Delta Air Strains battles with nation’s largest flight attendant union over shortened Covid sick depart

Flight attendants distribute refreshments to a packed Delta Airlines flight departing from Ronald Regan National Airport to MinneapolisSaint Paul International Airport on Friday, May 21, 2021.

Kent Nishimura | Los Angeles Times | Getty Images

Delta Airlines sent a cease and desist letter to the country’s largest cabin crew union after its president criticized the company’s reduced sick leave policy for employees with Covid-19.

Last Thursday, Association of Flight Attendants President Sara Nelson tweeted that the union had received “multiple reports” that Delta was “notifying workers in all work groups that they should come to work with symptoms, even if someone in the household tests positive.” She also said positive workers were told “to come to work after 5 days if the fever is below 100.9, even if they still test positive.”

A day later, Peter Carter, Delta’s Chief Legal Officer, mailed the letter to AFA.

“This information is not only false, it is criminal offense because it casts Delta in a highly negative light by suggesting that Delta asked employees to work while they were ill,” Carter’s letter said. “Such irresponsible behavior is inappropriate, defamatory and must be stopped immediately.”

Nelson, whose union does not represent Delta flight attendants but started one organize drive there in November 2019, defending her comments and saying Delta’s policies confused flight crews.

“Delta’s policy now addresses being asymptomatic before returning to work, which was a serious concern since those CDC policies were originally omitted from Delta’s policy announcement,” she wrote to Delta CEO Tuesday Ed Bastian. “But we still get questions from Delta flight attendants about returning to work with a low-grade fever and the fact that Delta’s current policy only recommends testing before returning to work and doesn’t require testing.”

Delta updated its Covid sick leave policy on Dec. 28 to five days off with wage protection — reduced from 10 days — that doesn’t require employees to spend days in their medical banks. Employees can get two extra days if they test positive again on the fifth day.

“Delta has always looked to science to formulate our policies regarding COVID-19,” a Delta spokesman said Tuesday. “We have sent a cease and desist letter because we believe institutions and leaders must speak carefully, truthfully and factually.”

The airline had asked the Centers for Disease Control and Prevention to halve the recommended isolation time for breakout Covid infections to five days, warning of staff shortages and flight cancellations coming later. JetBlue Airways and other airlines asked for the same change. CDC updated its guidance Dec. 27 after relaxing recommendations for healthcare workers.

Cancellations from staff ill with Covid and a series of winter storms topped 20,000 between Christmas and the first week of the year. United Airlines, which has 10 days of wage protection left for crews with Covid, said Tuesday it would further cut its schedule, with 3,000 workers, about 4% of its US employees, testing positive for the coronavirus.

Frontier Airlines and Spirit Airlines Give employees 10 days of wage protection if they test positive for Covid.

U.S. confirms nation’s first case of omicron Covid variant in California

US health officials have confirmed the new country’s first case. strongly mutated coronavirus variant named Omicron in California, the Centers for Disease Control and Prevention announced on Wednesday.

White House senior medical advisor Dr. Anthony Fauci said the person who was fully vaccinated had just returned to the San Francisco area from a trip to South Africa on November 22nd and tested positive on November 29th.

“The person is in self-quarantine and all close contacts have been contacted and all close contacts have so far tested negative,” he announced at a press conference at the White House, at which further details on the case were disclosed. “We feel good that this patient not only had mild symptoms, but that symptoms actually appear to be improving.”

The CDC said genome sequencing was originally performed at the University of California at San Francisco and confirmed by the CDC as an Omicron variant.

California Governor Gavin Newsom warned residents not to panic. “But we should stay vigilant,” he said on Twitter. “That means get vaccinated. Get empowered. Wear a mask indoors.” Newsom has scheduled a press conference on the variant at 3 p.m. ET. Newsom and local officials in San Francisco said they did not expect to put new restrictions on residents in the face of the Omicron.

“There is more panic than information about this new variant,” Newsom said, adding that everyone needs to be more vigilant, but bans are not being considered. “I think we can communicate to avoid closings, we can avoid closing our schools or shops. None of us want that to happen. “

Since South Africa first reported the variant to the World Health Organization a week ago it was found in the Canada, UK, Israel, Belgium, the Netherlands, Germany, Italy and Hong Kong, among others. World leaders are on high alert and fear that the virus is already spreading around the world.

The World Health Organization said Wednesday that Omicron has been reported in at least 23 countries.

Fauci said over the weekend that the variant would inevitably arrive in the US. Two cases were identified in Ontario, Canada, on Sunday. The variant originally known as B.1.1.529 was first discovered in Botswana and the South African province of Gauteng, where Johannesburg is located.

Moderna CEO Stephane Bancel warned on Monday that Omicron had already spread around the world. He pointed to flights arriving in Amsterdam from South Africa on Friday, when 61 out of 624 passengers tested positive for Covid. A total of 14 of them are infected with the Omicron strain, said the Dutch health authorities.

The Portuguese health authorities announced on Monday that 13 members and employees of a professional football team in Lisbon became infected with the variant after one of their players returned from a trip to South Africa.

“We also believe that it is already there in most countries,” said Bancel. “I believe that most of the countries that have had direct flights from South Africa in the past seven to 10 days already have cases in their country that they may not be aware of.”

The USA a travel ban was imposed from Monday for non-citizens who have traveled in the past 14 days in South Africa and seven other nearby countries. The UK and the European Union have similar travel restrictions in place.

President Joe Biden said Monday directs the Food and Drug Administration and Centers for Disease Control and Prevention to use “the fastest, no-compromise method available” to approve and bring potential vaccines for Omikron to market.

Current Covid vaccines are believed to provide at least some protection from the highly mutated Omicron strain, and booster vaccinations “greatly strengthen that protection,” Biden said in a White House speech.

Omicron was named “Variant of concern“By the World Health Organization on Friday, meaning it is more contagious, virulent or adept at bypassing public health measures, vaccines and therapeutics. The variant contains more than 30 mutations in the spike protein that allows the virus to enter the body. The new strain has a total of around 50 mutations, 10 of them in the receptor binding domain, the part of the virus that comes into contact with cells first.

Officials have warned that many of these mutations could lead to increased antibody resistance and transmissibility, which could limit the effectiveness of Covid vaccines.

“The molecular profile of the types of mutations you see (in Omicron) suggests that they may be more transmissible and elude some of the protection offered by vaccines,” Fauci said Wednesday. “But we don’t know that now.”

He said we need to prepare that immun protection from vaccines and recovery from Covid against Omicron could be diminished and stressed the need for boosters.

Dr. Angelique Coetzee, Chair of the South African Medical Association, described the symptoms associated with Omicron as “extremely mild” until now. However, Bancel cautioned that the symptoms reported in South Africa may not be a good predictor of the variant’s virulence, with less than 5% of the population being over 60 and far fewer comorbidities than in the US and Europe, where people do tend to get older and sicker.

“I think today it’s really impossible to know … I don’t think what is going to happen in South Africa in the next week or two will predict the full virulence of a virus,” said Bancel.

Drug manufacturers have responded quickly to the new variant. Pfizer and BioNTech said they could study Omicron and adjust their vaccine if necessary. Johnson & Johnson said it was already testing its vaccine against the variant. Modern said it would test three booster candidates against Omicron, including a higher dose of its original Covid booster. The company also said it will develop a booster dose specific to the variant.

For Americans going on vacation, they should still feel safe after Fauci celebrating indoors with the vaccinated family and friends.

“You can feel safe without wearing a mask and having dinner or a reception,” he said. “But if you are in a public gathering where you do not know the vaccination status of the people involved, it is very advisable to wear a mask.”

– CNBC’s Robert Towey and Kevin Breuninger contributed to this report.

In Alleged Well being Care ‘Cash Seize,’ Nation’s Largest Hospital Chain Cashes In on Trauma Facilities

After falling from a ladder and cutting his arm, Ed Knight said, he found himself at Richmond, Virginia’s Chippenham Hospital surrounded by nearly a dozen doctors, nurses and technicians — its crack “trauma team” charged with saving the most badly hurt victims of accidents and assaults.

But Knight’s wound, while requiring about 30 stitches, wasn’t life-threatening. Hospital records called it “mild.” The people in white coats quickly scattered, he remembered, and he went home about three hours later.

“Basically, it was just a gash on my arm,” said Knight, 71. “The emergency team that they assembled didn’t really do anything.”

Nevertheless, Chippenham, owned by for-profit chain HCA Healthcare, included a $17,000 trauma team “activation” fee on Knight’s bill, which totaled $52,238 and included three CT scans billed at $14,000. His care should have cost closer to $3,500 total, according to claims consultant WellRithms, which analyzed the charges for KHN.

HCA Healthcare’s activation fees run as high as $50,000 per patient and are sometimes 10 times greater than those at other hospitals, according to publicly posted price lists. Such charges have made trauma centers, once operated mainly by established teaching hospitals, a key part of the company’s growth and profit-generating strategy, corporate officials have said. HCA’s stock has doubled in three years. The biggest U.S. hospital operator along with the Department of Veterans Affairs, HCA has opened trauma centers in more than half its 179 hospitals and says it runs 1 of every 20 such facilities in the country.

And it’s not slowing down.

HCA “has basically taken a position that all of their hospitals should be trauma centers,” said Dr. Robert Winchell, describing conversations he had with HCA officials. Winchell is a trauma surgeon and former chairman of the trauma evaluation and planning committee at the American College of Surgeons.

Trauma patients are typically those severely injured in automobile accidents or falls or wounded by knives or guns.

State or local regulators confer the designation “trauma center,” often in concert with standards verified by the American College of Surgeons. The status allows a cascade of lucrative reimbursement, including activation fees billed on top of regular charges for medical care. Trauma centers are mostly exempt from 1970s-era certificate-of-need laws enacted to limit excessive hospital spending and expansion. The bills for all this — reaching into tens of thousands of dollars — go to private insurers, Medicare or Medicaid, or patients themselves.

“Once a hospital has a trauma designation, it can charge thousands of dollars in activation fees for the same care seen in the same emergency room,” said Stacie Sasso, executive director of the Health Services Coalition, made up of unions and employers fighting trauma center expansion by HCA and others in Nevada.

HCA’s expansion into trauma centers alarms health policy analysts who suggest its motive is more about chasing profit than improving patient care. Data collected by the state of Florida, analyzed by KHN, shows that regional trauma cases and expensive trauma bills rise sharply after HCA opens such centers, suggesting that many patients classified as trauma victims would have previously been treated less expensively in a regular emergency room.

Patients admitted to HCA and other for-profit hospitals in Florida with a trauma-team activation were far more likely to be only mildly or moderately injured than those at not-for-profit hospitals, researchers have found.

HCA is “cherry-picking patients,” said Ed Jimenez, CEO of the University of Florida Health Shands, which runs a Level I trauma center, the highest designation. “What you find is an elderly person who fell and broke their hip who could be perfectly well treated at their local hospital now becomes a trauma patient.”

HCA’s trauma center expansion makes superior care available to more patients, providing “lifesaving clinical services while treating all critically injured patients,” said company spokesperson Harlow Sumerford.

Richmond’s population “is booming,” said Chippenham spokesperson Jeffrey Caldwell. “This increase in demand requires that the regional health care system keep up.”

Trauma Is Big Business

HCA’s trauma center boom picked up speed in Florida a decade ago and has spread to its hospitals in Virginia, Nevada, Texas and other states. It has sparked fierce fights over who handles highly profitable trauma cases and debates over whether costs will soar and care suffer when rival centers go head-to-head competing for patients.

“There’s no question it’s a money grab” by HCA, said Jimenez, who was part of a largely unsuccessful effort to stop HCA’s trauma center expansion in Florida. “It was clear that their trauma activation fees were five or six times larger than ours.”

In a process shielded from public view in Virginia, Chippenham recently applied for and won the highest trauma center designation, Level I, providing the most sophisticated care — and putting it squarely in competition with nearby VCU Health. VCU has run the region’s only Level I facility for decades. In October, Chippenham announced a contract for its own helicopter ambulance, which gives it another way to increase its trauma business, by flying patients in from miles away. The Virginia Department of Health rejected KHN’s request to review HCA’s Chippenham trauma center application and related documents.

“This is a corporate strategy” by HCA “to grow revenue, maximize reimbursement and meet the interest of stockholders,” said Dr. Arthur Kellermann, CEO of VCU Health, who says his nonprofit, state-run facility is sufficient for the region’s trauma care needs. “Many people in the state should be concerned that the end result will be a dilution of care, higher costs and poorer outcomes.”

Chippenham’s Caldwell said the “redundancy” with VCU “allows the region to be better prepared for mass trauma events.”

Studies show trauma centers need high volumes of complex cases to stay sharp. Researchers call it the “practice makes perfect” effect. Patients treated for traumatic brain injuries at hospitals seeing fewer than six such cases a year died at substantially higher rates than such patients in more experienced hospitals, according to a 2013 study published in the Journal of Neurosurgery.

Another study, published in the Annals of Surgery, showed that a decrease as small as 1% in trauma center volume — because of competition or other reasons — substantially increased the risk that patients would die.

By splitting a limited number of cases, a competing, cross-town trauma center could set the stage for subpar results at both hospitals, goes the argument. The number of VCU’s admitted adult trauma patients decreased from nearly 3,600 in 2014, before Chippenham attained Level II status, to 3,200 in 2019, VCU officials said.

Chippenham was the only Level I center in Virginia that declined to disclose its trauma patient volume to KHN.

“People are trying to push the [trauma center] designation process beyond what may be good for the major hospitals that are already providing trauma care,” said Dr. David Hoyt, executive director of the American College of Surgeons, speaking generally. Local authorities who make those decisions, he said, can be “pressured by a hospital system that has a lot of economic pull in a community.”

Unlike regular emergency departments, Level I and Level II trauma centers make trauma surgeons, neurosurgeons and special equipment available round-the-clock. Centers with Levels III or IV designations offer fewer services but are still more capable than many emergency rooms, with round-the-clock lab services and extra training, for example.

Hospitals defend trauma team activation fees as necessary to cover the overhead of having a team of elite emergency specialists at the ready. At HCA hospitals they can run more than $40,000 per case, according to publicly posted charge lists, although the amount paid by insurers and patients is often less, depending on the coverage.

“Fees associated with trauma activation are based on our costs to immediately deploy lifesaving resources and measures 24/7,” said HCA spokesperson Sumerford, adding that low-income and uninsured patients often pay nothing for trauma care. “What patients actually pay for their hospital care has more to do with their insurance plan” than the total charges, he said.

There is no standard accounting for trauma-related costs incurred by hospitals. One method involves multiplying hourly pay for members of the trauma team by the potential hours worked. Hospitals don’t reveal calculations, but the wide variation in fees suggests they are often set with an eye on revenue rather than true costs, say industry analysts.

Reasonable charges for Knight’s total bill would have been $3,537, not $52,238, according to the analysis by WellRithms, a claims consulting firm that examined his medical records and Chippenham’s costs filed with Medicare. Given his minor injury, the $17,000 trauma activation fee “is not necessary,” said Dr. Ira Weintraub, WellRithms’ chief medical officer.

Often insurers pay substantially less than billed charges, especially Medicare, Knight’s insurer. He paid nothing out-of-pocket, and Chippenham collected a total of $1,138 for his care, HCA officials said after this article was initially published. But hospitals can maximize revenue by charging high trauma fees to all insurers, including those required to pay a percentage of charges, say medical billing consultants.

VCU Health charges up to $13,455 for trauma activation, according to its charge list.

Average HCA trauma activation charges are $26,000 in states where the company does business — three times higher than those of non-HCA hospitals, according to data from Hospital Pricing Specialists, a consulting firm that analyzed trauma charges in Medicare claims for KHN.

The findings are similar to those reported by the Tampa Bay Times in 2014, early in HCA’s trauma center expansion. The Times found that Florida HCA trauma centers were charging patients and insurers tens of thousands of dollars more per case than other hospitals.

Treating trauma patients in the ER is only the beginning of the revenue stream. Intensive inpatient treatment and long patient recoveries add to the income.

“We have more Level I, Level II trauma centers today than we have ever had in the company history,” HCA’s then-CEO, Milton Johnson, told stock analysts in 2016. “That strategy in turn feeds surgical growth. That strategy in turn feeds neurosciences growth, it feeds rehab growth.” Trauma centers attract “a certain cadre of high-value patients,” Dr. Jonathan Perlin, HCA’s chief medical officer, told analysts at a 2017 conference.

Patients at HCA’s largely suburban hospitals are more likely than those at an average hospital to carry private insurance, which pays much more than Medicare and Medicaid. More than half the company’s revenue in 2020 came from private insurers, regulatory filings show. Hospitals, in general, collect a little more than a third of their revenue from private insurers, according to the Department of Health and Human Services.

HCA’s trauma cases can fit the same profile. At Chippenham, in south Richmond, trauma cases are “90% blunt trauma,” according to the hospital’s online job posting last year for a trauma medical director. Blunt-trauma patients are generally victims of car accidents and falls and tend to have good insurance, analysts say.

VCU and other urban hospitals, on the other hand, treat a higher share of patients with gun and knife injuries — penetrating trauma — who are more often uninsured or covered by Medicaid. About 75% of VCU’s trauma cases are classified as blunt trauma, hospital officials said.

The 90% figure is “not accurate today,” Caldwell said. “Chippenham’s current mix of trauma type is aligned with that of other trauma centers in the region, and we treat traumas ranging from motor vehicle accidents to gunshots, stabbings and other critical injuries regularly.”

‘Trauma Drama’ in Florida and Beyond

HCA’s growth strategy is part of a wider trend. From 2010 to 2020 the number of Level I and Level II trauma centers verified by the American College of Surgeons nationwide increased from 343 to 567.

Nowhere has HCA added trauma centers more aggressively or the fight over trauma center growth been more acrimonious than in Florida. The state’s experience over the past decade may offer a preview of what’s to come in Virginia and elsewhere.

In the thick of the controversy, legislators stepped in to broker a 2018 truce — but only after the number of HCA trauma centers in the state had grown from one to 11 over more than a decade and helped spark an explosion in trauma cases, according to Florida Department of Health data.

News headlines called it “trauma drama.” Hospitals with existing centers repeatedly filed legal challenges to stop the expansion, with little effect. Florida’s governor at the time was Rick Scott, former chief executive of Columbia/HCA, a predecessor company to HCA.

After launching Level II centers across the state, HCA officials urged Florida regulators not to adopt CDC guidelines recommending severely injured patients be treated at the highest level of trauma care in a region — Level I, if available.

HCA “kept on working, working, working, working for 10 years” to gain trauma center approvals over objections, said Mark Delegal, who helped broker the legislative settlement as a lobbyist for large safety-net hospitals. “Once they had what they wanted, they were happy to lock the door behind them.”

HCA hospitals “serve the health care needs of their communities and adjust or expand services as those needs evolve,” said Sumerford.

As HCA added trauma centers, trauma-activation billings and the number of trauma cases spiked, according to Florida Department of Health data analyzed by KHN. Statewide, inpatient trauma cases doubled to 35,102 in the decade leading up to 2020, even though the population rose by only 15%. HCA’s share of statewide trauma cases jumped from 4% to 24%, the data shows.

Charges for trauma activations, also known as trauma alerts, for HCA’s Florida hospitals averaged $26,890 for inpatients in 2019 while the same fees averaged $9,916 for non-HCA Florida hospitals, the data shows. Total average charges, including medical care, were $282,600 per case in 2019 for inpatient trauma cases at HCA hospitals, but $139,000 for non-HCA hospitals.

HCA’s substantially higher charges didn’t necessarily result from patients with especially severe injuries, public university research found.

Over three years ending in 2014, Florida patients with sprains, mild cuts and other non-life-threatening injuries were “significantly more likely” to be admitted under trauma alerts at HCA hospitals and other for-profit hospitals than at nonprofit hospitals, according to research by University of South Florida economist Etienne Pracht and colleagues. HCA hospitals have admitted emergency department Medicare patients at substantially higher-than-average rates since 2011, suggesting that at other hospitals many would have been sent home, new research by the Service Employees International Union found.

“What’s going on with HCA is the Wall Street model they’re following,” said Pracht, who provided KHN with additional Florida Department of Health data showing soaring trauma cases. “And Wall Street’s not happy unless you’re expanding. They’re driven by the motive to keep the stock price high.”

Lobbying and Campaign Dollars

In Virginia, health care organizations need to go through a lengthy and public application process to add something as basic as a $1 million MRI imaging machine.

But to open or upgrade a trauma center, all that’s needed is the approval of the health commissioner after a confidential qualification procedure. Chippenham did not seek or obtain Level I verification from the American College of Surgeons before getting Level I approval from the state. It is ACS-verified as a Level II center and, Caldwell said, is seeking Level I status with ACS.

Virginia requires an “extensive application” and “in-depth” site reviews by experts before a hospital gains status as a trauma center, Dr. M. Norman Oliver, the commissioner, said in an email. “Chippenham Hospital met the requirements” to become a Level I center, he said.

Nearly 80% of HCA’s Level I and Level II trauma centers have been verified by the American College of Surgeons “and the others currently are pursuing this verification,” said HCA spokesperson Sumerford.

As in other states, HCA invests heavily in Virginia in political influence. Eleven Virginia lobbyists are registered with the state to advocate on HCA’s behalf. One lobbyist spent more than $5,000 from December 2019 through February 2020 treating public officials to reception spreads and meals at posh Richmond restaurants such as L’Opossum and Morton’s the Steakhouse, lobbying records submitted to Virginia’s Conflict of Interest and Ethics Advisory Council show. HCA’s political action committee donated $160,000 to state candidates last year, according to the records.

Like other hospital systems, HCA hires former paramedics for “EMS relations” or “EMS outreach” jobs. HCA’s EMS liaisons are expected to develop a “business plan, driving service line growth,” according to its employment ads.

Chippenham’s decision to start a helicopter ambulance operation last year to compete with others in transporting trauma patients surprised some public officials. HCA and its contractor had filed paperwork for the operation to be reimbursed by insurers when Richmond City Council members learned about it. Members “were not up to speed on this matter,” council member Kristen Larson told a May 2020 meeting of the Richmond Ambulance Authority, according to the minutes.

Chippenham’s air ambulance partner, private equity-owned Med-Trans, has been the subject of numerous media reports of patients saddled with tens of thousands of dollars in out-of-network surprise bills. It’s not unusual for air ambulances to charge $30,000 or more for transporting a patient from a highway accident or just across town, according to news reports.

Last year, 85% of Med-Trans flights for Virginia patients with health insurance were in-network, said a company spokesperson. But Med-Trans is out of network for Virginia members of Aetna and UnitedHealthcare, two of the state’s biggest carriers, said spokespeople for those companies. Med-Trans is part of Anthem Blue Cross Blue Shield’s network, an Anthem spokesperson said.

HCA runs trauma centers “really well,” said Winchell, who runs the Level I trauma center at NewYork-Presbyterian Weill Cornell Medical Center.

But “there are clearly areas of oversupply” for trauma centers generally, he said.

Instead of letting a drive for profits dictate trauma center expansion, health authorities need “objective and transparent metrics” to guide the designation of trauma centers, Winchell recently wrote in the Journal of the American College of Surgeons.

Free-market advocate “Adam Smith might have been a good economist,” he wrote, “but he would have been a very poor designer of trauma systems.”

KHN data editor Elizabeth Lucas contributed to this report.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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In alleged well being care ‘cash seize,’ nation’s largest hospital chain cashes in on trauma facilities

After falling from a ladder and cutting his arm, Ed Knight said he found himself at Richmond’s Chippenham Hospital surrounded by nearly a dozen doctors, nurses and technicians — its crack “trauma team” charged with saving the most badly hurt victims of accidents and assaults.

But Knight’s wound, while requiring about 30 stitches, wasn’t life-threatening. Hospital records called it “mild.” The people in white coats quickly scattered, he remembered, and he went home about three hours later.

“Basically, it was just a gash on my arm,” said Knight, 71. “The emergency team that they assembled didn’t really do anything.”

Nevertheless, Chippenham, owned by for-profit chain HCA Healthcare, included a $17,000 trauma team “activation” fee on Knight’s bill, which totaled $52,238 and included three CT scans billed at $14,000. His care should have cost closer to $3,500 total, according to claims consultant WellRithms, which analyzed the charges for KHN.

Ed Knight was taken to Chippenham Hospital after cutting his arm in a fall from a ladder. For stitching up Knight's wound and sending him home after a few hours, Chippenham Hospital's charges exceeded $50,000, according to a claims document in the case.Ed Knight was taken to Chippenham Hospital after cutting his arm in a fall from a ladder. For stitching up Knight’s wound and sending him home after a few hours, Chippenham Hospital’s charges exceeded $50,000, according to a claims document in the case. [ JULIA RENDLEMAN | Julia Rendleman for Kaiser Health News ]

HCA Healthcare’s activation fees run as high as $50,000 per patient and are sometimes 10 times greater than those at other hospitals, according to publicly posted price lists. Such charges have made trauma centers, once operated mainly by established teaching hospitals, a key part of the company’s growth and profit-generating strategy, corporate officials have said. HCA’s stock has doubled in three years.

The biggest U.S. hospital operator along with the Department of Veterans Affairs, HCA has opened trauma centers in more than half its 179 hospitals. It operates trauma centers at 11 of its more than 40 Florida hospitals and says it runs 1 of every 20 such facilities in the country.

And it’s not slowing down.

HCA “has basically taken a position that all of their hospitals should be trauma centers,” said Dr. Robert Winchell, describing conversations he had with HCA officials. Winchell is a trauma surgeon and former chairman of the trauma evaluation and planning committee at the American College of Surgeons.

Average HCA trauma activation charges are $26,000 in states where the company does business — three times higher than those of non-HCA hospitals, according to data from Hospital Pricing Specialists, a consulting firm that analyzed trauma charges in Medicare claims for KHN.

The findings are similar to those reported by the Tampa Bay Times in 2014, early in HCA’s trauma center expansion. The Times found that Florida HCA trauma centers were charging patients and insurers tens of thousands of dollars more per case than other hospitals.

Related: How HCA turned trauma into a money-maker

Trauma patients are typically those severely injured in automobile accidents or falls or wounded by knives or guns.

State or local regulators confer the designation “trauma center,” often in concert with standards verified by the American College of Surgeons. The status allows a cascade of lucrative reimbursement, including activation fees billed on top of regular charges for medical care. Trauma centers are mostly exempt from 1970s-era certificate-of-need laws enacted to limit excessive hospital spending and expansion. The bills for all this — reaching into tens of thousands of dollars — go to private insurers, Medicare or Medicaid, or patients themselves.

“Once a hospital has a trauma designation, it can charge thousands of dollars in activation fees for the same care seen in the same emergency room,” said Stacie Sasso, executive director of the Health Services Coalition, made up of unions and employers fighting trauma center expansion by HCA and others in Nevada.

HCA’s expansion into trauma centers alarms health policy analysts who suggest its motive is more about chasing profit than improving patient care. Data collected by the state of Florida, analyzed by KHN, shows that regional trauma cases and expensive trauma bills rise sharply after HCA opens such centers, suggesting that many patients classified as trauma victims would have previously been treated less expensively in a regular emergency room.

Patients admitted to HCA and other for-profit hospitals in Florida with a trauma-team activation were far more likely to be only mildly or moderately injured compared with those at not-for-profit hospitals, researchers have found.

HCA is “cherry-picking patients,” said Ed Jimenez, CEO of the University of Florida Health Shands, which runs a Level I trauma center, the highest designation. “What you find is an elderly person who fell and broke their hip who could be perfectly well treated at their local hospital now becomes a trauma patient.”

HCA’s trauma center expansion makes superior care available to more patients, providing “lifesaving clinical services while treating all critically injured patients,” said company spokesperson Harlow Sumerford.

Richmond’s population “is booming,” said Chippenham spokesperson Jeffrey Caldwell. “This increase in demand requires that the regional health care system keep up.”

Trauma is big business

HCA’s trauma center boom picked up speed in Florida a decade ago and has spread to its hospitals in Virginia, Nevada, Texas and other states. It has sparked fierce fights over who handles highly profitable trauma cases and debates over whether costs will soar and care suffer when rival centers go head-to-head competing for patients.

“There’s no question it’s a money grab” by HCA, said Jimenez, who was part of a largely unsuccessful effort to stop HCA’s trauma center expansion in Florida. “It was clear that their trauma activation fees were five or six times larger than ours.”

In a process shielded from public view in Virginia, Chippenham recently applied for and won the highest trauma center designation, Level I, providing the most sophisticated care — and putting it squarely in competition with nearby VCU Health. VCU has run the region’s only Level I facility for decades. In October, Chippenham announced a contract for its own helicopter ambulance, which gives it another way to increase its trauma business by flying patients in from miles away. The Virginia Department of Health rejected KHN’s request to review HCA’s Chippenham trauma center application and related documents.

“This is a corporate strategy” by HCA “to grow revenue, maximize reimbursement and meet the interest of stockholders,” said Dr. Arthur Kellermann, CEO of VCU Health, who says his nonprofit, state-run facility is sufficient for the region’s trauma care needs. “Many people in the state should be concerned that the end result will be a dilution of care, higher costs and poorer outcomes.”

Chippenham’s Caldwell said the “redundancy” with VCU “allows the region to be better prepared for mass trauma events.”

Studies show trauma centers need high volumes of complex cases to stay sharp. Researchers call it the “practice makes perfect” effect. Patients treated for traumatic brain injuries at hospitals seeing fewer than six such cases a year died at substantially higher rates than such patients in more experienced hospitals, according to a 2013 study published in the Journal of Neurosurgery.

Another study, published in the Annals of Surgery, showed that a decrease as small as 1% in trauma center volume — because of competition or other reasons — substantially increased the risk that patients would die.

By splitting a limited number of cases, a competing, cross-town trauma center could set the stage for subpar results at both hospitals, goes the argument. The number of VCU’s admitted adult trauma patients decreased from nearly 3,600 in 2014, before Chippenham attained Level II status, to 3,200 in 2019, VCU officials said.

Chippenham was the only Level I center in Virginia that declined to disclose its trauma patient volume to KHN.

“People are trying to push the [trauma center] designation process beyond what may be good for the major hospitals that are already providing trauma care,” said Dr. David Hoyt, executive director of the American College of Surgeons, speaking generally. Local authorities who make those decisions, he said, can be “pressured by a hospital system that has a lot of economic pull in a community.”

Unlike regular emergency departments, Level I and Level II trauma centers make trauma surgeons, neurosurgeons and special equipment available around the clock. Centers with Levels III or IV designations offer fewer services but are still more capable than many emergency rooms, with round-the-clock lab services and extra training, for example.

Hospitals defend trauma team activation fees as necessary to cover the overhead of having a team of elite emergency specialists at the ready. At HCA hospitals they can run more than $40,000 per case, according to publicly posted charge lists, although the amount paid by insurers and patients is often less, depending on the coverage.

“Fees associated with trauma activation are based on our costs to immediately deploy lifesaving resources and measures 24/7,” said HCA spokesperson Sumerford, adding that low-income and uninsured patients often pay nothing for trauma care. “What patients actually pay for their hospital care has more to do with their insurance plan” than the total charges, he said.

There is no standard accounting for trauma-related costs incurred by hospitals. One method involves multiplying hourly pay for members of the trauma team by the potential hours worked. Hospitals don’t reveal calculations, but the wide variation in fees suggests they are often set with an eye on revenue rather than true costs, say industry analysts.

Reasonable charges for Knight’s total bill would have been $3,537, not $52,238, according to the analysis by WellRithms, a claims consulting firm that examined his medical records and Chippenham’s costs filed with Medicare. Given his minor injury, the $17,000 trauma activation fee “is not necessary,” said Dr. Ira Weintraub, WellRithms’ chief medical officer.

Often insurers pay substantially less than billed charges, especially Medicare, Knight’s insurer. He paid nothing out-of-pocket, and Chippenham collected a total of $1,138 for his care, HCA officials said after this article was initially published. But hospitals can maximize revenue by charging high trauma fees to all insurers, including those required to pay a percentage of charges, say medical billing consultants.

VCU Health charges up to $13,455 for trauma activation, according to its charge list.

Average HCA trauma activation charges are $26,000 in states where the company does business — three times higher than those of non-HCA hospitals, according to data from Hospital Pricing Specialists, a consulting firm that analyzed trauma charges in Medicare claims for KHN.

Treating trauma patients in the ER is only the beginning of the revenue stream. Intensive inpatient treatment and long patient recoveries add to the income.

“We have more Level I, Level II trauma centers today than we have ever had in the company history,” HCA’s then-CEO, Milton Johnson, told stock analysts in 2016. “That strategy in turn feeds surgical growth. That strategy in turn feeds neurosciences growth, it feeds rehab growth.” Trauma centers attract “a certain cadre of high-value patients,” Dr. Jonathan Perlin, HCA’s chief medical officer, told analysts at a 2017 conference.

Patients at HCA’s largely suburban hospitals are more likely than those at an average hospital to carry private insurance, which pays much more than Medicare and Medicaid. More than half the company’s revenue in 2020 came from private insurers, regulatory filings show. Hospitals, in general, collect a little more than a third of their revenue from private insurers, according to the Department of Health and Human Services.

HCA’s trauma cases can fit the same profile. At Chippenham, in south Richmond, trauma cases are “90% blunt trauma,” according to the hospital’s online job posting last year for a trauma medical director. Blunt-trauma patients are generally victims of car accidents and falls and tend to have good insurance, analysts say.

VCU and other urban hospitals, on the other hand, treat a higher share of patients with gun and knife injuries — penetrating trauma — who are more often uninsured or covered by Medicaid. About 75% of VCU’s trauma cases are classified as blunt trauma, hospital officials said.

The 90% figure is “not accurate today,” Caldwell said. “Chippenham’s current mix of trauma type is aligned with that of other trauma centers in the region, and we treat traumas ranging from motor vehicle accidents to gunshots, stabbings and other critical injuries regularly.”

‘Trauma drama’ in Florida and beyond

HCA’s growth strategy is part of a wider trend. From 2010 to 2020 the number of Level I and Level II trauma centers verified by the American College of Surgeons nationwide increased from 343 to 567.

Nowhere has HCA added trauma centers more aggressively or the fight over trauma center growth been more acrimonious than in Florida. The state’s experience over the past decade may offer a preview of what’s to come in Virginia and elsewhere.

In the thick of the controversy, legislators stepped in to broker a 2018 truce — but only after the number of HCA trauma centers in the state had grown from one to 11 over more than a decade and helped spark an explosion in trauma cases, according to Florida Department of Health data.

News headlines called it “trauma drama.” Hospitals with existing centers repeatedly filed legal challenges to stop the expansion, with little effect. Florida’s governor at the time was Rick Scott, former chief executive of Columbia/HCA, a predecessor company to HCA.

After launching Level II centers across the state, HCA officials urged Florida regulators not to adopt CDC guidelines recommending severely injured patients be treated at the highest level of trauma care in a region — Level I, if available.

HCA “kept on working, working, working, working for 10 years” to gain trauma center approvals over objections, said Mark Delegal, who helped broker the legislative settlement as a lobbyist for large safety-net hospitals. “Once they had what they wanted, they were happy to lock the door behind them.”

HCA hospitals “serve the health care needs of their communities and adjust or expand services as those needs evolve,” said Sumerford.

As HCA added trauma centers, trauma-activation billings and the number of trauma cases spiked, according to Florida Department of Health data analyzed by KHN. Statewide, inpatient trauma cases doubled to 35,102 in the decade leading up to 2020, even though the population rose by only 15%. HCA’s share of statewide trauma cases jumped from 4% to 24%, the data shows.

Charges for trauma activations, also known as trauma-alerts, for HCA’s Florida hospitals averaged $26,890 for inpatients in 2019 while the same fees averaged $9,916 for non-HCA Florida hospitals, the data shows. Total average charges, including medical care, were $282,600 per case in 2019 for inpatient trauma cases at HCA hospitals, but $139,000 for non-HCA hospitals.

HCA’s substantially higher charges didn’t necessarily result from patients with especially severe injuries, public university research found.

Over three years ending in 2014, Florida patients with sprains, mild cuts and other non-life-threatening injuries were “significantly more likely” to be admitted under trauma alerts at HCA hospitals and other for-profit hospitals than at nonprofit hospitals, according to research by University of South Florida economist Etienne Pracht and colleagues. HCA hospitals have admitted emergency department Medicare patients at substantially higher-than-average rates since 2011, suggesting that at other hospitals many would have been sent home, new research by the Service Employees International Union found.

“What’s going on with HCA is the Wall Street model they’re following,” said Pracht, who provided KHN with additional Florida Department of Health data showing soaring trauma cases. “And Wall Street’s not happy unless you’re expanding. They’re driven by the motive to keep the stock price high.”

Lobbying and Campaign Dollars

In Virginia, health care organizations need to go through a lengthy and public application process to add something as basic as a $1 million MRI imaging machine.

But to open or upgrade a trauma center, all that’s needed is the approval of the health commissioner after a confidential qualification procedure. Chippenham did not seek or obtain Level I verification from the American College of Surgeons before getting Level I approval from the state. It is ACS-verified as a Level II center and, Caldwell said, is seeking Level I status with ACS.

Virginia requires an “extensive application” and “in-depth” site reviews by experts before a hospital gains status as a trauma center, Dr. M. Norman Oliver, the commissioner, said in an email. “Chippenham Hospital met the requirements” to become a Level I center, he said.

Nearly 80% of HCA’s Level I and Level II trauma centers have been verified by the American College of Surgeons “and the others currently are pursuing this verification,” said HCA spokesperson Sumerford.

As in other states, HCA invests heavily in Virginia in political influence. Eleven Virginia lobbyists are registered with the state to advocate on HCA’s behalf. One lobbyist spent more than $5,000 from December 2019 through February 2020 treating public officials to reception spreads and meals at posh Richmond restaurants such as L’Opossum and Morton’s the Steakhouse, lobbying records submitted to Virginia’s Conflict of Interest and Ethics Advisory Council show. HCA’s political action committee donated $160,000 to state candidates last year, according to the records.

Like other hospital systems, HCA hires former paramedics for “EMS relations” or “EMS outreach” jobs. HCA’s EMS liaisons are expected to develop a “business plan, driving service line growth,” according to its employment ads.

Chippenham’s decision to start a helicopter-ambulance operation last year to compete with others in transporting trauma patients surprised some public officials. HCA and its contractor had filed paperwork for the operation to be reimbursed by insurers when Richmond City Council members learned about it. Members “were not up to speed on this matter,” councilwoman Kristen Larson told a May 2020 meeting of the Richmond Ambulance Authority, according to the minutes.

Chippenham’s air ambulance partner, private equity-owned Med-Trans, has been the subject of numerous media reports of patients saddled with tens of thousands of dollars in out-of-network surprise bills. It’s not unusual for air ambulances to charge $30,000 or more for transporting a patient from a highway accident or just across town, according to news reports.

Last year, 85% of Med-Trans flights for Virginia patients with health insurance were in-network, said a company spokesperson. But Med-Trans is out of network for Virginia members of Aetna and UnitedHealthcare, two of the state’s biggest carriers, said spokespeople for those companies. Med-Trans is part of Anthem Blue Cross Blue Shield’s network, an Anthem spokesperson said.

HCA runs trauma centers “really well,” said Winchell, who runs the Level I trauma center at NewYork-Presbyterian Weill Cornell Medical Center.

But “there are clearly areas of oversupply” for trauma centers generally, he said.

Instead of letting a drive for profits dictate trauma center expansion, health authorities need “objective and transparent metrics” to guide the designation of trauma centers, Winchell recently wrote in the Journal of the American College of Surgeons.

Free-market advocate “Adam Smith might have been a good economist,” he wrote, “but he would have been a very poor designer of trauma systems.”

KHN data editor Elizabeth Lucas contributed to this report.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

A European-Type United Nations by Sandra Breka & Brian Finlay

For decades, multilateralism, based on a common overarching vision, has anchored the longest period of peace and stability in Europe. This alone should qualify the European Union as a model for the renewal of the United Nations.

BERLIN / WASHINGTON, DC – Last September, the General Assembly passed a to mark the 75th anniversary of the United Nations groundbreaking declaration Reaffirm the commitment to “mobilize resources” and “show unparalleled political will and leadership” to “secure the future we want”. The so-called UN75 declaration was an inspiring statement. But will it lead to significant changes?

  1. Getty / Bettman

History suggests it could be easy. After all, past anniversaries of the founding of the United Nations have brought about significant structural reforms. For example, on the 60th anniversary of the United Nations, the heads of state and government of the world established A peacebuilding commission to help countries make the transition from war to peace has expanded the human rights commission into a stronger human rights council and adopted the “Responsibility to Protect” doctrine to protect civilians in conflict areas.

The prospects of the UN75 declaration are further enhanced by the fact that it reflects the will of civil society. Before last year’s General Assembly, the United Nations launched a global survey to see what ordinary people care about. Of more than 1.3 million respondents, 87% said that international cooperation is critical to addressing today’s challenges.

The UN also supported more than 3,000 dialogues in 120 countries on “the future we want, the UN we need”. The results of these dialogues, which took place in “classrooms, meeting rooms, parliaments and community groups”, helped shape the declaration.

At the same time, national governments have worked to revive multilateral cooperation. Federal Foreign Minister Heiko Maas and French Foreign Minister Jean-Yves Le Drian announced the Alliance for Multilateralism Promote global cooperation in a time of resurgent nationalism. The alliance is now supported by more than 50 countries.

Similarly, last February, G7 leaders, including US President Joe Biden, proclaimed that they would work together to “make 2021 a turning point for multilateralism”. Working together to recover from the pandemic and “better rebuilding” were seen as a top priority.

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In particular, the countries also support the UN75 declaration. Two months after its unanimous approval, ten heads of state or government convened by Spain and Sweden published one Joint announcement Reaffirms its commitment to the Declaration and the ambition it embodies, and calls for reforms to the three main organs of the United Nations to create a “more agile, effective and accountable organization” capable of delivering “better” results.

All of these bode well for the future of multilateralism. However, turning words into actions is seldom easy, especially when it comes to so many actors with competing visions and interests. Given the nationalist and populist forces that are powerful in many parts of the world, the challenge ahead is all the greater. To do this, we should look to Europe.

The European Union has been a staunch advocate of multilateralism. In February, for example, the European Commission and the EU High Representative for Foreign Affairs and Security Policy Josep Borrell, issued a common communication to strengthen the EU’s contribution to rules-based multilateralism.

Likewise the Federal Chancellor Angela Merkel, French President Emmanuel Macron, President of the European Council Charles Micheland President of the European Commission Ursula von der Leyen joined the Secretary General of the United Nations Antonio Guterres and Senegalese President Macky sal in demand for one more inclusive multilateralism.

Europe’s leadership in this area makes sense. Although the EU is often classified as slow, risk averse and inflexible, it is characterized by its success in forging effective supranational policies and pooling resources to meet common challenges. The Europeans also particularly support international cooperation. In the UN survey, more than 90% of Europeans – a few percentage points above the global average – described international cooperation as “very important” or “essential”.

Building on Europe’s example of active multilateralism, our organizations, Robert Bosch Stiftung GmbH and the Stimson Center, along with other partners, recently brought together leading policy makers and experts from Europe and around the world to discuss how the UN75 Declaration will become a reality can. We identified several Key requirements.

For example, to ease pressure on the UN Security Council and the global humanitarian system, world leaders must take action to address the root causes of conflict. This means, for example, ensuring that basic social needs are met; Improving representation in politics; and strengthening national and regional government institutions.

Additionally, we need to address the “knowledge crisis” – including growing skepticism about science – that is undermining COVID-19 vaccination programs and climate mitigation efforts. This can be achieved through international and national campaigns that promote trust and combat disinformation.

A third need is to change the architecture and approach of global and regional financial institutions to fill gaps in digital participation, strengthen education, and make progress towards gender equality. Reforms of the legal and normative framework conditions are just as critical – in order to meet the challenges of today’s online and offline world.

Multilateral solutions can be difficult to develop, agree on and implement. This can make them appear inefficient and inefficient, with actors assuming they are better off doing it on their own. And yet, as Europe has shown time and again, the solutions forged from multilateral processes tend to be more inclusive, more effective and more lasting. Europe owes its longest period of peace and stability to these processes.

That alone should enable the EU to draw some valuable lessons for the renewal of the United Nations. An inclusive, adaptable and empowered UN, taking into account the EU’s experience, can provide a solid foundation for a rules-based international order that promotes global peace and stability while facilitating action to address common challenges. Such an institution could not be more worthy of our unwavering commitment and care.

Selena Gomez and J.Lo headline vax live performance for poor nations | Leisure




FILE – In this file photo dated January 19, 2020, Jennifer Lopez (left) and Alex Rodriguez take a selfie as they arrive at the 26th Annual Screen Actors Guild Awards at the Shrine Auditorium & Expo Hall in Los Angeles. Lopez and Rodriguez said in a statement on Saturday March 13, 2021 that reports of their breakup were inaccurate and they are working things through. A day earlier, several reports, based on anonymous sources, had said the couple had called off their two-year engagement.




FILE – Selena Gomez attends the “Dolittle” premiere in Los Angeles in this file photo taken on Jan. 11, 2020. Supported by an international concert by Gomez and headed by Jennifer Lopez, Global Citizen is launching an ambitious campaign to help medical professionals in the world’s poorest countries get COVID-19 vaccines quickly.




Selena Gomez and J.Lo do a Vax concert for poor nations

FILE – Jennifer Lopez arrives at the 25th Annual Critics’ Choice Awards at the Barker Hangar in Santa Monica, California on this January 12, 2020 file photo. Aided by an international concert hosted by Selena Gomez and conducted by Lopez, Global Citizen is unveiling an ambitious campaign to help medical professionals in the world’s poorest countries get COVID-19 vaccines quickly.

By GLENN GAMBOA AP Business Writer

NEW YORK (AP) – With the support of an international concert by Selena Gomez and headed by Jennifer Lopez, Global Citizen is unveiling an ambitious campaign to help medical professionals in the world’s poorest countries get COVID-19 vaccines quickly.

The anti-poverty organization announces the music event “VAX Live: The Concert to Unite the World” with the aim of encouraging companies and philanthropists to raise $ 22 billion for global vaccinations. The concert, which will air May 8 on ABC, CBS and FOX, as well as iHeartMedia radios and YouTube, also features the Foo Fighters, Eddie Vedder, J Balvin and HER

The acts will be recorded at SoFi Stadium in Los Angeles.

Leading up to the event, Hugh Evans, CEO of Global Citizen, highlighted the scale of the problem his organization wants to address.

“There are 27 million healthcare workers worldwide who do not have access to the vaccine,” Evans told The Associated Press. “I’m 38 years old and it’s not ethical for me to have access to the vaccine in front of these heroic first responders.” So we need governments urgently to start donating these cans. “

The Global Citizen program is part of a growing network of nonprofits and activists who seek wider and fairer distribution of COVID-19 vaccines. As of this month, Evans said 60 nations had not received COVID-19 vaccines.

U.S. joins 13 different nations in criticizing WHO’s China Covid report

This photo taken on Feb. 17, 2020 shows medical workers working at an exhibition center that has been converted into a hospital in Wuhan, central China’s Hubei Province.

STR | AFP via Getty Images

WASHINGTON – The United States signed a joint statement with 13 other nations on Tuesday criticizing the World Health Organization’s long-awaited report on the origins of Covid-19.

In one Joint announcementThe governments of Australia, Canada, the Czech Republic, Denmark, Estonia, Israel, Japan, Latvia, Lithuania, Norway, South Korea, Slovenia, the United Kingdom and the United States wrote that the report “was significantly delayed and not given access to full Original data and samples. “

“In the event of a major outbreak of an unknown pandemic pathogen, rapid, independent, expert-led and unhindered origin assessment is critical to better prepare our employees, our public health facilities, our industries and our governments for a successful response to it Outbreak and prevent future pandemics, “the joint statement said.

“In the future, WHO and all Member States must reassign themselves to access, transparency and timeliness,” the group added.

While The WHO’s 120-page report, published Tuesday and produced by a team of international scientists, helped improve the scientific community’s understanding of the deadly virus that struck the globe.

“We have not yet found the source of the virus and we must continue to follow science and leave no stone unturned,” said WHO Director General Tedros Adhanom Ghebreyesus said during a press conference on Tuesday.

“Finding the source of a virus takes time and we owe it to the world to find the source so we can take action together to reduce the risk of its recurrence. No single research trip can provide all the answers,” he added .

At the White House, press secretary Jen Psaki told reporters that the Biden administration is still examining the WHO report, adding that the results are “partial and incomplete”.

“The report lacks critical data, information and access. It presents a partial and incomplete picture,” said Psaki. “There is a second phase in this process that we believe should be led by international and independent experts. They should have full access to data,” she added.

Psaki criticized Beijing’s lack of transparency when asked about China’s participation in the WHO report, which was attended by at least 17 experts.

“Well, they weren’t transparent. They didn’t provide any underlying data. That is certainly not a cooperation,” she said.

Wales topped Six Nations champions as Scotland stun France

Scottish full-back Stuart Hogg plays the ball during the Six Nations rugby union tournament match between France and Scotland on March 26, 2021 at the Stade de France in Saint-Denis near Paris. (Photo by Anne-Christine POUJOULAT / AFP) (Photo by ANNE-CHRISTINE POUJOULAT / AFP via Getty Images)

ANNE-CHRISTINE POUJOULAT | AFP | Getty Images

Wales were crowned six-nation champions after Scotland won an impressive 27-23 win over France.

France had to make four tries and win by at least 21 points to win their first championship in eleven years, but they never got closer. Scotland continued to threaten excitement by nine minutes ahead of Finn Russell’s sacking.

After the clock was red and France were three points ahead, Brice Dulin decided to keep the ball in play but then conceded a penalty and the Scottish pressure finally showed when Duhan van der Merwe scored in the 84th minute for came into play second time.

It is Scotland’s first win in Paris since 1999.

Dulin, Damian Penaud and Swan Rebbadj crossed the hosts but they never looked like building the steam it took to deal a double blow to Wales after dramatically denying Wayne Pivac’s side the Grand Slam six days earlier had.

It was another rare away win for the Scots after triumphs in Wales and England in the past six months.

Scotland put pressure on quickly and France showed the kind of ambition it needed when making a quick throw and trying to play their way out of trouble after Russell made contact with the ball two meters from his attempt line.

The home side soon put some pressure on, but all they had to show was Romain Ntamack’s ninth-minute penalty.

Scotland soon rose to prominence, making two choices to score two penalties within the French 22. Hooker George Turner was held just in front of the line every time he attacked from the back of the lineout mouth, but Van der did
Merwe forced himself for the second time in the 15th minute.

There was a suspicion of a double move, but umpire Wayne Barnes tried without choosing to look again.

Russell added the two points and created another brilliant long kick that held out a meter from the trial line. The Scots prevailed against their opponents and Jamie Ritchie forced Dulin’s penalty, which Russell overturned to improve Scotland by seven points.

France’s players leave the pitch after winning the Six Nations rugby union match between France and Scotland on March 26, 2021 at the Stade de France in Saint-Denis near Paris. (Photo by MARTIN BUREAU / AFP) (Photo by MARTIN BUREAU / AFP via Getty Images)

MARTIN BUREAU | AFP | Getty Images

Another big kick from Stuart Hogg put France on their hindfoot but the hosts reduced the deficit when Ntamack scored a long-range penalty after a scrum violation.

The home team took the lead after half an hour and Scotland awarded a number of penalties in front of the post.

The pressure showed when Van der Merwe sold too early after a long throw from Antoine Dupont. Penaud went inside so Dulin could cross in the 36th minute and Ntamack turned brilliantly.

Hogg paid the price for conceding Scotland’s first-half penalty in the last minute, but Nick Haining stole the five-meter lineout to keep France’s lead at three at half-time.

Read more stories from Sky Sports

Scotland limited France’s goal to five points during Hogg’s Spell in Sin when Penaud picked up Virimi Vakatawa’s throw, threw the ball over Ali Price and landed in the corner.

Scotland regained control after the numbers were even. Russell kicked a penalty at close range and Sam Johnson was stopped five yards from the line after bursting forward after another successful lineout.

It was France’s turn to send out a series of penalties and David Cherry picked up a loose ball after a lineout before shooting through a gap and beyond. Russell converted to bring Scotland back to the top.

Rebbadj left over five minutes later but Ntamack missed the move and Scotland missed a good chance to qualify for a contact but Kirsch’s lineout was stolen.

Gregor Townsend’s side were still under pressure when Russell was sent off in the 71st minute after catching Dulin with an elbow near the throat trying to block the full-back.

All hopes for another stunning finish from France were dashed within two minutes when Baptiste Serin received a yellow card and Scotland decided again to push for the try instead of going over the post.

The pressure was relentless and Scotland was finally over when it found winger Van der Merwe on the left. Adam Hastings added the points to round out a dramatic championship.

CHIEF CHAT: New web site exhibits the place the cash goes for Cherokee Nation’s pandemic response | Information

The global COVID-19 pandemic has hit us all hard, but Cherokee Nation hasn’t sat back while the pandemic threatened our health and economy. With these efforts, the past year has been challenging, transformative, and ultimately hopeful.

In March 2020, the U.S. federal government passed CARES to help individuals, businesses, state and local governments, and tribes, including the Cherokee Nation, respond to the pandemic emergency. Cherokee Nation has responsibly spent more than $ 410 million of our CARES Act funds as part of our Response, Recover, and Recover spending plan.

Cherokee Nation used our funds to meet community needs such as housing, food security, and utility bill assistance. We have helped tribal people meet basic needs such as food, shelter, health care and clothing while the pandemic remains a threat. We have invested in protecting our employees from layoffs, helped Cherokee elders stay safe at home, and helped Cherokee students safely continue their education through distance learning.

We had to act quickly to get this investment into our communities, but we also want to ensure maximum transparency and accountability to the Cherokee people. It is for this reason that the Cherokee Nation Treasurer recently released the COVID-19 Report on Responding, Recovering, and Recovering Issues. It can be found at www.respondrecoverrebuild.com.

The new website is a centralized resource for Cherokees to help ensure their tribal government transparently and effectively manages coronavirus recovery funds. It shows a breakdown of spending and the number of ways tribal citizens have received assistance. We are proud to have provided direct assistants to more than 130,000 citizens and to have helped thousands through critical programs created or expanded through the CARES Act.

As we vaccinate more Cherokees and leave this pandemic behind, we will continue to provide financial transparency and open communication with our citizens. Cherokees have the right to know how aid funds are being used.

I applaud the Cherokee Nation finance team for their resilience, adaptability, and professionalism. Despite the turmoil in northeast Oklahoma and around the world last year, Cherokee Nation has remained in good financial shape.

Further highlights of the past year are:

• $ 177 million for jobs so employees never missed a paycheck or seen layoffs in the past year.

• $ 54 million to individual citizens for emergency relief, clothing assistance, supplies, and other needs.

• $ 38 million for PPE and safety supplies, including development of Cherokee Nation’s N95 and N99 mask production facilities. Once the Cherokee Nation is operational, it will be the only N99 mask manufacturer in the US.

• $ 22 million for public health infrastructures such as new health clinics for employees, expanded shelters against domestic violence, and improvements to community water pipes and water treatment.

• US $ 19 million technology grants to help students purchase the equipment they need for distance learning.

• $ 27 million to improve broadband connectivity, including shipping over 9,000 wireless wireless hotspots with one year of free service to Cherokee Nation citizens without an internet connection.

• $ 27 million for food security, including the construction of five new food distribution centers, a meat processing facility and additional refrigerated trucks.

Federal CARES law and the Cherokee Nation’s Response, Restoration and Reconstruction Plan have allowed us to invest quickly in what will help most Cherokees. We have and will continue to act urgently and consciously in how we use tribal resources and the spending report reflects this. We will continue to provide detailed information on the www.respondrecoverrebuild.com Website about our efforts to protect elders, families, jobs, education, and the health of our people until this crisis is over.