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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. (KGTV) - A San Diego plan to let houses of worship build affordable housing on land they already own could expand across the entire state.Tuesday, the Assembly Appropriations Committee will debate Senate Bill 899, also known as the "YIGBY" bill. YIGBY stands for "Yes In God's Back Yard."People behind the concept in San Diego say it's one way to help solve California's housing crisis."It's a potential solution," says YIGBY Project Coordinator Mary Lydon. "We need all solutions on deck right now for this housing crisis. It's not going to solve the problem. But it is a very interesting solution."RELATED: Churches trying to build affordable housing to help with homeless problemThe San Diego City Council passed a law in 2019 to ease zoning restrictions and parking requirements on churches and other houses of worship that would allow them to build affordable housing in their parking lots.RELATED: City Council allows churches to build hosing in parking lotsChurch leaders say that land is under-utilized because they only need parking for the whole congregation once a week.Senate Bill 899 goes a little further, letting houses of worship and other private colleges build affordable housing on any land they own, as long as it is in a residentially zoned area.In San Diego, Bethel AME is the first congregation to get a housing project underway as part of the YIGBY movement. They own a duplex in Logan Heights. The church plans to demolish the duplex and replace it with a three-story, 16-unit apartment complex."This falls right into our great commission," says Senior Pastor Harvey Vaughn. "Clothe the naked, feed the hungry, and house the homeless... To provide safe, affordable affordale housing to people - that's a no brainer to me."San Diego's YIGBY group got some push-back from people who say apartment complexes, even small ones managed by churches, don't belong in neighborhoods full of single-family homes.Lydon says that's a luxury the state can no longer afford."We've had people saying, 'No,' in our city, in our region, in this state for decades. And it just put us in a place of great challenge," she says."We need housing for all incomes. And we have to work on this together. We are going to have to agree that some compromises are going to need to be made."A recent study from UC Berkeley says San Diego has nearly 4,700 acres of land that would qualify for YIGBY housing. The coalition hopes to build 3,000 units within the next five years.But first, the bill has to pass through the legislature.The State Senate approved SB 899 earlier this summer. If the Assembly Appropriations Committee approves it, the bill will need to pass a full vote of the Assembly and then get Governor Newsom's signature before it can go into effect. 2785

SACRAMENTO, Calif. (AP) -- California Gov. Gavin Newsom and the Democratic-controlled state Legislature agreed on a budget deal that would to cover the state's estimated .3 billion budget deficit.Newsom and legislative leaders announced the agreement Monday. No details were immediately available about what's in the agreement.But in a joint statement, Newsom and the leaders of the Senate and Assembly say the agreement protects core services including education, health care and the social safety net.The full statement:“The COVID-19 global pandemic has caused a sudden and dramatic change in our nation’s and state’s economic outlook – and has had a cascading effect on our state budget. California was better positioned for this sudden change than at almost any time in its history, building out record reserves following years of responsible budgeting. Even still, the size and scope of the pandemic and the accompanying economic crisis have been unprecedented – leaving California to make hard choices and figure out how to sustain critical services with much less.“In the face of these challenges, we have agreed on a budget that is balanced, responsible and protects core services – education, health care, social safety net and emergency preparedness and response. This budget also invests in California small businesses harmed by the pandemic.“This agreement reflects our shared commitment to supporting schools, and is built on a foundation of equity – allocating billions of dollars for students most affected by learning loss and continuing our state’s leadership toward reforming the criminal justice system.“To be clear, this budget required some tough decisions and more work remains ahead. But they were necessary steps for keeping California on firm fiscal footing while we continue to meet the COVID-19 challenge, protect vital services and our most vulnerable communities, and build a strong fiscal bridge to a safe, speedy economic resurgence. Californians are doing their part – now it’s imperative for our federal partners to pass a responsible and comprehensive relief plan so states and local communities can continue to keep Americans safe while leading our national economic recovery.”California's revenue has tanked during the coronavirus pandemic as a statewide stay-at-home order forced many businesses to close and caused millions of people to lose their jobs. 2402

SACRAMENTO, Calif. (AP) — California wants to give more benefits to people living in the country illegally as lawmakers in the state Senate advanced a 4 billion spending proposal Wednesday that would expand health coverage and tax credits for immigrants.The proposal would let low-income immigrants living in the country illegally get government-funded health coverage if they are 65 and older or between the ages of 19 and 25.The Senate's budget writing-panel also agreed to let some people who don't have Social Security numbers qualify for the state's earned income tax credit — a program for the poor that boosts people's tax refunds. The credit would apply to people who have an individual tax identification number, which includes immigrants in the country legally and illegally."These are people who are working, who are paying taxes," Senate Budget Committee chairwoman Holly Mitchell, D-Los Angeles, said. "That's a population we ought not leave behind."Some Republicans have opposed the proposals, especially since the state is also considering imposing a tax penalty on people in the country legally who refuse to purchase health insurance. But they likely don't have the votes to stop it.The proposals build on the spending plan Democratic Gov. Gavin Newsom released earlier this year that would extend Medi-Cal eligibility to young adults and double the tax credit to ,000 for every family with at least one child under the age of 6, making about 3 million households eligible to receive it.Newsom's proposal did not include expanding eligibility for the tax credit to immigrants. It's unclear how much money that would cost.Newsom wanted to pay for the expanded tax credit by selectively conforming California's tax code with portions of the tax changes President Donald Trump signed into law in 2017. That would have generated about .7 billion in new revenue for the state, mostly from businesses taxes.The Senate rejected those tax changes."We've just got to figure out where else to get that money from," Mitchell said.The Senate proposal is the first indication how the Democratic-controlled legislature will react to Newsom, who took office in January. The Assembly plans to finalize its budget proposal on Friday, which trigger negotiations with the Newsom administration.Lawmakers must pass a budget by June 15. If they don't, state law requires them to forfeit their salaries.The Senate plan does not deviate much from Newsom's proposal, adopting his revenue projections that include a .5 billion surplus.The Senate plan rejects a proposed new tax on most residential water bills to pay for drinking water improvements. Instead, they opted to use 0 million of existing tax dollars to help some struggling public water systems make improvements.In 2017, more than 450 public water systems covering more than half a million people failed to comply with safety standards. That number doesn't include people who use private wells or public systems with fewer than 15 connections, which are not regulated by the state.Newsom has argued for the tax, saying it would protect the money by making it harder for lawmakers to divert the spending elsewhere. But lawmakers from both parties have balked at implementing a new tax while the state has a projected surplus of .5 billion.Still, some Republicans were wary the tax could return once Democratic leaders conclude their budget negotiations next month."My issue is trust," said Sen. Jim Nielsen, R-Gerber. "Republicans have been duped, at their political peril, by placing and misplacing their trust." 3590

SACRAMENTO, Calif. (AP) — California lawmakers are considering proposals that would make the state the first in the nation to offer government-funded health care to adult immigrants living in the country illegally.Democratic Gov. Gavin Newsom has proposed covering immigrants 19 to 25.A proposal in the state Senate would expand that coverage to include people 65 and older, while the Assembly is considering a bill that would extend benefits to all low-income immigrants 19 and older.California already covers immigrants 18 and younger regardless of their status.A final decision on wider coverage may come down to cost.Newsom estimates his plan covering young adults would cost million a year. Legislative staffers estimate the Senate's plan could cost 4 million and the Assembly proposal .2 billion annually.Newsom estimates California will have a .5 billion budget surplus. But he has urged lawmakers to constrain spending, warning the next recession could cost the state billion in revenue. 1019