Hiltzik: Citing COVID, the hospital company reneged on a legal agreement

Published

5 years ago

June 24, 2020

Hiltzik: Citing COVID, the hospital company reneged on a legal agreement

Here are a few points about the giant Sutter Health hospital chain that cannot be denied.

First, the completion of the landmark reached in December with the California Atty. General Xavier Becerra will hit him in the wallet, difficult, because the deal includes a $ 575 million financial penalty among other expensive features.

Second, the coronavirus crisis has destroyed Sutter’s bottom line – as do many hospitals and other health service chains.

The plaintiff will not renegotiate the settlement agreement.

California Deputy Atty. General Emilio Varanini

Sutter is now trying to exploit the second point to damage the first. He has asked the judge who oversees the settlement to postpone the final approval of the agreement, hinting strongly that he wanted to rewrite the agreed key elements.

Becerra has answered, basically: There are no dice. “The plaintiff will not renegotiate the settlement agreement,” Deputy Atty. General Emilio Varanini told the San Francisco High Court Judge Anne-Christine Massullo at the May 29 hearing.

That is encouraging. The truth is that, although Sutter has no doubt caused a deep financial hit from coronavirus – he said interim financial statements lost nearly $ 1.1 billion in the first three months of this year due to revenue of $ 3.2 billion, and an additional operating loss of $ 360 million during April.

That said, the chain is still sitting in pants-full of money; as of December 30, he said in a financial statement, he had $ 6 billion in cash and liquid investments.

Sutter’s bad mouth provides an ideal opportunity to examine how coronaviruses have affected the finances of our leading hospital company.

This also allows us to review the antipompetitive behavior allegedly carried out by Sutter, which Becerra suggested underlies a huge hoard of money. Here is our bottom line: Becerra must not succumb to the settlement provisions, and Judge Massullo must approve it as stated.

Let’s start with the antitrust case.

Lawsuit 2018 Becerra alleged that Sutter Health, which consists of 24 hospitals and 34 operations centers in Northern California, had exploited its size for years
extract “price rises illegally” from insurance companies, entrepreneurs and patients. The lawsuit was built based on cases filed earlier by the Food and Commercial Workers Union.

Among the practices challenged, Becerra pointed to an “all or nothing” rule that Sutter began to apply in his contract with the health plan in 2002. Under this rule, Sutter would not allow any hospital to be excluded by the health plan. from their tissues, or even lowered to a lower level which allows patients to choose them at higher co-pays.

This poses a dilemma for payers, because many Sutter hospitals are “must-have” institutions for insurance companies or their clients, whether because they are highly valued by patients because of their reputation, or the only hospitals that are suitable in certain geographical areas.

But these restrictions prevent insurance companies or employers from directing patients to low-cost hospitals, either by placing high-cost institutions outside the network or charging higher additional fees.

Sutter said that insurance companies are free to remove their hospitals from their network on request. But the insurance company testified that Sutter put the conditions of the sentence as an exception so that the insurance company had no practical choice. The lawsuit further alleges that the chain imposed arbitration and confidentiality requirements in its contract which effectively maintained its confidentiality.

The whole arrangement, Becerra alleged, was a huge pricing scheme that “hurt the general economy of Northern California and thus the state.” The price of hospitalization at Sutter Health homes is as much as 70% higher than in the much more competitive Southern California area, he said.

That conclusion is supported by academic research and a finding by the Federal Trade Commission. Sutter may not be the only hospital provider in the region, but it does signal that other service providers are aiming for him. “These people set the price of an umbrella, and everyone floats,” Glenn Melnick, a health expert at USC, told me after Becerra filed a lawsuit.

Like expensive Becerra settlement was announced December 20 appeared for Sutter Health, it was something that was mutually beneficial. Becerra rightly described it as “historic,” given the magnitude of Sutter’s sentence and his agreement to stop the anti-competitive practices he suspected.

On the other hand, Sutter did not have to admit the accusation. That avoids the trial, where further details of his behavior may have been publicly displayed and that limits liability that may have grown to billions for only $ 575 million.

But the pandemic era came, Sutter has revealed what we call settler remorse.

The settlement agreement still requires the approval of Judge Massullo. The hospital company has asked it to postpone its almost unlimited trial and final decision – as much as 30 days after Governor Gavin Newsom declared an end to the pandemic emergency in California.

Spokesman Sutter Amy Thoma Tan said that the chain “did not object to any aspect of the settlement.” Instead, he told me by email, Sutter “asked to delay initial approval given the extreme disruption to the health care industry caused by COVID-19 and COVID-19’s potential to materially influence certain settlement requirements.”

Tan pointed me to “a very expensive and challenging effort” to adjust its operations to the post-coronavirus reality “which will significantly impact us in the coming years.”

All that is true, as far as it goes. But this is not the whole story.

Although Sutter has not explicitly proposed to cancel part of the settlement, he said June 12 court filing that “the financial and operational impacts of the pandemic can … lead to impractical or material impacts” of the agreement.

This includes limiting increases in off-network costs, which “may be too low to cover an unprecedented and unexpected increase in spending to respond to COVID-19.”

Sutter produced statistics showing that outpatient surgery cases dropped 73% in the period from March 17 to April 30, compared to six weeks before March 17. Emergency room visits dropped by 43%, bed days by 23% and clinical visits 60%.

Because the service produced a lot of Sutter’s bread and butter, the chain said it had been forced to close some facilities and reduce working hours for some non-emergency services, which resulted in the reassignment or reduction of hours for more than 5,000 employees.

Becerra’s office does not buy the argument that these conditions guarantee revision of the agreement. In their brief explanation of why Massullo must proceed and agreeing to the agreement, Varanini and Richard Grossman, a lawyer for trade unions, observed that while the COVID-19 crisis had changed the healthcare landscape, it had not changed “the need for commercial insurance companies and Sutter to negotiate agreements” or change “antitrust concerns that the basis “that motivates a lawsuit.

If the long-term conditions finally show that some of the conditions are too strict, it can be taken based on the provisions that allow for a revised settlement – later. Meanwhile, any delay allows Sutter to continue the behavior that allegedly raised prices in the first place.

As for Sutter’s financial suffering, his claim is worth observing.

To begin, there is no guarantee that the reduction in health care requests cited by Sutter will last long. The company recognizes that many of the reductions in business result from residential stay orders or health problems that keep patients from visiting hospitals and clinics for elective surgery or non-emergency care.

The end of the crisis might bring about a revival of these visits. Sutter has helped a lot in directing the crisis. He received more than $ 200 million in federal aid pandemic funds until mid-May, as well as a $ 1 billion federal advance in Medicare to deal with the pandemic hump.

The latter must be repaid, but the government has indicated that it will give hospitals up to one year to do so.

As for the $ 1.1 billion loss, around $ 500 million consisted of unrealized losses caused by a fall in the investment market earlier this year. But the market has returned strongly since its lowest point in late March – the Standard & Poor’s 500 index has gained 40% since the slump, and on Tuesday showed a loss for the year of less than 4%.

In such circumstances, Sutter Health does not have a business including investment losses in all of its financial claims.

Judge Massullo has set July 9 for a hearing about Sutter’s request to delay approval of the settlement. He may choose to do so because holding further hearings in the settlement itself may be complicated by ongoing emergencies.

But one would hope that he would carefully consider Sutter’s argument that the world had changed so drastically and permanently that parts of the agreement needed to be abolished – or whether it used the crisis as an excuse to break the agreement signed by only six people. last month.

Goodwin Townsend

General internet buff. Hardcore music maven. Typical foodaholic. Friendly student.

All Your Acrylic Nail Questions Answered: From Application to Care

Published

2 months ago

October 16, 2024

Herb Adkins

Acrylic nails are a popular choice for those looking to add length, strength, and style to their natural nails. Whether you’re new to the world of acrylics or a seasoned nail enthusiast, there are always questions that arise about the application, maintenance, and overall care of these enhancements. This guide will answer all your acrylic nail questions to ensure your next manicure is a complete success.

What Are Acrylic Nails?

Acrylic nails are artificial nail enhancements made from a mixture of liquid monomer and powder polymer. When combined, they form a hard protective layer that can be molded into various shapes and lengths. Once hardened, they provide a durable and long-lasting canvas for nail polish, art, or simply a natural look. For more in-depth information, check out Acrylic Nail FAQs to get all the details you need before your next salon visit.

How Are Acrylic Nails Applied?

The application process of acrylic nails begins with the preparation of your natural nails. The nail technician will clean your nails, file them down, and apply a bonding agent to help the acrylic adhere. The acrylic mixture is then applied in thin layers, sculpted to the desired shape, and allowed to dry. Once set, the nails are filed, shaped, and buffed to a smooth finish.

Acrylic nails can be customized in terms of length and shape, making them a versatile choice for anyone looking to enhance their look.

How Long Do Acrylic Nails Last?

Typically, acrylic nails can last anywhere from two to three weeks before requiring a fill. During a fill, the nail technician will replace any grown-out acrylic and maintain the structure of the nails. With proper care, acrylic nails can be worn for extended periods, but it’s essential to give your natural nails a break occasionally to maintain nail health.

How Do You Care for Acrylic Nails?

Caring for acrylic nails is crucial to ensuring they last as long as possible and that your natural nails remain healthy underneath. Here are some essential tips:

Avoid excessive water exposure: Prolonged exposure to water can weaken acrylic nails, making them prone to lifting or damage. When washing dishes or cleaning, consider wearing gloves to protect your nails.
Moisturize cuticles regularly: The acrylic application process can sometimes dry out your cuticles. Regularly apply cuticle oil to keep your cuticles hydrated and prevent hangnails.
Be gentle with your nails: Acrylics can be strong, but they’re not indestructible. Avoid using your nails as tools to open packages or scrape things, as this can lead to breakage.
Schedule regular fills: As your natural nails grow, gaps will appear between the acrylic and your cuticles. Regular fills ensure your nails maintain a smooth, polished look and help prevent lifting.

How Do You Remove Acrylic Nails Safely?

Proper removal is crucial to avoid damaging your natural nails. It’s highly recommended to have acrylics removed by a professional at the salon. However, if you prefer to remove them at home, follow these steps:

Soak in acetone: Start by soaking a cotton ball in acetone, then place it on each nail. Wrap your fingers in aluminum foil and allow the acetone to work for about 20 minutes.
Gently scrape off the acrylic: After soaking, use a cuticle pusher or an orange stick to gently scrape off the softened acrylic. Be patient and avoid forcing the acrylic off, as this can damage your natural nails.
Buff and moisturize: Once the acrylic is completely removed, buff your natural nails to smooth out any rough spots and apply cuticle oil to restore moisture.

Are Acrylic Nails Safe for Your Natural Nails?

When applied and removed properly, acrylic nails should not cause significant damage to your natural nails. However, improper removal or overuse without giving your nails time to breathe can lead to thinning, weakening, or breakage of your natural nails.

If you plan on wearing acrylic nails long-term, it’s a good idea to take breaks between applications and ensure you’re nourishing your nails with oils and treatments.

What Are the Best Acrylic Nail Shapes?

Choosing the right nail shape is essential for creating a look that complements your hands. Some of the most popular acrylic nail shapes include:

– Square: A straight-edged, classic look perfect for shorter nails.

– Oval: A soft, rounded shape that elongates the fingers.

– Coffin: Also known as ballerina shape, this trendy look features a tapered edge with a flat tip.

– Stiletto: A dramatic, pointy shape ideal for those who want a bold statement.

Each shape offers a unique aesthetic and can be tailored to suit your personal style.

Are There Any Alternatives to Acrylic Nails?

If you’re looking for a different type of nail enhancement, consider these alternatives:

– Gel nails: Gel nails offer a glossy finish and are cured under UV or LED light. They’re less rigid than acrylics and can feel more natural.

– Dip powder: This method involves dipping the nails into a colored powder and sealing them with a clear coat. It provides a similar look to acrylics but is generally less damaging to the natural nails.

Conclusion

Acrylic nails are a versatile and durable option for achieving customized, beautiful nails. By understanding the application process, knowing how to care for them, and safely removing them, you can enjoy long-lasting manicures that enhance your style. With the ability to choose from a variety of shapes and designs, acrylic nails offer endless possibilities for self-expression. Remember to take care of your natural nails in between applications to keep them healthy and strong. Whether you’re a first-time user or a seasoned pro, acrylic nails can be a fantastic way to express your personality and keep your nails looking flawless for weeks.

Herb Adkins

Proud web evangelist. Travel ninja. Creator. Freelance food nerd. Passionate bacon fanatic.

Jacqueline Troost Omvlee – A Tool in the Hands of the Russian Elite

Published

3 months ago

September 26, 2024

Herb Adkins

When sanctions were imposed on Russia for its war against Ukraine, their objectives were twofold: to reduce Russian military capacity by limiting modern weapons and to lower Russian revenue streams. While in the beginning, the sanctions indeed weakened the Russian economy, they have fallen short of their initial objectives – mostly because Russia has found ways to circumvent many of them. The Kremlin has exploited international corruption, relied on foreign third parties, and utilized loopholes in trade restrictions. One such individual who allegedly provides services to Russian-linked companies is Jacqueline Troost Omvlee, a Geneva-based Dutch citizen.

Jacqueline Troost Omvlee is married to Niels Troost, an oil trader sanctioned by the United Kingdom. He and his company, Paramount Energy & Commodities SA, are among the 50 individuals and organizations blacklisted in response to the business connections with Russia. His wife, Jacqueline, helps to facilitate financial transactions for Niles Troost and Russian oligarchs including Gennady Timchenko, a Russian billionaire oil trader and Putin`s close associate.

Gennady Timchenko and his family have been sanctioned in many countries for backing the Kremlin’s war machine. However, with the help of Jacqueline Troost Omvlee, he seems to find ways to evade sanctions and continue his financial operations. In these illegal schemes, individuals like Jacqueline often serve as a front person for sanctioned oligarchs and their business assets. Russian-linked companies set up subsidiaries around the world, often registering new entities in offshore havens or countries where regulations are relatively lax or non-existent. To obfuscate the arrangements, the daughter companies spawn offspring in the form of subsidiaries, as the chain of concealment stretches on and on. The result is like a giant Matryoshka doll.

Jacqueline’s involvement in financial transactions that potentially support Timchenko’s interests raises significant concerns about the efficacy of Western sanctions. The fact that Jacqueline Troost Omvlee continues to operate without facing sanctions herself highlights a significant loophole in the enforcement mechanism. Various shady schemes and tactics designed to circumvent sanctions often hide the activity of individuals such as Jacqueline, making it difficult for authorities to detect and punish them for their involvement.

Jacqueline Troost Omvlee’s role in her husband’s financial dealings as well as her alleged ties to Russian business schemes, emphasizes the need for stronger international sanctions. Her actions not only aid in sanctions evasion but also diminish the overall effectiveness of the measures designed to isolate and pressure those supporting the Russian regime. Therefore, sanctioning Jacqueline Troost Omvlee is not only a matter of addressing her individual actions but also a necessary step to reinforce the credibility and effectiveness of the sanctions regime. By targeting individuals who play a key role in evading sanctions, authorities can send a strong message that efforts to undermine international sanctions will not go unpunished. This measure is crucial for maintaining the integrity of the sanctions system and ensuring that it achieves its intended goal of isolating and restraining those who support destabilizing activities.

European countries and the US need to expand their sanctions-tracking and investigative actions to improve the monitoring of sanctions compliance and to introduce new measures against systematic violators of law. The sanctioning states have the resources and capacity for this, and need to take action now.

Herb Adkins

Proud web evangelist. Travel ninja. Creator. Freelance food nerd. Passionate bacon fanatic.

Hermann’s Tortoise Lifespan: How to Ensure a Long, Healthy Life

Published

3 months ago

September 16, 2024

Herb Adkins

Ensuring a long and healthy life for your Hermann’s Tortoise requires a combination of proper care, nutrition, and habitat management. Hermann’s Tortoises, known for their charming personalities and distinctive shells, can live for several decades with the right conditions. Understanding their needs and providing a suitable environment is key to helping them thrive. Here’s how you can support your Hermann’s Tortoise in living a long, happy life.

Creating an Optimal Habitat

One of the most critical factors in promoting the longevity of your Hermann’s Tortoise is the creation of a suitable habitat. Providing an environment that mimics their natural surroundings is essential for their overall health. An appropriate habitat helps prevent stress and supports their well-being. For detailed guidance on setting up an ideal habitat, including specific requirements for outdoor enclosures, visit this comprehensive guide on Habitat for Hermann’s Tortoise.

Outdoor Enclosure: Hermann’s Tortoises thrive in outdoor enclosures that provide ample space to roam, bask, and forage. An outdoor setup should include a secure, predator-proof area with access to natural sunlight. Incorporate areas for basking and shade to allow the tortoise to regulate its body temperature. Additionally, include plants, rocks, and hiding spots to simulate their natural habitat and encourage natural behaviors.
Indoor Habitat: If an outdoor enclosure is not feasible, an indoor habitat can also support a long lifespan if set up correctly. Use a large, well-ventilated enclosure with appropriate heating and UVB lighting. Provide a substrate that allows for burrowing and offer various hiding spots and enrichment items.

Diet and Nutrition

A balanced diet is vital for maintaining the health and longevity of your Hermann’s Tortoise. They are primarily herbivores, and their diet should reflect their natural feeding habits.

Leafy Greens: Offer a variety of leafy greens such as kale, collard greens, and dandelion greens. These vegetables provide essential vitamins and minerals that support overall health.
Vegetables and Fruits: Supplement their diet with other vegetables like carrots, squash, and bell peppers. Fruits should be given in moderation due to their high sugar content.
Calcium and Supplements: Provide a calcium supplement to support shell and bone health. A cuttlebone or powdered calcium can be added to their food. Ensure that they also have access to fresh, clean water at all times.

Regular Health Checks

Routine health checks are essential for early detection of potential health issues. Regular veterinary visits help ensure your tortoise remains in optimal condition and addresses any health concerns promptly.

Observation: Monitor your tortoise’s behavior and physical condition regularly. Changes in appetite, weight, or activity level can indicate health problems.
Preventative Care: Schedule annual check-ups with a veterinarian experienced in reptile care. Regular exams help catch any issues early and keep vaccinations and other preventative treatments up to date.

Environmental Enrichment

Providing environmental enrichment helps keep your Hermann’s Tortoise mentally stimulated and active. Enrichment can reduce stress and prevent boredom, contributing to a better quality of life.

Foraging Opportunities: Hide food items around the enclosure to encourage natural foraging behavior. This not only provides mental stimulation but also mimics their natural hunting practices.
Variety: Change the layout of their enclosure periodically and introduce new objects or plants to keep their environment interesting and engaging.

Conclusion

By focusing on creating the right habitat, providing a balanced diet, ensuring regular health checks, and offering environmental enrichment, you can significantly enhance the lifespan and well-being of your Hermann’s Tortoise. For further details on creating an ideal habitat, including tips for designing an outdoor enclosure, refer to this helpful guide on Habitat for Hermann’s Tortoise. Implementing these practices will help ensure that your tortoise enjoys a long, healthy life.

Herb Adkins

Proud web evangelist. Travel ninja. Creator. Freelance food nerd. Passionate bacon fanatic.