npr--2020-09-10--Some Hospitals Fail To Set COVID-19 Patients Apart, Putting Others at Risk

Some Hospitals Fail To Set COVID-19 Patients Apart , Putting Others at Risk Nurses at Alta Bates Summit Medical Center in Oakland , Calif. , were on edge as early as March , when patients with COVID-19 began to show up in areas of the hospital that were not set aside to care for them .
The Centers for Disease Control and Prevention had advised hospitals to isolate COVID-19 patients to limit staff 's exposure and help conserve high-level personal protective equipment that 's been in short supply .
Yet COVID-19 patients continued to be scattered through the Oakland hospital @ @ @ @ @ @ @ Division of Occupational Safety and Health .
The concerns included the sixth-floor medical unit where veteran nurse Janine Paiste-Ponder worked .
Patients on that floor who were coronavirus-positive were not staying in their rooms , either because they were confused or disinterested in the rules .
Hospital employees were not provided highly protective N95 respirators , says Mike Hill , a nurse in the hospital intensive care unit and the hospital 's chief representative for the California Nurses Association , which filed complaints to Cal/OSHA , the state 's workplace safety regulator .
@ @ @ @ @ @ @ time before one of the nurses died on one of these floors , '' Hill says .
Two nurses fell ill , including Paiste-Ponder , 59 , who died of complications from the virus on July 17 .
The concerns raised in Oakland also have swept across the U.S. , according to interviews , a review of government workplace safety complaints and health facility inspection reports .
A Kaiser Health News investigation found that dozens of nursing homes and hospitals ignored official guidelines to separate COVID-19 patients from those not infected with the @ @ @ @ @ @ @ spread and leaving staff unprepared and infected or , in some cases , dead .
As recently as July , a National Nurses United survey of more than 21,000 nurses found that 32 % work in a facility that does not have a dedicated COVID-19 unit .
At that time , the coronavirus had reached all but 17 U.S. counties , data collected by Johns Hopkins University shows .
Our investigation discovered that patients with COVID-19 have been commingled with uninfected patients in health care facilities in states including California , Florida , @ @ @ @ @ @ @ Maryland and New York .
A COVID-19 outbreak was in full swing at the New Jersey Veterans Home at Paramus in late April when health inspectors observed residents with dementia mingling in a dayroom — coronavirus-positive patients as well as others awaiting test results .
At the time , the center had already reported infections with the coronavirus among 119 residents and 46 virus-related deaths , according to a Medicare inspection report .
The assistant director of nursing at an Iowa nursing home insisted on April 28 that they did `` not have @ @ @ @ @ @ @ overrode the orders of a community doctor that several patients who had fevers and falling oxygen levels be isolated , an inspection report shows .
By mid-May , the facility 's COVID-19 case log showed 61 patients with the virus and nine dead .
Federal work-safety officials have closed at least 30 complaints about this sort of mixing of patients in hospital units nationwide — without issuing a citation .
The complaints include a claim that a Michigan hospital kept patients who tested negative for the virus in the COVID unit in May @ @ @ @ @ @ @ had COVID-19 patients in the same unit as those with no infection , according to a closed complaint to the federal Occupational Safety and Health Administration .
Federal Health and Human Services officials have called on hospitals to tell them each day if they have a patient who came in without COVID-19 but developed an apparent or confirmed case of the coronavirus 14 days later .
Hospitals filed 48,000 reports from June 21 through Aug. 28 , though the number reflects , in some cases , multiple reports on the same person .
@ @ @ @ @ @ @ mixed in with others for a variety of reasons .
Some hospitals say they have limited tests , so patients carrying the virus were identified only after they had already exposed others .
In other cases , they had false-negative test results or their facility was dismissive of federal guidelines , which carry no force of law .
And while federal Medicare officials have inspected nearly every U.S. nursing home in recent months — and states have occasionally levied fines and cut off new admissions for isolation lapses — hospitals have seen less @ @ @ @ @ @ @ , a hospital in the Sutter Health network , the nursing staff made it clear in official complaints to Cal/OSHA that they wanted administrators to follow the state 's stringent legal requirements in the way it handles people who have aerosol-transmitted diseases .
From the start , some staffers wanted all the state-required protections from a virus that has been increasingly shown to be transmitted by tiny particles that float through the air .
The regulations call for patients with a virus like the one that causes COVID-19 to be moved to a @ @ @ @ @ @ @ — or to a specialized facility .
The rules say those patients should be in a room that includes air purification via HEPA filtration or that has negative air pressure , meaning circulating air in the room is pulled out via an exhaust system , instead of drifting into the hallway when a door is opened .
Initially , in March , Alta Bates hospital outfitted a 40-bed COVID unit at its Oakland campus , according to Hill .
But when a surge of patients failed to materialize , that unit was pared @ @ @ @ @ @ @ a steady stream of patients infected with the virus have been admitted , he says , many testing positive only days after admission — and after they 'd been housed in regular rooms in the facility .
From March 10 through July 30 , Hill 's nurses union and others filed eight complaints to Cal/OSHA , including allegations that the hospital had failed to follow isolation rules for COVID-19 patients , some on the cancer floor .
So far , regulators have done little .
California Gov .
Gavin Newsom had ordered workplace @ @ @ @ @ @ @ supporting compliance '' instead of enforcement , except as regards the `` most serious violations . ''
According to Frank Polizzi , a spokesman for Cal/OSHA , officials in his agency responded to to the employee complaints by reaching out by mail and phone to `` ensure the proper virus prevention measures are in place . ''
Two investigations are ongoing , Polizzi says .
Meanwhile , Cal/OSHA records show that a third investigation — related to transport workers not wearing N95 respirators while they moved COVID-19-positive patients ( and others who had @ @ @ @ @ @ @ Sutter facility near the hospital — resulted in a $ 6,750 fine .
The string of complaints also says the hospital did not give staff the necessary personal protective equipment ( PPE ) that 's required under state law — an N95 respirator or something more protective — for caring for virus patients .
Instead , Hill says , employees working on the hospital floors where some patients infected with COVID-19 were being treated were provided lower-quality surgical masks — a concern reflected in complaints filed with Cal/OSHA .
Hill believes that Paiste-Ponder @ @ @ @ @ @ @ the virus from COVID-19 patients who did not remain in their rooms .
`` It is sad , because it did n't really need to happen , '' Hill says .
Polizzi says investigations into the July 17 death and another staff hospitalization are ongoing .
A Sutter Health spokesperson says the hospital takes allegations , including Cal/OSHA complaints , seriously , and its highest priority is keeping patients and all members of the health team and other workers safe .
The hospital system 's statement also says that the practice of grouping @ @ @ @ @ @ @ a tool that `` must be considered in a greater context , including patient acuity , hospital census and other environmental factors . ''
CDC guidelines are not strict when it comes to the topic of keeping COVID-19 patients sectioned off , noting that `` facilities could consider designating entire units within the facility , with dedicated [ staff ] , '' to care for these patients .
That approach succeeded at the University of Nebraska Medical Center in Omaha .
A recent study reported `` extensive '' viral contamination around COVID-19 patients @ @ @ @ @ @ @ standard '' infection control techniques in place , staffers who cared for COVID-19 patients did not get the virus .
The hospital set up an isolation unit with air pumped away from the halls , restricted access to the unit and trained staff to use well-developed protocols and N95 respirators — at a minimum.What worked in Nebraska , though , is far from standard elsewhere .
Cynthia Butler , a nurse and National Nurses United member at Fawcett Memorial Hospital in Port Charlotte , on Florida 's west coast , says she actually @ @ @ @ @ @ @ — where she knew what she was dealing with and had full PPE — than on a general medical floor .
She believes she caught the virus from a patient who had COVID-19 but was housed on a general floor in May .
A similar situation occurred in July , when another patient had an unexpected case of COVID-19 — and Butler says she got another positive test then herself .
She says both patients did not meet the hospital 's criteria for testing admitted patients , and the lapses leave her on @ @ @ @ @ @ @ OSHA inspector who reached out to her about a complaint her union filed about the facility .
`` Every time I go into work it 's like playing Russian roulette , '' Butler says .
A spokesperson for HCA Healthcare , which owns the hospital , says it tests patients coming from long-term care facilities and any patient going into surgery , as well as those with virus symptoms .
She says all medical employees and other workers on staff have access to PPE and practice vigilant sanitation , universal masking and social @ @ @ @ @ @ @ not an option for Butler , though , who says she cleans , feeds and starts IVs for patients and offers reassurance when they are isolated from family .
`` I 'm giving them the only comfort or kind word they can get , '' says Butler , who has recently gone on unpaid leave over safety concerns .
`` I 'm in there doing that and I 'm not being protected . ''
Given research showing that up to 45 % of COVID-19 patients are asymptomatic , the University of California , @ @ @ @ @ @ @ every patient who is admitted , says Dr. Robert Harrison , a UCSF professor who consults on occupational health at the hospital .
The testing is done for the safety of staff and to reduce spread within the hospital , he says .
Patients who test positive are separated into a COVID-19-only unit .
And health care workers who learn they 've spent more than 15 minutes within 6 feet of a patient later determined to have COVID-19 are typically sent home for two weeks , he says , if they did n't @ @ @ @ @ @ @ time .
Outside of academic medicine , though , front-line nursing staff and other health care workers have turned to union leaders to push for such protections .
In Southern California , leaders of the National Union of Healthcare Workers filed an official complaint with state hospital inspectors about the risks posed by intermingled COVID-19 patients at Fountain Valley Regional Hospital in Orange County.The hospital is part of for-profit Tenet Health .
There , according to the complaint , patients were not routinely tested for the coronoavirus upon admission .
One nursing assistant @ @ @ @ @ @ @ a patient on a general medical floor who required monitoring .
At the conclusion of the second shift , she was told the patient was just found to be positive for the coronavirus .
The worker had worn only a surgical mask — not an N95 respirator or any form of eye protection — according to the complaint to the California Department of Public Health .
The nursing assistant was not offered a coronavirus test or quarantined before her next two shifts , the complaint says .
The state health department says it @ @ @ @ @ @ @ .
Barbara Lewis , Southern California hospital division director with the union , says COVID-19 patients at the hospital were on the same floor as cancer patients and post-surgical patients who were walking the halls to speed their recovery .
She says managers took steps to separate the patients only after the union held a protest , spoke to local media and complained to state health officials .
Hospital spokesperson Jessica Chen says the hospital `` quickly implemented '' changes directed by state health authorities .
Sometimes , when there 's a surge @ @ @ @ @ @ @ place some COVID-19 patients on the same nursing unit as other patients , she says , but patients infected with the virus are placed in single rooms with closed doors .
Patients can get a test for the coronavirus via a physician 's order , Chen says , and employees can get the test in the community .
That 's in contrast , Lewis says , to high-profile examples of the stricter precautions now being taken in professional sports .
`` Now we 're seeing what 's happening with baseball and basketball — @ @ @ @ @ @ @ with a high level of caution , '' Lewis says .
`` Yet we have thousands and thousands of health care workers going to work in a very scary environment . ''
More than 40 % of the people who have died of COVID-19 have lived in nursing homes or assisted living facilities , researchers have found .
The mixing of patients in close quarters — people who have the coronavirus infection with those who do n't — has been a concern at some nursing homes , too , which Medicare officials discovered @ @ @ @ @ @ @ more than 15,000 facilities .
News reports this summer have highlighted the problem at an Ohio nursing home and at a Maryland facility where the state levied a $ 70,000 fine for its failure to keep infected patients away from those who were n't sick .
Fair Havens Center , a Miami Springs , Fla. , nursing home , also faced penalties when inspectors discovered 11 roommates of patients who tested positive for COVID-19 were moved to rooms with other residents — putting those new roommates at heightened risk .
Florida regulators cut @ @ @ @ @ @ @ show , and Medicare authorities levied a $ 235,000 civil monetary penalty .
The vice president of operations at the nursing home told inspectors that isolating exposed patients would mean isolating the entire facility : Everyone had been exposed to the 32 staff members who tested positive for the virus , the report says .
Fair Havens Center did not respond to our request for comment .
In Iowa , Medicare officials declared a state of `` immediate jeopardy '' at Pearl Valley Rehabilitation and Care Center in Muscatine , Iowa in late @ @ @ @ @ @ @ community doctor , the assistant nursing director had kept patients who had COVID-19 in the facility , citing a general order by Pearl Valley 's medical director to avoid sending patients to the ER `` if you can help it . ''
Meanwhile , several patients were documented by facility staff to have fevers and falling oxygen levels , the Medicare inspection report shows .
Within two weeks , the facility discovered it had an expanding outbreak , with 61 residents infected and nine dead , according to the report .
Medicare officials @ @ @ @ @ @ @ Home in New Jersey , state Sen. Joseph Vitale said during a legislative hearing in mid-August .
Glenn Osborne , president of the facility 's residents council , testified during the hearing that people living there were returned to the same shared rooms after hospitalizations — a breach in safety protocols during the pandemic Osborne , an honorably discharged Marine , said he saw more fellow residents of the skilled nursing facility die than fellow service members during his military service .
The Menlo Park and Paramus veterans home — where inspectors saw @ @ @ @ @ @ @ commingling in a day room — have each reported more than 180 COVID-19 cases among residents , 90 among staff and at least 60 deaths from the disease .
A spokesperson for the homes says he could not comment for this story , because of pending litigation .
`` These deaths should not have happened , '' Osborne told the assembled New Jersey legislators in his testimony .
`` Many of these deaths were absolutely avoidable , in my humble opinion . ''
Kaiser Health News is a nonprofit , editorially independent program @ @ @ @ @ @ @ is not affiliated with Kaiser Permanente .

Some Hospitals Fail To Separate COVID-19 Patients, Putting Others At Risk
Enlarge this image toggle caption National Nurses United National Nurses United
Nurses at Alta Bates Summit Medical Center in Oakland, Calif., were on edge as early as March, when patients with COVID-19 began to show up in areas of the hospital that were not set aside to care for them.
The Centers for Disease Control and Prevention had advised hospitals to isolate COVID-19 patients to limit staff's exposure and help conserve high-level personal protective equipment that's been in short supply.
Yet COVID-19 patients continued to be scattered throughout the Oakland hospital, according to complaints to California's Division of Occupational Safety and Health. The concerns included the sixth-floor medical unit where veteran nurse Janine Paiste-Ponder worked.
Patients on that floor who had the coronavirus were not staying in their rooms, either because they were confused or disinterested in the rules. Hospital employees were not provided highly protective N95 respirators, says Mike Hill, a nurse in the hospital intensive care unit and the hospital's chief representative for the California Nurses Association, which filed complaints to Cal/OSHA, the state's workplace safety regulator.
"It was just a matter of time before one of the nurses died on one of these floors," Hill says.
Two nurses fell ill, including Paiste-Ponder, 59, who died of complications from COVID-19 on July 17.
toggle caption National Nurses United
The concerns raised in Oakland also have swept across the U.S., according to interviews, a review of government workplace safety complaints and health facility inspection reports. A Kaiser Health News investigation found that dozens of nursing homes and hospitals ignored official guidelines to separate COVID-19 patients from those not infected with the coronavirus, in some places fueling its spread and leaving staff unprepared and infected or, in some cases, dead.
As recently as July, a National Nurses United survey of more than 21,000 nurses found that 32% work in a facility that does not have a dedicated COVID-19 unit. At that time, the coronavirus had reached all but 17 U.S. counties, data collected by Johns Hopkins University shows.
Our investigation discovered that patients with COVID-19 have been commingled with uninfected patients in health care facilities in states including California, Florida, New Jersey, Iowa, Ohio, Maryland and New York.
A COVID-19 outbreak was in full swing at the New Jersey Veterans Home at Paramus in late April when health inspectors observed residents with dementia mingling in a dayroom — coronavirus-positive patients as well as others awaiting test results. At the time, the center had already reported coronavirus infections among 119 residents and 46 virus-related deaths, according to a Medicare inspection report.
The assistant director of nursing at an Iowa nursing home insisted on April 28 that they did "not have any COVID in the building" and overrode the orders of a community doctor that several patients who had fevers and falling oxygen levels be isolated, an inspection report shows.
By mid-May, the facility's COVID-19 case log showed 61 patients with the virus and nine dead.
Federal work-safety officials have closed at least 30 complaints about this sort of mixing of patients in hospital units nationwide — without issuing a citation. The complaints include a claim that a Michigan hospital kept patients who tested negative for the virus in the COVID unit in May. An upstate New York hospital also had COVID-19 patients in the same unit as those with no infection, according to a closed complaint to the federal Occupational Safety and Health Administration.
Federal Health and Human Services officials have called on hospitals to tell them each day if they have a patient who came in without COVID-19 but developed an apparent or confirmed case of the coronavirus 14 days later. Hospitals filed 48,000 reports from June 21 through Aug. 28, though the number reflects, in some cases, multiple reports on the same person.
Patients infected with the coronavirus have been mixed in with others for a variety of reasons. Some hospitals say they have limited tests, so patients carrying the virus were identified only after they had already exposed others. In other cases, they had false-negative test results or their facility was dismissive of federal guidelines, which carry no force of law.
And while federal Medicare officials have inspected nearly every U.S. nursing home in recent months — and states have occasionally levied fines and cut off new admissions for isolation lapses — hospitals have seen less scrutiny.
The scene inside Sutter
At Alta Bates in Oakland, a hospital in the Sutter Health network, the nursing staff made it clear in official complaints to Cal/OSHA that they wanted administrators to follow the state's stringent legal requirements in the way it handles people who have aerosol-transmitted diseases. From the start, some staffers wanted all the state-required protections from a virus that has been increasingly shown to be transmitted by tiny particles that float through the air.
The regulations call for patients with a virus like the one that causes COVID-19 to be moved to a specialized unit within five hours of identification — or to a specialized facility. The rules say those patients should be in a room that includes air purification via HEPA filtration or that has negative air pressure, meaning circulating air in the room is pulled out via an exhaust system, instead of drifting into the hallway when a door is opened.
Initially, in March, Alta Bates hospital outfitted a 40-bed COVID-19 unit at its Oakland campus, according to Hill. But when a surge of patients failed to materialize, that unit was pared to 12 beds.
Since then, a steady stream of patients infected with the virus have been admitted, he says, many testing positive only days after admission — and after they'd been housed in regular rooms in the facility.
From March 10 through July 30, Hill's nurses union and others filed eight complaints to Cal/OSHA, including allegations that the hospital had failed to follow isolation rules for COVID-19 patients, some on the cancer floor.
So far, regulators have done little. California Gov. Gavin Newsom had ordered workplace safety officials to "focus on ... supporting compliance" instead of enforcement, except as regards the "most serious violations."
According to Frank Polizzi, a spokesman for Cal/OSHA, officials in his agency responded to the employee complaints by reaching out by mail and phone to "ensure the proper virus prevention measures are in place." Two investigations are ongoing, Polizzi says.
Meanwhile, Cal/OSHA records show that a third investigation — related to transport workers not wearing N95 respirators while they moved COVID-19-positive patients (and others who had a suspected coronavirus infection) at a Sutter facility near the hospital — resulted in a $6,750 fine.
The string of complaints also says the hospital did not give staff the necessary personal protective equipment (PPE) that's required under state law — an N95 respirator or something more protective — for caring for virus patients.
Instead, Hill says, employees working on the hospital floors where some patients infected with COVID-19 were being treated were provided lower-quality surgical masks — a concern reflected in complaints filed with Cal/OSHA.
Hill believes that Paiste-Ponder and another nurse on her floor caught the virus from COVID-19 patients who did not remain in their rooms.
"It is sad, because it didn't really need to happen," Hill says.
Polizzi says investigations into the July 17 death and another staff hospitalization are ongoing.
A Sutter Health spokesperson says the hospital takes allegations, including Cal/OSHA complaints, seriously, and its highest priority is keeping patients and all members of the health team and other workers safe.
The hospital system's statement also says that the practice of grouping together patients who have the virus is a tool that "must be considered in a greater context, including patient acuity, hospital census and other environmental factors."
Concerns at other hospitals
CDC guidelines are not strict when it comes to the topic of keeping COVID-19 patients sectioned off, noting that "facilities could consider designating entire units within the facility, with dedicated [staff]," to care for these patients.
That approach succeeded at the University of Nebraska Medical Center in Omaha. A recent study reported "extensive" viral contamination around COVID-19 patients there, but noted that with "standard" infection control techniques in place, staffers who cared for COVID-19 patients did not get the virus.
The hospital set up an isolation unit with air pumped away from the halls, restricted access to the unit and trained staff to use well-developed protocols and N95 respirators — at a minimum. What worked in Nebraska, though, is far from standard elsewhere.
Cynthia Butler, a nurse and National Nurses United member at Fawcett Memorial Hospital in Port Charlotte, on Florida's west coast, says she actually felt safer working in the COVID-19 unit — where she knew what she was dealing with and had full PPE — than on a general medical floor.
She believes she caught the virus from a patient who had COVID-19 but was housed on a general floor in May. A similar situation occurred in July, when another patient had an unexpected case of COVID-19 — and Butler says she got another positive test then herself.
She says both patients did not meet the hospital's criteria for testing admitted patients, and the lapses leave her on edge — concerns she relayed to an OSHA inspector who reached out to her about a complaint her union filed about the facility.
"Every time I go into work it's like playing Russian roulette," Butler says.
A spokesperson for HCA Healthcare, which owns the hospital, says it tests patients coming from long-term care facilities and any patient going into surgery, as well as those with virus symptoms. She says all medical employees and other workers on staff have access to PPE and practice vigilant sanitation, universal masking and social distancing.
Social distancing from patients is not an option for Butler, though, who says she cleans, feeds and starts IVs for patients and offers reassurance when they are isolated from family.
"I'm giving them the only comfort or kind word they can get," says Butler, who has recently gone on unpaid leave over safety concerns. "I'm in there doing that and I'm not being protected."
Given research showing that up to 45% of COVID-19 patients are asymptomatic, the University of California, San Francisco Medical Center is now testing every patient who is admitted, says Dr. Robert Harrison, a UCSF professor who consults on occupational health at the hospital.
The testing is done for the safety of staff and to reduce spread within the hospital, he says. Patients who test positive are separated into a COVID-19-only unit.
And health care workers who learn they've spent more than 15 minutes within 6 feet of a patient later determined to have COVID-19 are typically sent home for two weeks, he says, if they didn't have an N95 respirator on at the time.
Outside of academic medicine, though, front-line nursing staff and other health care workers have turned to union leaders to push for such protections.
In Southern California, leaders of the National Union of Healthcare Workers filed an official complaint with state hospital inspectors about the risks posed by intermingled COVID-19 patients at Fountain Valley Regional Hospital in Orange County.The hospital is part of for-profit Tenet Health. There, according to the complaint, patients were not routinely tested for the coronavirus upon admission.
One nursing assistant spent two successive 12-hour shifts caring for a patient on a general medical floor who required monitoring. At the conclusion of the second shift, she was told the patient was just found to be positive for the coronavirus.
The worker had worn only a surgical mask — not an N95 respirator or any form of eye protection — according to the complaint to the California Department of Public Health. The nursing assistant was not offered a coronavirus test or quarantined before her next two shifts, the complaint says.
The state health department says it can't comment on a pending inspection.
Barbara Lewis, Southern California hospital division director with the union, says COVID-19 patients at the hospital were on the same floor as cancer patients and post-surgical patients who were walking the halls to speed their recovery.
She says managers took steps to separate the patients only after the union held a protest, spoke to local media and complained to state health officials.
Hospital spokesperson Jessica Chen says the hospital "quickly implemented" changes directed by state health authorities. Sometimes, when there's a surge in COVID-19 cases, her facility does place some COVID-19 patients on the same nursing unit as other patients, she says, but patients infected with the virus are placed in single rooms with closed doors.
Patients can get a test for the coronavirus via a physician's order, Chen says, and employees can get the test in the community.
That's in contrast, Lewis says, to high-profile examples of the stricter precautions now being taken in professional sports.
"Now we're seeing what's happening with baseball and basketball — they're tested every day and treated with a high level of caution," Lewis says. "Yet we have thousands and thousands of health care workers going to work in a very scary environment."
Nursing homes face penalties
More than 40% of the people who have died of COVID-19 have lived in nursing homes or assisted living facilities, researchers have found.
The mixing of patients in close quarters — people who have the coronavirus with those who don't — has been a concern at some nursing homes, too, which Medicare officials discovered when they reviewed infection control practices at more than 15,000 facilities.
News reports this summer have highlighted the problem at an Ohio nursing home and at a Maryland facility where the state levied a $70,000 fine for its failure to keep infected patients away from those who weren't sick.
Fair Havens Center, a Miami Springs, Fla., nursing home, also faced penalties when inspectors discovered 11 roommates of patients who tested positive for COVID-19 were moved to rooms with other residents — putting those new roommates at heightened risk.
Florida regulators cut off admissions to the facility, records show, and Medicare authorities levied a $235,000 civil monetary penalty.
The vice president of operations at the nursing home told inspectors that isolating exposed patients would mean isolating the entire facility: Everyone had been exposed to the 32 staff members who tested positive for the virus, the report says.
Fair Havens Center did not respond to our request for comment.
In Iowa, Medicare officials declared a state of "immediate jeopardy" at Pearl Valley Rehabilitation and Care Center in Muscatine, Iowa in late April. Against the orders of a community doctor, the assistant nursing director had kept patients who had COVID-19 in the facility, citing a general order by Pearl Valley's medical director to avoid sending patients to the ER "if you can help it."
Meanwhile, several patients were documented by facility staff to have fevers and falling oxygen levels, the Medicare inspection report shows. Within two weeks, the facility discovered it had an expanding outbreak, with 61 residents infected and nine dead, according to the report.
Medicare officials also are investigating Menlo Park Veterans Memorial Home in New Jersey, state Sen. Joseph Vitale said during a legislative hearing in mid-August. Glenn Osborne, president of the facility's residents council, testified during the hearing that people living there were returned to the same shared rooms after hospitalizations — a breach in safety protocols during the pandemic
Osborne, an honorably discharged Marine, said he saw more fellow residents of the skilled nursing facility die than fellow service members during his military service. The Menlo Park and Paramus veterans home — where inspectors saw dementia patients with and without the virus commingling in a day room — have each reported more than 180 COVID-19 cases among residents, 90 among staff and at least 60 deaths from the disease.
A spokesperson for the homes says he could not comment for this story, because of pending litigation.
"These deaths should not have happened," Osborne told the assembled New Jersey legislators in his testimony. "Many of these deaths were absolutely avoidable, in my humble opinion."
Kaiser Health News is a nonprofit, editorially independent program of the Kaiser Family Foundation. KHN is not affiliated with Kaiser Permanente.


npr--2020-09-10--In Rural Fukushima, 'The Border Between Monkeys And Humans Has Blurred'

In Rural Fukushima , 'The Border Between Monkeys And Humans Has Blurred' Shuichi Kanno rips tape off the top of a large cardboard box at his house in the mountains in Fukushima prefecture in Japan .
He opens the box and rustles around to pull out pack after pack of long , thin Roman candle fireworks .
The words `` Animal Exterminating Firework '' are written in Japanese on the side of each canister .
Kanno has been battling hordes of macaque monkeys that have encroached upon his neighborhood in a rural area of Minamisoma .
These fireworks are his @ @ @ @ @ @ @ monkeys any physical harm , but to scare them away with a loud bang .
That is , until they regain their confidence and come back a few days later , which they do like clockwork , Kanno says .
`` In the early morning while I 'm sleeping , just when I 'm about to wake up , I hear the noise , '' the 79-year-old says in Japanese as he stacks the fireworks on his living room table .
`` The sound of the monkeys running around on the roof , @ @ @ @ @ @ @ my food .
I have to fight them . ''
Hundreds of thousands of people evacuated this area nine years ago , fleeing plumes of radioactive material after three reactors exploded at the Daiichi nuclear power plant , one of the most serious nuclear disasters in history .
Whole towns and neighborhoods like Kanno 's were left empty of human life for years — and , much like Chernobyl , nature started to reclaim the space .
Plants poke through sidewalks and buildings , while wild boar , raccoons and foxes roam the @ @ @ @ @ @ @ many evacuation orders have lifted and people have started to return , meaning humans and animals are having to figure out new ways to coexist — or not .
`` The monkeys never used to come here , but after the disaster , the border between monkeys and humans has blurred , '' Kanno explains .
`` The houses were empty , but the gardens were still growing — plums , pears , chestnuts , persimmons .
It was a wonderland for monkeys , an all-you-can-eat buffet .
And they remembered that .
@ @ @ @ @ @ @ edge of the evacuation area , relatively far from Daiichi .
People stayed away for only a few years , but by the time they came back , the monkeys had become comfortable .
And , Kanno points out , half the houses are still empty and only older people came back .
They just do n't have the numbers they need to win the battle against the monkeys without backup .
That is where the fireworks come in , subsidized by the local government after residents complained .
The governments here have @ @ @ @ @ @ @ such as wild boar traps and electric fences for farmers , to help communities with animal problems .
Yuriko Kanno , 75 , Shuichi 's wife , comes into the living room , looks at the pile of fireworks and laughs .
`` I 've been worried that this village is going to become like that movie , the monkey planet one , '' she says , referring to Planet of the Apes .
`` I 've seen it — it could happen ! ''
She walks away giggling .
Shuichi Kanno is @ @ @ @ @ @ @ , yes , but they 're also a source of entertainment for the aging residents , he concedes .
`` Look , I think they 're cute .
I would absolutely never hurt them , '' he says .
`` None of this is their fault .
It 's nuclear power 's fault .
It 's the fault of humans . ''
Shuichi Kanno is a leader in the neighborhood , and he 's in charge of distributing the fireworks to any of his neighbors who want them .
The neighbors all have @ @ @ @ @ @ @ the dangers and — most importantly , he says — that they will not hurt any animals .
He loads the fireworks into the trunk of his car and drives down forest roads from house to house , dropping off packs of fireworks at every stop .
As he drives , he points to all the natural beauty in the area .
The nuclear disaster did n't just change his relationship with monkeys , he says .
`` I loved hiking , and foraging for wild vegetables , finding wild mushrooms .
But @ @ @ @ @ @ @ Kanno explains , referring to the high levels of radioactive cesium still present in the dense forests here .
`` We ca n't have a relationship with nature anymore .
It 's gone . ''
He pulls up to the house of Hachiro Endo , 77 , whose family has been in the area for generations .
The home has a beautiful garden in front and long strands of drying persimmons hanging in the garage .
Endo is delighted by the delivery .
He has gone through his entire stockpile protecting his garden @ @ @ @ @ @ @ time , '' Endo sighs .
`` The monkeys , they 've taken over my life . ''
He says he remembers a time when he was little and his grandfather tried to lure the monkeys down from the mountains into the village , hoping to boost tourism to the area by becoming a monkey town .
He was never successful — the macaques were too afraid of humans to come down and stay .
`` If only he could see it now , '' he says with a laugh .
A few @ @ @ @ @ @ @ monkey patrol .
He has just seen a troop of monkeys running from his house out into the neighborhood .
He 's wearing knee-high rubber boots , a bright orange jacket and a baseball cap while clutching a firework in one hand and the steering wheel of his pickup truck in the other .
He drives slowly , leaning forward to scan the hills as he goes .
And then suddenly , he slams on his brakes .
`` There they are ! ''
he shouts , pointing behind a shed .
Dozens @ @ @ @ @ @ @ , scrambling up trees and crawling up the hillside .
He jumps out of the truck and pulls the firework from underneath his jacket , loading it onto a kind of stick so he can hold it far away .
He lights the fuse and smiles , pointing it toward the hill .
Three loud booms echo through the trees .
The monkeys scatter .
Kanno bursts into a grin , giggling .
Then he runs to every house nearby , making sure his neighbors know that he just saved their gardens from @ @ @ @ @ @ @ n't be back tomorrow ! ''
Kanno calls , waving the spent firework , giddy with excitement .
`` I won today ! ''
But even as he says that he loads a fresh firework and tucks it into his coat .
The monkeys will be back , and the battle will continue .
Kat Lonsdorf ( @ lilkat_bigworld ) is NPR 's Above the Fray fellow .
The fellowship is sponsored by the John Alexander Project , which supports foreign reporting in undercovered parts of the world .
Follow the fellowship on @ @ @ @ @ @ @ ( @ thejohnaproject ) .

In Rural Fukushima, 'The Border Between Monkeys And Humans Has Blurred'
Enlarge this image toggle caption Claire Harbage/NPR Claire Harbage/NPR
Shuichi Kanno rips tape off the top of a large cardboard box at his house in the mountains in Fukushima prefecture in Japan. He opens the box and rustles around to pull out pack after pack of long, thin Roman candle fireworks. The words "Animal Exterminating Firework" are written in Japanese on the side of each canister.
Kanno has been battling hordes of macaque monkeys that have encroached upon his neighborhood in a rural area of Minamisoma. These fireworks are his main deterrent — not to cause the monkeys any physical harm, but to scare them away with a loud bang. That is, until they regain their confidence and come back a few days later, which they do like clockwork, Kanno says.
Enlarge this image toggle caption Claire Harbage/NPR Claire Harbage/NPR
"In the early morning while I'm sleeping, just when I'm about to wake up, I hear the noise," the 79-year-old says in Japanese as he stacks the fireworks on his living room table. "The sound of the monkeys running around on the roof, getting into the gardens, eating all my food. I have to fight them."
Hundreds of thousands of people evacuated this area nine years ago, fleeing plumes of radioactive material after three reactors exploded at the Daiichi nuclear power plant, one of the most serious nuclear disasters in history. Whole towns and neighborhoods like Kanno's were left empty of human life for years — and, much like Chernobyl, nature started to reclaim the space. Plants poke through sidewalks and buildings, while wild boar, raccoons and foxes roam the streets. But in recent years, many evacuation orders have lifted and people have started to return, meaning humans and animals are having to figure out new ways to coexist — or not.
Enlarge this image toggle caption Claire Harbage/NPR Claire Harbage/NPR
"The monkeys never used to come here, but after the disaster, the border between monkeys and humans has blurred," Kanno explains. "The houses were empty, but the gardens were still growing — plums, pears, chestnuts, persimmons. It was a wonderland for monkeys, an all-you-can-eat buffet. And they remembered that."
His neighborhood is on the very edge of the evacuation area, relatively far from Daiichi. People stayed away for only a few years, but by the time they came back, the monkeys had become comfortable. And, Kanno points out, half the houses are still empty and only older people came back. They just don't have the numbers they need to win the battle against the monkeys without backup.
Enlarge this image toggle caption Claire Harbage/NPR Claire Harbage/NPR
That is where the fireworks come in, subsidized by the local government after residents complained. The governments here have provided several different kinds of tools, such as wild boar traps and electric fences for farmers, to help communities with animal problems.
Yuriko Kanno, 75, Shuichi's wife, comes into the living room, looks at the pile of fireworks and laughs. "I've been worried that this village is going to become like that movie, the monkey planet one," she says, referring to Planet of the Apes. "I've seen it — it could happen!"
She walks away giggling. Shuichi Kanno is laughing too. The monkeys are annoying, yes, but they're also a source of entertainment for the aging residents, he concedes.
Enlarge this image toggle caption Claire Harbage/NPR Claire Harbage/NPR
"Look, I think they're cute. I would absolutely never hurt them," he says. "None of this is their fault. It's nuclear power's fault. It's the fault of humans."
Shuichi Kanno is a leader in the neighborhood, and he's in charge of distributing the fireworks to any of his neighbors who want them. The neighbors all have to sign an agreement saying they understand the dangers and — most importantly, he says — that they will not hurt any animals.
He loads the fireworks into the trunk of his car and drives down forest roads from house to house, dropping off packs of fireworks at every stop. As he drives, he points to all the natural beauty in the area. The nuclear disaster didn't just change his relationship with monkeys, he says.
"I loved hiking, and foraging for wild vegetables, finding wild mushrooms. But now it's so dangerous," Kanno explains, referring to the high levels of radioactive cesium still present in the dense forests here. "We can't have a relationship with nature anymore. It's gone."
Enlarge this image toggle caption Claire Harbage/NPR Claire Harbage/NPR
He pulls up to the house of Hachiro Endo, 77, whose family has been in the area for generations. The home has a beautiful garden in front and long strands of drying persimmons hanging in the garage.
Endo is delighted by the delivery. He has gone through his entire stockpile protecting his garden. "I'm alert all the time," Endo sighs. "The monkeys, they've taken over my life."
He says he remembers a time when he was little and his grandfather tried to lure the monkeys down from the mountains into the village, hoping to boost tourism to the area by becoming a monkey town. He was never successful — the macaques were too afraid of humans to come down and stay.
"If only he could see it now," he says with a laugh.
Enlarge this image toggle caption Claire Harbage/NPR Claire Harbage/NPR
A few days later, Kanno is out on monkey patrol. He has just seen a troop of monkeys running from his house out into the neighborhood. He's wearing knee-high rubber boots, a bright orange jacket and a baseball cap while clutching a firework in one hand and the steering wheel of his pickup truck in the other.
He drives slowly, leaning forward to scan the hills as he goes. And then suddenly, he slams on his brakes.
"There they are!" he shouts, pointing behind a shed. Dozens of monkeys are jumping toward the forest, scrambling up trees and crawling up the hillside.
He jumps out of the truck and pulls the firework from underneath his jacket, loading it onto a kind of stick so he can hold it far away. He lights the fuse and smiles, pointing it toward the hill.
Enlarge this image toggle caption Claire Harbage/NPR Claire Harbage/NPR
Three loud booms echo through the trees. The monkeys scatter. Kanno bursts into a grin, giggling. Then he runs to every house nearby, making sure his neighbors know that he just saved their gardens from almost certain devastation.
"They won't be back tomorrow!" Kanno calls, waving the spent firework, giddy with excitement. "I won today!"
But even as he says that he loads a fresh firework and tucks it into his coat. The monkeys will be back, and the battle will continue.
Kat Lonsdorf (@lilkat_bigworld) is NPR's Above the Fray fellow. The fellowship is sponsored by the John Alexander Project, which supports foreign reporting in undercovered parts of the world. Follow the fellowship on Instagram (@thejohnaproject) and Twitter (@thejohnaproject).


npr--2020-09-10--The Pandemic Has Researchers Worried About Teen Suicide

The Pandemic Has Researchers Worried About Teen Suicide Teen and youth anxiety and depression are getting worse since COVID lockdowns began in March , early studies suggest , and many experts say they fear a corresponding increase in youth suicide .
At the end of June , the Centers for Disease Control and Prevention surveyed almost 10,000 Americans on their mental health .
They found symptoms of anxiety and depression were up sharply across the board between March and June , compared with the same time the previous year .
And young people seemed to be the hardest-hit of any @ @ @ @ @ @ @ respondents to that survey said they had `` seriously considered '' suicide in the past 30 days .
For those ages 18 to 24 , the number was 1 in 4 — more than twice as high .
Data collection for several studies on teen mental health during the pandemic is currently underway .
And experts worry those studies will show a spike in suicide , because young people are increasingly cut off from peers and caring adults , because their futures are uncertain and because they are spending more time at home @ @ @ @ @ @ @ have access to lethal weapons .
`` Teenagers are in a developmental space where it is critically important that they have regular contact with their peers and are able to develop close and ongoing relationships with adults outside the home , such as their teachers , their coaches , their advisers , '' says Lisa Damour , an adolescent psychologist who is a columnist and host of the podcast Ask Lisa : The Psychology of Parenting .
`` And I worry very much about what it means for that to be disrupted by @ @ @ @ @ @ @ COVID come as youth suicide was already at a record high before the pandemic , with increases every year since 2007 .
Suicide is the second leading cause of death among people ages 10-24 , after accidents , as it has been for many years , according to the most recent data available from the CDC .
Not having guns in the home , or keeping them safely locked away , is another overlooked factor in suicide risk .
A new analysis of the latest CDC data , just released by the advocacy @ @ @ @ @ @ @ that the rate of specifically firearm suicides increased 51 % for 15-24 year olds in the decade ending in 2018 .
Among 10- to 14-year-olds , who have a lower rate of suicide to begin with , suicide by gun increased a staggering 214 % in that time frame .
Gun suicide is astonishingly lethal : Of all suicide attempts not involving guns , 94 % fail , and most of those people do not try again , Everytown reports .
Of all suicide attempts that do involve guns , 90 % succeed @ @ @ @ @ @ @ ownership correlates with the youth suicide rate , state by state .
A study last year found that for each 10 percent increase in household gun ownership in a state , the suicide rate for 10- to 19-year-olds increases by more than 25 percent .
And , the presence of guns is another community risk factor that has increased during the pandemic : From March to July 2020 , Everytown reports , gun sales doubled compared with the year before .
Carrson Everett , 17 , says when he himself attempted suicide , @ @ @ @ @ @ @ guns safely locked away and out of reach most likely helped save his life .
He says that during the pandemic , `` Teenagers are already having the effect of isolation , staying at home and everything .
And now there 's all these new firearms in their homes and , you know , we ca n't tell who 's safely storing their guns and who is n't .
And it 's very dangerous . ''
Everett has started his senior year of high school in Kingsport , Tenn. , on a hybrid @ @ @ @ @ @ @ 's home , he says he wonders what he 's missing out on at school .
`` Everyone feels isolated , and it 's been very tough for everybody . ''
He says these past few months have been especially hard for him because he has depression and anxiety .
Plus , he says he 's been bullied for years for being gay , including over video chat during distance learning .
Everett is a volunteer for Students Demand Action , an anti-gun violence group .
He said he 's learned that gun @ @ @ @ @ @ @ crime or mass shootings , but also suicide .
`` I wrote an op-ed about a kid that was my age over in Cookeville , Tennessee , that had taken his own life with a firearm because he had been outed [ as gay ] at school .
So , you know , it 's very relatable for me . ''
Damour , the teen psychologist , explains that not having guns in the home , or keeping them safely locked away , is important especially for adolescents because `` teens are impulsive @ @ @ @ @ @ @ says parents need to know that suicide is preventable .
A red flag is when sadness is more than a passing mood .
Caregivers need to check in regularly — which can be unexpectedly complicated when the whole family is spending so much time at home .
A common pattern , she notes , is parents trying to work during the day , and teenagers staying up late at night to have time to themselves .
This is n't inherently a problem , Damour says , but `` there 's a difference between @ @ @ @ @ @ @ hole up in their room for days at a time . ''
If a teen talks about harming themselves or wanting to disappear , a parent should ask directly , `` Is that something you think you might really do or you think about doing ?
Or are you just letting me know that you 're very upset right now ? ''
And , she adds , hear them out without dismissing what they 're saying .
She also says parents should look out for anger : `` In teenagers , uniquely , @ @ @ @ @ @ @ .
That depression in teenagers sometimes looks like a prickly porcupine .
Everybody rubs them the wrong way .
And that is easy to miss because sometimes we 'll just dismiss that as being a snarky teenager . ''
If school is all-virtual , she says , parents should look for safe sports , work or volunteer opportunities that allow teens to have social time and contact with other caring adults .
Finally , Damour says she sees one bright spot : During the pandemic , she and other clinicians are finding that @ @ @ @ @ @ @ is working surprisingly well with adolescents .
`` The teenagers that I see are often talking to me from their bedrooms , sometimes flopped over in their beds , '' she says .
`` There 's something unguarded about it that 's very different than having them sit in my office . ''
And , virtual therapy can lower barriers to access for families who might have had to travel to get accessible mental health care .
If you or someone you know is having suicidal thoughts , reach out for help .
@ @ @ @ @ @ @ 24 hours a day at 800-273-8255 .

The Pandemic Has Researchers Worried About Teen Suicide
Enlarge this image LA Johnson/NPR LA Johnson/NPR
Teen and youth anxiety and depression are getting worse since COVID lockdowns began in March, early studies suggest, and many experts say they fear a corresponding increase in youth suicide.
At the end of June, the Centers for Disease Control and Prevention surveyed Americans on their mental health. They found symptoms of anxiety and depression were up sharply across the board between March and June, compared with the same time the previous year. And young people seemed to be the hardest-hit of any group.
Almost 11 percent of all respondents to that survey said they had "seriously considered" suicide in the past 30 days. For those ages 18 to 24, the number was 1 in 4 — more than twice as high.
Data collection for several studies on teen mental health during the pandemic is currently underway. And experts worry those studies will show a spike in suicide, because young people are increasingly cut off from peers and caring adults, because their futures are uncertain and because they are spending more time at home, where they are most likely to have access to lethal weapons.
"Teenagers are in a developmental space where it is critically important that they have regular contact with their peers and are able to develop close and ongoing relationships with adults outside the home, such as their teachers, their coaches, their advisers," says Lisa Damour, an adolescent psychologist who is a columnist and host of the podcast Ask Lisa: The Psychology of Parenting. "And I worry very much about what it means for that to be disrupted by the pandemic."
The stressors of COVID come as youth suicide was already at a record high before the pandemic, with increases every year since 2007. Suicide is the second leading cause of death among people ages 10-24, after accidents, as it has been for many years, according to the most recent data available from the CDC.
Not having guns in the home, or keeping them safely locked away, is another overlooked factor in suicide risk. A new analysis of the latest CDC data, just released by the advocacy group Everytown for Gun Safety, found that the rate of specifically firearm suicides increased 51% for 15-24 year olds in the decade ending in 2018. Among 10- to 14-year-olds, who have a lower rate of suicide to begin with, suicide by gun increased a staggering 214% in that time frame.
Gun suicide is astonishingly lethal: Of all suicide attempts not involving guns, 94% fail, and most of those people do not try again, Everytown reports. Of all suicide attempts that do involve guns, 90% succeed. That's one reason that gun ownership correlates with the youth suicide rate, state by state. A study last year found that for each 10 percent increase in household gun ownership in a state, the suicide rate for 10- to 19-year-olds increases by more than 25 percent.
And, the presence of guns is another community risk factor that has increased during the pandemic: From March to July 2020, Everytown reports, gun sales doubled compared with the year before.
Carrson Everett, 17, says when he himself attempted suicide, the fact that his parents kept their guns safely locked away and out of reach most likely helped save his life. He says that during the pandemic, "Teenagers are already having the effect of isolation, staying at home and everything. And now there's all these new firearms in their homes and, you know, we can't tell who's safely storing their guns and who isn't. And it's very dangerous."
Everett has started his senior year of high school in Kingsport, Tenn., on a hybrid schedule. On the days that he's home, he says he wonders what he's missing out on at school. "Everyone feels isolated, and it's been very tough for everybody."
He says these past few months have been especially hard for him because he has depression and anxiety. Plus, he says he's been bullied for years for being gay, including over video chat during distance learning.
Everett is a volunteer for Students Demand Action, an anti-gun violence group that is part of Everytown. He said he's learned that gun violence isn't just a matter of crime or mass shootings, but also suicide. "I wrote an op-ed about a kid that was my age over in Cookeville, Tennessee, that had taken his own life with a firearm because he had been outed [as gay] at school. So, you know, it's very relatable for me."
Damour, the teen psychologist, explains that not having guns in the home, or keeping them safely locked away, is important especially for adolescents because "teens are impulsive."
What parents can do
She says parents need to know that suicide is preventable. A red flag is when sadness is more than a passing mood. Caregivers need to check in regularly — which can be unexpectedly complicated when the whole family is spending so much time at home.
A common pattern, she notes, is parents trying to work during the day, and teenagers staying up late at night to have time to themselves. This isn't inherently a problem, Damour says, but "there's a difference between allowing privacy and allowing a teenager to hole up in their room for days at a time."
If a teen talks about harming themselves or wanting to disappear, a parent should ask directly, "Is that something you think you might really do or you think about doing? Or are you just letting me know that you're very upset right now?" And, she adds, hear them out without dismissing what they're saying.
She also says parents should look out for anger: "In teenagers, uniquely, depression can take the form of irritability. That depression in teenagers sometimes looks like a prickly porcupine. Everybody rubs them the wrong way. And that is easy to miss because sometimes we'll just dismiss that as being a snarky teenager."
If school is all-virtual, she says, parents should look for safe sports, work or volunteer opportunities that allow teens to have social time and contact with other caring adults.
Finally, Damour says she sees one bright spot: During the pandemic, she and other clinicians are finding that telemedicine — therapy over video chat — is working surprisingly well with adolescents.
"The teenagers that I see are often talking to me from their bedrooms, sometimes flopped over in their beds," she says. "There's something unguarded about it that's very different than having them sit in my office."
And, virtual therapy can lower barriers to access for families who might have had to travel to get accessible mental health care.
If you or someone you know is having suicidal thoughts, reach out for help. The National Suicide Prevention Lifeline is open 24 hours a day at 800-273-8255.


npr--2020-09-10--Pandemic Financially Imperils Nearly Half of American Households, Poll Finds

Cynthia Maclin can not get out of bed most days .
Chronic lung disease leaves her short of breath and ended her 45-year career as a medical administrator .
COVID-19 cases are on the rise in her hometown of Chicago , and Maclin 's already lost eight friends and family members to the virus , including the father of her two daughters .
For the first time this month , she 's also unable to pay rent .
So Maclin , 66 , feels the crush of grief , loneliness , depression and financial stress — but she has n't @ @ @ @ @ @ @ `` I have not seen my pulmonary doctor to listen to my lungs , to check my oxygen levels , '' says Maclin .
She has n't seen her psychiatrist , or her primary care doctor .
`` All these things have an impact , '' she says , through labored breaths .
Maclin is just one among many in the U.S. facing a cascade of economic and health-related problems revealed in a new survey by NPR , the Robert Wood Johnson Foundation and Harvard 's T.H .
Chan School of Public Health @ @ @ @ @ @ @ households in America — 46 % — report facing serious financial pain during the pandemic — a problem that is more acute in the four largest U.S. cities , and among Latino and Black households .
Hundreds of billions in government stimulus and other support did not make an apparent dent in their struggles .
In addition , over half , or 54 % , of those with household incomes below $ 100,000 reported serious financial problems , compared to only 20 % of those with incomes above that threshold .
In short @ @ @ @ @ @ @ challenges run deeper and broader than previously understood , says Robert Blendon , professor emeritus of health policy and political analysis at Harvard and co-author of the survey .
`` I would have expected that all the aid that was coming from various sources would have narrowed , not eliminated , the differences by race and ethnicity , '' but it did not , he says .
At the time of the survey , the federal government was offering $ 600 a week in additional benefits for the unemployed .
That was not @ @ @ @ @ @ @ have likely gotten worse .
'Nothing ... to fall back on' '' It 's going to get worse because there is nothing for the people we surveyed ... to fall back on , '' Blendon says .
Depending on which city , anywhere from 50 % to 80 % of Latino and Black households in New York City , Los Angeles , Chicago and Houston report serious financial problems — such as depleted savings , the inability to pay rent or mortgage , or pay their credit cards .
Many , like Maclin @ @ @ @ @ @ @ after medical care they needed was put off .
For Maclin , the financial woes seep from one area of her life to another .
The battery in her truck recently died , for example — transport she relies on to get food and medicine .
She used some of the $ 1,200 federal stimulus money to fix it , but that money is now long gone , and she still has bills she ca n't pay .
`` I try so hard not to cry , '' says Maclin , who lives @ @ @ @ @ @ @ and seven great-grandkids — I would love to see them , but I ca n't , '' she says , weeping .
A lack of family funds compounds other problems in peoples ' lives , social services agencies confirm .
A lot of people facing multiple health and financial problems have been turning to the Legal Aid Foundation of Los Angeles in recent months .
The nonprofit helps low-income families on a range of issues , from employment and housing to medical benefits .
`` There is a minimum of at least three @ @ @ @ @ @ @ is housing insecurities ... because of their loss of job , or they 're dealing with food insecurity , '' says Ronnette Ramos is a managing attorney at the foundation .
That 's magnifying health conditions as well , leading to higher anxiety and blood pressure among clients , she says .
Many landlords , some dependent on rental income to survive , are feeling the pinch , along with their tenants .
Ramos says the landlords of some of her clients are trying to find ways around the state and federal moratoria @ @ @ @ @ @ @ an already huge housing crisis in L.A. '' Renters pay more than 50 % of what they make towards rent , so that does n't leave much room for life upheaval , '' Ramos says .
`` And we 've been almost now in six months of life upheaval . ''
'We 're the last people to recover' In some cases , financial difficulties are forcing people to make big changes .
Gregory Cooper spent 30-plus years in accounting and operations in the oil and gas industry , but had to move out @ @ @ @ @ @ @ without work .
`` I mean , I have an MBA and I have two certifications , but I 'm struggling still , '' says Cooper , 60 , who moved in with his elderly mother in Alexandria , La .
He finally landed a government accounting job making about $ 40,000 a year — half what he used to make .
He says it would be terrifying to be without a job right now , because of his age and his race .
Black unemployment rates always run higher than the average @ @ @ @ @ @ @ almost the last people to recover when it comes to unemployment . ''
Cooper says he worries the pandemic is intensifying unrest over the racial inequities in education and employment in the U.S .
Yet those dynamics also feel familiar to him : `` I see our parents do it , and show us how to make ends meet , '' he says .
`` I think that sometimes is good , versus being born with a silver spoon in your mouth . ''
But for some , including Alvaro Castro , 58 @ @ @ @ @ @ @ .
The married father of two was born in Columbia and for three decades has lived in a suburb of Miami .
He made more than $ 100,000 a year , until he lost his job as a television producer last September .
It was April before he found steady work as a contractor , making less than he 'd earned previously .
`` When you have four people for five months , and only one person is producing , it 's hard , '' he says .
`` Especially with food ; @ @ @ @ @ @ @ spring , he fell behind on mortgage and car payments , as he scrimped and saved on every expense he could think of . '
I do n't have enough to pay this medical co-payment' But there were some things they could not postpone .
Like his wife 's cataract surgery in April .
`` I remember that she called me from the hospital — the clinic — and said , ' I do n't have enough to pay this medical co-payment , ' `` Castro says .
They moved funds around to @ @ @ @ @ @ @ Part of surviving the pandemic , he says , has meant taking a more philosophical approach to life 's problems .
`` Money is not the most important factor in our life , '' Castro says .
`` Maybe the most important factor in your life is the way that you relate with others , the way [ you ] share the time with your loved ones , or the way that you already appreciate how they feel about you . ''

'I Try So Hard Not To Cry': Nearly Half Of U.S. Households Face A Financial Crisis
Enlarge this image Kim Ryu for NPR Kim Ryu for NPR
Cynthia Maclin cannot get out of bed most days.
Chronic lung disease leaves her short of breath and ended her 45-year career as a medical administrator. COVID-19 cases are on the rise in her hometown of Chicago, and Maclin has already lost eight friends and family members to the virus, including the father of her two daughters. For the first time, this month, she's also unable to pay rent.
So Maclin, 66, feels the crush of grief, loneliness, depression and financial stress — but she hasn't been able to see her doctors.
"I have not seen my pulmonary doctor to listen to my lungs, to check my oxygen levels," says Maclin. She hasn't seen her psychiatrist, or her primary care doctor. "All these things have an impact," she says, through labored breaths.
Maclin is just one among many in the U.S. facing a cascade of economic and health-related problems revealed in a new survey by NPR, the Robert Wood Johnson Foundation and Harvard's T.H. Chan School of Public Health. The poll finds nearly half the households in America — 46% — report facing serious financial pain during the pandemic. It is a problem that is more acute in the four largest U.S. cities, and among Latino and Black households. Hundreds of billions in government stimulus and other support did not make an apparent dent in their struggles.
In addition, over half, or 54%, of those with household incomes below $100,000 reported serious financial problems, compared with only 20% of those with incomes above that threshold.
Loading...
In short, the results show the personal financial challenges run deeper and broader than previously understood, says Robert Blendon, professor emeritus of health policy and political analysis at Harvard and co-author of the survey. "I would have expected that all the aid that was coming from various sources would have narrowed, not eliminated, the differences by race and ethnicity," but it did not, he says.
At the time of the survey, the federal government was offering $600 a week in additional benefits for those collecting unemployment. That was not renewed after July. That means things have likely gotten worse.
'Nothing ... to fall back on'
"It's going to get worse because there is nothing for the people we surveyed ... to fall back on," Blendon says.
Depending on which city, anywhere from 50% to 80% of Latino and Black households in New York City, Los Angeles, Chicago and Houston report serious financial problems — such as depleted savings, the inability to pay rent or mortgage, or the inability to pay their credit cards. Many, like Maclin, also say their health has worsened after medical care they needed was put off.
For Maclin, the financial woes seep from one area of her life to another. The battery in her truck recently died, for example — transport she relies on to get food and medicine. She used some of the $1,200 federal stimulus money to fix it, but that money is now long gone, and she still has bills she can't pay.
"I try so hard not to cry," says Maclin, who lives alone. "I have nine grandkids and seven great-grandkids — I would love to see them, but I can't," she says, weeping.
A lack of family funds compounds other problems in people's lives, social services agencies confirm.
Loading...
A lot of people facing multiple health and financial problems have been turning to the Legal Aid Foundation of Los Angeles in recent months. The nonprofit helps low-income families on a range of issues, from employment and housing to medical benefits.
Financial problems magnify health issues
"There is a minimum of at least three issues per phone call, whether it is housing insecurities ... because of their loss of job, or they're dealing with food insecurity," says Ronnette Ramos, a managing attorney at the foundation. That's magnifying health conditions as well, leading to higher anxiety and blood pressure among clients, she says.
Many landlords, some dependent on rental income to survive, are feeling the pinch, along with their tenants. Ramos says the landlords of some of her clients are trying to find ways around the state and federal moratoria on evictions — and that is exacerbating an already huge housing crisis in L.A.
"Renters pay more than 50% of what they make towards rent, so that doesn't leave much room for life upheaval," Ramos says. "And we've been almost now in six months of life upheaval."
'We're the last people to recover'
In some cases, financial difficulties are forcing people to make big changes.
Gregory Cooper spent 30-plus years in accounting and operations in the oil and gas industry but had to move out of Houston after more than a year without work.
"I mean, I have an MBA and I have two certifications, but I'm struggling still," says Cooper, 60, who moved in with his elderly mother in Alexandria, La. He finally landed a government accounting job making about $40,000 a year — half what he used to make. He says it would be terrifying to be without a job right now, because of his age and his race.
Black unemployment rates always run higher than the average, he notes. "We're almost the last people to recover when it comes to unemployment."
Cooper says he worries the pandemic is intensifying unrest over the racial inequities in education and employment in the U.S. Yet those dynamics also feel familiar to him. "I see our parents do it, and show us how to make ends meet," he says. "I think that sometimes is good, versus being born with a silver spoon in your mouth."
But for some, including Alvaro Castro, 58, financial hardship is a new experience. The married father of two was born in Colombia and for three decades has lived in a suburb of Miami. He made more than $100,000 a year, until he lost his job as a television producer last September. It was April before he found steady work as a contractor, making less than he had earned previously.
"When you have four people for five months, and only one person is producing, it's hard," he says. "Especially with food; it's quite expensive."
This spring, he fell behind on mortgage and car payments, as he scrimped and saved on every expense he could think of.
'I don't have enough to pay this medical copayment'
But there were some things they could not postpone. Like his wife's cataract surgery in April.
"I remember that she called me from the hospital — the clinic — and said, 'I don't have enough to pay this medical copayment,' " Castro says. They moved funds around to scrape together the $250 copayment.
Part of surviving the pandemic, he says, has meant taking a more philosophical approach to life's problems.
"Money is not the most important factor in our life," Castro says. "Maybe the most important factor in your life is the way that you relate with others, the way [you] share the time with your loved ones, or the way that you already appreciate how they feel about you."


npr--2020-09-10--NYPD Study: Implicit Bias Training Changes Minds, Not Necessarily Behavior

As U.S. law enforcement departments are accused of racist policing , one of the most common responses by the people in charge has been to have officers take `` implicit bias '' training .
The training usually consists of a seminar in the psychological theory that unconscious stereotypes can lead people to make dangerous snap judgments .
For instance , unconscious associations of African Americans with crime might make cops quicker to see them as suspects .
After the 2014 Ferguson , Mo.
, protests , states rushed to require the training .
Now a majority do , with New @ @ @ @ @ @ @ .
But despite the boom in implicit bias training , there has been little real-life research into whether it actually changes what police officers do on the job .
`` It 's like I 'm offering you a pill to fix some disease , and I have n't tested to see whether it actually works , '' says Joshua Correll , an associate professor of psychology at the University of Colorado Boulder , where he studies racial bias .
`` Expecting that we can take people in and train them to reduce their @ @ @ @ @ @ @ it 's been supported by the literature . ''
That 's why Correll is excited about a new study at the New York Police Department that allowed researchers to track the effects of mandatory implicit bias training as it was implemented in 2018 .
Their findings ?
As measured in surveys before and after their training , NYPD officers expressed more awareness of the concept of implicit bias and greater willingness to try to manage it .
`` We could certainly say that the training can be credited with elevating officers ' comprehension @ @ @ @ @ @ @ says Robert E. Worden , director of the John F. Finn Institute for Public Safety in Albany , N.Y. , and the lead author of the study .
But then the researchers examined data about NYPD officers ' actions on the job before and after the training .
Specifically , they looked at a breakdown of the ethnic disparities among the people who were arrested and had other kinds of interactions with those officers .
And in those numbers , they found no meaningful change .
`` It 's fair to say that @ @ @ @ @ @ @ training on officers ' enforcement behaviors , '' says Worden .
Worden calls it a `` null result '' : It does n't prove implicit bias training changes cops ' behavior , but it does n't disprove it either .
`` We believe that our training reduces biased behavior on the streets of the jurisdictions where we train , '' says Lorie Fridell , the University of South Florida criminology professor who developed the `` Fair and Impartial Policing '' curriculum used in New York .
`` That the research did n't detect @ @ @ @ @ @ @ mean that they did not occur . ''
She points to the inherent difficulties in measuring real-life outcomes in policing , especially in a place like New York .
Multiple other variables may have clouded the data , such as the city 's preexisting efforts to reduce race as a factor in police stops .
The NYPD brass also does n't seem to be bothered by the lack of change in behaviors .
`` That was n't the objective , '' says First Deputy Commissioner Benjamin B. Tucker .
`` The training was @ @ @ @ @ @ @ self-reflection and just to understand that any biases that they may have may creep into their job , '' he says .
`` That awareness , we think , adds value in and of itself . ''
Tucker says the training is worth the $ 5.5 million it costs per year .
Anecdotally , police officers around the U.S. are getting used to the training and even warming to it .
`` I think that even the most cynical cop out there would agree that prejudice on the street is a problem and @ @ @ @ @ @ @ something , '' says Adam Plantinga , a San Francisco police sergeant who writes about policing .
Plantinga says his department 's training was `` pretty good , '' because it helped officers explore the unconscious associations that might affect their split-second decisions .
`` If we approach a suspect who 's reaching for his pocket , '' he says , `` does that white suspect get a second or two more of a grace period than the suspect of color , before we draw our gun ? ''
But from a purely @ @ @ @ @ @ @ `` self-reflection , '' as the NYPD 's Tucker put it , actually lead to fairer policing , especially given the unresolved debate among researchers about how — or even whether — implicit bias governs behavior ?
Correll , the psychology professor , says the training itself probably does n't hurt , but there 's an opportunity cost to consider , especially if the effort to `` fix '' implicit bias in officers displaces other kinds of training or gives a city an excuse to ignore factors that are external to policing .
@ @ @ @ @ @ @ at the level of the individual [ police officer 's ] brain , '' Correll says .
`` You need to intervene at the level of the culture , '' such as grappling with the reasons certain communities have more encounters with the police , such as poverty or public housing policies that end up concentrating particular ethnic groups in crime-prone areas .
Even one of the pioneers of the theory of implicit bias , Harvard University psychology professor Mahzarin Banaji , worries about the quality of implicit bias training for police .
@ @ @ @ @ @ @ concepts ] has been in the hands of people called 'diversity trainers , ' and they 're like politicians — they do n't have to have any expertise , '' Banaji says , referring to the decentralized , entrepreneurial reality of the world of police consultants and trainers .
She does n't like the fact that departments usually make the training mandatory .
That 's likely to create resistance , she says , and it defeats the goal of convincing officers that they stand to benefit from understanding their unconscious biases and learning @ @ @ @ @ @ @ the same time , she says , even the best implicit bias training should n't be expected to produce immediate changes in the behaviors of a whole police department .
`` That , to me , is like saying , 'Can I give you a lecture on climate change ? '
and tomorrow you 're going to stop driving your car and start taking public transportation , '' she says .
`` I do n't think the question is commensurate with the behavior that they 're measuring . ''
She believes there are @ @ @ @ @ @ @ can say we know how to deal effectively with implicit bias .
Others are trying to make progress on that .
Following the NYPD study , the next major attempt to test the effectiveness of implicit bias training on police is work being done by Lois James , at Washington State University .
She 's one of the developers of Counter Bias Training Simulation , a curriculum that uses video scenarios in shooting simulators to show officers the dangers created by implicit bias .
The hope is that a more hands-on experience will @ @ @ @ @ @ @ 's not assuming it works .
`` As someone who 's literally developed an implicit bias program , [ I think ] it would be irresponsible for us to not test the outcome , '' James says .
`` It ca n't be just speculation . ''
She 's in the middle of an experiment with the Sacramento Police Department in which some officers will get her simulator-based training , some will get traditional , seminar-style implicit bias training and some will get neither .
Then her graduate students will review the body @ @ @ @ @ @ @ the public — before and after the training period — and score them for how civilly the officers treat each ethnic group .
James says she finds it `` disheartening '' that the NYPD study found no behavioral change , and she says , `` Many people are expecting me to find nothing too , but we 'll see . ''
Even if her study also finds no behavioral change , she says , `` it does n't mean we should eradicate implicit bias training .
It just means we have to work @ @ @

NYPD Study: Implicit Bias Training Changes Minds, Not Necessarily Behavior
As U.S. law enforcement departments are accused of racist policing, one of the most common responses by the people in charge has been to have officers take "implicit bias" training.
The training usually consists of a seminar in the psychological theory that unconscious stereotypes can lead people to make dangerous snap judgments. For instance, unconscious associations of African Americans with crime might make cops quicker to see them as suspects.
After the 2014 Ferguson, Mo., protests, states rushed to require the training. Now a majority do, with New Jersey joining the list late last month.
But despite the boom in implicit bias training, there has been little real-life research into whether it actually changes what police officers do on the job.
"It's like I'm offering you a pill to fix some disease, and I haven't tested to see whether it actually works," says Joshua Correll, an associate professor of psychology at the University of Colorado Boulder, where he studies racial bias. "Expecting that we can take people in and train them to reduce their implicit bias — I don't think it's been supported by the literature."
That's why Correll is excited about a new study at the New York Police Department that allowed researchers to track the effects of mandatory implicit bias training as it was implemented in 2018.
Their findings? As measured in surveys before and after their training, NYPD officers expressed more awareness of the concept of implicit bias and greater willingness to try to manage it.
Loading...
"We could certainly say that the training can be credited with elevating officers' comprehension of what implicit bias is," says Robert E. Worden, director of the John F. Finn Institute for Public Safety in Albany, N.Y., and the lead author of the study.
But then the researchers examined data about NYPD officers' actions on the job before and after the training. Specifically, they looked at a breakdown of the ethnic disparities among the people who were arrested and had other kinds of interactions with those officers. And in those numbers, they found no meaningful change.
Loading...
"It's fair to say that we could not detect effects of the training on officers' enforcement behaviors," says Worden.
Worden calls it a "null result": It doesn't prove implicit bias training changes cops' behavior, but it doesn't disprove it either.
The trainers are undeterred.
"We believe that our training reduces biased behavior on the streets of the jurisdictions where we train," says Lorie Fridell, the University of South Florida criminology professor who developed the "Fair and Impartial Policing" curriculum used in New York. "That the research didn't detect those changes in behavioral outcomes does not mean that they did not occur."
She points to the inherent difficulties in measuring real-life outcomes in policing, especially in a place like New York. Multiple other variables may have clouded the data, such as the city's preexisting efforts to reduce race as a factor in police stops.
The NYPD brass also doesn't seem to be bothered by the lack of change in behaviors.
"That wasn't the objective," says First Deputy Commissioner Benjamin B. Tucker. "The training was designed just to have them do some self-reflection and just to understand that any biases that they may have may creep into their job," he says. "That awareness, we think, adds value in and of itself."
Tucker says it's worth the $5.5 million it cost to train the department's 36,000 officers.
Anecdotally, police officers around the U.S. are getting used to the training and even warming to it.
"I think that even the most cynical cop out there would agree that prejudice on the street is a problem and you've got to try to do something," says Adam Plantinga, a San Francisco police sergeant who writes about policing.
Plantinga says his department's training was "pretty good," because it helped officers explore the unconscious associations that might affect their split-second decisions.
"If we approach a suspect who's reaching for his pocket," he says, "does that white suspect get a second or two more of a grace period than the suspect of color, before we draw our gun?"
But from a purely utilitarian perspective, do such moments of "self-reflection," as the NYPD's Tucker put it, actually lead to fairer policing, especially given the unresolved debate among researchers about how — or even whether — implicit bias governs behavior?
Correll, the psychology professor, says the training itself probably doesn't hurt, but there's an opportunity cost to consider, especially if the effort to "fix" implicit bias in officers displaces other kinds of training or gives a city an excuse to ignore factors that are external to policing.
"You don't need to intervene at the level of the individual [police officer's] brain," Correll says. "You need to intervene at the level of the culture," such as grappling with the reasons certain communities have more encounters with the police, such as poverty or public housing policies that end up concentrating particular ethnic groups in crime-prone areas.
Even one of the pioneers of the theory of implicit bias, Harvard University psychology professor Mahzarin Banaji, worries about the quality of implicit bias training for police.
"The teaching [of implicit bias concepts] has been in the hands of people called 'diversity trainers,' and they're like politicians — they don't have to have any expertise," Banaji says, referring to the decentralized, entrepreneurial reality of the world of police consultants and trainers.
She doesn't like the fact that departments usually make the training mandatory. That's likely to create resistance, she says, and it defeats the goal of convincing officers that they stand to benefit from understanding their unconscious biases and learning ways to compensate for them.
At the same time, she says, even the best implicit bias training shouldn't be expected to produce immediate changes in the behaviors of a whole police department.
"That, to me, is like saying, 'Can I give you a lecture on climate change?' and tomorrow you're going to stop driving your car and start taking public transportation," she says. "I don't think the question is commensurate with the behavior that they're measuring."
She believes there are still years of research ahead before we can say we know how to deal effectively with implicit bias.
Others are trying to make progress on that. Following the NYPD study, the next major attempt to test the effectiveness of implicit bias training on police is work being done by Lois James, at Washington State University. She's one of the developers of Counter Bias Training Simulation, a curriculum that uses video scenarios in shooting simulators to show officers the dangers created by implicit bias.
The hope is that a more hands-on experience will have a deeper impact, but she's not assuming it works.
"As someone who's literally developed an implicit bias program, [I think] it would be irresponsible for us to not test the outcome," James says. "It can't be just speculation."
She's in the middle of an experiment with the Sacramento Police Department in which some officers will get her simulator-based training, some will get traditional, seminar-style implicit bias training and some will get neither. Then her graduate students will review the body camera videos of officers' interactions with the public — before and after the training period — and score them for how civilly the officers treat each ethnic group.
James says she finds it "disheartening" that the NYPD study found no behavioral change, and she says, "Many people are expecting me to find nothing too, but we'll see."
Even if her study also finds no behavioral change, she says, "it doesn't mean we should eradicate implicit bias training. It just means we have to work harder."


npr--2020-09-09--Trump Adds Ted Cruz, Tom Cotton To List Of Potential Supreme Court Picks

President Trump has released an additional 20 names he would select from if any Supreme Court vacancies arise during his remaining time in office , including the president 's rival-turned-Senate ally , Ted Cruz .
The list also includes Sens .
Tom Cotton and Josh Hawley as well as two former U.S. solicitors general .
The president 's running list , which he first compiled in 2016 , already included more than a dozen conservative legal minds from across the country .
With Wednesday 's additions , he adds bulk to the number of justices he would choose from to @ @ @ @ @ @ @ `` Over the next four years , the next president will choose hundreds of federal judges and one , two , three , four Supreme Court justices , '' Trump said during a Wednesday press conference at the White House .
He described a bleak picture if `` radical left judges '' were nominated under Democratic rival Joe Biden .
Trump 's updated list , which includes several women and people of color , reflects the emphasis the Republican Party has to pay in its attempt to court voters more broadly outside of @ @ @ @ @ @ @ circles .
The Wednesday list includes Daniel Cameron , the Black , conservative Kentucky attorney general who has faced criticism over his handling of the police shooting death of Breonna Taylor , which sparked nationwide protests against police brutality .
Supreme Court nominations are among the most consequential and long-lasting decisions a president can make .
Justices to the highest court in the land have a lifetime appointment and are the final say in controversial decisions such as abortion rights , same-sex marriage and civilian gun ownership .
In a tweet following Trump @ @ @ @ @ @ @ a handful of sitting U.S. senators the president said he would choose from if the time came , declined the president 's endorsement to the court .
`` I appreciate the President 's confidence in listing me as a potential Supreme Court nominee .
But as I told the President , Missourians elected me to fight for them in the Senate , and I have no interest in the high court .
I look forward to confirming constitutional conservatives , '' Hawley wrote .
The full list of Trump 's additional picks is @ @ @ @ @ @ @ , judge on the 9th U.S .
Circuit Court of Appeals Daniel Cameron of Kentucky , that state 's attorney general Paul Clement of Virginia , former U.S. solicitor general Sen. Tom Cotton of Arkansas Sen. Ted Cruz of Texas Stuart Kyle Duncan of Louisiana , judge on the 5th U.S .
Circuit Court of Appeals Steven Engel of the District of Columbia , assistant attorney general for the Office of Legal Counsel at the Department of Justice Noel Francisco , former U.S. solicitor general Sen. Josh Hawley of Missouri James Ho of @ @ @ @ @ @ @ Gregory Katsas of Virginia , judge on the U.S. Court of Appeals for the District of Columbia Circuit Barbara Lagoa , a judge from Florida on the 11th U.S .
Circuit Court of Appeals Christopher Landau of Maryland , U.S. ambassador to Mexico Carlos Muñiz of Florida , justice on the Florida Supreme Court Martha Pacold of Illinois , judge of the U.S. District Court for the Northern District of Illinois Peter Phipps of Pennsylvania , judge on the 3rd U.S .
Circuit Court of Appeals Sarah Pitlyk of Missouri , judge of @ @ @ @ @ @ @ District of Missouri Allison Jones Rushing of North Carolina , judge on the 4th U.S .
Circuit Court of Appeals Kate Todd of Virginia , deputy assistant to the president and deputy counsel to the president Lawrence VanDyke of Nevada , judge on the 9th Circuit

Trump Adds Ted Cruz, Tom Cotton To List Of Potential Supreme Court Picks
Enlarge this image toggle caption Joe Raedle/Getty Images Joe Raedle/Getty Images
President Trump has released an additional 20 names he would select from if any Supreme Court vacancies arise during his remaining time in office, including the president's rival-turned-Senate ally, Ted Cruz. The list also includes Sens. Tom Cotton and Josh Hawley as well as two former U.S. solicitors general.
The president's running list, which he first compiled in 2016, already included more than a dozen conservative legal minds from across the country. With Wednesday's additions, he adds bulk to the number of justices he would choose from to bolster the court's conservative majority.
"Over the next four years, the next president will choose hundreds of federal judges and one, two, three, four Supreme Court justices," Trump said during a Wednesday press conference at the White House. He described a bleak picture if "radical left judges" were nominated under Democratic rival Joe Biden.
Trump's updated list, which includes several women and people of color, reflects the emphasis the Republican Party has to pay in its attempt to court voters more broadly outside of white, often older, reliably conservative circles.
The Wednesday list includes Daniel Cameron, the Black, conservative Kentucky attorney general who has faced criticism over his handling of the police shooting death of Breonna Taylor, which sparked nationwide protests against police brutality.
Supreme Court nominations are among the most consequential and long-lasting decisions a president can make. Justices to the highest court in the land have a lifetime appointment and are the final say in controversial decisions such as abortion rights, same-sex marriage and civilian gun ownership.
In a tweet following Trump's announcement, Hawley, one of a handful of sitting U.S. senators the president said he would choose from if the time came, declined the president's endorsement to the court.
"I appreciate the President's confidence in listing me as a potential Supreme Court nominee. But as I told the President, Missourians elected me to fight for them in the Senate, and I have no interest in the high court. I look forward to confirming constitutional conservatives," Hawley wrote.
The full list of Trump's additional picks is as follows:
Bridget Bade of Arizona, judge on the 9th U.S. Circuit Court of Appeals
Daniel Cameron of Kentucky, that state's attorney general
Paul Clement of Virginia, former U.S. solicitor general
Sen. Tom Cotton of Arkansas
Sen. Ted Cruz of Texas
Stuart Kyle Duncan of Louisiana, judge on the 5th U.S. Circuit Court of Appeals
Steven Engel of the District of Columbia, assistant attorney general for the Office of Legal Counsel at the Department of Justice
Noel Francisco, former U.S. solicitor general
Sen. Josh Hawley of Missouri
James Ho of Texas, judge on the 5th Circuit
Gregory Katsas of Virginia, judge on the U.S. Court of Appeals for the District of Columbia Circuit
Barbara Lagoa, a judge from Florida on the 11th U.S. Circuit Court of Appeals
Christopher Landau of Maryland, U.S. ambassador to Mexico
Carlos Muñiz of Florida, justice on the Florida Supreme Court
Martha Pacold of Illinois, judge of the U.S. District Court for the Northern District of Illinois
Peter Phipps of Pennsylvania, judge on the 3rd U.S. Circuit Court of Appeals
Sarah Pitlyk of Missouri, judge of the U.S. District Court for the Eastern District of Missouri
Allison Jones Rushing of North Carolina, judge on the 4th U.S. Circuit Court of Appeals
Kate Todd of Virginia, deputy assistant to the president and deputy counsel to the president
Lawrence VanDyke of Nevada, judge on the 9th Circuit