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Rural hospitals across the country are in a difficult spot right now. COVID-19 is hitting them harder than many metropolitan hospitals as they deal with issues of lower staffing.According to the National Center for Biotechnology Information, about 20% of our nation’s population lives in rural areas, yet less than 9% of our nation’s physicians practice there.Add on the fact that according to CDC data, COVID is killing rural Americans at a rate 3.5 times higher than those living in metropolitan areas, and this issue is affecting staff and patient care.“I’m very worried about rural health care because rural health care is teetering on the brink right now,” said Dr. Kurt Papenfus, an ER doctor at Keefe Memorial Hospital in rural Cheyenne Wells, Colorado. “There’s a darkness in this illness that I can’t say I’ve said about any other illness.In late October, Dr. Papenfus contracted COVID-19 as he was traveling back from the Northeast to visit his daughter.“I was very cognizant and was wearing a mask at all times, social distancing, and washing my hands,” Papenfus said. “But I remember having this thought on the train that this is a super-spreader event.”When he got home, Papenfus got tested and was confirmed positive for COVID-19. The diagnosis put Keefe Memorial in a tailspin as he served as the only ER doctor in the small 25-bed hospital.“We are a trauma level four hospital so keeping that physician on staff 24/7 is what we are required to do,” said Stella Worley, Keefe Memorial’s CEO. “And it is getting to be more of a challenge to have hired physicians out here in rural [America].”Within minutes of learning of Dr. Papenfus’ COVID-positive diagnosis, Worley was on the phone with several different hospitals working to find a replacement. Within a few hours, they had settled on a former ER doctor who moved to another hospital in Texas a few months prior.After she agreed, Keefe Memorial paid the doctor to drive 10 hours from Texas to Colorado and fill in immediately as Papenfus recovered at home for the next two weeks.“Worst-case scenario is you would have to divert patients if there’s no one in the door to care,” said Worley.Populations in rural America tend to be older, poorer, and less insured than the nation at large, according to the National Conference of State Legislatures.Since 2010, hospital closures in rural America have been growing as there have been 118, including 17 last year.The closures only exacerbate a growing lack of health care coverage in rural America, said Dr. Dan Derksen, a rural health care expert and family physician“Once a critical access hospital (25 beds with a 24/7 emergency department and at least 35 miles from another facility) closes, they almost never come back,” he said. 2756

SACRAMENTO, Calif. (AP) — California has elected its youngest state lawmaker in more than eight decades. It elevated a 25-year-old progressive Democrat who already has years of legislative experience to the state Assembly. Alex Lee survived a crowded nine-candidate primary election in March, then trounced his Republican rival in a San Francisco Bay Area district that includes part of Silicon Valley. He plans to keep living with his mom in San Jose for the time being and had to take a part-time gig economy delivery job to make ends meet during his campaign. Lee has worked for five different lawmakers either as a college intern or more recently a paid aide. 671

Russian hackers are at it again. They’re already targeting this year’s midterm elections.“One, to try to infiltrate our election infrastructure, and second, to try to infiltrate our minds with misinformation,” says David Becker, executive director and founder of The Center for Election Innovation & Research, of the Russian meddling.In 2016, Russian hackers targeted voting systems in at least 21 states, according to Homeland Security officials. While no votes were changed, states are now trying to prepare for what could happen this year.“States are going to need the federal government to step up, because states can’t defend against a nation state as big as Russia,” says Becker.Congress approved 0 million in election security funding for states. Becker said the money will go toward things like new voting machines that are more secure, updating computer software to protect voter information and hiring and training staff on cyber threats. House and Senate Republicans blocked millions in additional funding to bolster election security efforts, saying it’s too soon to allocate additional money and want to see how states use the 0 million already given out. While state and local governments are working to protect our elections, Becker said voters can also do something to help out.“Register to vote; check your registration and then go vote – earlier by mail if possible,” Becker says. “If there has been some kind of incident, if the Russian’s have infiltrated a voter list for instance, we will discover that early thanks to people voting and when we discover it early we can fix it early and make sure it has no impact on the election.” 1690

SACRAMENTO, Calif. (AP) — California Gov. Gavin Newsom cracked down on oil producers Tuesday, halting approval of hundreds of fracking permits until independent scientists can review them and temporarily banning new wells using another drilling method that regulators believe is linked to one of the largest spills in state history.The state Division of Oil, Gas and Geothermal Resources announced it will not approve new wells that use high-pressure steam to extract oil from underground. It’s the type of process Chevron uses at an oil field in the Central Valley that leaked more than 1.3 million gallons (4.9 million liters) of oil and water this summer.That process is different from fracking, which uses water and other chemicals at high pressure to extract oil. California has 263 pending fracking permits but has not approved any of them since July. That’s when Newsom fired California’s top oil and gas regulator after learning the state had increased fracking permits by 35% since he took office in January, angering environmental groups.Newsom, a Democrat, called the crackdown necessary to strengthen the state’s oversight of oil and gas extraction “as we phase out our dependence on fossil fuels and focus on clean energy sources.”“This transition cannot happen overnight; it must advance in a deliberate way to protect people, our environment and our economy,” Newsom said.California has been a leader on environmental issues, with Newsom's Democratic predecessor, Jerry Brown, making climate change his signature effort. Brown was criticized for failing to ban fracking or oil drilling, arguing that the state needed to tackle demand before moving on to supply.The oil industry called Newsom’s changes “disappointing,” with the Western States Petroleum Association saying California’s environmental regulations already lead the world.“Every barrel delayed or not produced in this state will only increase imports from more costly foreign sources that do not share our environmental safety standards,” group president Catherine Reheis-Boyd.California is one of the top five states for oil production, producing more than 161 million barrels last year. Fracking occurs in some of the state’s largest oil fields, mostly in the Central Valley.The steam method is less prevalent but accounted for 8 million barrels of the state’s oil production in 2018, according to the Department of Conservation. But regulators believe it is linked to the oil spill at a Chevron well that began in May.It was the largest oil spill in California since 1990, when a tanker unleashed more than 400,000 gallons (1.5 million liters) of crude oil off the coast of Huntington Beach.But despite its size, the Chevron spill has had minimal effects on the environment.The oil spilled into a dry creek bed, and the company cleaned it up before rains could wash it into fresh water. It also did not significantly harm wildlife, with just a “handful of birds” needing to be euthanized, according to Jason Marshall, chief deputy director of the California Department of Conservation.A second well at the oil field about 35 miles (55 kilometers) west of Bakersfield has been leaking intermittently since 2003. State officials ordered Chevron to stop the leak in April, and the company has been making progress, Marshall said.Regulators have fined the energy giant .7 million for the leaks. A Chevron spokeswoman referred comment to the Western States Petroleum Association, whose leader said, “There is nothing more important than the health and safety of the communities where the women and men of our industry work, live and raise their families."The moratorium will be in place while two national laboratories — Lawrence Livermore and Sandia — study the high-pressure steam process to see what regulations, if any, can make it safer. Other wells in California use the steam method and have not had any spills.“These oil leaks cannot be the cost of doing business,” California Natural Resources Secretary Wade Crowfoot said. “There needs to be a clear trajectory to eliminate them. Not reduce them in number, but fully eliminate them.”The moratorium will not affect existing wells, which will be assessed individually. Some existing wells have been using high-pressure steam for so long that stopping it could weaken the geology and cause more spills, Crowfoot said.Officials said they would seek an independent audit of California’s permitting process for fracking and other types of oil extraction.In July, advocacy groups Consumer Watchdog and FracTracker revealed the state’s fracking permits had doubled during the first six months of Newsom’s administration. The groups said that of those permits, 45% benefited companies where state officials owned stock.Jamie Court, president of Consumer Watchdog, called Newsom’s new orders “an important step toward reining in the most high risk extraction techniques.”“The ultimate test of his tenure for climate change and the public will be simple math about how many fewer permits are issued and how many existing wells are closed,” Court said. “Net zero wells should be his goal.” 5122

Rudy Giuliani's assertion to CNN this week that President Donald Trump can't be indicted by the special counsel, and thus can't face a subpoena, banks on a series of internal Justice Department policies.The question to this day is untested in the court system. Yet the step-by-step process Robert Mueller or any special counsel could follow for a President under investigation has several possible outcomes.According to several legal experts, historical memos and court filings, this is how the Justice Department's decision-making on whether to indict a sitting president could play out:First, there must be suspicion or allegations of a crime. Did the President do something criminally wrong? If the answer is no, there would be no investigation.But if the answer is maybe, that puts federal investigators on the pursuit. If they find nothing, Justice Department guidelines say they'd still need to address their investigation in a report summarizing their findings.If there could be some meat to the allegations, the Justice Department would need to determine one of two things: Did the potentially criminal actions take place unrelated to or before to the presidency? Or was the President's executive branch power was crucial in the crime?That determination will come into play later, because Congress' power to impeach and remove a president from office was intended by the framers of the Constitution to remedy abuse of the office, legal scholars say.Perhaps, though, the special counsel decides there's enough evidence to prove that the President broke the law.That's where the Office of Legal Counsel opinions come in.In 1973 and 2000, the office, which defines Justice Department internal procedure, said an indictment of a sitting president would be too disruptive to the country. This opinion appears to be binding on the Justice Department's decision-making, though it's possible for Deputy Attorney General Rod Rosenstein to choose to override the opinion, give Mueller permission to ignore it and take it to court, or ask the office to reexamine the issue by writing a new opinion.This sort of legal briefing has been done before, like in the year after the 1973 opinion, when then-special prosecutor Leon Jaworski wrote a Watergate-era memo describing why the President should not be above the law.Of course, there's another immediate option if a special counsel finds the President did wrong. Prosecutors could use the "unindicted co-conspirator" approach. This would involve the special counsel's office indicting a group of conspirators, making clear the President was part of the conspiracy without bringing charges against him.At any time, in theory, a special counsel could decide to delay an indictment until the President leaves office -- so as not to interfere with the functioning of the executive branch. The other options would be to drop the case or send an impeachment referral to Congress. As evidenced by Mueller's actions previously in the investigations of Trump's personal attorney Michael Cohen and former campaign chairman Paul Manafort, any steps this special counsel takes will likely come with the full support of the acting attorney general on the matter, Rosenstein.The question of whether a President could be subpoenaed is a story for another day. 3303