宜宾修鼻头(在宜宾祛眼袋哪里效果好) (今日更新中)

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) — Athletes at California colleges could hire agents and sign endorsement deals under a bill the state Legislature sent to the governor on Wednesday, setting up a potential confrontation with the NCAA that could jeopardize the athletic futures of powerhouse programs like USC, UCLA and Stanford.Gov. Gavin Newsom has not said whether he will sign it. But the NCAA Board Of Governors is already urging him not to, sending him a letter Wednesday saying the bill "would erase the critical distinction between college and professional athletics" and would have drastic consequences for California's colleges and universities."Because it gives those schools an unfair recruiting advantage, (it) would result in them eventually being unable to compete in NCAA competitions," the letter said. "These outcomes are untenable and would negatively impact more than 24,000 California student-athletes across three divisions."Newsom has 30 days to either sign the bill, veto it or let it become law without his signature.The bill would allow student-athletes to hire agents and be paid for the use of their names, images or likenesses. It would stop California universities and the NCAA from banning athletes that take the money. If it becomes law, it would take effect Jan. 1, 2023."I'm sick of being leveraged by the NCAA on the backs of athletes who have the right to their own likeness and image, this is about fairness," Assemblywoman Sydney Kamlager-Dove, a Los Angeles Democrat, said Monday.The Senate voted 39-0 to pass the bill, which has the endorsement of NBA superstar LeBron James, who skipped college and went directly to the NBA before the league changed its rules to require players to be at least one year removed from high school before entering the draft. But the bill could impact James' 14-year-old son, who is a closely watched basketball prospect in Los Angeles.The NCAA is the governing body for college sports. But membership is voluntary. Athletes can get valuable scholarships, but the NCAA has long banned paying athletes to preserve the academic missions of colleges and universities. But college sports have since morphed into a multibillion-dollar industry, igniting a debate over the fairness of not paying the industry's most visible labor force.Earlier this year, NCAA President Mark Emmert told lawmakers that passing the bill would be premature, noting the NCAA has a committee — led by Ohio State athletic director Gene Smith and Big East Commissioner Val Ackerman — that is exploring the issue. Their report is due in October.The NCAA committee has already said it won't endorse a plan to pay athletes as if they were employees, but they could ease limits on endorsement deals for athletes. The NCAA already lets athletes accept money in some instances. Tennis players can accept up to ,000 in prize money and Olympians can accept winnings from their competitions.The bill still puts some restrictions on athletes, such as forbidding them from signing endorsement deals that conflict with their school's existing contracts.Republican Assemblyman Jim Patterson of Fresno was the only lawmaker to speak against the bill, though he did not cast a vote. He said allowing athletes to make money could make universities in rural areas less competitive because there could be fewer sponsorship opportunities in the area.But other lawmakers argued banning college athletes from being paid was a violation of their freedoms."Playing college sports should not have to come at the cost of personal liberty, dignity, self-expression or any other value this legislature is charged with protecting," said Republican Assemblyman Kevin Kiley of Rocklin. "Let's send a loud and clear message to the NCAA."But in and around California, schools and conferences believe this legislation might not be the best solution.The Pac-12, which includes Southern California, UCLA, Stanford and Cal, issued a statement Wednesday reiterating its previous stance — asking the California Legislature to delay the debate until the NCAA announces formal proposals."We all want to protect and support our student-athletes, and the Pac-12 has played a leadership role in national reforms for student-athletes over the past years," the statement said. "The question is what's the best way to continue to support our student-athletes. We think having more information and informed views will be helpful."J.D. Wicker, the athletic director at San Diego State, a Mountain West Conference member, agreed, saying "California weighing in on this complicates that.""I think the frustration for me is that they probably don't truly understand the NCAA and how we work as a governing body," Wicker said. "Again, it's schools across 50 states and it's all of us working together, whereas the state of California will only harm California schools." 4858

RICHMOND, Va. — Crews have arrived to remove a statue of Confederate General J.E.B. Stuart from Richmond's Monument Avenue — an area of the city that contains several Confederate statues that Mayor Levar Stoney has promised to remove.The J.E.B. Stuart monument is one of about a dozen statues Stoney has ordered be removed from city property.Statues of Confederate General Stonewall Jackson and Confederate Naval Commander Matthew Fontaine Maury were removed from Monument Avenue last week and taken to an undisclosed location. A statue of Confederate President Jefferson Davis was toppled by protesters last month.A statue to Confederate General Robert E. Lee is located on state-owned property and could be removed once legal challenges to its removal make their way through court.The Stuart statue, erected in 1907, is the first monument Stoney promised would be removed following the holiday weekend.The mayor said it would cost .8 million to remove the statues. He said the money would come from the Department of Public Works and be reimbursed by a private fund.While city attorney Haskell Brown told Richmond City Council that Stoney did not have the power to remove statues, Stoney said he believed he is on sound legal ground to remove the statues using his emergency powers as the Emergency Management Director."That's in our Emergency Operations Plan. That is also the part of the governor's declaration of emergency that I'm the emergency manager," Stoney said. "And also, the City Council spoke to this in June 8, when they passed a resolution ordinance that gave me such powers."Stoney said over the course of the last several weeks, thousands have gathered in the city, and there have been more than 139 calls of service along the Monument Avenue corridor.The mayor said failing to remove the statues presented a severe, immediate and growing threat to public safety.Stoney said the removed statues would be placed in temporary storage while Richmond enters a 60-day administrative process during which the city will solicit public input while determining the fate of the statues.This story was originally published by Gabrielle Harmon and Scott Wise on WTVR in Richmond, Virginia. 2206

SACRAMENTO, Calif. (AP) — An investigation has found many California state agencies have failed to provide sexual harassment training for all their supervisors as required by state law.Capital Public Radio reported Tuesday its investigation found nearly 60 percent of agencies surveyed by the State Personnel Board did not provide the training, up from 25 percent in 2016 and 32 percent in 2017.The public radio station reports that since 2016, the State Personnel Board has identified nearly 1,800 state government supervisors at dozens of agencies who did not receive the required training.A state law requires businesses with 50 or more workers and all state agencies to provide two hours of sexual harassment training to new supervisors within six months of being hired or promoted. 794

Rockers Metallica is set to rock out on Aug. 29 as they bring its concert to drive-ins across the nation.Encore Drive-in Nights announced the rock group will perform at venues in the U.S. and in Canada.Tickets would go on sale Aug. 14 at ticketmaster.com/encore-metallica.For a full list of sites, click here."Needless to say, this is an exciting first for us as we continue to explore new ways to connect with you and keep playing live… this definitely qualifies as a unique and memorable experience for us," the band said. "We hope you think so too!"The drive-in concert series was launched by Encore Live after the success of Garth Brooks' concert in June. Country star Blake Shelton also did a show back on July 25. 727

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