Cyberflashing – old-style sexual harassment for the digital age

Cyberflashing is when a perpetrator sends an unsolicited nude or sexual image of their genitals to another person without that person’s consent. Colloquially known as “dick pics” or the less commonly discussed “twat shot”, cyberflashing is swiftly becoming a widespread form of digital sexual harassment, accessible through emerging technologies such as AirDrop, where images can be sent between any Apple devices located within a 20 to 30-metre radius.

Cyberflashing has also been taking place on social media, particularly through direct messages on platforms such as Messenger and Twitter, and for those engaged in online dating.

US-based dating site Bumble found cyberflashing such a problem that it worked closely with politicians to develop a new law in Texas criminalising the electronic transmission of sexually explicit material, if the person who received it hasn’t given consent.

There’s more research needed to explore the prevalence of cyberflashing. However, a 2018 YouGov poll found that about 41 per cent of women aged 18 to 36 had received an unsolicited “dick pic”. This increased to 53 per cent for women aged 18 to 24.

A recent campaign by the Huffington Post has also seen about 70 women from the UK report details of being cyberflashed in a range of settings, including on public transport, in lecture theatres, schools and bars.

Another form of harassment and IBA

It’s important here to distinguish between the sending of nude or sexual images to another person who has consented to this act (sometimes referred to as “sexting” or “nude selfies”), and cyberflashing, which is an unwanted, unsolicited and non-consensual encounter.

While some have argued that cyberflashing may be playful, motivated by a desire to bond or flirt, or because the perpetrator genuinely believes that’s what the target of the image desires (however incorrect and harmful this assumption may be), cyberflashing is unquestionably a form of technology-facilitated sexual violence that fits within the dimensions of image-based abuse – the non-consensual creation, distribution and threat to distribute nude or sexual images – and other forms of online harassment.

There can be very serious harms experienced from cyberflashing. These can vary depending on the context and situation in which the cyberflashing occurs. A description of some of the impacts identified by the women interviewed by the Huffington Post range from being disgusted and feeling sick, to feeling fearful for their safety, sexually violated and experiencing mental health issues.

Cyberflashing is also another way in which we see the continuum of sexual violence playing out. Coined by Liz Kelly, this concept can be understood as the idea that many women and others who come from marginalised groups experience a spectrum of unwanted sexual violations across their lifetimes, meaning much ‘“typical” and “aberrant” male behaviours shade into one another.

Read more: Image-based abuse: the disturbing phenomenon of the ‘deep fake’

This essentially means that the impacts and harms experienced in any one incident of sexual violence or harassment connect with, reinforce, and amplify the impacts of a lifetime of these experiences.

Understanding that an individual can experience multiple forms of sexual violence within a continuum of sexual violence allows for connections to be made between everyday intimate intrusions, such as street sexual harassment, and other forms of sexual violence and abuse.

It also allows for a better understanding of the cumulative effects of sexual harms and intrusions into women’s lives, where women can experience a sense of never knowing when or if the catcall, the unwanted touch or the cyberflashing may turn into rape.

Is cyberflashing captured by law?

As it stands, Australia has a piecemeal approach to dealing with cyberflashing through the law. A one-off instance of cyberflashing is not specifically criminalised in Australia, unless the perpetrator is under 18 years, in which case it may fall within the sending of child exploitation materials.

Cyberflashing may, however, be captured under a range of other offence types. For example, it’s a federal offence to use a carriage service to menace, harass or cause offence, which could apply to cyberflashing. In Victoria, it’s illegal to engage in sexual activity directed at another person, which could include cyberflashing, depending on the content of the image. And in South Australia, it’s an offence to behave in an indecent manner in a public place, while visible from a public place, or in a place other than a public place when you intend to offend or insult another person.

Cyberflashing is unquestionably a form of technology-facilitated sexual violence that fits within the dimensions of image-based abuse.

Similar obscenity and indecent exposure of genital offences exist in all states and territories, although some require the act to occur in a public place such as a school, or the exposure must occur alongside an indecent act, behaviour or intention to cause harm.

It’s not entirely clear how these laws could be applied to cyberflashing, despite this abuse fitting broadly within this definition. If the cyberflashing is ongoing, it could also potentially be captured under various state and territory stalking laws.

New wine in old bottles?

Like many forms of abuse that are facilitated through technology, the act of exposing one’s genitals to another person without their consent is unfortunately not new. We’re all familiar with the stereotypical depiction of a “flasher” standing naked underneath a long jacket, exposing themselves to unsuspecting people as they pass by. In this regard, it’s not technology itself that’s to blame for cyberflashing, but the increased accessibility and commercialisation of such technologies provides the tools for perpetrators to cyberflash, and to do so anonymously while standing within metres of the victim.

For example, while created to make exchange of data easier for people, Apple’s AirDrop technology has two major flaws that facilitate cyberflashing.

The first is that AirDrop is automatically set to public on everyone’s Apple device, so unless you physically change this (meaning you have the knowledge that you need to do this and how to do this), your Apple phone, iPad, laptop or desktop will automatically appear as a potential “contact” point for anyone else with an Apple device. In such cases, you could be cyberflashed, and all you’ll know is the name of the person’s Apple device and that they’re located nearby.

Second, when Person A cyberflashes Person B using AirDrop, the unsolicited image is automatically displayed on Person B’s screen with a message asking them to confirm if they would like to receive it. Hence the cyberflashing takes place instantaneously and without Person B having any capacity to stop themselves from seeing it.

Without doubt, there are new demands on the types of legal (and non-legal) responses and regulatory frameworks required to specifically address emerging forms of digital sexual harassment.

This has been recognised by the Australian government, which has identified technology-facilitated abuse as a national priority in the latest iteration of The National Plan to Reduce Violence against Women and their Children 2010-2022.

Addressing cyberflashing requires a concerted approach that brings together legal, policy and regulatory interventions, alongside education and prevention campaigns to raise awareness of the causes, harms and impacts of technology-facilitated sexual violence, and to address problematic norms, values and beliefs around gender, masculinity and sexuality that are embedded in modern societies.

The Article was originally published on Cyberflashing – old-style sexual harassment for the digital age

Many Doctors Treating Alcohol Problems Overlook Successful Drugs

As millions of Americans battle alcohol abuse problems each year, public health officials suggest that two often overlooked medications might offer relief to some.

More than 18 million people abuse or are dependent on alcohol, yet a key study funded by the federal government reported last year that only 20 percent will ever receive treatment of any kind. In fact, just slightly more than 1 million seek any type of formal help, ranging from a meeting with a counselor or a doctor to entering a specialized treatment program.

Acknowledging that for many people peer-support programs, such as Alcoholics Anonymous, work well, federal officials also want to encourage physicians to be more involved in identifying and treating alcohol problems and are seeking to increase awareness of drug treatments.

“We want people to understand we think AA is wonderful, but there are other options,” said George Koob, the director of the National Institute of Alcohol Abuse and Alcoholism, a part of the federal National Institutes of Health. “Let a thousand flowers bloom, anything helps.”

The NIAAA has developed a branch dedicated to development of medications and is supporting trials of drugs to give patients and doctors more options.

NIAAA and the Substance Abuse and Mental Health Services Administration also asked a panel of outside experts to report last summer on drug options.

“Current evidence shows that medications are underused in the treatment of alcohol use disorder, including alcohol abuse and dependence,” the panel reported. It noted that although public health officials and the American Medical Association say dependence on alcohol is a medical problem, there continues to be “considerable resistance” among doctors to this approach.

It is still rare for a person struggling with an alcohol use disorder to even hear that medication therapy exists. That partly reflects the overwhelming tradition to treat alcohol abuse through 12-step programs. It’s also a byproduct of limited promotion by the drugs’ manufacturers and confusion among doctors about how to use them.

Naltrexone and acamprosate are the two drugs on the market for patients with alcohol cravings.

“They’re very safe medications,” said Koob. “And they’ve shown efficacy.”

2014 analysis in the Journal of the American Medical Association of past studies found that both drugs “were associated with reduction in return to drinking.”

For one North Carolina woman eager to get sober, naltrexone provided that help. Dede said she went to hundreds of Alcoholics Anonymous meetings. She spent time in two different rehabilitation facilities, one of which cost her $30,000 out of pocket. But she still struggled.

“The self-loathing was the worst thing about it,” she said. “I hated myself as an alcoholic, but I could not stop.”

Eight years ago she decided to try yet another approach — meetings for people who had drinking problems with counselors at the University of North Carolina at Chapel Hill. That’s where she first heard about naltrexone.

One of the counselors mentioned Dr. James C Garbutt, a professor of psychiatry who treats patients with alcohol use disorders, often using naltrexone. She asked to get an appointment with him but was told it would take weeks to fit her in. She wouldn’t wait that long. Instead, she showed up in the doctor’s waiting room and stayed until he was able to see her.

“I begged. I really begged to get to see him,” she explained.

With the help of naltrexone and one-on-one counseling, Dede said she has consumed no more than two sips of wine since that visit. She agreed to be interviewed on the condition that Kaiser Health News use only her nickname because she has tried to keep her alcohol abuse private.

A third drug is also available, but it does not work against alcohol cravings. Disulfiram, also known by the brand name Antabuse, makes people violently ill when they consume alcohol. It has been found to be less effective in helping stem alcohol abuse than the other two drugs.

Naltrexone, which is also used to help treat opiate addiction, comes in both an oral and injectable form and has few side effects. It was approved for use in alcohol addiction in 1994. Acamprosate was approved in 2004 to treat only alcohol problems. It comes as a tablet.

When naltrexone came on the market, sales teams had trouble explaining how the drug worked differently than Antabuse to the non-physician administrators who made treatment decisions in addiction clinics, addiction experts said. Many misunderstood how and for whom the drug worked. Some of that persists today.

“They got three years” of market exclusivity, said Dr. Henry Kranzler, director for the Center for Studies of Addiction at the University of Pennsylvania. “Three years is not a very long time to make a market where there really isn’t much of a market and they didn’t.” The company discontinued its effort to market the drug in 1997.

Many of the same marketing problems also persist for acamprosate.

Some of naltrexone’s history in opioid treatment also hurt its image. The drug blocks the effects of opioid receptors in the brain. So any patients who took it without having completely detoxed from opiates were launched into agonizing withdrawal. The label urged doctors only to prescribe the medication to patients that had already been opiate-free for at least 10 days.

But it doesn’t have the same effect on patients with alcohol use disorders. A patient who drinks while taking naltrexone will get drunk — and not have those withdrawal symptoms. Yet, when the drug was approved for alcohol use disorders in 1994, the label still stated patients should be completely sober before using naltrexone.

Often, care providers consider complete abstinence the only successful outcome of treatment, yet patients who drink while taking naltrexone get drunk without the opioid-induced reward to reinforce the behavior. The absence of this reward makes drinking less appealing in the future.

Garbutt, who was on the expert panel last year, encourages complete abstinence for his patients, but also supports patients who would rather set a goal of harm reduction.

“If we can reduce your intake 80 percent and reduce your heavy drinking days a lot, that’s also very positive,” he said. “Some people just aren’t ready. The idea of sobriety is just too big of a concept for them to wrap their head around.” And naltrexone can help patients with either of these goals — abstinence or reduced drinking.

In fact, explained Garbutt, while naltrexone does help patients remain abstinent, “the effect of reducing heavy drinking is the most prominent effect of naltrexone.”

The Article was originally published on Many Doctors Treating Alcohol Problems Overlook Successful Drugs

Distilleries, wineries shuttered by Gov. Greg Abbott’s bar shutdown say they should be exempted

The owners and patrons of Ironroot Republic Distillery in Denison hardly consider the business to be a bar in the traditional sense.

There’s no loud music or dancing. The doors closed at 5:30 p.m. most nights before the pandemic. On Saturdays, they closed at 3 p.m. Most of its business came from out-of-towners booking tours who wanted to sip the “World’s Best Bourbon,” as designated by the World Whiskies Awards.

Nonetheless, Ironroot Republic Distillery was shut down late last month with the rest of the bars in the state under Gov. Greg Abbott’s latest executive order. Meanwhile, other businesses like restaurants, theme parks and bowling alleys are still open with limited occupancy. Abbott’s order required any business that gets 51% or more of its revenue from alcohol sales to close.

“We’re tourism industry businesses, we’re not bars. So they shouldn’t treat us like bars,” said Dan Garrison, owner of another tasting room, Garrison Brothers Distillery in Hye, a community in the Texas Hill Country.

Distillery, winery and even some restaurant owners with high alcohol sales say they are unfairly being caught in the crossfire of the statewide bar shutdown, despite running starkly different operations from those Abbott warned against when he issued his latest executive order.

“We’re all struggling to survive right now,” Garrison said. “And we’re about to lose a heck of a growing industry if the governor doesn’t do something.”

As COVID-19 cases and hospitalizations climbed in June, Abbott closed bars for a second time. He later expressed remorse in an interview for opening bars so soon, saying that the “bar setting, in reality, just doesn’t work with a pandemic,” noting that people “go to bars to get close and to drink and to socialize, and that’s the kind of thing that stokes the spread of the coronavirus.”

When Ironroot Republic Distillery shut down, most of the people who booked tours could no longer purchase bottles unless they were local to the area, owner Robert Likarish said. Delivering or mailing liquor to consumers isn’t allowed unless there’s a restaurant attached and the business has a mixed beverage permit.

Because it’s in a rural area, it’s been a challenge to get traffic to the distillery for curbside pickup. And even if people do come, state law only allows distilleries to sell two bottles of liquor to a customer within 30 days.

“Essentially, all the things that we’d normally do to help sell and push movement of our product are gone,” Likarish said.

Spencer Whelan, executive director of the Texas Whiskey Association, said the governor’s executive orders didn’t take into account the business models of distilleries and similar businesses.

“It was just kind of generally a wide-swath brush applied to everybody in the alcohol manufacturing industry if they had any kind of retail onsite consumption,” Whelan said.

Whelan is calling for the two-bottle limit to be waived and Sunday sales be allowed. But more than anything, he is urging Abbott to allow age-verified delivery — so that distillers can sell their products across the state.

“What’s going to make an impact is the ability for us to ship to somebody in Dallas when you’re in the Hill Country and make sure that there’s an age-verified way for it to be delivered,” he said, noting that Kentucky and other states have already passed similar rules.

He said his organization ran a letter-writing campaign that generated 14,000 letters asking Abbott for expanded options. He said he hasn’t yet heard back.

“We need the governor to understand that this is a different business model, and places like Kentucky have figured this out,” he said. “Texas is still refusing to even acknowledge that it’s a topic that needs to be addressed.”

Abbott did not respond to requests for comment.


Wineries, which often have spacious outdoor vineyards and patios where patrons can spread out, say they’re also being unfairly targeted.

“We were highly impacted by the shutdown and the pandemic just because we were forced to basically close our tasting room, which is where 90% of our sales are generated,” Lost Draw Cellars owner Andrew Sides said.

After missing out on sales in April and May— the months that typically perform best — the Fredericksburg winery reopened at the beginning of June with new rules: All tastings were moved outside, and only one group of people who came together was allowed at a time.

But then, along with bars, the winery was forced to close.

Sides said he wished that Abbott’s order had been more specific — his permit is different from bars’ permits, and people are largely taking the wine offsite to consume at home. It’s frustrating for him when other similar businesses — like a local salsa maker who allows onsite testing — can stay open.

“The whole intent for most tasting rooms and wineries is for people to come and try wine, buy it and leave,” he said.

Sides said he will stave off of layoffs as long as he can, but he’s not sure how long that could be.

Bending Branch Winery in Comfort, near Fredericksburg, has been closed since March but was gearing up to open right before the shutdown order, general manager Jennifer McInnis Fadel said. The staff purchased hand sanitizer, devised social distancing strategies and underwent new safety training. The winery’s first appointment was set for three hours after Abbott announced his order and had to be canceled.

Wineries have the ability to direct ship to customers, so in response to being closed, Bending Branch has changed its operating model to accommodate delivery and pickup orders.

Fadel said wineries typically have a lot of outdoor space to utilize and doesn’t think it’s very different than how restaurants operate. But closing wineries could also have a negative impact on agriculture in the state, she said.


The bar shutdown has also closed many restaurants that have high alcohol sales, industry experts said.

The Texas Restaurant Association estimated that at least 1,500 restaurants that serve alcohol have been forced to close, putting 35,000 employees out of work under Abbott’s executive order.

The Friendly Spot Ice House — an outdoor burgers and beer venue popular among families in San Antonio — had only reopened for two weeks when Abbott ordered bars to close in late June. Because its revenue generated from alcohol sales outpaces food sales, the ice house was also forced to close down.

Jody Newman, the owner of the San Antonio staple, waited for five days, hoping that something would change, before letting her staff go.

“I’m a person of reason, and I’m a person that believes in the system,” she said through tears. “But firing my staff was gut wrenching.”

Newman hopes Texas leaders will provide clarity to a rapidly changing situation. She said she doesn’t think the bar shutdown was intended to target a business like hers. She wants to know what the plan is if things improve and what the plan is if they don’t.

“Restaurants are not like a light switch. I mean, you have to bring your staff back, and you have to buy inventory,” she said. “One of the worst things that’s happening right now is how our staff is being treated and just almost completely disregarded.”

Disclosure: The Texas Restaurant Association has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. Find a complete list of them here.

Legislators could strip school districts of discretion over medical cannabis in schools

Some state lawmakers are ready to remove school districts’ discretion over how medical cannabis is administered to students who are medical cannabis patients.

The issue of how and when approved students can get their medicine has been divisive and controversial at times. But this year New Mexico became one of about a dozen states to allow some students to consume cannabis at school. Unlike other states, New Mexico’s law left some decisionmaking up to school districts. That local control has stirred additional controversy and caused some confusion amongst lawmakers. Some of those lawmakers say school districts abused that privilege.

State law allows districts to come up with their own policies for medical cannabis, including limitations on who administers the medical cannabis. Districts in Albuquerque, Rio Rancho and Estancia only allow parents or guardians to dose their respective student. The law also allows for schools to apply for an exception to allowing medical cannabis on campus if the school district is concerned with losing federal funding, as cannabis is still federally illegal. According to a representative from the state Public Education Department who addressed an interim legislative panel last week, no schools in New Mexico have applied to opt out. Further, PED said, there has been no reports of federal funds threatened in any of the other states that now let students use medical cannabis on school grounds.

‘They’ve done the opposite of the right thing’

During the 2019 legislative session, Sen. Jacob Candelaria, D- Albuquerque, sponsored one of the bills to allow medical cannabis in public schools. The bill allowed schools the option of getting  an exception from PED if the district was concerned about the loss of federal funding. The bill also allowed schools some flexibility in how students are given their medical cannabis. Now, Candelaria said, he plans to introduce legislation that would ultimately strip school districts’ discretion.

“We do enabling legislation and it’s up to the districts to do the right thing, and in this instance they’ve done the opposite of the right thing,” he said. “They’ve abused their authority and discretion to deny kids an education, period.”

Candelaria points to school districts in Albuquerque, Rio Rancho and Estancia as examples of schools that have policies prohibiting any school employees from administering medical cannabis. Neither PED or the state’s Department of Health actively track specific age ranges of medical cannabis patients, but there are a little more than 200 cannabis patients who are minors.

Confusion over policies

In addition to hearing from PED and the Department of Health last week, the Legislative Health and Human Services Committee heard from Tisha Brick, who has been pushing lawmakers and school officials to allow her son Anthony to use his medical cannabis at school in Estancia.

Brick pleaded with members of the committee and PED to do something to help get her son back in school. During that meeting, there seemed to be confusion among committee members about why Estancia Public Schools would still not let Brick’s son in school.

Advisory committee member, Rep. Liz Thomson, D-Albuquerque, asked Brick about her ability to show up to school and administer her son’s medicine.

“So the one change that has benefited you, for lack of a better…is that you can now do it on school grounds as opposed to…,” Thomson started.

Brick nodded her head, “no.”

“Not even that?” Thomson clarified.

“No,” Brick said.

Brick clarified.

“With all due respect, although the wording of that statute does say that parents can come give medical cannabis on school grounds, that does not mean a school district can or will allow [it],” she said.

But it turns out, Estancia Public Schools does have a policy in place for medical cannabis. Like Rio Rancho and Albuquerque school districts, Estancia requires a parent or guardian to administer medical cannabis.

But Brick said she doesn’t trust the school district. Brick’s distrust of the school district goes back to the previous superintendent who would not allow Brick’s son to use cannabis on school grounds before the new law went into effect. Brick then took the district to federal court where a judge dismissed many of her claims, but the case is still pending. Now the district has a new superintendent, Dr. Cindy Sims, but Brick said she doesn’t think things will change. Brick provided NM Political Report with an email exchange between herself and Estancia school officials. The email, Brick said, showed that Sims was uninterested to meet with her to discuss the issue.

In July 2019, an Estancia Schools staff member emailed Brick and Sims with a list of potential meeting dates to discuss her son’s Individual Education Plan (IEP) so he could start going back to school. In response, Sims said she wouldn’t be there unless specifically requested.

“Ugh,” Sims wrote. “Forward it to Evelyn, please. Unless she directs me to, there is no reason for me to be there outside of possibly reviewing the Medical Administration Policy. I am having a glass of wine myself.”

NM Political Report emailed Sims and asked about the district’s policy and her email comments. She expressed regret for letting her frustration get the best of her.

“In regard to my email, I was responding to the email conversation via phone to comments that are omitted from the chain you have provided,” Sims said. “My frustration to those comments show, and should have remained private. I would never want to conduct myself in a manner that would bring embarrassment to the district, and should have kept my frustration to myself, and not be provoked as I was.”

And, she said, Estancia Public Schools does in fact have a policy for medical cannabis in schools.

“The district adopted an administration of medical cannabis policy and stand ready to serve the needs of any student according to that policy,” Sims wrote. “The policy is on the district website.”

But even with a policy in place, Brick would still need to go to her son’s school each time he needs to be dosed with an oral version of cannabis, and he takes it on-demand.

“Anthony takes his medical cannabis in moments of mental health crisis where he has lost control and can’t be de-escalated,” Brick said.

If she were to get a job or go to school in Albuquerque it would take her about an hour to get to her son at school and by then, she said, police or even child protective services might already be involved.

It’s still too early to tell what issues, besides budgetary ones, Gov. Michelle Lujan Grisham will allow to be discussed during the next legislature. But previous events point to cannabis being a major topic during the upcoming 30-day session.

Last year, for example, she announced she would ask the Legislature to look at legalizing cannabis for adult recreational use. Plus, a change in the medical cannabis law allowed non-residents of New Mexico a chance at becoming medical cannabis patients under the state’s program. Both the governor’s office and DOH are taking the issue to the state Court of Appeals in an attempt to overturn a state district court judge’s ruling that the state must allow any person who qualifies to get a medical cannabis patient card, regardless of their address.

Clarification: A previous version of this story said a judge dismissed Tisha Brick’s legal claims. While a judge did dismiss many of her claims, Brick’s civil suit is still pending.

The Article was originally published on Legislators could strip school districts of discretion over medical cannabis in schools

I Have To Work’: Agricultural Workers In The West Harvest Crops Through Fire Smoke

Wildfires are ravaging large swaths of the West in the middle of the wine grape harvest, sending hazardous smoke through picturesque vineyards.

It’s forcing many agricultural workers to make a stark choice: Should they prioritize their health or earn badly needed money?

“The truth is that I have to work,” said Maricela, 48, a team leader at a vineyard near Medford in southern Oregon. There are multiple fires blazing close to the town.

“It’s not easy to work now,” she said. “The smoke is so dense. … I feel dizzy, my throat hurts and my head feels like it’s going to explode.”

Air quality is ranked as “very unhealthy” in this part of southern Oregon, according to the U.S. government air quality monitoring website Many of the agricultural areas in the West have seen plummeting air quality in recent weeks.

Maricela, who has already been forced to evacuate twice as a result of the fires, said her employer gave her the option to stay home without risking her job. But she said she has no choice. She hasn’t been able to pay her electricity bill in three months, partly because she lost work hours due to the pandemic. She asked NPR not to use her last name, because like many agricultural workers, she doesn’t have work documents.

Her employer told her it will pay her an extra dollar per hour because of the fires.

She said she can’t think about the long-term health effects of the smoke. “I pray I stay healthy.” Maricela said she doesn’t have any preexisting health conditions; she doesn’t have health insurance, either. “All I have are my hands to work,” she said.

Agricultural workers vulnerable, lack information

More than 40 large wildfires are ravaging Oregon, Washington state and California, according to the National Interagency Fire Center, and have burned almost 4 million acres.

Agricultural workers are among the most vulnerable as the disaster unfolds, said Reyna Lopez Osuna, 33. She’s the executive director of Pineros y Campesinos Unidos del Noroeste, which works to improve labor conditions for farmworkers in Oregon.

As the fires ramped up last week, “there were rumors and a lot of confusion of what was happening next,” Lopez Osuna said. She said her phone was ringing constantly as workers frantically tried to figure out if they were required to come into work, even as evacuation zones shifted quickly.

One factor adding to the confusion is the lack of information in Spanish and Indigenous languages from Mexico and Central America such as Mam, Lopez Osuna said.

Counties were putting out emergency information on social media, she said, “but a lot of the farmworkers don’t have Facebook or access to the best Wi-Fi.”

More broadly, Lopez Osuna is alarmed about the impact of climate change on wildfires. It’s causing them to burn more frequently and intensely. After this fire season settles, she said, “The industry needs to work on guidelines and protections for agricultural workers.”

Lopez Osuna, the daughter of farmworkers who migrated from Mexico in the 1980s, understands that the wildfires also force employers to make difficult choices.

“There is a short timeline to pick these fruits and vegetables,” she said. “It means that people and employers are having to make really tough choices.”

“I couldn’t expose them”

Janis Pate, owner of Arlyn Vineyard southwest of Portland, said she hasn’t allowed her crew to work since Saturday.

“I couldn’t expose them, I just couldn’t in good conscience,” Pate said, adding the smoke was too dense on her 40-acre vineyard. She sent them home on Saturday with pay.

The former corporate risk management executive-turned-farmer said there are still about 30 tons of grapes on the vines “that may or may not ever get harvested.” That’s about half of her annual crop.

“It may be just a loss,” she said.

Smoke can harm grape vines. Pate said she’s testing her grapes for smoke taint. It’s possible that she could lose up to $3,500 per ton of fruit.

Members of her crew has gone on to another job after their work at her vineyard stopped. “I felt defeated, I thought I was protecting them,” she said, but added that she understands the calculations workers have to make.

Some workers are forced to stay home

As some agricultural workers pick crops through a blanket of smoke, others are waiting at home for a chance to work again.

“It’s frustrating,” said Elia, 38, who lives in Woodburn, Ore., and asked that NPR use only her first name because she doesn’t have work documents. She usually picks blueberries and grapes, but her employer has canceled her work due to the fires.

The single mother of four hasn’t been able to work in a week. It’s particularly difficult timing because she lost seven weeks of work in March and April due to the pandemic.

Because of her immigration status, Elia doesn’t qualify for federal aid. She’s relied on help from organizations such as Pineros y Campesinos Unidos del Noroeste, which has provided her with about $1,200 and groceries to help her through this period.

“I would be in the fields now if it were up to me, I’d be working, breathing this thick smoke because I have no choice, I have financial needs,” Elia said. She was coughing as she spoke to NPR, saying the smoke burns her throat.

“I’m behind in rent and other bills will have to wait,” Elia said. “You work for survival, you work for every penny.”

The Article was originally published on I Have To Work’: Agricultural Workers In The West Harvest Crops Through Fire Smoke

The hair of the dog and other hangover cure fallacies

It’s party time again. But we know all too well that a happy drink or three can leave us feeling hungover the next day. It’s not just the headaches, nausea and moodiness. Our performance is also shot. Some studies show that driving with a hangover makes you just as impaired as driving (illegally) with a blood alcohol level of 0.08 per cent! So maybe it really is safer if we stayed in bed.

Roughly three out of every four people who drink to the point they’re intoxicated will have some hangover the next morning. Prevention is better than cure. In fact, there’s no cure, despite many historical claims to the contrary.

The usual explanation for our hangovers is the accumulation of toxic chemical byproducts of alcohol. The problem with this theory is that by the time our hangover symptoms are at their worst (i.e. the next morning), all of the alcohol and its various chemical metabolites have completely left our body.

Some say it’s not the alcohol but the other chemicals that come with it. So ‘pure’ drinks like vodka and gin don’t have the same problems as a complex red wine. But even 100 per cent pure alcohol mixed with 100 per cent pure water can cause a hangover.

Some say it’s dehydration, so drinking more water or juices does the trick for them. After all, the ancient Romans always added water to wine. But this wasn’t to prevent a hangover. Most likely, the unsanitised water was undrinkable on its own, and more palatable and far safer to drink when sterilised with some alcohol in it.

A typical beer is 96 per cent water and about 4 per cent alcohol. This 4 per cent is eventually turned into about the same mass of water by our liver. Consequently, a glass of beer and a glass of water are about the same in water content in the end.

Most of the extra water we’d try to drink to compensate for the booze will simply make us pee even more or then have to get up in the night to go to the bathroom. Regardless, we’ll still end up feeling dry, thirsty and hungover in the morning.

The counter-attack

Perhaps the most famous and pervasive theory is that a hangover is really a kind of drug withdrawal. After all, the unpleasant symptoms only start after the alcohol leaves our system. And you can’t really be drunk and hungover at the same time, can you?

Taking this impeccable logic to its obvious conclusion, like any other withdrawal, we must take the thing we are missing, which in the case of bad hangover means having another drink. This is the rough rationale for starting the morning with what’s known as a ‘counter-beer’ in Germany (as in counter-act), a ‘repair beer’ in Scandinavia, or a richiamino in Italy. In the English-speaking world it’s known as taking the ‘the hair of the dog’.

This striking phrase originates from the idea that the hair of the dog (that bit you) could help heal the wound it had just inflicted. And it’s perfectly true that if you’re going into alcohol withdrawal, taking the hair of the dog temporarily gets rid of the (withdrawal) symptoms.

However, alcohol withdrawal and a hangover are definitely not the same beast. Anyone can get a hangover after a single bout of drinking, whereas alcohol withdrawal only happens with chronic alcoholics. Of course, alcoholics can and often have a hangover too, making the hair of the dog a notable cure-all.

Most of the extra water we’d try to drink to compensate for the booze will simply make us pee even more or then have to get up in the night to go to the bathroom.

Perhaps the most important contributor to our hangover is how well we sleep after a night out and how un-refreshed we feel in the morning. This is a bit like jet lag. Consequently, desperate people use many of the same cures for both, including coffee, melatonin, vigorous exercise and of course, sunglasses. Actually staying in the dark does really help the unpleasant sensation of a hangover and reduces the recovery time. Whether this actually helps to synchronise our body clock is a moot point. The light always seems much too bright.

The Article was originally published on The hair of the dog and other hangover cure fallacies

Sobering Up: In An Alcohol-Soaked Nation, More Seek Booze-Free Social Spaces

ST. LOUIS — Not far from the Anheuser-Busch brewery, Joshua Grigaitis fills a cooler with bottles and cans in one of the city’s oldest bars.

It’s Saturday night, and the lights are low. Frank Sinatra’s crooning voice fills the air, along with the aroma of incense. The place has all the makings of a swank boozy hangout.

Except for the booze.

Pop’s Blue Moon bar, a fixture of this beer-loving city since 1908, has joined an emerging national trend: alcohol-free spaces offering social connections without peer pressure to drink, hangovers or DUIs. From boozeless bars to substance-free zones at concerts marked by yellow balloons, sober spots are popping up across the nation in reaction to America’s alcohol-soaked culture, promising a healthy alternative for people in recovery and those who simply want to drink less.

“We evolved as social creatures. This is a good trend if you want the experience of companionship and social culture but don’t want the negatives,” said William Stoops, a University of Kentucky professor who studies drug and alcohol addiction. “It can help people make better choices.”

A federal survey shows nearly 67 million Americans binge drink at least monthly, meaning women down four drinks during a single occasion, men five. Midwestern states have some of the highest binge-drinking rates in terms of both prevalence and intensity, putting millions of people at risk.

Research links excessive alcohol use to fatty liver, cirrhosis and cancers of the breast, liver, colon, mouth and throat as well as heart disease, high blood pressure, stroke, dementia, anxiety and depression. Nearly half of murders involve alcohol, according to studies. Drinking kills about 88,000 people annually, according to the Institute for Health Metrics and Evaluation at the University of Washington. Such diseases and social ills cost the nation an estimated $249 billion a year.

Even one drink a day is unhealthy, said Dr. Sarah Hartz, an assistant professor of psychiatry at Washington University in St. Louis. “If you’re going to drink, know it’s not good for you.”

For Grigaitis, 41, who also goes by Joshua Loyal and is co-owner of the bar, tying all his fortunes to alcohol was “weighing on my soul” after 20 years in the business. He cut way back on his own drinking and began holding boozeless Saturday nights in January, offering hop water, nonalcoholic beers and drinks infused with cannabis-derived CBD.

“I love everything about the bar business — except the alcohol,” he said. “The nonalcoholic beverage movement is a growing group. I’m making a decision to choose this and I’m proud of it.”

Chris Marshall, who founded Sans Bar in Austin, Texas, in 2015, got sober in 2007 and was working as a counselor when a client shared how difficult it was to navigate the social world without alcohol. The client’s relapse and subsequent death was his call to action.

Sans Bar held a national tour this year with pop-up events in St. Louis, Portland, Ore., and Anchorage, Alaska, and opened a permanent location in Austin. It draws a largely female crowd all along the sobriety spectrum, from those in recovery to the “sober curious.” People gather for hours to sip handmade mocktails, talk, dance and listen to speakers and sober musicians.

“If you closed your eyes on a Friday night, you’d think you were in a regular bar,” he said. “This is not about being sober forever. This is about being sober for the night.”

Alcohol’s Pervasiveness: ‘The Wallpaper Of People’s Lives’

Alcohol has become so ubiquitous that it’s perfectly acceptable to wear T-shirts announcing “Mama needs some wine” or “Daddy needs a beer.”

“It’s normalized,” said Boston University School of Public Health professor David Jernigan. “It’s like the wallpaper of people’s lives.”

Elsewhere, in Rock Hill, S.C., Liberty Tax served margaritas when customers went in to finish their taxes last April. And a dentist’s office that treats adults and children hosts after-hours drop-in events that include wine. Neither of those businesses responded to requests for comment.

“Culturally, we know it’s not OK to hand out opioids when you’re getting your hair or nails done, yet alcohol kills more people than opioids, and businesses will hand it out,” said Alexandra Greenawalt, director of prevention at the nonprofit addiction treatment center Keystone Substance Abuse Services in Rock Hill.

Washington, D.C., has 2,055 outlets that sell alcohol — one for every 315 people, which Jernigan said is high. Some low-income, primarily African-American neighborhoods have few retail outlets other than liquor stores and convenience stores selling beer and wine.

Lothorio Ross, 38, started drinking at about 17 while on fishing trips with his father. Now homeless in D.C. and coping with alcoholism, he said, he can get alcohol on credit from some liquor stores. But he said he’s trying to quit with the help of the nonprofit Father McKenna Center and reminding himself what life used to be like.

“Up until I started drinking in my teens, I was having fun,” said Ross. “So, you can have fun without drinking; it is possible.”

Outside major cities, entertainment often revolves around alcohol. Social worker Stephanie Logan-Rice said she grew up in Aberdeen, S.D., where her mother drank herself to death, succumbing to liver cirrhosis three years ago at 56.

Logan-Rice was in sixth grade when she realized her mother was drinking wine or vodka out of Tupperware glasses or plastic water bottles.

“I just thought it was normal,” she said.

When Logan-Rice, 39, got to high school, she drank from beer bongs in cars during lunch with friends and went to cornfields for keg parties. The drinking continued when she moved to Minnesota for college. In her 20s, she drank every day.

She finally quit five years ago. She now has two children her mother didn’t live long enough to meet.

Since giving up booze, Logan-Rice said, she has seen alcohol in unexpected places — even an assisted living facility that offered bottles of wine as door prizes when she attended an early-afternoon presentation about hospice care.

“I get it if I go into a restaurant,” she said. “But not an assisted living place.”

Declining A Drink: Recovering Alcoholics, The ‘Sober Curious’ And The Health-Conscious

America’s pervasive alcohol culture has pushed people to find creative ways to socialize soberly.

In South Carolina, the Keystone treatment center hosts events for local college students at Winthrop University featuring nonalcoholic beverages.

In Washington, D.C., members of a growing sober LGBTQ community organize dry reading groups and rafting trips and alcohol-free nights out instead of hitting gay bars. Tom Hill, a vice president at the National Council for Behavioral Health, who is gay and in recovery, said those activities create a “sense of socialization and camaraderie to replace what they had.”

Nationally, sober raves such as Daybreaker morning dance parties have caught on, fueled only by dancing.

Still, Devra Gordon, a behavioral health therapist in nearby Fairfax County, Va., said she advises people who are grappling with substance abuse to attend concerts and raves with just their sober friends — and they should attend recovery meetings before and after. The meetings help avoid falling into a “euphoric recall” and romanticizing past substance use, she said.

“Having fun and drinking alcohol is an illusion,” said Cortez McDaniel, who is recovering from alcohol and drug abuse disorders and heads services at the Father McKenna Center. “We have to stop believing the lie, and then we have to start practicing something different.”

At Pop’s Blue Moon, Jaclynn Rowell, who reads tarot cards for customers, said the health benefits of no-booze nights are a big draw. And many are happy to avoid awkward questions about religion, pregnancy and sobriety that can arise at regular bars when someone asks why they’re not drinking.

Stephanie Keil, 39, spent two hours with friends there on a recent Saturday night and said she’d love to see more boozeless bars.

Though she drinks now and then, places like these help her responsibly navigate nightlife in the city where Budweiser was born.

O’Donnell reported from Washington, D.C.; Ungar reported from St. Louis.

[Correction: This story was updated at 4:30 p.m. ET on July 9 to remove a reference about the Clothes Mentor high-end secondhand store in Rock Hill, S.C. The store’s owner said it has not served margaritas at the shop, as the story originally reported.]

The Article was originally published on Sobering Up: In An Alcohol-Soaked Nation, More Seek Booze-Free Social Spaces

“This is freedom”: Texas House moves to expand alcohol sales on Sundays and at breweries

Texas Legislature 2019

The 86th Legislature runs from Jan. 8 to May 27. From the state budget to health care to education policy — and the politics behind it all — we focus on what Texans need to know about the biennial legislative session.


The Texas House voted Thursday to extend beer and wine sales on Sundays and to let craft breweries sell beer to go.

Those new expansions of alcohol sales were amendments to a broader bill regarding the efficiency and operations of the Texas Alcoholic Beverage Commission that must pass this legislative session in order to avoid shutting down the agency.

Both amendments were opposed by the bill’s author, state Rep. Chris Paddie, R-Marshall. Paddie still cast a vote for the legislation, which received preliminary passage along a 135-0 vote, though he noted that the bill was no longer “completely clean.”

The bill will still need a final stamp of approval in the House before it can head to the Senate for consideration. Once it’s in the upper chamber, members there can tweak the legislation. That means the upper chamber could strip those two new amendments from the legislation. (Update: The House passed the bill on third reading Friday morning, sending it to the Senate.)

The two amendments proposed by state Reps. Drew Springer, R-Muenster, and Eddie Rodriguez, D-Austin, consumed most of the debate Thursday. Springer’s amendment would allow beer and wine sales to begin at 10 a.m. instead of noon on Sundays in licensed retailers such as convenience and grocery stores. It passed in a 99-40 vote. In laying out his amendment, Springer said his motion would put wine and beer sales in line with what’s currently allowed at on-premise consumption locations, such as restaurants and bars.

“We allow country clubs to sell mimosas at 10 a.m.,” Springer said during the debate on the House floor.

He also said his proposal won’t affect liquor stores, which aren’t allowed to operate on Sundays.

The passage of Springer’s amendment was met with a chipper response from state Rep. Terry Canales, D-Edinburg, who exclaimed upon its passage: “This is freedom. This is eagles!”

The House narrowly approved Rodriguez’s amendment allowing craft breweries to sell beer to go — something that’s already legal in every other state, the representative said Thursday evening.

His amendment produced more of a nail-biter in the chamber. Paddie initially moved to table the amendment, and it initially looked like he prevailed by a one-vote margin. But a verification vote later clarified that the amendment was actually favorable to a majority of House members.

“We have to make these changes for these small breweries to grow,” Rodriguez said. “Let’s vote for small businesses here in Texas. Let’s vote for beer to go.”

The Article was originally published on “This is freedom”: Texas House moves to expand alcohol sales on Sundays and at breweries

Nursing homes fought federal emergency plan requirements for years. Now, they’re coronavirus hot spots.

ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for The Big Story newsletter to receive stories like this one in your inbox.

On Dec. 15, 2016, the nation’s largest nursing home lobby wrote a letter to Donald Trump, congratulating the president-elect and urging him to roll back new regulations on the long-term care industry.

One item on the wish list was a recently issued emergency preparedness rule. It required nursing homes to draw up plans for hazards such as an outbreak of a new infectious disease.

Trump’s election, the American Health Care Association, or AHCA, wrote, had demonstrated that voters opposed “extremely burdensome” rules that endangered the industry’s thin profit margins.

“Part of the public’s message was asking for less Washington influence, less regulation, and more empowerment to the free market that has made our country the greatest in the world,” AHCA wrote. “We embrace that message and look forward to working with you to improve the lives of the residents in our facilities.”

The letter was another salvo in the industry’s fight against regulations designed to stop diseases like COVID-19 from devastating elderly residents of the nation’s nursing homes, according to a review of documents and data by New Mexico In Depth; The News & Observer of Raleigh, North Carolina; and ProPublica.

The lack of pandemic plans helps explain why nursing homes have been caught unprepared for the new coronavirus, patient advocates and industry observers said. Across the country, more than one in four nursing homes have registered an outbreak, according to mediareports. More than 16,000 nursing home residents and workers have died, accounting for 17% of COVID-19 deaths nationwide, according to an AARP tally on May 18. That figure is likely an understatement of the true scope of the harm.

Ongoing questions about the regulations may also have played a role. The 2016 rules mandated planning for all kinds of hazards, citing Ebola as an example. In 2019, the Trump administration clarified that nursing homes needed to include a specific plan for outbreaks of unfamiliar and contagious diseases — such as the coronavirus.

The plans must address how facilities will respond in an emergency — specifying how nursing homes will decide to shelter in place or evacuate and how they will provide residents with food, water, medicine and power. Nursing homes have to train their staff on these plans and practice them at least twice a year, if possible by participating in a drill with local agencies.

Some nursing homes were slow to comply, according to an analysis of inspection data, watchdog reports and interviews with ombudsmen and advocates. Inspectors have found more than 24,000 deficiencies with nursing homes’ emergency plans between November 2017, when the so-called “all hazards rule” took effect, and March 2020, according to public data reviewed by the news organizations. The violations occurred in 6,599 facilities, equal to about 43% of the country’s nursing homes.

Because of how the Centers for Medicare and Medicaid Services tracks the data, it’s not possible to say exactly how many of the emergency planning violations related specifically to a failure to plan for an infectious disease outbreak. Failures to meet routine infection control standards were excluded from the analysis.

But nursing home advocates say that more detailed plans accounting for expected staff and equipment shortages would have likely resulted in fewer deaths and illnesses at nursing homes stricken by the coronavirus. The current rule requires nursing homes to make contingency staffing preparations, but it doesn’t require stockpiles of personal protective equipment, or PPE.

“It’s just a river of grief, and it could have been prevented,” said Pat McGinnis, executive director of California Advocates for Nursing Home Reform.

Emergency plans help facilities train their staff ahead of time and guide tough decisions during a crisis, said Ted Goins, the president and CEO of Lutheran Services Carolinas, a nonprofit based in Salisbury, North Carolina, that runs several highly rated elder-care facilities.

“COVID-19 is a perfect example of why we have emergency plans in our facilities, and I’m sure that’s why it’s a requirement,” Goins said.

AHCA declined to make any executives available for an interview. In a statement, the group said the pandemic shows that nursing homes should be a bigger priority for resources but not for regulation.

“As we assess the COVID-19 pandemic and how to prepare our healthcare system for future outbreaks, more regulation is not necessarily always the answer,” AHCA said in the statement. “There will be time to look back and determine what we can do better for future pandemics or crises.”

One place to start: a nursing home and rehabilitation center in Albuquerque, New Mexico, with five deaths and 42 infections tied to a COVID-19 outbreak and no plan for dealing with a pandemic, according to its employees and New Mexico public records.

“Pandemic response? I mean, I don’t think anybody was really prepared for a pandemic of this level or this quickly,” said Edwardo Rivera, the facility’s administrator. “We did have some things in place, but nothing could have prepared us for what COVID-19 was.”

An emergency call

Robert Potts, 91, once flew America’s leaders around the globe.

A retired Air Force colonel who flew combat missions in Korea and Vietnam, Potts returned to the United States to serve as pilot for Air Force One and Air Force Two in the 1960s, according to service records and a family member. He spoke of flying President John F. Kennedy and first lady Jacqueline Kennedy.

After he fell at home and hit his head in March, Potts wound up at Advanced Health Care of Albuquerque, part of a nationwide network of 22 post-hospitalization rehabilitation and skilled nursing facilities.

The Albuquerque facility is a top-rated rehabilitation center with personal bedrooms and wine glasses in the dining hall. It takes care of patients needing physical, occupational or speech therapy after hospitalization.

In early April, AHC of Albuquerque staff and residents began testing positive for the coronavirus. Concerned about her father’s health, Potts’ daughter Susan wanted to bring him home. Somebody from the facility — Susan could not remember exactly who — assured the family that Potts had tested negative for COVID-19.

When the AHC of Albuquerque van arrived at the Potts residence in the city’s affluent Northeast Heights on the afternoon of April 10, the Potts family’s caretaker was there to greet him. Rosemary Ortiz, 57, recalled that the driver reassured her that Potts was negative for COVID-19.

Ortiz, however, noticed that Potts had symptoms that corresponded with the disease: a runny nose and a dry cough. The next day, Saturday, those symptoms worsened. By Sunday morning, he complained of shortness of breath and chest pain. He was dizzy, Ortiz recalled.

Ortiz drove him first to an urgent care facility, where he registered a temperature of 100 degrees. At a nurse’s recommendation, Ortiz drove Potts to Presbyterian Hospital in downtown Albuquerque.

“Wouldn’t it be something if I had the COVID and I gave it to you guys, to the family,” she recalled him telling her.

“Don’t say that, we don’t want that!” Ortiz responded.

At Presbyterian, Potts tested positive for COVID-19. He was admitted to the fourth-floor ICU.

Ortiz returned to her home that evening, a two-room casita in Albuquerque’s South Valley that she shares with a roommate.

She worried that Potts was dying.

Something pretty basic

The drive to ensure that nursing homes were better prepared for emergencies began amid disaster and disease.

In the aftermath of Hurricane Katrina in 2005, the inspector general for the U.S. Department of Health and Human Services found that nursing homes were unprepared for emergencies despite complying with existing federal standards. The watchdog recommended strengthening the federal requirements to be more specific about the elements that must be in a disaster plan and encourage more coordination with state and local emergency management officials.

In 2009, the Government Accountability Office examined preparedness for a flu pandemic and recommended that the federal government do more to advise health care providers on emergency plans and monitor their performance. The shortcomings were underscored by an outbreak of swine flu that year, which sickened nursing home residents nationwide.

In 2013, the concerns over infectious outbreaks began to take concrete form. The Centers for Medicare and Medicaid Services, or CMS, proposed updating the emergency preparedness requirements for all health care providers that participate in Medicare and Medicaid, including nursing homes.

“This was really something pretty basic,” said Richard Mollot, the executive director of the Long Term Care Community Coalition, which advocates for nursing home residents and their families.

But nursing home operators didn’t see it that way. They objected to the new requirements, arguing they would be costly and burdensome. Over the next three years, they repeatedly voiced their concerns as CMS finalized the new rule.

“We are concerned that CMS has underestimated the amount of time, training and resources necessary to implement many of these requirements,” Catholic Health Initiatives, which operates 40 long-term care, assisted-living and residential-living facilities, said in a formal response to the CMS proposal.

The Continuing Care Leadership Coalition, which represents nonprofit and public post-acute and long-term care providers in the New York metropolitan area, told CMS that the additional personnel and equipment — such as backup generators — needed to comply with the new regulations risked the economic stability of some of its members. “We view the proposed changes as considerable from a financial standpoint, in excess of appropriate minimum standards to participate in the Medicare and Medicaid programs, and we expect they would necessitate significant staffing and operational enhancements,” the organization said.

CMS rejected the appeals, issuing its final rules in September 2016. Nursing homes and other facilities had one year to implement the changes.

A few months later, AHCA sent its letter to Trump. The group followed up by asking Tom Price, Trump’s first HHS secretary, to stop implementing the new requirements and write a new rule. “We are happy to work with your team and CMS staff to provide more specific suggestions,” the industry group said.

The following year, the Trump administration proposed fulfilling some of AHCA’s wishes. The organization had warned that creating and updating the plans risked taking time away from patients.

Advocates for nursing home residents objected that CMS was contradicting its own conclusions. Public health officials said a rollback would undo potentially life-saving improvements.

CMS ultimately decided to remove the mandate for nursing homes to document coordination with local authorities.

But the agency remained insistent on the need to plan for pandemics and other outbreaks of new diseases: “CMS determined it was critical for facilities to include planning for infectious diseases within their emergency preparedness program,” it said in a memorandum issued in February 2019.

A confused response

On March 10, just a day before authorities announced New Mexico’s first positive COVID-19 case, Kate Brennan was listening to sports radio on her way to work at AHC of Albuquerque, located in a neighborhood of industrial and business parks. The most senior physical therapist at the facility, she listened with alarm to news about the spread of the coronavirus.

She pulled into the parking lot at the same time as Edwardo Rivera, the top administrator. What were they going to do to protect patients and staff from a COVID-19 outbreak, she asked.

“Katie, it’s nothing more than the flu. It’s not a big deal,” she said he told her.

Rivera said he could not recall making such a statement. But on March 13, CMS issued new COVID-19 measures for nursing homes nationwide. The agency recommended the screening of residents and staff for fever and respiratory symptoms, restricting “all visitors, effective immediately,” except for end-of-life visits, and canceling all group activities and communal dining.

The measures appeared to catch Rivera and his management team by surprise. Their response over the next several weeks was confused and uncertain, employees and patients’ family members said.

By March 15, AHC of Albuquerque announced a halt to family visits. Staff and contractors were checked at the facility door for fever. But group therapy in the gym did not immediately stop, according to former employees who were there at the time. Patients were given the option of eating meals in their own rooms, according to an employee’s cellphone text, but meals in the facility’s dining room continued.

Brennan grew increasingly worried that AHC was not adequately preparing. Despite the CMS regulations, Brennan and several others said they had never received any kind of training on how to handle an epidemic.

“We never talked about COVID-19 training, I know that. Never. Never,” Brennan said.

Nurse Carole J. Welch agreed, as did two other AHC of Albuquerque employees interviewed on the condition that they remain anonymous. Fire drills were the only disaster planning and exercises about which Welch and Brennan were aware, they said.

“There was never anything mentioned about COVID-19,” Welch said. “At all-staff meetings, everybody signs a sign-in sheet. If state inspectors ever ask them for documentation for in-service training or sign-in sheets for COVID-19 trainings, unless they’ve made them up, there aren’t any.”

Nor did the facility participate in any community drills or exercises in recent years other than fire drills, Welch and Brennan agreed.

Rivera said several COVID-19 training sessions had been held since early January. Asked if AHC of Albuquerque had conducted staff training to prepare for the pandemic — explaining how the coronavirus can be transmitted and what precautions are needed to avoid its spread — Rivera said they’d been doing such training “for a while now,” a claim vociferously denied by staff.

In March, the New Mexico Department of Health rushed inspectors to AHC of Albuquerque as part of a statewide effort to review facilities’ emergency response plans in anticipation of the coronavirus pandemic. No deficiencies were noted in either planning or training. Health Department officials did not respond to questions about whether inspectors specifically examined the pandemic response portion of the facility’s emergency plan.

But Rivera acknowledged that AHC had no pandemic response plan, as federal rules require, just a more general disaster response plan. He noted he had not coordinated with local health officials to plan or drill for an epidemic to identify potential problems.

“We did not coordinate much when it comes to an epidemic of this fashion with the [state] Department of Health,” Rivera said. “They did review all of our policy procedures and emergency preparedness plan and everything was checked off and OK’d. But there was never any official training with the Department of Health.”

When asked directly whether AHC of Albuquerque had a generic emergency plan rather than one specific to the needs of a pandemic (such as infection control and PPE supplies), Rivera said: “Correct.”

To Brennan, Rivera’s attitude was too lax for the situation facing the facility’s patients and residents. She believed the lack of guidance was putting her and her patients at risk.

Brennan said she would not work with patients without appropriate PPE and announced she was taking personal leave on March 16. She was fired. Welch asked to be changed from full time to an on-call nurse on April 5 because of similar concerns as Brennan’s. She later learned she, too, had been fired.

“I think in 2 weeks we will see a lot occur … and perhaps our standards will rise … or won’t need to,” Brennan texted to a supervisor. “But in the meantime, I felt we should do more, be more.”

Rivera declined to comment on personnel matters.

“The cost is human lives”

AHC of Albuquerque’s failure to create a pandemic plan is not unique among nursing homes. A 2018 report by Democratic staff of the U.S. Senate Finance Committee concluded that nursing homes are still unprepared even for more common emergencies like hurricanes.

While some homes have devoted a lot of energy to protecting their residents from disasters, many facilities are doing the bare minimum, according to David Grabowski, a professor of health care policy at Harvard Medical School.

“I don’t think it’s ever been a major area of focus,” Grabowski said, “somewhat because CMS hasn’t forced this and really held their feet to the fire.”

The inspectors who verify whether a nursing home meets emergency preparedness standards are supposed to read the plan to make sure it’s updated and “encompasses potential hazards.” They should also confirm that the nursing home has been training its employees on the emergency plan and ensure that the facility has made preparations for communicating and delegating authority in a crisis.

The most commonly cited problem for nursing homes’ emergency preparedness is failing to rehearse their plans in a community drill, usually organized by local emergency management or a hospital-led health care coalition.

Since inspectors are tasked with identifying immediate hazards, they may be less focused on scrutinizing emergency plans, said Eric Carlson, directing attorney of Justice in Aging, which advocates for impoverished seniors.

In 2019 and 2020, the HHS inspector general found that inspectors in at least five states — CaliforniaNew YorkFloridaTexas and Missouri — were not thoroughly policing the new emergency preparedness rule. CMS has said it will expand its oversight of states’ enforcement.

Another indication of underenforcement is how much violations vary across the country. Advocates and experts say the variation more likely reflects different states’ inspection priorities rather than how much facilities are actually doing.

California has one of the highest citation rates, with inspectors finding more than three emergency-preparedness violations per facility since November 2017, according to the analysis. At least 56 facilities have been cited for failing to plan for potential pandemics.

New Mexico cited nursing homes for emergency-preparedness deficiencies at about the same rate, but it’s not possible to say how many of those deficiencies related specifically to failing to plan for confronting a new infectious disease. Today, nursing homes account for 31% of all COVID-19 deaths in New Mexico.

The citation rate in New York, where more than 5,800 nursing home residents died with confirmed or presumed infections, was much lower, roughly one deficiency per nursing home.

North Carolina registered few deficiencies. Although the state has more than 400 nursing homes, its inspectors issued just 44 emergency-preparedness citations to 40 facilities, none related to a nursing home’s failure to prepare for an epidemic.

Despite this apparently clean record, North Carolina’s nursing homes have been ravaged by COVID-19. Nursing home residents make up more than half of the state’s deaths. About 20% of facilities have had outbreaks, and some have been unable to stop the virus’s spread before virtually every resident was infected.

At Louisburg Healthcare and Rehabilitation, all but five of the facility’s 61 residents caught the virus and 19 died. Despite the federal directive to coordinate with local emergency managers, the nursing home didn’t submit its plan for review.

Jeff Bright, the emergency manager of Franklin County, where the nursing home is located, said the first time he talked to the facility’s administrator was after the outbreak began. “The initial conversation was, ‘Oh good gracious, we’re overwhelmed,’” he said.

In a statement, the nursing home’s management company, Liberty Healthcare, acknowledged that local emergency officials had not reviewed the facility’s emergency plan. But the company said its plan contained a section on pandemic influenza response that proved helpful. State inspectors have reviewed the nursing home’s emergency plan three times since the new rule took effect, the company noted, and each time the facility was found in compliance.

Regulators should do more to make sure that nursing homes and local emergency officials work together, advocates said.

“Facilities should have been better prepared for this,” Melanie McNeil, Georgia’s long-term care ombudsman, said. “The cost is human lives. That’s the cost of not being prepared. We know that people in long-term care are vulnerable.”

The outbreak begins

Brennan’s concerns proved prescient on April 3 — the 13th day at AHC of Albuquerque for an elderly Navajo patient in Room 222.

That day, the man had coughing fits in the dining room and therapy gym, according to current and former employees. The next day, on Saturday, he was still coughing and had a fever, so staff quarantined him in his room and administered a nasal swab to test for COVID-19.

Word of his positive test result came the following day, April 5 — Palm Sunday. He was the first person known to have become infected at the facility.

That morning, the facility’s nursing director told staff to assign only one certified nursing assistant, or CNA, to enter the patient’s room, Welch said. But the CNA working in Room 222 was not told to avoid contact with other patients to avoid the risk of spreading the coronavirus, according to Welch. Several people who the CNA attended were later diagnosed with COVID-19.

Rivera said the CNA took necessary precautions, including the use of personal protective equipment. But employees present at the facility on April 5 said the CNA was wearing a surgical mask, not one of the more protective N95 masks.

Rivera acknowledged that staff likely played a role in spreading the virus by mid-April.

“I would say it was indirect” spread between residents by staff, Rivera said. “At that time, we had all of our patients, remember, in isolation at that time, in their rooms.”

Between April 5 and May 8, 42 people — 18 patients and 24 staff — at AHC of Albuquerque would test positive for the disease, according to the state Health Department. Patients were sent home or to other nearby facilities like The Watermark assisted living center and the Canyon Transitional Rehabilitation Center, but only after testing negative twice, Rivera said.

Five residents died, including two men and two women in their 70s and 80s, and Roslyn K. Pulitzer, 90, a distant relative of the newspaper family who created the Pulitzer Prize, the nation’s highest journalistic honor.

Pulitzer, a psychotherapist and fine arts photographer, drew her final breath holding the ungloved hand of Kay Lockridge, her partner of 36 years, at 8:45 a.m. on Thursday, April 30, at the University of New Mexico Hospital’s intensive care unit.

“If we had known they had a case, Roz wouldn’t have gone there,” said Lockridge, a journalist. “I wish we’d known.”

Outbreaks, staff cuts and a disengaged doctor

AHC of Albuquerque had a history of problems with containing infectious outbreaks, according to employees and a review of state Health Department inspection reports dated 2009 to 2020.

There have been recurring infections involving Clostridium difficile, commonly called C. diff, according to current and former AHC of Albuquerque employees and state inspection reports. C. diff is a drug-resistant bacterium that causes diarrhea and potentially lethal gut inflammation. Rivera said the facility has had no C. diff cases in 2020. He did not return calls regarding previous outbreaks.

Repeated problems with C. diff are a red flag for infection control problems, said Dusti Harvey, an Albuquerque attorney who previously worked for Sun Healthcare Group, a long-term nursing and post-hospitalization rehabilitation company.

Federal regulations for nursing homes, including those for infection control, have been in place since 1989, Harvey noted.

“This is something that nursing homes should have been doing for the last 30 years,” Harvey said. “Nursing homes should have been set up for COVID-19 way before it happened.”

AHC of Albuquerque was also short-staffed, according to employees. Changes in billing for physical therapy had led to layoffs in September 2019. The facility had also begun to accept older, more fragile patients.

The situation was a “perfect storm for things to go awry with the introduction of COVID-19 into the facility,” Brennan said. “Less staff, less cohesion, less communication, less direction. They brought in more patients that were inappropriate for effective group therapy due to their numerous medical issues.”

Rivera insisted the changes to Medicare payments did not affect patient demographics and that staffing was not a problem.

A final concern for some employees was Dr. Ralph S. Hansen, the facility’s medical director and one of its two designated infection control specialists. Neither Hansen nor the other designated specialist, a nurse, have a current credential in infectious disease management, according to records from the American Board of Medical Specialties and the New Mexico Board of Nursing.

“Dr. Hansen has an infectious disease background,” Rivera said. But Hansen had not conducted any staff training, he acknowledged.

Current and former workers described Hansen as “disengaged” and “disconnected.” Patients’ missed doses of antibiotics and delayed lab results went unpursued.

Hansen was fired by a medical group in California and subsequently surrendered his California medical license after he allegedly stole other physicians’ prescription pads and self-prescribed Ritalin under his own and fictitious names 326 times between 2004 and 2007, California Medical Board records show. He was charged in 2007 with 15 felony counts of burglary, forgery and obtaining controlled substances by fraud, the records show. In a November 2007 plea bargain, he admitted only to obtaining a controlled substance by fraud.

But the following year, he moved to New Mexico, where he was issued a conditional medical license in March 2009 requiring monitored drug-abuse treatment and quarterly self-reports on his compliance with treatment, board records show. He went to work for the state prison in Los Lunas and the state Health Department. In 2014, the New Mexico Medical Board granted Hansen an unrestricted medical license, records show. He stopped working for the state in October 2015.

Hansen did not return repeated calls and messages.

By May 7, the COVID-19 outbreak at AHC of Albuquerque had peaked and largely resolved, Rivera said. As of Monday, May 11, the facility had only five patients who tested positive.

Rivera did not return recent phone calls seeking updated figures.

Uncounted victims

At least two other people might be uncounted victims of the outbreak at AHC of Albuquerque.

After Rosemary Ortiz dropped off Robert Potts at the hospital, she drove back to her own home, the two-room casita where she has lived since childhood.

The following week, Ortiz developed a cough and shortness of breath. She soon became dizzy and feverish, with terrible headaches. Despite the small size of her home, she had trouble walking to the front door.

Ortiz tested positive for the coronavirus.

“I was so sick I thought I was not going to see my kids or my mother ever again,” she said. “I thought I was going to die.”

At home, Ortiz had kept her distance from her roommate, fearful of infecting her. But then she heard the woman coughing.

The roommate, too, tested positive for the coronavirus.

Reached by phone, Ortiz stopped to catch her breath and announced that she had been weeding her yard, back on her feet. As of Tuesday, May 26, she had still tested positive for the coronavirus, even though she felt better.

Inside, Ortiz’s roommate was still sick and coughing.

“But I think she’s doing better,” Ortiz said.

Ortiz had learned that Potts had been transferred to the Canyon Transitional facility for hospice care after several weeks at Presbyterian hospital. Ortiz said Potts’ health has improved and he may be released to go home in a few weeks.

Ortiz paused.

“I miss him. I miss Mr. Potts very much,” she said.

Bryant Furlow is a reporter for New Mexico In Depth. Carli Brosseau is a reporter for The News & Observer of Raleigh, North Carolina. Isaac Arnsdorf is a reporter for ProPublica.

The Article was originally published on Nursing homes fought federal emergency plan requirements for years. Now, they’re coronavirus hot spots.

Coronavirus Ripples Hit New York City Merchants From 7,000 Miles Away

The local economic impact of coronavirus is stretching beyond Wall Street: City clothing retailers say they are already feeling the side effects.

“I’ve had to turn down business or tell clients I’m not sure when I can deliver their order,” said Stuart Smith, 50, a custom tailor from Riverdale whose suits range in price from $695 to $10,000. “Business is down about 12%. We’re talking thousands of dollars. I’m a one-man show, so I’m feeling it.”

Smith’s plight is shared by small apparel shops throughout the city that depend on Chinese textile factories temporarily shuttered by the ongoing coronavirus outbreak, said Edward Hertzman, founder and president of the fashion trade publication Sourcing Journal.

“It’s going to affect the mom and pops that are relying on wholesalers getting seasonal products into the country from China,” Hertzman said. “If I am a brand, and I’m prioritizing my list of retailers, I’m going to go down the list starting with the larger retailers. Some of the mom and pops may get left out.”

‘Please Be Patient’

Smith’s made-to-order clothing factory in Qingdao, China, about 685 miles from the epidemic’s epicenter in Wuhan, already had been closed for a two-week Lunar New Year holiday when the outbreak hit last month. It remained on lockdown for an additional three weeks.

“Things were in the pipeline and delayed, and so I had to turn down weddings because I didn’t know when we’d be back,” Smith said. “The factory is now reopened, but they’re only allowing the locals back to work.”

Migrant workers and those who had returned home for the holidays have not been able to return to work, Smith added.

“I communicate with the factory on WhatsApp,” Smith said. “I can tell by the tone of their emails and texts that they’re worried, but they just say, ‘We’re doing our best, please be patient.’”

Particularly worrisome, Smith said, is a shortage of viscose and polyester materials in funky prints that he uses to create custom linings for suits or sports jackets.

“Clients love these very crazy themed linings, with little wine corks or maybe martini glasses,” Smith said. “It’s very frustrating not to know whether those are back in stock or not. If I can’t tell clients exactly when I can deliver, it doesn’t make me look good. Nobody wants to look bad in front of a client.”

‘Passover’s Coming’

Smith said he hoped things returned to normal before his springtime rush.

“I’m a Jewish guy and Passover’s coming,” he said. “My clients want to know if I can deliver for the holiday.”

Hertzman said that textile factories are starting to reopen. “But the issue is how quickly can they ramp up to full capacity,” he noted. “Plus, there are not a lot of vessels leaving those ports, and once they start, there may be huge bottlenecks and delays.”

Some businesses, like the Gifts & Luggage t-shirt and souvenir shop in Midtown, stress that they have been spared coronavirus supply problems because they don’t use Chinese factories.

“We get our products from Bangladesh,” said manager Mohammed Khan, 38, who has worked at the store for nearly a decade. “Things are slow, but it’s more because of the weather and people aren’t traveling so much. It’s not from the virus.”

But Hertzman pointed out that international apparel supply sources, including Bangladesh, Vietnam and Lesotho, “get 90% of their fabric and trim from China, so they’ll eventually start feeling the impact, too.”

Retail’s Positive Prognosis

Despite uncertainty from the virus, as well as the ongoing tariff war and presidential race, the National Retail Federation this week forecasted that retail sales would increase between 3.5% and 4.1% to more than $3.9 trillion this year.

“There are always wild cards we cannot control like coronavirus and a politically charged election year,” NRF President and CEO Matthew Shay said in a statement. “But when it comes to the fundamentals, our economy is sound and consumers continue to lead the way.”

Told of the federation’s forecast, Smith replied, “From your lips to God’s ears.”

Hertzman called the rosy outlook a bit premature.

“The situation is very fluid,” he said. “Plus, we have to consider the psychological factor of fear. If people start saying, ‘I don’t want to go to the shopping mall,’ that can create a downturn or a recession. It’s a dangerous recipe for disaster.”

Khan remained optimistic.

“Business will pick up, but not because of this guy,” he said, pointing to a column of red Make America Great Again hats stacked behind him.

“But because of…” he added, pressing his hands together in prayer and pointing skyward.

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The Article was originally published on Coronavirus Ripples Hit New York City Merchants From 7,000 Miles Away