he stood in his pyjamas outside the hospital.

The presidential Blue House initially said the number of dead was at least 41, but deferred to a toll of 37 from the fire chief of Miryang, which is about 270 km (170 miles) southeast of Seoul, the capital, and home to about 108,000 people.

Fire officials posted a list of at least 26 victims outside the hospital, their ages ranging from 34 to 96 years, with at least a score over 70.

Families crowded round a handwritten list of names and hospital rooms that officials had scrawled on a wall at a nearby funeral home.

The fire broke out around 7.30 a.m. (2230 GMT) at the rear of the emergency room on the hospital’s first floor, fire official Choi Man-woo told a televised news briefing.

The street outside the hospital featured in the 2007 South Korean drama “Miryang,” or “Secret Sunshine,” which garnered awards at Cannes and other film festivals.

But on Friday, witnesses described scenes of chaos in the sub-freezing temperatures, as nearby residents rushed to take portable hotpacks to shivering victims.

Woo said he was walking home after working a graveyard shift when he saw the fire and patients trying to escape the blaze.

“The firefighters were shouting at us not to go inside the building, so I stayed and helped others bring the patients down the slides.”

Television broadcast images of black smoke billowing from the windows and entrance of the hospital as flames flickered.

At least 177 patients – most of them elderly – were at the hospital and an adjacent nursing home when the fire broke out, hospital director Song Byeong-cheol told reporters.

Song said three of the nine hospital staff on duty at the time died, including at least one doctor, a nurse, and a nurse’s aide, all killed on the second floor.

Most of those who died were on the first and second floors, said Choi, but added that there were no deaths from burns.

Seven people were critically injured, while 126 had less serious wounds, officials told a Friday evening briefing.

The injured were treated at 14 regional hospitals.

By Friday afternoon, police had cordoned off the burnt-out hospital, as forensic investigators combed the smoke-blackened building. Charred debris and shattered glass littered the ground outside.

NO SPRINKLER SYSTEM

Asia’s fourth-largest economy, with one of the world’s fastest ageing populations, South Korea has faced criticism in recent years over inadequate safety standards.

Song said the six-storey hospital did not have a sprinkler system and was not large enough to require one under the law.

The nursing home annexe, where no patients died, is covered by a new law, however, and Song said the hospital had planned to begin installing a sprinkler system there next week.

Health Minister Park Neung-hoo said the government would consider changing the law.

Interior ministry guidelines published in December 2016 suggest sprinklers for all buildings of six or more storeys.

Officials said they were still investigating the cause of the fire, but were looking at a possible short circuit in the emergency room’s heating and cooling system.

“According to an initial eyewitness, fire broke out where there are two air-conditioning and heating devices in the emergency room,” Song said.

“Others said an electric spark occurred on the ceiling of the emergency room and then fire spread quickly.”

The hospital had regular safety inspections and was built to government standards, with fire exits and extinguishers, many of which were used during the fire, he added.

President Moon Jae-in held an emergency meeting with top aides and urged “all necessary measures” to help survivors.

Interior Minister Kim Boo-kyum, who visited Miryang to apologise for the fire, promised government help for victims, Yonhap news agency said.

In December, 29 people were killed in a blaze at an eight-storey fitness centre in Jecheon City, most of them women trapped in a sauna by toxic fumes. The event fed anger over reports of shoddy construction, among other shortcomings.

In 2014, a fire at a rural hospital killed 21 people, while a 2008 warehouse fire outside Seoul killed 40.

(Reporting by Christine Kim; Additional reporting Yuna Park, Dahee Kim and Hyonhee Shin; Writing by Josh Smith; Editing by Simon Cameron-Moore and Clarence Fernandez)

Short on staff: Nursing crisis strains U.S. hospitals

Registered nurse Kara Salonga, pictured at nursing station at the West Virginia University Hospitals in Morgantown, West Virginia, U.S., September 6, 2017. Picture taken September 6, 2017. REUTERS/Mike Wood

By Jilian Mincer

MORGANTOWN, West Virginia (Reuters) – A shortage of nurses at U.S. hospitals hit West Virginia’s Charleston Area Medical Center at the worst possible time.

The non-profit healthcare system is one of the state’s largest employers and sits in the heart of economically depressed coal country. It faces a $40 million deficit this year as it struggles with fewer privately insured patients, cuts in government reimbursement and higher labor costs to attract a shrinking pool of nurses.

To keep its operations intact, Charleston Medical is spending this year $12 million on visiting or “travel” nurses, twice as much as three years ago. It had no need for travel nurses a decade ago.

“I’ve been a nurse 40 years, and the shortage is the worst I’ve ever seen it,” said Ron Moore, who retired in October from his position as vice president and chief nursing officer for the center. Charleston Area Medical’s incentives include tuition reimbursement for nursing students who commit to work at the hospital for two years.

“It’s better to pay a traveler than to shut a bed,” he said.

Hospitals nationwide face tough choices when it comes to filling nursing jobs. They are paying billions of dollars collectively to recruit and retain nurses rather than risk patient safety or closing down departments, according to Reuters interviews with more than 20 hospitals, including some of the largest U.S. chains.

In addition to higher salaries, retention and signing bonuses, they now offer perks such as student loan repayment, free housing and career mentoring, and rely more on foreign or temporary nurses to fill the gaps.

The cost nationwide for travel nurses alone nearly doubled over three years to $4.8 billion in 2017, according to Staffing Industry Analysts, a global advisor on workforce issues.

The burden falls disproportionately on hospitals serving rural communities, many of them already straining under heavy debt like the Charleston Area Medical Center.

These hospitals must offer more money and benefits to compete with facilities in larger metropolitan areas, many of them linked to well-funded universities, interviews with hospital officials and health experts show.

Along West Virginia’s border with Pennsylvania, university-affiliated J.W. Ruby Memorial Hospital in Morgantown is spending $10.4 million in 2017 compared with $3.6 million a year earlier to hire and retain nurses.

But these costs are part of the facility’s expansion this year, including adding more than 100 beds as it grows programs and takes over healthcare services from smaller rural providers that have scaled back or closed.

J.W. Ruby, the flagship hospital for WVU Medicine, offers higher pay for certain shifts, tuition reimbursement, $10,000 signing bonuses and free housing for staff who live at least 60 miles away.

Next year, the hospital is considering paying college tuition for the family members of long-time nurses to keep them in West Virginia.

“We’ll do whatever we need to do,” said Doug Mitchell, vice president and chief nursing officer of WVU Medicine-WVU Hospitals.

NOT LIKE OTHER SHORTAGES

Nursing shortages have occurred in the past, but the current crisis is far worse. The Bureau of Labor Statistics estimates there will be more than a million registered nurse openings by 2024, twice the rate seen in previous shortages.

A major driver is the aging of the baby boomer generation, with a greater number of patients seeking care, including many more complex cases, and a new wave of retirements among trained nurses.

Industry experts, from hospital associations to Wall Street analysts, say the crisis is harder to address than in the past. A faculty shortage and too few nursing school slots has contributed to the problem.

Hospitals seek to meet a goal calling for 80 percent of nursing staff to have a four-year degree by 2020, up from 50 percent in 2010. They also face more competition with clinics and insurance companies that may offer more flexible hours.

Healthcare experts warn that the shortfall presents risks to patients and providers. Research published in August in the International Journal of Nursing Studies found that having inadequate numbers of registered nurses on staff made it more likely that a patient would die after common surgeries.

UAB Hospital in Birmingham, Alabama, has invested millions to attract nurses, but still has 300 jobs to fill. At times, nursing vacancy rates in some of its departments has hit 20 percent or higher.

“We’ve rarely canceled a surgery or closed a bed because of lack of staffing,” said Terri Poe, chief of nursing at the hospital, the state’s largest, which serves many low income and uninsured residents.

Last year, the medical center covered nearly $200 million in unreimbursed medical costs for patients. It spent $4.5 million for visiting nurses during fiscal 2016, including $3 million for post-surgery services, compared with $858,000 in 2012.

Healthcare labor costs typically account for at least half of a facility’s expenses. They jumped by 7.6 percent nationally last year, after climbing at a rate closer to 5 percent annually in recent years, said Beth Wexler, vice president non-profit healthcare at Moody’s. The spending has proven a boon for medical staffing companies like AMN Healthcare and Aya Healthcare.

Missouri’s nursing shortage reached a record high in 2017, with almost 16 percent – or 5,700 – of positions vacant, up from 8 percent last year. Thirty-four percent of Missouri registered nurses are 55 or older.

“Our biggest challenge is getting the pipeline of experienced nurses,” said Peter Callan, director of talent acquisition and development at the University of Missouri Health Care in Columbia, which is expanding. “There are fewer and fewer as people retire.”

Last year, the academic medical center hired talent scouts to identify candidates, Callan said. It spends $750,000 a year on extras to attract and keep nurses, including annual $2,000 bonuses to registered nurses who remain in hard-to-fill units and up to five years of student loan repayment assistance. It offers employee referral bonuses and a chance to win a trip to Hawaii.

Smaller hospitals find it much harder to compete in this climate. More than 40 percent of rural hospitals had negative operating margins in 2015, according to The Chartis Center for Rural Health.

In rural Missouri, 25-bed Ste. Genevieve County Memorial Hospital had to offer signing bonuses, tuition reimbursement and pay differentials when staffing is “critically low” in units such as obstetrics.

They haven’t closed beds, but have hired less experienced nurses, raised salaries and turned away at least one patient who would have been in its long term care program.

“We’ve had to try whatever it takes to get nurses here,” said Rita Brumfield, head of nursing at the hospital. “It’s a struggle every day to get qualified staff.”

To see the entire graphic on the U.S. nursing shortage, click http://tmsnrt.rs/2xQ9Y0K

(Editing by Michele Gershberg and Edward Tobin)

Charlie Gard’s parents say hospital denied their ‘final wish’ for dying son

Charlie Gard's parents Connie Yates and Chris Gard read a statement at the High Court after a hearing on their baby's future, in London. REUTERS/Peter Nicholls

LONDON (Reuters) – The parents of Charlie Gard, a terminally ill baby who a judge ordered should be sent to a hospice to die, said Britain’s top pediatric hospital had denied them their final wish to decide the arrangements for their son’s death.

After a harrowing legal battle that prompted a global debate over who has the moral right to decide the fate of a sick child, a judge on Thursday ordered that Charlie be moved to a hospice where the ventilator that keeps him alive will be turned off.

His parents had sought first to take him home but Great Ormond Street Hospital (GOSH) said that was not possible due the ventilation Charlie needs, they then asked for several days in a hospice to bid farewell to their son.

But they were unable to find doctors to oversee such an extended period of time and so a judge ruled that Charlie be moved to a hospice to die.

“GOSH have denied us our final wish,” his mother, Connie Yates, was quoted as saying by the BBC.

“Despite us and our legal team working tirelessly to arrange this near impossible task, the judge has ordered against what we arranged and has agreed to what GOSH asked,” she said. “This subsequently gives us very little time with our son.”

Great Ormond Street Hospital, a pioneering pediatric center, said that it deeply regretted the breakdown in relations with Charlie’s parents, in a case that has involved months of legal wrangling and has even drawn comment from U.S. President Donald Trump and Pope Francis.

“Most people won’t ever have to go through what we have been through, we’ve had no control over our son’s life and no control over our son’s death,” Charlie’s mother said.

“We just want some peace with our son, no hospital, no lawyers, no courts, no media, just quality time with Charlie away from everything, to say goodbye to him in the most loving way.”

(Reporting by Guy Faulconbridge; Editing by Louise Ireland)

More hospital closings in rural America add risk for pregnant women

Dr. Nicole Arthur (R), visits Tariyana Wiggins, a high school teacher, shortly after the birth of Troy O’Brien Williams in the hospital room at the North Baldwin Infirmary, a 70-bed hospital in rural Bay Minette, Alabama, U.S. on June 22, 2017. REUTERS/Jilian Mincer

By Jilian Mincer

Bay Minette, Alabama (Reuters) – Dr. Nicole Arthur, a family practice physician, was trained to avoid Cesarean deliveries in child-birth, unless medically necessary, because surgery increases risks and recovery time.

But she has adjusted her approach since arriving last year at the 70-bed North Baldwin Infirmary in rural, southern Alabama.

Low patient admissions and high costs mean the hospital does not have doctors on site around-the-clock to administer anesthesia in the case of an unexpected emergency Cesarean.

As a result, Dr. Arthur performs the surgery if there are any signs of complication, rather than waiting and running the risk that comes with the 20 to 30 minutes it takes for an anesthesiologist to arrive in the middle of the night.

“It’s better for me to do a C-section when I suspect that something may happen,” she said of her new strategy. “Getting the baby out healthy and happy outweighs some of the risk.”

Physicians in rural communities across America are facing the same tough choices as Dr. Arthur. Hospitals are scaling back services, shutting their maternity wards or closing altogether, according to data from hospitals, state health departments, the federal government and rural health organizations.

Nationally, 119 rural hospitals that have shut since 2005, with 80 of those closures having occurred since 2010, according to the most recent data from the North Carolina Rural Health Research Program.

To save on insurance and staffing costs, maternity departments are often among the first to get shuttered inside financially stressed rural hospitals, according medical professionals and healthcare experts.

“It’s been a slow and steady decline,” said Michael Topchik, the National Leader for the Chartis Center for Rural Health, about maternity ward closings. “It’s very expensive care to offer, especially when it’s lower volume.”

More than 200 maternity wards closed between 2004 and 2014 because of higher costs, fewer births and staffing shortages, leaving 54 percent of rural counties across the United States without hospital-based obstetrics, data from the University of Minnesota’s Rural Health Research Center show.

The trend has escalated recently even though the national healthcare law, known as Obamacare, was designed in part to help rural hospitals thrive. But unpaid patient debt has risen among rural hospitals by 50 percent since the Affordable Care Act was passed, according to the National Rural Health Association, especially in states that decided not to expand Medicaid – the state and federal insurance program for the poor.

The outlook for these hospitals was not poised to improve had Congress approved legislation to replace Obamacare. Senate Republicans’ proposed cuts to Medicaid would have pushed about 150 more rural hospitals into the red, according to the Chartis Center for Rural Health, mainly in states that voted Republican in the last election.

But late on Monday, Senate Majority Leader Mitch McConnell said the Republican effort to repeal and immediately replace Obamacare will not be successful, after two of McConnell’s Senate conservatives announced that they would not support the bill.

PAIN FELT BEYOND THE BELTWAY

The consequences go beyond politics.

When local doctors and midwives leave town, rural women lose access to essential services. Many skip or delay prenatal care that could prevent complications, premature birth or even death. The U.S. infant mortality rate is among the highest in developing countries at 5.8 deaths per 1,000 births.

Pregnant woman in rural areas are more likely to have their deliveries induced or by Cesarean section that, while potentially life-saving, are more expensive and risky than a normal vaginal birth, according to patients, medical professionals and researchers.

Almost a year after her second son’s birth, Courtney Cross is still repaying money she borrowed because of the smaller paychecks and larger gas bills she had from driving 60 minutes each way to a specialist in Mobile, Alabama.

“There were some days I had to reschedule because of the money factor,” said Cross, a medical technician and mother of two, who some months made the trip multiple times. “I had to make money.”

Cross is not alone. The most common reasons for the hospital closures are people and money. More and more people are moving to urban areas in pursuit of work and a better paycheck. And in most states, lower revenue from insurance and U.S. government payments are pushing these hospitals into financial stress, particularly in states that did not build out their Medicaid programs as Obamacare allowed.

“The majority of births in rural America are paid for by Medicaid, and Medicaid is not the most generous payer,” said Diane Calmus, government affairs and policy manager for the National Rural Health Association. “For most hospitals it is a money losing proposition.”

This is the main reason why Connie Trujillo shuttered her midwife practice this spring in Las Vegas, New Mexico. The local hospital had closed its maternity ward, and the closest hospital to deliver babies was at least 60 miles away. She sees more elective inductions because the patients live far away and can’t afford to go back and forth.

“Some of them just don’t have the resources,” she said. A year after shuttering, the hospital is trying to hire additional staff to reopen the ward.

MORE SCHEDULED DELIVERIES

The number of induced U.S. deliveries nationally has doubled since 1990 to about 23.3 percent, but rates are significantly higher in rural areas, where it is routinely offered to women traveling long distances, especially if the weather is bad.

Induced labor and surgery come at a high cost. Commercial insurance and Medicaid paid about 50 percent more for Cesarean than vaginal births, according to a 2013 Truven Health Analytics report. The report said Medicaid payments for maternal and newborn care for a vaginal birth was $9,131 versus $13,590 for a C-section.

In largely rural West Virginia – where the Summersville Regional Medical Center became the latest hospital to stop delivering newborns earlier this year – elected inductions for first time mothers rose to 28.7 percent in 2015 from 24.1 percent in 2011, according to data provided to Reuters by the West Virginia Perinatal Partnership, a statewide effort to improve care.

“Inductions allow the physicians to manage their case loads and timing of deliveries,” said Amy Tolliver, director of the Perinatal Partnership. “We know that inductions are happening in small hospitals that have difficulty with staffing.”

To address staffing issues at Dr Arthur’s hospital in Alabama, the facility paid temporary doctors for a year to keep the department open when one of its two maternity doctors stopped doing deliveries.

“It’s important to have access (to obstetrics),” said hospital president Benjamin Hansert, who also organized a group of doctors from Mobile about 40 minutes away to cover some of the shifts so that staff doctors would not always be on call. “Where the mother goes for care, the rest of the family will follow.”

For the full graphic on hospital closures, click http://tmsnrt.rs/2us7qDM

(Editing by Caroline Humer and Edward Tobin)