阜新部两侧疼痛是什么原因(神农架部检查设备) (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) — Gov. Jerry Brown has reappointed two leaders of California's embattled high-speed rail board days before leaving office.Brown on Wednesday gave Dan Richard and Tom Richards new four-year terms. They serve as chairman and vice chairman, respectively, of the California High-Speed Rail Authority's board of directors. It oversees the project to construct a high-speed train traveling between San Francisco and Los Angeles in less than three hours.The project is years behind scheduled and tens of millions of dollars over budget. A recent audit faulted the authority for poor contract management and decision making.Brown's action comes five days before he hands the governorship over to fellow Democrat Gavin Newsom.The terms of two other governor-appointed board members have expired, meaning Newsom may still have a chance to choose members. 876

SACRAMENTO, Calif. (AP) — As the political battle to overturn California's gas tax increase intensified, the state transportation agency coordinated frequently with the public affairs firm working to block the repeal on behalf of unions, construction companies and local government groups, emails obtained by The Associated Press show.The California State Transportation Agency and Sacramento-based Bicker, Castillo & Fairbanks organized news conferences and other efforts to promote legislation to raise the tax to fund road and bridge repairs, which passed the Legislature in April 2017. After Gov. Jerry Brown signed it, the agency and firm continued planning events and coordinating social media posts as opponents gathered signatures for repeal.Three ethics experts interviewed by the AP said the emails raise concerns that the agency's relationship with the firm was too close, but none saw a clear violation of campaign laws, which prohibit the use of public resources for political campaigns.REPORT: Gas tax funds reportedly being used to campaign against Prop 6The repeal qualified for the November ballot in June. The firm, BCF, continues to work for the anti-repeal coalition, which includes the League of California Cities and the California Chamber of Commerce.Some communications between BCF and the state agency involved politics, according to more than 200 emails from 2017 and the first half of this year obtained by the AP through the California Public Records Act.Last fall, the agency and firm discussed opinion pieces "targeting" U.S. Rep. Darrell Issa and three other vulnerable Republicans in Congress. National Democratic leaders see those seats as key to winning control of the U.S. House.RELATED: Caltrans' gas tax freeway signs raise concerns with FedsIn January, a BCF partner, Kathy Fairbanks, communicated with the agency about designing a campaign logo for Proposition 69, a June ballot measure involving how gas tax proceeds are spent. And an undated memo shows the agency and firm also planned to coordinate efforts for several months through the primary.Loyola Law School Professor and government ethics expert Jessica Levinson said the relationship between the firm and agency appears too close, and the exchange about the congressmen crossed an ethical line.RELATED: California campaign watchdog investigates gas tax campaign"I mean way over the line," she said.BCF and agency officials said the communications were appropriate to educate the public about the law and that they ramped down coordination when the firm took an official campaign role."Clearly the agency was trying to coordinate with the campaign, and they shouldn't have," said Bob Stern, a government ethics expert who helped write California's campaign laws. But he added the actual amount of time government workers spent coordinating with the firm was likely minimal.Ann Ravel, who served on the Federal Election Commission and California's Fair Political Practices Commission, said the volume of emails raises questions about whether the agency aided one side.RELATED: Poll: Support strong for Proposition 6, which repeals California's gas tax"It seems like maybe it's a little too cozy, but I wouldn't say that it's clearly inappropriate," Ravel said.The legislation approved last year raised gas taxes by 12 cents per gallon and added diesel and vehicle fees to generate billion annually. Proposition 6 would repeal the increase and require voters approve gas and vehicle tax increases.The ballot measure is a centerpiece of California Republicans' efforts to boost turnout. GOP Congress members — including House Speaker Paul Ryan of Wisconsin, Majority Leader Kevin McCarthy of Bakersfield and Orange County's Mimi Walters — are among the repeal's biggest financial backers.Leaders of the repeal campaign have asked the federal government to investigate their claims that public resources have been used against them, based on emails and other documents that show local government workers discussing the repeal effort. Those documents are different from the ones the AP obtained. Opponents also circulated a video of a Caltrans contractor passing out anti-Proposition 6 fliers to drivers.The California Department of Transportation, known as Caltrans, falls under the state transportation agency.Melissa Figueroa, the agency's deputy secretary for communications and strategic planning, said it's the agency's job to inform the public about the impact of laws, and it has done so in the past, including for California's "motor voter" registration law."We're trying to be good stewards of taxpayer dollars," Figueroa said.The agency communicated much less frequently with the firm and stopped coordinating social media posts once the official anti-Proposition 6 campaign started, Figueroa said."Prior to that point, it was more of a collaborative effort because they were not in campaign mode," Figueroa said.BCF partner Brandon Castillo said the coalition registered as a fundraising committee in December and officially became a ballot measure campaign in March to support Proposition 69.BCF and other gas tax supporters routinely asked the agency for information, but they did not coordinate on creating campaign materials, Figueroa said. The agency also fulfilled numerous public records requests filed by gas tax opponents, she said.However, an undated memo outlining agency and coalition plans from March through the primary election shows the firm and the agency coordinated the timing of announcements and events. It details plans for the state to tout new construction projects while the coalition campaigned for Proposition 69.The agency and coalition coordinated their schedules, but the agency wasn't involved in campaigning for Proposition 69, Figueroa said.Castillo sent the email about op-eds focused on GOP candidates Sept. 20, 2017."Hey Melissa — We're penning opeds (sic) targeting the following congressional republicans," he wrote. He identified Reps. Jeff Denham, Steve Knight, Walters and Issa and asked Figueroa for information about projects funded by the gas tax increase in their districts.At the time, the coalition was working to persuade California's influential Republican congressional delegates to reject the repeal.Several days after Castillo's email, Figueroa suggested she or Brian Kelly, then the agency's leader, help find an author for the piece targeting Issa, considered the most vulnerable California incumbent before he decided against seeking re-election.Castillo responded saying coalition members were working on it and asked: "Do you have anyone in mind that could influence Republicans/Issa?"The documents obtained by the AP don't include further exchanges on the issue. In interviews, Castillo and Figueroa said the agency never suggested an author. Figueroa said she offered help because the op-ed would educate people in Issa's district.The piece ultimately was written by the mayor of Encinitas, a suburb north of San Diego, and ran the following month in the San Diego Union-Tribune. It touted projects in the district funded by the gas tax increase but didn't mention Issa.Levinson found the exchange surprising because it seemed to directly reference campaign activities."I don't want to say it's a smoking gun, but that is so much more explicit than I ever would have predicted they would be," she said.Prominent gas tax repeal supporters, including gubernatorial candidate John Cox and conservative activist Carl DeMaio, criticized the agency's activity."It's against the law, and it also shows that you can't trust them with money," DeMaio said. "I think that what you're seeing is just the tip of the iceberg." 7732

SACRAMENTO, Calif. (AP) — A statue of a Spanish missionary in downtown Sacramento, California has been toppled by demonstrators. The Sacramento Bee reports the statue of Father Junipero Serra in Capitol Park was brought down during a protest focusing on the rights and historical struggle of indigenous people. The 18th century Roman Catholic priest founded nine of California’s 21 Spanish missions and forced Native Americans to stay at those missions after they were converted or face brutal punishment. Statues of Serra have been defaced in California for several years by people who said he destroyed tribes and their culture. 638

SACRAMENTO, Calif. (AP) — California Gov. Gavin Newsom is willing to throw a financial lifeline to the state's major utilities dealing with the results of disastrous wildfires — but only if they agree to concessions including tying executive compensation to safety performance.A proposal unveiled Friday by Newsom's office aims to stabilize California's investor-owned utilities and protect wildfire victims as the state faces increasingly destructive blazes. Regulators say some previous fires were caused by utility equipment.Pacific Gas & Electric Corp., the largest of the three investor-owned utilities, filed for bankruptcy in January as it faced tens of billions of dollars in potential costs from blazes, including the November fire that killed 85 people in the Paradise area.Newsom hopes to strike a deal with lawmakers in just three weeks, but leaders in the Legislature said they haven't been given a formal legislative proposal and would need to go through their normal review process.The plan comes as credit ratings agencies look wearily upon the utilities.Southern California Edison and San Diego Gas & Electric had their ratings downgraded earlier this year, and executives have pushed lawmakers to come up with a plan that stabilizes the industry.Newsom proposal would give Southern California Edison and San Diego Gas & Electric the power to decide which form of financial aid they want, based on whether they're willing to make their shareholders contribute.They could choose a liquidity fund to tap to quickly pay out wildfire claims or a larger insurance fund that would pay claims directly to people who lose their homes to fire.The ratings agency Moody's has said creating a sort of insurance or liquidity fund would have a positive impact on the credit of utilities in the state.The liquidity fund would be about .5 billion and paid for by a surcharge on ratepayers, said Ana Matosantos, Newsom's cabinet secretary. If utilities want the larger insurance fund, they'd have to pitch in another .5 billion. Both utilities have to agree on which option to choose. Officials at neither company immediately responded to requests for comment.PG&E would not get a say in which fund the state uses or be able to tap a fund until it resolves its claims from the 2017 and 2018 wildfire seasons and emerges from bankruptcy. Its exit plan could not harm ratepayers and it would have to continue the utility's contributions to California's clean energy goals.The utilities would have to implement a number of safety measures to tap into the fund, such as tying executive compensation to safety, forming a safety committee within its board of directors and complying with wildfire mitigation plans.State legislators voted last year to require California's electric companies to adopt those plans. Southern California Edison told legislative staff last year the company wants to spend 2 million to improve power lines and deploy new cameras in high-risk areas.PG&E has said it will inspect 5,500 additional miles of power lines and build 1,300 new weather stations to improve forecasting. Most of its inspections are done, officials said.The state would also require power companies to spend a combined billion on safety over three years. This would include upgrading utility infrastructure as well as developing new early warning and fire detection technologies.Companies would be able to pass on the actual costs of these measures to consumers but could not make a profit off the steps.The California Public Utilities Commission, which regulates utilities, would decide how that billion is split up. Newsom's plan would also create a Wildfire Safety Division and Advisory Board at the CPUC.Matosantos described the draft requirements for additional safety spending as unprecedented and argued that mandating companies meet those guidelines to tap into the fund protects electric customers from paying for the costs of a catastrophic wildfire.Still, lawmakers plan to do their own analysis of the proposal."In order for any solution to work, the Legislature and governor will have to work together," Senate President pro Tempore Toni Atkins, a fellow Democrat, said in a statement. 4234

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