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RICHMOND, Va. (AP) — By the time drug enforcement agents swooped into his small medical office in Martinsville, Virginia, in 2017, Dr. Joel Smithers had prescribed about a half a million doses of highly addictive opioids in two years.Patients from five states drove hundreds of miles to see him, spending up to 16 hours on the road to get prescriptions for oxycodone and other powerful painkillers."He's done great damage and contributed ... to the overall problem in the heartland of the opioid crisis," said Christopher Dziedzic, a supervisory special agent for the Drug Enforcement Administration who oversaw the investigation into Smithers.In the past two decades, opioids have killed about 400,000 Americans, ripped families apart and left communities — many in Appalachia — grappling with ballooning costs of social services like law enforcement, foster care and drug rehab.Smithers, a 36-year-old married father of five, is facing the possibility of life in prison after being convicted in May of more than 800 counts of illegally prescribing drugs, including the oxycodone and oxymorphone that caused the death of a West Virginia woman. When he is sentenced Wednesday, the best Smithers can hope for is a mandatory minimum of 20 years.Authorities say that, instead of running a legitimate medical practice, Smithers headed an interstate drug distribution ring that contributed to the opioid abuse epidemic in West Virginia, Kentucky, Ohio, Tennessee and Virginia.In court filings and at trial, they described an office that lacked basic medical supplies, a receptionist who lived out of a back room during the work week, and patients who slept outside and urinated in the parking lot.At trial, one woman who described herself as an addict compared Smithers' practice to pill mills she frequented in Florida."I went and got medication without — I mean, without any kind of physical exam or bringing medical records, anything like that," the woman testified.A receptionist testified that patients would wait up to 12 hours to see Smithers, who sometimes kept his office open past midnight. Smithers did not accept insurance and took in close to 0,000 in cash and credit card payments over two years."People only went there for one reason, and that was just to get pain medication that they (could) abuse themselves or sell it for profit," Dziedzic said.The opioid crisis has been decades in the making and has been fueled by a mix of prescription and street drugs.From 2000 to 2010, annual deaths linked to prescription opioids increased nearly fourfold. By the 2010s, with more crackdowns on pill mills and more restrictive guidelines on prescriptions, the number of prescriptions declined. Then people with addictions turned to even deadlier opioids. But the number of deaths tied to prescription opioids didn't begin to decline until last year, according to data from the U.S. Centers for Disease Control and Prevention.Martinsville, where Smithers set up shop, has been particularly hard hit.A city of about 14,000 near Virginia's southern border, Martinsville once was a thriving furniture and textile manufacturing center that billed itself as the "Sweatshirt Capital of the World." But when factories began closing in the 1990s, thousands of jobs were lost. Between 2006 and 2012, the city had the nation's third-highest number of opioid pills received per capita, according to an Associated Press analysis of federal data.Andrew Kolodny, a Brandeis University doctor who has long been critical of opioids, said that in recent years, doctors became less comfortable writing lots of opioid prescriptions and many big prescribers retired. That opened an opportunity for others."If you're one of the guys still doing this," he said, "you're going to have tons of patients knocking down your door."During his trial, Smithers testified that after he moved to Virginia, he found himself flooded with patients from other states who said many nearby pain clinics had been shut down. Smithers said he reluctantly began treating these patients, with the goal of weaning them off high doses of immediate-release drugs.He acknowledged during testimony that he sometimes wrote and mailed prescriptions for patients he had not examined but insisted that he had spoken to them over the phone.Once, he met a woman in the parking lot of a Starbucks, she handed him 0 and he gave her a prescription for fentanyl, an opioid pain reliever that is 50 to 100 times more potent than morphine.When area pharmacists started refusing to fill prescriptions written by Smithers, he directed patients to far-flung pharmacies, including two in West Virginia. Prosecutors say Smithers also used some patients to distribute drugs to other patients. Four people were indicted in Kentucky on conspiracy charges.At his trial, Smithers portrayed himself as a caring doctor who was deceived by some patients."I learned several lessons the hard way about trusting people that I should not have trusted," he said.Smithers' lawyer told the judge he had been diagnosed with depression and anxiety. Family members said through a spokesperson that they believe his decisions were influenced by personal stress, and emotional and mental strain.Even before he opened his Martinsville practice in August 2015, Smithers had raised suspicions. West Virginia authorities approached him in June 2015 about a complaint with his practice there, but when they returned the next day with a subpoena, they found his office cleaned out and a dumpster filled with shredded papers and untested urine samples.Some of Smithers' patients have remained fiercely loyal to him, insisting their severe chronic pain was eased by the powerful painkillers he prescribed.Lennie Hartshorn Jr., the father of the West Virginia woman who died two days after taking drugs Smithers prescribed, testified for the defense.Hartshorn said his daughter, Heather Hartshorn, told someone "she would rather be dead than in pain all the time." According to a form Heather Hartshorn filled out when she went to see Smithers, she had chronic pain in her lower back, legs, hips and neck from a severe car accident and a fall.When asked by Smithers' lawyer if he blames Smithers for anything, Lennie Hartshorn said he does not.Smithers has been denied bond while he awaits sentencing. His attorney did not respond to inquiries from AP. Smithers has said he plans to appeal.____Associated Press reporters Geoff Mulvihill and Riin Aljas contributed to this story. 6501

SACRAMENTO, Calif. (AP) — California voters on Tuesday rejected a ballot measure that would have capped dialysis clinics' profits in an effort to improve patient care.Proposition 8 would have limited profits for dialysis clinics that provide vital treatment for people whose kidneys don't work properly.The measure was the most expensive initiative on the 2018 ballot in California, generating more than 0 million in campaign contributions. A health care workers union, Service Employees International Union-United Healthcare Workers West, funded the million supporting campaign. Dialysis companies contributed more than 1 million to kill the initiative.The union argued Proposition 8 would stop the dialysis companies from cutting corners to make money and force them to invest more of their revenue into patient care. Supporters say the profit-hungry companies don't adequately clean clinics and overwork staff.Dialysis providers say the measure was actually a tactic to pressure the dialysis companies to let workers unionize and would have forced clinics to close. They say most California clinics provide high quality care.Dialysis companies' effort to kill the measure was the most expensive campaign on one side of a ballot initiative in the U.S. since at least 2002. Most of that money came from the two largest dialysis companies operating in California: Denver-based DaVita Inc. and Germany-based Fresenius Medical Care.The measure would have barred dialysis clinics from charging patients more than 115 percent of what providers spend on patient care and quality improvement. If clinics exceeded that limit, they would have to provide rebates or pay penalties.Although the measure didn't spell out exactly which expenses counted toward the limit, dialysis companies argued critical management expenses would be classified as profits and bankrupt clinics.RELATED CONTENT 1898

SACRAMENTO, Calif. (AP) — A highly decorated U.S. Forest Service police dog suffered nine stab wounds during a marijuana raid in Northern California. But he survived after he was airlifted to a veterinary clinic. What's more, it's the second time the dog, named Ice, recovered after being seriously injured. The agency said Friday that Ice was wounded late last month in the Klamath National Forest south of the Oregon border. He kept hold of the suspect even after he was stabbed. A helicopter flew Ice to a veterinary clinic in Medford, Oregon. The agency says Ice had multiple stab wounds that were more severe during a similar raid in 2016. 652

RIPON, Wisconsin — An assistant professor at a Wisconsin college is getting national attention for the research she just published about a dog's empathy for its owner.The idea came to Ripon College's Julia Meyers-Manor when her collie tried to save her mom from a pile of pillows when she was just playing with her children.In her study, Meyers-Manor observed whether dogs would open a door if their "trapped" owner was on the other side crying or humming, and if so, how much of an effort they would make to "rescue" the person. She also recorded the dogs' heart rate variability.Meyers-Manor said dogs can "feel" your emotions. One dog named Molly rammed through the door and leaped into her owner's arms."If we're distressed they become distressed," Meyers-Manor said.The animals, however, had a hard time deciphering whether the human was being truthful."In the crying condition the dogs basically ran in, and if they did, they did it within 20 seconds," said the assistant professor.About 50 percent of the dogs rammed through the door. Meyers-Manor said the other half did not because they were too stressed over what they saw and heard."Dogs were pacing, whining, showing all types of stress behaviors by their owner's distress," said Meyers-Manor. "So they start to shut down and freeze from opening the door."To many people's surprise, she found service K-9's in the study performed no different than any other pooch.None of the more than 30 animals were hurt in this study.You can read the assistant professor's published research by clicking here. 1596

SACRAMENTO, Calif. (AP) — The western Joshua tree will be considered for protection under the California Endangered Species Act because of threats from climate change and habitat destruction. The state Fish and Game Commission on Tuesday voted to accept a petition that provides the yucca plants protected status for a year while the agency conducts a study. After the review, commissioners will determine whether the species should be formally protected under the law. The petition by the Center for Biological Diversity came amid rising concern about the future of the crazy-limbed trees with spiky leaves that have come to symbolize the Mojave Desert and draw throngs to Joshua Tree National Park. 708

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