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SACRAMENTO, Calif. (AP) — A man charged with killing a rookie California police officer made his first brief court appearance Monday wearing a four-inch gauze pad covering what officials said was a self-inflicted injury.Adel Sambrano Ramos was appointed a public defender during a five-minute court hearing, and spoke only to acknowledge his name.Ramos, 45, faces a murder charge that could bring him the death penalty in Wednesday's slaying of 26-year-old Sacramento Officer Tara O'Sullivan. He's also charged with attempting to murder her training officer and with possessing two illegal assault-style rifles.He did not enter a plea.Assistant Chief Deputy District Attorney Rod Norgaard defended police from criticism that they took 45 minutes to rescue O'Sullivan with an armored vehicle because they were pinned down by rifle fire that could penetrate standard bulletproof vests."There was nothing that could have been done to save her life," he said after the hearing. "The nature of that injury is such that it could happen in an emergency room and she would not be save-able. So I find it very disheartening that people are criticizing the police response time to evacuate her. That has no merit whatsoever."He also took exception to questions of whether O'Sullivan was properly trained."Nothing in the training or lack thereof is the cause of this," he said. "There is an individual responsible for this, not law enforcement."Assistant Public Defender Diane Howard declined comment, as did Police Chief Daniel Hahn, who sat quietly in the back of the courtroom. Hahn was one of at least a dozen uniformed police officers and deputies watching as the hearing unfolded.Ramos was shackled at the hands, waist and ankles and surrounded by three deputies in the courtroom's holding cage. Two more stood just outside the cage.He was wearing a standard orange jail uniform during the hearing, though officials said that has been taken away from him at the jail after he tried to harm himself Sunday morning.Ramos suffered "some self-inflicted head wounds. He had smashed his head against a bed frame in his cell," Sacramento County Sheriff's Sgt. Tess Deterding said before the hearing.Jail employees immediately stopped him from further injury and took him to an outside hospital, she said. He was returned to the jail 12 hours later.He's now in a psychiatric wing of the jail "where we've taken even further precautions to make sure he doesn't hurt himself like that," Deterding said.He is under constant watch in what is called a safety cell, which has no bunk or other furnishings."Obviously we can't take away the walls and floor," she said, but "there's nothing inside the room. It's just basically four walls."He is provided a thin mattress and what is known as a suicide smock instead of regular jail garb: "It's tear-resistant, things like that, they can't turn it into a noose," she said. There are mental health employees in that unit in the event they are needed or requested by Ramos.Ramos also has had no contact with other inmates since he arrived.Memorial services for a O'Sullivan are set for Thursday at the Bayside Church's Adventure Campus in Roseville, California. She was fatally shot during a domestic violence call as she and other officers helped an unidentified woman pack her belongings from the garage of a North Sacramento home, authorities said.Authorities said Ramos was heavily armed with assault rifles, a shotgun and a handgun and fired dozens of times at officers during an hours-long standoff before surrendering. 3558

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 health officials have reported the state's first coronavirus death of a child.The state Department of Public Health said Friday the victim was a teenager, had other health conditions and died in the Central Valley.No other details were released.The state's death toll surpassed 9,000 on Friday, and three-quarters were 65 and older.Only about 9% of California's half-million confirmed virus cases are children, and very few have suffered conditions serious enough for hospitalization.Scientists still aren't certain why children don't seem to be as seriously affected by the virus as adults. 637

SACRAMENTO, Calif. (AP) — California has overhauled its sex education guidance for public school teachers, encouraging them to talk about gender identity with kindergarteners and giving advice to help LGBT teenagers navigate relationships and practice safe sex.The guidance won't recommend students read books that describe anal sex, bondage and other sex acts after getting hundreds of complaints from concerned parents and conservative groups.A few hundred people gathered on the state Capitol grounds in Sacramento on Wednesday morning, carrying signs that read "stop sexualizing my kids" and "respect parental rights." The crowd soon filled the lobby of the California Department of Education, with parents busily handing out snacks to occupy their children for what could be a long day. Those who could not get inside circled the building holding signs.Patricia Reyes traveled more than 400 miles from her home in Anaheim Hills to bring her six children, who attend or have attended public schools, to Wednesday's board meeting. They included her 4-year-old daughter, Angelie, who carried a sign that read: "Protect my innocence and childhood.""It's just scary what they are going to be teaching. It's pornography," the 45-year-old mother said. "If this continues, I'm not sending them to school."Michele McNutt, 49, focused on the framework's attention to healthy relationships and consent, something she said is never too soon to teach her two daughters in public school, ages 11 and 9."Withholding medically accurate, scientific information from them actually causes more harm and does not actually protect innocence," she said while wearing a purple T-shirt that read "protect trans students." ''If you don't give kids accurate information about their own body ... how are they able to make good choices?"California's education standards tell school districts what students should know about a particular subject at the end of every grade level. The state's curriculum framework gives teachers ideas on how to do that. The state updated its health education standards in 2008. But because of a budget crisis, state officials never gave schools a framework for how to teach them.The more-than-700-page document compiled over three years does not require schools to teach anything, but it is designed to expose teachers to current research about health education and give guidance about how to teach it. It's also influenced by a 2015 state law that made California one of the first states to address LGBT issues as part of sex education.The framework tells teachers that students in kindergarten can identify as transgender and offers tips for how to talk about that, adding "the goal is not to cause confusion about the gender of the child but to develop an awareness that other expressions exist.""I think that people hear the word 'transgender' or 'gender identity' in guidance for kindergarten through grade three and they think the worst," said Stephanie Gregson, director of the Curriculum Frameworks and Instructional Resources Division at the California Department of Education. "It's really about civil rights issues."The framework gives tips for discussing masturbation with middle-schoolers, including telling them it is not physically harmful, and for discussing puberty with transgender teens that creates "an environment that is inclusive and challenges binary concepts about gender."Much of the pushback has focused not on the framework itself, but on the books it recommends students read. One suggested book for high schoolers is "S.E.X.: The All-You-Need-to-Know Sexuality Guide to Get You Through Your Teens and Twenties." It includes descriptions of anal sex, bondage and other sexual activity — depictions California Family Council President Jonathan Keller described as "obscene."On Wednesday, State Board of Education member Feliza I. Ortiz-Licon asked the board to remove that book, and a few others, from the guidance. She said the books had "created panic" and distracted from the framework's goals, including teaching students about consent and sex trafficking."It's important to know the board is not trying to ban books. We're not staying that the books are bad," she said. "But the removal will help avoid the misunderstanding that California is mandating the use of these books." 4326

RIDGECREST, Calif. (AP) — Officials in Southern California expressed relief Saturday that damage and injuries weren't worse after the largest earthquake the region has seen in nearly 20 years, while voicing concerns about the possibility of major aftershocks in the days and even months to come.No fatalities or major injuries were reported after Friday night's 7.1-magnitude earthquake, which jolted an area from Sacramento to Mexico and prompted the evacuation of the Navy's largest single landholding, Naval Air Weapons Station China Lake in the Mojave Desert.The quake struck at 8:19 p.m. Friday and was centered 11 miles (18 kilometers) from Ridgecrest, the same area of the desert where a 6.4-magnitude temblor hit just a day earlier. It left behind cracked and burning buildings, broken roads, obstructed railroad tracks and leaking water and gas lines.RELATED: PHOTOS: 7.1M earthquake hits SoCalAfter the Ridgecrest EQ: Taking a closer look at San Diego's fault lines The light damage was largely due to the remoteness of the area where the tremblor occurred. Only 28,000 people live in the Ridgecrest area, which is sandwiched between more populated areas of Southern California and Las Vegas' Clark County. But seismologists warned that the area could see up to 30,000 aftershocks over the next six months.April Hamlin said she was "already on edge" when the second quake rattled her Ridgecrest home. She and her three kids initially thought it was another aftershock."But it just kept on intensifying," she said. "The TV went over, hanging by the cord. We heard it break. We heard glass breakage in the other rooms, but all we could do was stay where we were until it stopped."With the possibility of aftershocks and temperatures forecast to reach 100 degrees (38 Celsius) over the next several days, officials were taking precautions.RELATED:6.4-magnitude earthquake rattles July 4th for Southern California, San DiegansSan Diegan near epicenter during quakeThe California National Guard was sending 200 troops, logistical support and aircraft, said Maj. Gen. David Baldwin. The Pentagon had been notified, and the entire California Military Department was put on alert, he said.Naval Air Weapons Station China Lake said in a Facebook post that nonessential workers were evacuated and operations halted. The epicenters of both quakes were on the base, and officials said they are continuing to asses damage. Officials said most employees live off the base, but they authorized the evacuation so those who live on base can be eligible for reimbursements.The California Office of Emergency Services brought in cots, water and meals and set up cooling centers in the region, Director Mark Ghilarducci said.RELATED:Why didn't San Diego get an alert after July 4's earthquake? It isn't readyYour homeowner's or renter's insurance won't help much after an earthquake. Here's whyState highway officials shut down a 30-mile (48-kilometer) section of State Route 178 between Ridgecrest and the town of Trona southwest of Death Valley, due to a rockslide and severe cracking. The move left Trona temporarily cut off. California Department of Transportation spokeswoman Christine Knadler said crews worked through the night to patch the roadway, but it remained rough and uneven.Ron Mikulaco, 51, and his nephew, 23-year-old Brad Fernandez, stood on 178 on Saturday looking at the cracks. The pair drove from Huntington Beach, some 170 miles (274 kilometers) southwest of Ridgecrest. Mikulaco, an amateur geologist, wanted to show his nephew "the power of Mother Nature," and they had the epicenter's latitude and longitude coordinates ready."We put that in the GPS and we'll get as close as we can," Fernandez said.RELATED:Video: 7.1M earthquake shuts down Disneyland ridesSouthern California is rumbling with about one aftershock every minuteIn Ridgecrest, local fire and police officials said they were initially swamped by calls for medical and ambulance service. But police Chief Jed McLaughlin said there was "nothing but minor injuries such as cuts and bruises, by the grace of God."Two building fires — one involving a mobile home — were quickly doused, McLaughlin said, and natural gas lines where leaks were reported were shut off.In Trona, a town of about 2,000 people considered the gateway to Death Valley, fire officials said up to 50 structures were damaged. San Bernardino County Supervisor Robert Lovingood said FEMA delivered a tractor-trailer full of bottled water because of damage to water lines. Gov. Gavin Newsom declared a state of emergency for the county.RELATED:Reminder, San Diego: Be earthquake ready with a plan, disaster kitRidgecrest's earthquakes didn't happen along the San Andres faultJulia Doss, who maintains the Trona Neighborhood Watch page on Facebook, said the only food store in town is a Family Dollar store that was shuttered Saturday."The only way to get food is to drive to Ridgecrest, and with only three gas stations in town I'm worried we may soon run out of fuel," Doss said.Antoun Abdullatif, 59, owns liquor stores and other businesses in Ridgecrest and Trona."I would say 70% of my inventory is on the floor, broken," he said. "Every time you sweep and you put stuff in the dust bin, you're putting 0 in the trash."But he has stopped cleaning up, believing another earthquake is on the way.Lucy Jones, a seismologist at the California Institute of Technology and a former science adviser at the U.S. Geological Survey, said the new quake probably ruptured along about 25 miles (40 kilometers) of fault line and was part of a continuing sequence. The seismic activity is unlikely to affect fault lines outside of the area, Jones said, noting that the gigantic San Andreas Fault is far away.Egill Hauksson, another Caltech seismologist, said later in the day that scientists believe the continuing sequence could produce more than 30,000 quakes of magnitude 1 or greater over six months. He said the probability of a magnitude 7 over the next week is about 3%, but one or two magnitude 6 quakes are expected. 6071