The Australian white supremacist gunman who killed 50 people in two mosques in Christchurch, New Zealand last Friday was en route to carry out a third attack when he was apprehended, police said Wednesday.Continue reading “New Zealand terrorist attack mosque shooter was on way to commit third attack when arrested by police!”
SOUTH, a restaurant and jazz venue on Philadelphia’s North Broad Street, specializes in Southern food. The menu features artisanal variations of buttermilk fried chicken, catfish, and gumbo. The kitchen is halal — no pork — and so has devised creative work-arounds: green beans are made with turkey butt instead of ham hock, for example.
Sous chef Kurt Evans was not yet born when Edna Lewis’ landmark book, “The Taste of Country Cooking,” was published in 1976. Nevertheless, it is his touchstone.
“I didn’t want to go to culinary school and do all this French cuisine,” he said while stirring a vat of grits over a low flame. “A lot of my peers – African-American chefs — don’t want to be classified as fried chicken chefs or, you know, the ham hock guy. They don’t want to be in that box. When you look at Edna Lewis’ cookbooks, Southern food is so much more than that.”
Evans keeps first-edition copies of Lewis’ books on hand at SOUTH, to consult when menu planning and to share with newbies. Last year, Evans teamed up with chef Tim Thomas to stage a multicourse dinner, “Unspoken Titans,” in homage to Lewis.
Unlike many of America’s best-known chefs, Lewis did not appear on television, perhaps because of her race or her reserved personality. The new generation of emerging chefs will not find clips of her on YouTube. She became famous – even appearing on a 2014 U.S. postage stamp – entirely through her writing.
“What got me was, I saw “Top Chef” season 14, and they did a tribute to Edna Lewis. I was into it. I couldn’t wait to see it,” said Evans. “It hurt my heart to see that all the minority chefs didn’t know who she was. You should know who Edna Lewis is.”
The TV exposure helped: Sales of “The Taste of Country Cooking” spiked after that “Top Chef” episode.
Born in 1916 in Freetown, Virginia – a small farming community established by newly emancipated former slaves after the Civil War — Lewis used food to describe a rural America in terms of natural wonder and the black community of her youth. “Country Cooking” lifted Southern cuisine out of the fryer and made it haute. Meals were dictated by seasonal availability.
“Breakfast was about the best part of the day. There was an almost mysterious feeling about passing through the night and awakening to a new day,” she wrote in “The Taste of Country Cooking,” in the spring section.
“If it was a particularly beautiful morning, it was expressed in the grace. Spring would bring our first and just about only fish – shad. It would always be served for breakfast, soaked in salt water for an hour or so, rolled in seasoned cornmeal, and fried carefully in home-rendered lard with a slice of smoked shoulder for added flavor.”
When she wrote that, Lewis had already left Freetown decades earlier for New York. There, she passed through a series of careers, from cooking for literati at Café Nicholson, to writing, to raising pheasants, to designing dresses, to opening and closing her own restaurant, and, briefly, working as a docent in the American Museum of Natural History.
For all her rhapsodies on country living, Lewis loved New York City.
“She fit perfectly and was very comfortable in the city,” said John T. Hill, who photographed Lewis for four decades. “She liked people, and she liked the energy.”
A few dozen of Hill’s photographs are on display at Haverford College, comprising an exhibition “Edna Lewis: Chef and Humanitarian.” Most of the pictures were taken in Freetown, where Lewis visited frequently, particularly for an annual reunion on Emancipation Day or Juneteenth. That day became a communal feast day for the residents of Freetown.
There are also pictures of the house built by Lewis’ grandmother, a stonemason and bricklayer who was the property of a plantation owner. Lewis never tried to hide the slavery in her family’s past.
“It’s a cultural history. She talks about her family, the environment, and how that influenced the food,” said William Williams, a humanities professor and photography curator at Haverford.
Williams, a former student of Hill at Yale, installed the exhibition in part because he finds “The Taste of Country Cooking” to be a subversive book.
“It’s subversive in that it’s not all about fancy New York or California. It’s about rural Virginia,” he said. “If you look in the magazines and books, that locale is featured, not New York.”
In writing from the perspective of her childhood growing up in Freetown, Lewis was only steps away from the plantation where her grandparents were enslaved.
Lewis’ editor, Judith Jones, once asked her why she has no Thanksgiving recipes.
“Edna Lewis’ reply was, ‘We didn’t celebrate Thanksgiving. We celebrated Emancipation Day,’” said Williams. “That’s a very subtle notion about black pride.”
In the photos, Lewis looks as fresh and bright as the tomatoes she is harvesting, and the sunflowers towering over her, and the ripe apples picked from the orchard. An accomplished seamstress, she made her own clothes: sometimes with colorful, African-inspired textiles, sometimes a plain, crisp white dress.
“The dress that she’s wearing in that field of sunflowers is a white dress – it’s a very elegant dress,” said Hill. “Curious thing is, somebody – the art director or somebody – they decided she could not be seen wearing a white dress because that signals ‘maid.’ So they changed the color of the dress to pink. Which I thought was just so beside the point, I couldn’t believe it.”
The photo exhibition is an expanded version of a show that hung last spring in “Crook’s Corner,” a restaurant in Chapel Hill, North Carolina. That was created to mark the release of a book of new essays by dozens of authors, “Edna Lewis: At the Table with an American Original,” published by the University of North Carolina Press.
Despite Pennsylvania U.S. Senator Bob Casey’s self-described “pro-life” views, he’s been able to form alliances with progressives who support abortion rights. On this episode, we talk with WHYY reporter Dave Davies to examine the tightrope act Casey walks in garnering political support as a Democrat while trying to stay true to his ideals.
The U.S. Supreme Court has declined to consider another appeal by Republican state lawmakers over this year’s changes to Pennsylvania’s congressional district map.
With the way the old districts were drawn in 2011, Republicans had such a substantial advantage that they captured nearly three-quarters of the state’s congressional delegation with a far smaller share of statewide votes – in some years, fewer than half.
These lopsided results ultimately prompted lawsuits in 2017.
And, in January, the state Supreme Court overturned that map, deeming it an unconstitutional partisan gerrymander. It then had its own expert draw up a new one that’s considered more competitive overall.
Republicans responded by trying to get a stay on the decision from the U.S. Supreme Court in hopes of preventing the new map from being in place for midterms coming up next week.
Those attempts failed.
This most recent attempt sought to get the nation’s top court to consider the matter before the 2020 election cycle.
That was rejected on Monday.
The man police said killed 11 people and wounded six others in the deadliest attack on Jews in U.S. history is facing 29 federal charges after the massacre Saturday at the Tree of Life synagogue in Pittsburgh,
Twenty-two of those charges carry a potential death penalty.
But that doesn’t necessarily mean Robert Bowers will be put to death.
Bowers is facing both state and federal charges. It’s unclear when he’ll be arraigned on the state ones, but he has already had his first hearing on federal counts.
A spokesman for the Allegheny County district attorney said it’s still possible Bowers could be prosecuted under state law — District Attorney Stephen Zappala is working with federal officials to figure that out.
Robert Dunham, with the Death Penalty Information Center in Washington, D.C., said the state versus federal distinction isn’t about severity — just the specifics of the case.
Although Pennsylvania currently has a moratorium on executions, Dunham noted, death sentences still can be handed down.
“Prosecutors still are pursuing the death penalty, and death sentences have been imposed,” he said. “It is conceivable that those death sentences will, in time, be carried out.”
Regardless of who prosecutes, Dunham advised they act with care.
“It may well be that pursuing the death penalty is not something that would honor the victims,” he said. “That’s something I think the prosecutors need to be discussing with the religious community in Pittsburgh as a whole.”
Federal prosecutors have said they plan to pursue the death penalty, and U.S. Attorney General Jeff Sessions indicated he may support it.
There have been only three federal executions since 1963. All were carried out between 2001 and 2003 in Terre Haute, Indiana.
With midterm elections a week away, political action committees that have no campaign contribution limits continue to spend heavily on both the Pa. congressional and U.S. Senate races. Since Keystone Crossroads checked last week, PAC spending went up by more than $3 million, greatly affecting some of the contests.
Eleven of the state’s 18 congressional races have attracted outside money as Pennsylvania has become a battleground for control of the U.S. House of Representatives.
Most notably, the 1st Congressional District race between incumbent Republican Brian Fitzpatrick and Democratic challenger Scott Wallace continues to attract interest from outside groups making independent expenditures.
Planned Parenthood Votes recently spent $730,000 to support Wallace, and the National Republican Congressional Committee kicked in $380,000 last week, bringing its total support for Fitzpatrick to $3.2 million.
Between this support and money spent by candidates from direct contributions, the race in the 1st Congressional District has become more expensive than the U.S. Senate race, where incumbent Democrat Bob Casey is running against Republican challenger Lou Barletta.
Of Scott Wallace’s direct contributions, $12.7 million has come from his own wallet.
Pa. 1st Congressional District
|IE Group||IE Spending|
|Planned Parenthood Votes||$1,104,351.91|
|NextGen Climate Action Committee||$218,856.75|
|America Votes Action Fund||$20,550.40|
|Total IE Spending||$1,692,799.19|
|IE Group||IE Spending|
|Congressional Leadership Fund||$3,659,558.86|
|No Labels Action||$591,645.05|
|American Unity PAC, Inc.||$515,748.00|
|Republican Jewish Coalition||$513,010.25|
|Defending Main Street SuperPAC||$472,823.73|
|Citizens for Responsible Energy Solutions||$141,850.00|
|Main Street Advocacy||$125,000.00|
|American Hospital Association PAC||$34,000.00|
|Environmental Defense Action Fund||$30,270.00|
|Humane Society Legislative Fund||$19,601.15|
|Total IE Spending||$9,292,844.18|
In the U.S. Senate race, Casey received a $550,000 boost of support recently from a PAC called PA Values. Barletta continues to attract very little outside support.
|IE Group||IE Spending|
|For Our Future||$291,064.24|
|American Federation of State County and Municipal Employees AFL-CIO||$82,974.56|
|Unidosus Action PAC||$29,690.76|
|Progressive Turnout Project||$38,627.37|
|Casa in Action PAC||$10,581.67|
|Human Rights Campaign Equality Votes PAC||$192.53|
|Total IE Spending||$1,610,383.22|
|IE Group||IE Spending|
|Stars and Stripes Forever PAC||$15,680.97|
|Total IE Spending||$15,680.97|
In the tightly contested 10th Congressional District race in the capitol region, incumbent Republican Scott Perry holds a slight spending advantage over Democratic challenger George Scott.
Perry, the beneficiary of $1.1 million in PAC support, holds a 2 point lead according to the New York Times.
Pa. 10th Congressional District
|IE Group||IE Spending|
|With Honor Fund||$256,893.07|
|NextGen Climate Action Committee||$92,684.95|
|House Majority PAC||$60,620.54|
|For Our Future||$24,589.61|
|AFL-CIO COPE Treasury||$22,401.77|
|America Votes Action Fund||$20,550.40|
|Casa in Action PAC||$20,191.35|
|Total IE Spending||$730,240.72|
|IE Group||IE Spending|
|America First Action, Inc.||$707,940.42|
|House Freedom Fund||$167,437.39|
|Heritage Action for America||$132,990.06|
|House Freedom Action||$98,964.26|
|National Rifle Association Victory Fund||$21,418.64|
|American Conservative Union||$5,000.00|
|Freedomworks for America||$2,500.00|
|Total IE Spending||$1,136,250.77|
Outside spending continues to benefit Democrat Susan Wild in the 7th Congressional District. Her supporters have given her a $3 million advantage over Republican Marty Nothstein, and she leads him by 7 points in a recent poll.
Pa. 7th Congressional District
|IE Group||IE Spending|
|House Majority PAC||$621,586.16|
|Alliance for American Values||$149,986.72|
|Environment America Action Fund||$67,857.93|
|Next Gen Climate Action Committee||$51,050.00|
|Priorities USA Action||$40,666.30|
|Progressive Turnout Project||$40,227.37|
|For Our Future||$30,116.42|
|Immigrant Voters Win PAC||$12,000.00|
|Alliance for Retired Americans||$3,450.00|
|Total IE Spending||$1,777,617.76|
|IE Group||IE Spending|
|American Jobs and Growth PAC||$37,294.82|
|Total IE Spending||$37,294.82|
The largest outside contributions from the past week have come from both the Republican and Democratic Congressional Campaign Committees, Planned Parenthood, and MoveOn.org.
Democrats maintain a $20 million advantage in total spending, but more outside money has been spent on Republican campaigns.
|Total Spending||Spending from IE||% Spending from IE|
Midterm elections will be held November 6th. For a breakdown of all the races, use this table.
A white man charged with shooting and killing two African-Americans at a Kroger supermarket in Kentucky last week had first tried to enter a predominantly African-American church, police say.
Gregory Bush, 51, was charged with killing Maurice Stallard, 69, and Vickie Lee Jones, 67, at the supermarket in Jeffersontown, Ky., a suburb of Louisville.
As more information about the Wednesday attack and its alleged perpetrator have emerged, there are indications that Bush chose his targets because of the color of their skin.
Federal investigators are looking into the fatal shootings as “potential civil rights violations such as hate crimes,” Russell Coleman, the U.S. attorney for the Western district of Kentucky, said in a statement.
The details are chilling.
Bush allegedly walked into the Kroger, pulled a gun and shot Stallard in the back of the head, then shot him several more times. Then he went outside and killed Jones, who also died from multiple gunshot wounds, according to The Associated Press.
Louisville resident Ed Harrell told the Courier-Journal that as he crouched in the Kroger parking lot clutching his own revolver, the gunman walked by him and said, “Don’t shoot me. I won’t shoot you. Whites don’t shoot whites.”
Police say that just a few minutes before heading to the Kroger, Bush first tried to get into the First Baptist Church of Jeffersontown, a predominantly African-American church. Jeffersontown Police Chief Sam Rogers told reporters that surveillance video showed Bush yanking on the church doors. If Bush had come to the church an hour earlier that day, some 70 people would have been gathered there, and the door might have been unlocked, the Courier-Journal reported.
At the First Baptist Church on Sunday, Rogers told the congregation that the attack was racially motivated, calling it the “the elephant in the room that some don’t want to acknowledge in this case,” according to the Louisville newspaper.
“I won’t stand here and pretend that none of us know what could have happened if that evil man had gotten in the doors of this church,” the police chief said.
The newspaper also reports that Bush’s ex-wife, who is black, said in court records that he had called her a “[N-word] bitch.” Bush has a lengthy criminal record, including being convicted of domestic assault for punching his father in the face and lifting his mother by her neck. His convictions did not prevent him from legally owning firearms.
Bush is now in jail, facing two murder counts and 10 counts of felony wanton endangerment.
Some observers criticized the relative lack of national media attention that the shooting received last week. The attack in Jeffersontown occurred on the same day that news headlines were dominated by the packages containing possible explosive devices that had been received by a number of Democratic leaders and media organizations.
“The bombs, though, were actually Wednesday’s second-most important story in this country. The other most important story caught the media’s attention for just a few minutes, then faded right back out of the news cycle,” Shaun King wrote at The Intercept last Thursday.
In a speech to the Federalist Society of Kentucky, Sen. Mitch McConnell, R-Ky., called for the death penalty if Bush is convicted. “If these are not hate crimes, I don’t know what a hate crime is,” McConnell said, according to Politico.
A two-year effort to get Mumia Abu-Jamal another chance to appeal his murder conviction is on hold for at least another month.
After listening to oral arguments on Monday, Philadelphia Common Pleas Court Judge Leon Tucker gave Abu-Jamal’s lawyers until Dec. 3 to track down some additional evidence. If nothing is found, it is expected Tucker will make his ruling, possibly without another hearing.
The decision drew an emotional outburst from Maureen Faulkner, the widow of Daniel Faulkner, the Philadelphia police officer Abu-Jamal was convicted of killing in 1982.
“I have another 30 days that I have to go through this pain,” said Faulkner, in tears, before being escorted out of the courtroom. “This is wrong.”
Tucker took the opportunity to send a message of his own.
“The court is not going to rush to judgment in this case,” he said. “No matter how long it takes, the court is going to do the right thing.”
The odds of an appeal hinge on what Tucker decides about another man: Ronald Castille. Specifically, his time as chief justice of the Pennsylvania Supreme Court and his days as Philadelphia district attorney.
On Monday, Abu-Jamal’s lawyers again argued that Castille should have recused himself when their client’s case went before the high court because Castille fought Abu-Jamal’s initial appeal when he was district attorney.
They also said Castille personally pushed former Gov. Bob Casey to sign the execution warrants for death row inmates convicted of murdering a police officer. And Castille urged a former state senator to pass legislation aimed at expediting – and creating a timetable – for that process, Abu-Jamal’s attorneys argued.
“There’s lots of reason to be concerned about Ron Castille’s neutrality when he became a Supreme Court justice,” said Judith Ritter, one of Abu-Jamal’s lawyers, after the two-hour hearing.
In a 1990 letter to Casey, repeatedly cited by both sides, Castille urges him to “send a clear and dramatic message to all cop killers.” The second page of the letter includes the names of several inmates, but not Abu-Jamal, at the time in the midst of his direct appeal.
Prosecutors argued that helps prove Castille had no “personal significant involvement” in Abu-Jamal’s case, adding there’s nothing unusual about a district attorney reaching out to the governor or lobbying a lawmaker.
What’s more, “Castille is not the DA when [Abu-Jamal] was arrested, when he was put on death row,” said Assistant District Attorney Tracey Kavanagh, who is prosecuting the case.
Ed Rendell, the former governor and Philadelphia mayor, was the city’s top prosecutor at the time.
Before delaying his ruling on the high-profile case, Tucker revealed this ruling would not be easy for him.
“I’ll be candid, this is a difficult case,” he said.
A school district near Allentown recently, and rather quietly, became Pennsylvania’s first to pass a policy permitting teachers to carry guns in schools.
But a backlash has since developed, setting up a showdown over the place of guns in Pennsylvania schools that could set statewide precedent.
In September, the Tamaqua Area School District in Schuylkill County revised a policy to explicitly allow “administrators, teachers, or other employees” to have guns on school district property, so long as they meet certain training and certification requirements.
Although the policy itself says little about implementation, school board member Nicholas Boyle said he and others envision a program where, at any given time, about three unidentified staffers in each school carry concealed weapons. Boyle thinks the initiative would give schools in this largely rural district a better chance of fighting off an attacker, while also acting as a deterrent.
“Nobody really knows who’s carrying, so the security guard or police officer wouldn’t be targeted first,” Boyle said.
Not everyone is convinced, though, and skeptics have already formed a Facebook group about the proposed change. Those skeptics include the head of the local teachers union, and a chorus of parents.
Most district residents are “very pro-gun,” said Karen Tharp, a parent and grandparent of district students, but she doesn’t think teachers should double as security.
“I don’t want loaded guns in the school, especially in the hands of people who are not professionals and who are not trained to do this as their job on a daily basis,” said Tharp.
School security emerged as a front-page topic earlier this year after a pair of high-profile school shootings. Pennsylvania recently set aside $60 million to help districts beef up security, and conservative politicians across the country, including President Donald Trump, advocate allowing teachers to carry weapons as a way to thwart future violence.
Some states have already embraced the tactic.
At least eight states have policies that allow non-security personnel to carry firearms, at least 10 allow concealed carry permit holders to have guns in schools, and at least 21 have “policies that allow schools or districts to give individuals permission to carry firearms,” according to a 2018 report by the Education Commission of the States.
Pennsylvania has none of the above policies, and a bill introduced last legislative session on the subject failed to pass.
But Tamaqua board members think they’re on solid legal ground because there’s also no law explicitly disallowing the kind of policy they recently passed.
“It’s uncharted territory, but there is no law that says we can’t have legally trained armed staff,” said Boyle.
Shira Goodman, executive director of CeaseFirePA, a gun control advocacy group, questions that interpretation, arguing that “school districts are a branch of government that usually has specifically enumerated policies and powers.”
“I would say it’s not at all clear that they can be doing this,” she added.
Goodman said her group is “looking into the law,” but wants to “let the public process play out” before considering legal options.
School officials will hold a community meeting on November 7 to discuss the policy and any potential changes.
A Jersey Shore attorney who hosted a radio show and taught seminars on elder law has been sentenced to 10 years in state prison for stealing more than $3 million dollars from at least two dozen elderly clients and laundering the money.
Robert Novy, 67, of Brick was taken into custody after the sentencing in Ocean County Superior Court last Friday. He pleaded guilty in July for first degree money laundering.
Many of the victims did not have close relative to guard their interests, and in some cases, suffered from dementia, according to state authorities.
Officials say that Novy, whose law office was in Manchester, used the stolen funds for his own benefit, paying personal, and business expenses.
“Novy preyed upon vulnerable seniors who trusted him as their attorney to guard their interests. Instead, he callously stole their life savings, betraying their trust and the oath he took to uphold the law,” said Attorney General Gurbir S. Grewal. “We have secured justice with this lengthy prison sentence and have ensured that his victims will receive restitution from the assets we seized from him during our investigation.”
He must serve three years and four months before becoming eligible for parole and pay restitution to the victims out of two finds that the state is creating using assets previously seized by the state.
Novy also surrendered his New Jersey law license and must pay $500,000 to the state as an anti-money laundering profiteering penalty.
New Jersey Governor Phil Murphy announced Monday, the sixth year anniversary of Superstorm Sandy plowing into the coastline, a $50 million appropriation to assist the 1,200 families who have not yet finished rebuilding.
Speaking at an event in Union Beach, the Raritan Bay community in Monmouth County that was devastated by the storm, Murphy said the zero-interest, forgivable loan will fully fund unmet needs above and beyond the maximum $150,000 grant.
Homeowners within the Reconstruction, Rehabilitation, Elevation, and Mitigation (RREM) Program and the Low-to-Moderate Income (LMI) Homeowner Rebuilding Program, the two main housing recovery programs for homeowners impacted by Superstorm Sandy, are eligible.
“With these programs, our objective is to find a path forward for the homeowners who have not finished rebuilding and who find themselves stuck because they don’t have the financial means to move ahead,” Murphy said in a news release.
According to state officials, the loan would be uncapped, require no monthly payments, and would be calculated based on the remaining eligible work under the state rebuilding program that is needed.
Loan recipients must live in the house for 15 years following construction completion. If the house is sold before 15 years, a portion of the loan would be due upon sale.
Murphy also announced that homeowners required to repay excess grant funds will be eligible to apply to the state for an “extreme financial hardship allowance.”
“We want to work with people who are struggling financially to determine what they can realistically contribute, and we want to get them across the finish line so they can return home and get some much-overdue normalcy in their lives,” the governor said.
The state will fund the program with unspent federal recovery funds. Murphy said more than $1 billion remains available, although most is reserved for U.S. Army Corps of Engineers coastal projects.
Bomb squads were called to a post office in Atlanta on Monday about a suspicious package sent to CNN, investigators said Monday, just hours before a court hearing for a Florida man accused of sending packages containing explosive material to prominent Democrats.
The FBI said via its Twitter account that the recovered package was “similar in appearance” to those sent by 56-year-old Cesar Sayoc, whom authorities accuse of sending explosive material to Democrats and other prominent critics of President Donald Trump.
CNN President Jeff Zucker says all mail to CNN has been screened offsite since last week, when a series of package bombs began appearing around the country. Among them were two apparent mail bombs sent to CNN.
Sayoc was scheduled to appear Monday in federal court in Miami. He is accused of sending bubble-wrapped manila envelopes to Democrats such as Barack Obama, Hillary Clinton and Joe Biden. The packages were intercepted from Delaware to California. At least some listed a return address of U.S. Debbie Wasserman Schultz, former chair of the Democratic National Committee.
She represents the Florida district where the former male stripper, pizza driver and strip club DJ lived in an older van covered with bumper stickers praising Trump, disparaging Democrats and CNN and showing rifle crosshairs over liberals like Clinton and filmmaker Michael Moore.
Although authorities did not immediately say who might be responsible for the most recent package to CNN, the FBI said it believes the package discovered Monday is “similar in appearance” to those that Sayoc is accused of sending. Law enforcement officials have said they believe the packages were staggered and more could be discovered.
Separately, a U.S. official told The Associated Press that Sayoc kept a list of elected officials and others who investigators believe were intended targets. The official also said authorities recovered soldering equipment, a printer, and stamps similar to those used on the package bombs.
The official wasn’t authorized to discuss an ongoing investigation and spoke on condition of anonymity to the AP.
Sayoc was arrested Friday outside a South Florida auto parts store after investigators said they identified him through fingerprint and DNA evidence. He is being prosecuted in New York, so his Florida hearing will likely be brief and process-oriented. The main issue will be whether he waives extradition to New York and whether he seeks release on bail.
Authorities say Sayoc faces more than 50 years in prison if convicted on all charges. None of the bombs exploded and no one was injured.
Associated Press writer Michael Balsamo contributed to this report from Washington.
Janet Winston had a rash that wouldn’t go away.
The English professor from Eureka, Calif., always had been sensitive to ingredients in skin creams and cosmetics. This time, however, the antifungal cream she was prescribed to treat her persistent rash seemed to make things worse. Was she allergic to that, too?
Winston, 56, who works at Humboldt State University, found out the dermatologist in her rural Northern California town was booked months in advance. So, as Winston often does for specialized treatment, she turned to Stanford Health Care, a nearly six-hour drive south. She hoped to finally clear up her rash and learn what else she might be allergic to.
Winston, who had avoided lipstick and other skin products for years, said that 119 tiny plastic containers of allergens were taped to her back over three days of testing. Winston ultimately learned that she was allergic to — among other things — linalool (a compound of lavender and other plants); the ketoconazole cream prescribed to treat her persistent rash; the antibiotic neomycin; a clothing dye; a common preservative used in cosmetics; and the metals gold, nickel and cobalt.
Her Stanford-affiliated doctor had warned her that the extensive allergy skin-patch testing she needed might be expensive, Winston said, but she wasn’t too worried. After all, Stanford was an in-network provider for her insurer — and her insurance, one of her benefits as an employee of the state of California, always had been reliable.
Then the bill came.
Patient: Janet Winston, 56, of Eureka, Calif., English professor at Humboldt State University
Total bill: $48,329, including $848 for the time Winston spent with her doctor. Winston’s health insurer, Anthem Blue Cross, paid Stanford a negotiated rate of $11,376.47. Stanford billed Winston $3,103.73 as her 20 percent share of the negotiated rate.
Service provider: Dr. Golara Honari of Stanford Health Care’s outpatient dermatology clinic in Redwood City, Calif.
Medical procedures: Extensive allergy skin-patch testing to determine which substances caused Winston’s contact dermatitis, or skin rashes.
“I was grateful I had such wonderful care at Stanford, but I was pretty outraged they could charge that,” Winston said. “No one cut into me. No one gave me anesthesia. I had partly open plastic containers filled with fluid taped to my back.”
What gives: Medical billing analysts told Kaiser Health News that Stanford’s charges for Winston’s allergy patch test appeared excessive. They were surprised to hear that Winston’s insurer, Anthem Blue Cross, paid Stanford more than $11,000 for the treatment.
Stanford’s list price, however, is $399 per allergen.
“That charge is astronomical and nuts,” said Margaret Skurka, a retired professor of health informatics at Indiana University and a medical coding and billing consultant who advises hospitals and providers. She reviewed Winston’s bill.
The “usual, customary and reasonable” charge for testing a single allergen in the high-cost San Francisco Bay Area is about $35, said Michael Arrigo, a San Francisco-based medical billing expert witness who also reviewed Winston’s bill. “The data seems pretty conclusive that the charges in this case are inflated.”
For the type of allergy skin-patch testing Winston received, the average charge physicians submitted to Medicare — an important data point for private insurers — was about $16 per allergen in 2016, according to Medicare payment data.
An Anthem spokesman noted that one of the insurer’s examiners did review the bill but could not say whether it received extra scrutiny because of its high cost. “We try to strike a balance between protecting affordability and providing a broad network of providers to create choices,” Eric Lail said in an emailed statement.
Winston’s case highlights how some health providers set exorbitant rates, knowing they’ll ultimately be paid a lesser amount. Patients rarely pay these rates — known as “chargemaster” or list prices — and they can generate headlines for the $100 aspirin. But such list prices, as the starting point for negotiations and discounts, do influence the amounts insurers pay, and ultimately what patients pay as their share of cost.
Stanford Health Care also has a lot of power in dealing with insurers like Anthem Blue Cross. The academic medical system includes hospitals and outpatient clinics across the San Francisco Bay Area, as well as a number of large doctor practices in the region.
That kind of consolidation and market power can raise health care prices. Insurers in the region have long grappled with Stanford’s high costs, at times withdrawing the health system from their networks.
But the breadth and depth of the academic medical system — not to mention its popularity with high-end customers in the Bay Area — makes it difficult for insurers to exclude a powerhouse like Stanford from a network for long.
A study recently published in Health Affairs found that such consolidation in California has caused health care costs to spike for both patients and insurers.
Patrick Bartosch, a spokesman for Stanford Health Care, said that Winston’s doctor customized her treatment rather than using off-the-shelf patch tests. The university health system operates a large allergen bank of its own, he said.
“In this case, we conducted a comprehensive evaluation of the patient and her environmental exposures and meticulously selected appropriate allergens, which required obtaining and preparing putative allergens on an individual basis,” Bartosch said in an emailed statement.
Leemore Dafny, a Harvard University health care economist, said big health systems such as Stanford’s — which owns multiple hospitals and outpatient clinics — can pressure insurers to pay big.
“Everyone wants to point fingers at the providers, but … a lot of times [insurers] roll over and pay the rates,” she said.
Resolution: After some bargaining with Stanford’s billing department, Winston ultimately paid $1,561.86 out of pocket. She made the argument that her doctor had told her the cost per allergen would be about $100, not nearly the $400 Stanford ultimately charged her insurer.
The takeaway: Insurers often tell patients to “shop around” for the best price and to make sure they choose in-network providers to avoid surprises.
Winston did everything right and still got caught out. As a state employee, she had great insurance and Stanford was an in-network provider.
Winston said her doctor warned her the test would be expensive, but she never anticipated that could mean close to $50,000. So don’t be afraid to ask for specific numbers. In the high-priced U.S. health system, “expensive” and “cheap” often take on entirely different meanings than those in everyday life.
Clearly uncomfortable with the charges, Winston’s physician advised her — in advance — to contest it with Stanford’s billing department. So Winston did, and Stanford gave her a nearly 50 percent discount for her coinsurance share of the bill. It never hurts to ask.
Still, Stanford received more than $12,000 total from Winston and her insurer for allergy-patch tests — a cost that is borne by insurance policyholders and taxpayers.
Researchers have linked consolidation by Northern California providers such as Stanford and Sutter Health to higher health costs for the region’s consumers. A local health workers union also has taken aim at Stanford’s costs with two city ballot initiatives that attempt to rein in what Stanford and other health providers can charge patients in Palo Alto and Livermore.
“I was grateful I had so much insurance, and that it was in-network, and I could afford the [final] bill,” Winston said. “On the other hand, I thought, ‘How can they get away with this?’ Most Americans could never afford this procedure, at least at this facility, and it made me think about the grand piano in the lobby.”
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You can follow Barbara Feder Ostrov on Twitter: @barbfederostrov.
April Dembosky, from member station KQED, provided audio reporting. NPR produced and edited the interview with Elisabeth Rosenthal for broadcast.
Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente.
Copyright 2018 NPR. To see more, visit http://www.npr.org/.
Guest: Lynsey Addario
LYNSEY ADDARIO has spent two decades photographing some of the world’s worst humanitarian crises. She’s documented the genocide in Darfur, life in Afghanistan under the Taliban, the US-led invasion in Iraq, and the plight of Syrian refugees. She’s worked in some of the most dangerous places in the world and has been kidnapped twice. Throughout her career, she’s also focused her lens on women living through conflicts. Addario’s photojournalism has been awarded a MacArthur and a Pulitzer Prize and she’s the author of the memoir, It’s What I Do. This hour, we’ll talk with Addario about the wars, atrocities, humanity and resilience that she’s witnessed and her new book of photography, Of Love & War.
The addition of new quality measures for nursing homes receiving federal funds could soon upset the pecking order of Philadelphia’s best — and worst — nursing homes, according to the latest government data.
Roughly once every quarter, the federal government updates its quality rankings for nursing homes that receive funds from Medicare and Medicaid. Each facility receives an overall star rating — from one to five — based on its most recent health inspections, staff-to-patient ratios, and quality of care.
But this month, the results included something new — stats tracking pressure ulcers, patient-treatment plans, and fall-related injuries.
The new measures could offer key insights into the quality of staff responsiveness and care, said David Hoffman, president of a national health care consulting firm based in Philadelphia.
“I think staffing is the most important issue in long-term care,” Hoffman said. “And it’s not just numbers — it’s competence.”
For example, pressure ulcers, otherwise known as bedsores, are what Hoffman calls “multifactorial,” meaning they can be caused by a variety of care deficiencies. The Center for Medicare and Medicaid Services website cites three possible deficiencies: inadequate nutrition, failure to reposition residents often enough, and a lack of padding.
“So it’s important to look at that number and think, ‘Well, while I may not be a clinician, what does it mean that somebody’s skin is breaking down and developing painful wounds?’” Hoffman said. “And so it’s relevant as to how care is being delivered in that facility.”
Hoffman says fall-related injuries are also closely tied to staff behavior.
“The ongoing issue is how responsive our staff is to the basic needs of a resident who needs assistance,” he said, adding that many falls occur when patients with mobility issues give up on waiting for staff and attempt to get in or out of bed or over to the bathroom, themselves.
“If we assess individuals correctly upon admission, and, if they’re at high risk for falls, then we put certain interventions in place,” he said.
Though the new measures aren’t yet being calculated into overall ratings — the Center for Medicare and Medicaid Services said that will begin as early as this fall — preliminary results are already showing that they could affect facilities’ rankings.
For example, compare the 10 worst-ranked nursing homes in Philadelphia based on overall ratings with the 10 worst nursing homes as determined by percentage of patients with pressure wounds and fall-related injuries.
While there is some overlap, a number of the worst-performing nursing homes based on the new measures boast otherwise decent ratings.
Care Pavilion Nursing and Rehabilitation Center in Old City features an overall rating of three out of five stars — solidly average. But the facility is among the city’s 10 worst performers when it comes both to pressure wounds and fall-related injuries.
A look at its latest health inspections also shows troubling infractions, including failure to follow physician instructions related to patients’ health; failure to supervise a patient whose self-administration of insulin led to a hospital visit; and the temporary escape of a patient who was known to be an elopement risk.
Bala Nursing and Retirement likewise boasts an overall rating of three stars, despite having the second-highest rate of patients with new or worsening pressure ulcers in the city.
Third-worst when it comes to pressure ulcers is Laurel Square Healthcare and Rehabilitation Center, which has a five-star overall rating. Recent health inspections show that Laurel has been cited for its high medication error rate and repeated failure to keep tabs on a patient who was found to be leaving dialysis in order to go drinking.
Centennial Healthcare and Rehabilitation, which has the highest percentage of fall-related injuries in the city, has a four-star overall rating. Citations include misplaced belongings, medication errors, and failure to update medical records.
Health inspection reports, which are available online, can offer specifics about deficiency citations, along with context that helps reveal whether incidents are isolated or part of a pattern, Hoffman said.
An even better way of judging a nursing home is making a visit.
“One of the first things I recommend is going to the facility at mealtime and watching how staff interacts with the residents,” he said. “That tells me a lot about the quality of the building regardless of all these numbers.”
The full updated quality ratings, along with original datasets, are available here.