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An obscure drug discount program stifles use of federal lifeline by rural hospitals • South Dakota Searchlight

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An obscure drug discount program stifles use of federal lifeline by rural hospitals • South Dakota Searchlight


Facing ongoing concerns about rural hospital closures, Capitol Hill lawmakers have introduced a spate of proposals to fix a federal program created to keep lifesaving services in small towns nationwide.

In Anamosa, Iowa — a town of fewer than 6,000 residents located more than 900 miles from the nation’s capital — rural hospital leader Eric Briesemeister is watching for Congress’ next move. The 22-bed hospital Briesemeister runs averages about seven inpatients each night, and its most recent federal filings show it earned just $95,445 in annual net income from serving patients.

Yet Briesemeister isn’t interested in converting the facility into a rural emergency hospital, which would mean getting millions of extra dollars each year from federal payments. In exchange for that financial support, hospitals that join the program keep their emergency departments open and give up inpatient beds.

“It wasn’t for us,” said Briesemeister, chief executive of UnityPoint Health-Jones Regional Medical Center. “I think that program is a little bit more designed for hospitals that might not be around without it.”

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Nationwide, only about two dozen of the more than 1,500 eligible hospitals have become rural emergency hospitals since the program launched last year. At the same time, rural hospitals continue to close — 10 since the fix became available.

Federal lawmakers have introduced a handful of legislative solutions since March. In one bill, senators from Kansas and Minnesota list a myriad of tactics, including allowing older closed facilities to reopen.

Another proposal introduced in the House by two Michigan lawmakers is the Rural 340B Access Act. It would allow rural emergency hospitals to use the 340B federal drug discount program, which Congress created in 1992.

The 340B program, named after its federal statute, lets eligible hospitals and clinics buy drugs at a discount and then bill insurance companies, Medicare, or Medicaid at market rates. Hospitals get to keep the money they make from the difference.

Congress approved 340B as an indirect aid package to help struggling hospitals stay afloat. Many larger hospitals say the cash is used for community benefits and charity care, while many small hospitals depend on the drug discounts to help cover staffing and operational shortfalls.

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Currently, emergency hospitals are not eligible for 340B discounts. According to a release from U.S. Rep. Jack Bergman (R-Mich.), the House proposal would “correct this oversight.” Backers of the House bill include the American Hospital Association and the National Rural Health Association.

In Iowa, Briesemeister said the 340B federal drug discount program “can be used for tremendous good.” The small-town hospital uses money it makes from 340B to subsidize emergency services and uninsured and underinsured patients who frequent the emergency department, he said.

Chuck Grassley, Iowa’s longtime Republican senator, shepherded the Rural Emergency Hospital program into law. His spokesperson, Gillie Maddox, did not respond directly to questions about why the federal law creating rural emergency hospitals omitted the 340B program. Instead, Maddox said the designation was a “product of bipartisan negotiations.”

A survey conducted by the health analytics and consulting firm Chartis, along with the National Rural Health Association, found that nearly 80% of rural hospitals had participated in 340B and nearly 40% said they reaped $750,000 or more annually from the program. 

Sanford Health, a largely rural health system headquartered in Sioux Falls, South Dakota, considered converting a handful of smaller critical access hospitals into rural emergency hospitals.

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Martha Leclerc, vice president of corporate contracting for Sanford, said the system analyzed how much revenue would be lost by closing inpatient beds, which is also a requirement of the emergency hospital program, and by being unable to file for drug discounts.

In the end, she said, switching did not “make a lot of sense.”

Creative thinking needed to save rural hospitals

While many rural hospitals are clamoring for the 340B provision to be added to the rural emergency hospital program, opponents have said 340B can be a cash cow for hospitals that don’t serve enough vulnerable patients.

Nicole Longo is deputy vice president of public affairs for the Pharmaceutical Research and Manufacturers of America, the nation’s largest, most influential pharmaceutical lobbying group. She wrote in a recent blog post that hospital systems and chain pharmacies are “exploiting the program” and said patients have not benefited from the growth in the program.

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In an interview, Longo said PhRMA supports rural emergency hospitals being able to access 340B because they are treating “vulnerable patients in underserved communities” and are “true safety net providers.”

PhRMA, she said, wants to encourage a thoughtful conversation about “which types of hospitals should be in the program.” Last year, PhRMA formed an unlikely pact with community health centers to create the Alliance to Save America’s 340B Program, or ASAP 340B.

Vacheria Keys, associate vice president of policy and regulatory affairs at the National Association of Community Health Centers, said, “There is a new day of openness, from all parties.”

Use of the drug discount program skyrocketed after provisions in the Patient Protection and Affordable Care Act, passed in 2010, allowed hospitals and clinics to contract with an unlimited number of retail pharmacies, such as Walgreens and CVS, which are paid a fee to dispense the discounted drugs. 

Adam J. Fein, president of the industry research organization Drug Channels Institute, reports that the 340B program is the second-largest federal drug program, trailing Medicare Part D. The flow of drugs purchased under the 340B program reached $53.7 billion in 2022, about $9.8 billion more than in 2021.

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In response to the exploding use of contract pharmacies, pharmaceutical manufacturers have restricted the drugs they offer at a discount through the pharmacies. That throttling is affecting rural hospitals like Labette Health, a Kansas hospital whose president asked President Joe Biden for help in dealing with the pharmaceutical companies.

Rena Conti, an associate professor of markets, public policy, and law at Boston University’s Questrom School of Business, has studied the drug discounts for years and said she has “significant worries about expanding” the 340B program.

“There is a lot of money being generated in this program that we really can’t understand exactly how much that really is and exactly who it is benefiting,” Conti said.

At the same time, said Conti, a health care economist, giving rural hospitals access to the federal drug discounts “makes sense because they are hospitals that are serving particularly vulnerable patient populations.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
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South Dakota

Man who killed transgender Native American woman in 2022 takes manslaughter plea • South Dakota Searchlight

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Man who killed transgender Native American woman in 2022 takes manslaughter plea • South Dakota Searchlight


The man who shot a transgender Native American woman to death in 2022 pleaded guilty to second-degree manslaughter this week in Pennington County. 

Pennington County State’s Attorney Lara Roetzel filed first-degree manslaughter, drug and firearms charges against 54-year-old Gregory Edward Landers in February, about a year and a half after he killed 30-year-old Acey Morrison in his Rapid City trailer.

The case caught national attention in LGBTQ+ circles in part because of the extended wait between the time Landers called 911 to report the killing and the date on which he was indicted by a grand jury in Rapid City. Morrison was honored in 2022 during the annual Transgender Day of Remembrance, which takes place each November in memory of transgender people who lost their lives to violence in the preceding year.

Gregory Landers. (Courtesy of Pennington County State’s Attorney’s Office)
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Landers pleaded guilty to the second-degree manslaughter charge on Monday in Rapid City, two days before this year’s day of remembrance. 

Second-degree manslaughter involves the reckless killing of another human being. The maximum penalty is 10 years in the state penitentiary.

A letter from Roetzel in the Landers case file says she intends to ask for a 10-year sentence with three years suspended at his Dec. 19 sentencing. His other charges were dismissed as part of the deal.

“This case is a tragic reminder of the consequences of reckless and violent actions,” Roetzel said in a statement to South Dakota Searchlight. “By accepting responsibility through his guilty plea, Mr. Landers is being held accountable for the harm he caused. We remain committed to seeking justice for victims like Acey Morrison and ensuring our community remains safe.”

Court documents offer insight into self-defense arguments

Landers told law enforcement he’d shot Morrison in self-defense when he called 911 to report the killing. He maintained that he’d acted in self-defense throughout court proceedings this year. 

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Most of the documents, exhibits, photos and transcripts associated with his effort to have the manslaughter charge dismissed under South Dakota’s “Stand Your Ground” law are sealed. 

The documents that remain public do offer some new details on the situation. Landers claimed he’d let Morrison stay the night after the two connected on a dating app, but that she wouldn’t leave when he asked. He said she’d broken his ribs in an altercation over the shotgun that killed her. 

Court documents say he was treated for bruised ribs and a broken hand after the homicide. The lead investigator characterized the break to Landers’ hand as a “boxer’s fracture,” an injury typically associated with punching someone or something.

‘Stand your ground’ law alters criminal justice landscape

Landers argued throughout the proceedings that he’d wrestled a shotgun away from Morrison before shooting her in the chest, and had moved to hire an expert to re-check for DNA on the weapon. In a letter to Judge Heidi Linngren, Landers called himself an innocent man and wrote that he should not be convicted because of “incompetent” DNA testing.

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That testing found Morrison’s DNA on the weapon, including near the barrel of the gun, but it had more of Landers’ DNA on it. Her left index finger was blown off in the shooting, according to a motion from Roetzel asking Judge Linngren to deny Landers’ request for immunity from prosecution. That’s consistent with her hands being “at the top of the barrel of the muzzle at the time of discharge.”

Roetzel’s arguments noted that Landers had accused Morrison of performing a factory reset of his phone, presumably to steal and sell it, but later admitted he’d wiped the phone’s memory to conceal information from law enforcement. Landers also said he and Morrison hadn’t had sex, despite DNA evidence to the contrary, and that the physical fight between them took place in a bedroom and a closet that were undisturbed when officers arrived.

“Defendant says he acted in self-defense, but his words have little meaning, given the number of lies he has been caught telling,” Roetzel wrote.

Lead detective resigns

Morrison’s mother, Edelyn Catches of Oglala, grew frustrated with the justice system as she awaited an answer about her daughter’s death. 

Just over a year after Morrison’s death, Catches lost her son Daniel Freeman to homicide in an incident that took place on the Pine Ridge Reservation and has yet to draw criminal charges.

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Nine months and counting: Slain transgender woman’s family frustrated by wait for justice

The U.S. Attorney’s Office prosecutes felony crimes on tribal lands. U.S. Attorney spokeswoman Ace Crawford was not immediately able to offer any information on the Freeman case Thursday afternoon.

The charges for Landers were a relief for Catches, but she said the self-defense arguments and an issue with the lead investigator in the case, Cameron Ducheneaux, had her anxious about the outcome. 

Ducheneaux resigned from the Pennington County Sheriff’s Office for reasons that aren’t disclosed in the public court file. His resignation is noted in the file, but documents and personnel records that could shed further light on the resignation were only made available to the prosecution, defense and judge.

On Thursday, Catches said she’d been told that Ducheneaux’s situation could have called his credibility into question at Landers’ trial. The trial was initially set to begin this week.

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The plea deal means Ducheneaux will not be called to testify at a trial, nor would his credibility be called into question by Landers’ attorney.

“Looking at what we were facing, he actually had a chance of walking,” Catches said Thursday.

Tony Mangan, spokesman for the state Division of Criminal Investigation, said Ducheneaux remains a certified law enforcement officer, and that a hearing on his certification will take place during a meeting of the Law Enforcement Officers Standards and Training Commission meeting on Dec. 4. 

The process of working through the self-defense arguments, seeing images of Morrison after the killing and hearing accusations leveled at Morrison throughout was stressful, Catches said.

“It was just way out of Acey’s character, the way he described the altercation,” Catches said.

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She’s glad Roetzel pursued the case, despite the wait, and that Landers has now admitted to recklessly killing Morrison.

“It was an uphill fight the whole way,” Catches said. “At least he’ll get something, and it will be on the record that he killed Acey.”

 

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Matt Gaetz bows out as Trump’s pick for attorney general • South Dakota Searchlight

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Matt Gaetz bows out as Trump’s pick for attorney general • South Dakota Searchlight


WASHINGTON — Former Florida Congressman Matt Gaetz announced Thursday he’s withdrawing as President-elect Donald Trump’s planned nominee for attorney general days after securing the appointment.

Gaetz’s path to Senate confirmation was highly unlikely following years of investigations about alleged drug usage and payments for sex, including with an underage girl. He submitted his resignation to Congress last week.

“While the momentum was strong, it is clear that my confirmation was unfairly becoming a distraction to the critical work of the Trump/Vance Transition,” Gaetz wrote in a social media post. “There is no time to waste on a needlessly protracted Washington scuffle, thus I’ll be withdrawing my name from consideration to serve as Attorney General. Trump’s DOJ must be in place and ready on Day 1.” 

Trump posted on social media afterward that he “greatly” appreciated “the recent efforts of Matt Gaetz in seeking approval to be Attorney General.”

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“He was doing very well but, at the same time, did not want to be a distraction for the Administration, for which he has much respect,” Trump wrote. “Matt has a wonderful future, and I look forward to watching all of the great things he will do!”

The House Ethics Committee voted along party lines Wednesday not to release its report on Gaetz, following more than three years of investigation. Gaetz has repeatedly denied any wrongdoing, including the allegations that he had sex with a minor.

Meetings with senators

Trump’s running mate, Ohio Sen. J.D. Vance, spent Wednesday shuffling Gaetz between meetings with Republicans on the Senate Judiciary Committee, which would have held his confirmation hearing. Republicans will control the Senate in the new session of Congress beginning in January.

South Carolina Sen. Lindsey Graham, the top Republican on the Judiciary Committee, wrote on social media that he respected Gaetz’s decision to withdraw his name from consideration as AG.

“I look forward to working with President Trump regarding future nominees to get this important job up and running,” Graham said.

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The office of Sen. John Kennedy of Louisiana, fellow Senate Judiciary Committee Republican, declined to comment.

Gaetz’s future is unclear, given that he resigned from the U.S. House last week and notified the chamber he didn’t plan to take the oath of office for the upcoming 119th Congress.

He first joined the House in January 2017 and led efforts to remove former House Speaker Kevin McCarthy from that role last year, setting off a month-long stalemate within the House Republican Conference over who should lead the party.

The race to fill his empty seat in a special election has already attracted six candidates, mostly Republicans in a heavily conservative-leaning district.

Gaetz could jump into the race for his old seat, possibly winning a place back in the House of Representative next year following the special election.

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AG oversees Department of Justice

The attorney general is responsible for overseeing the Department of Justice, which includes the federal government’s top law enforcement agencies as well as prosecutors.

The Bureau of Alcohol, Tobacco, Firearms and Explosives, or ATF, Drug Enforcement Administration, Federal Bureau of Investigation, Federal Bureau of Prisons, Office for Victims of Crime, Office on Violence Against Women and U.S. Attorneys’ offices are among the 40 entities within the DOJ and its 115,000-person workforce.

Congress approved $37.52 billion for the Department of Justice in the most recent full-year spending bill.

Trump had two attorneys general during his first term as president. He first nominated former Alabama Sen. Jeff Sessions, whom Trump later fired amid disputes, and then Bill Barr. 

Ashley Murray contributed to this story

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This is a developing report that will be updated.

Last updated 12:47 p.m., Nov. 21, 2024



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Duke 75-71 South Dakota State (Nov 17, 2024) Game Recap – ESPN

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Duke 75-71 South Dakota State (Nov 17, 2024) Game Recap – ESPN


BROOKINGS, S.D. — — Jadyn Donovan finished with 23 points and 15 rebounds to help No. 16 Duke hold off South Dakota State 75-71 on Sunday.

Donovan hit 11 of 17 shots from the floor and added four assists and four steals for the Blue Devils (4-1). It was the second double-double this season for the sophomore.

Ashlon Jackson totaled 17 points and four assists for Duke. Vanessa de Jesus scored 13 off the bench.

Brooklyn Meyer scored 25 points on 9-for-13 shooting to lead the Jackrabbits (3-1). Paige Meyer had 12 points and seven assists. Haleigh Timmer scored 11 on 5-for-7 shooting. Kallie Theisen grabbed 12 rebounds but did not score.

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Jackson had nine points to guide the Blue Devils to a 23-18 advantage after one quarter.

Donovan scored off a rebound to give Duke a 10-point lead with 90 seconds left before halftime. But Brooklyn Meyer had the only basket from there and South Dakota State trailed 38-30.

The Jackrabbits grabbed the lead at 47-45 after Timmer’s layup and two free throws by Meyer. Donovan answered with a dunk off a rebound and finished off a three-point play, and Reigan Richardson and Toby Fournier sank shots in the final 44 seconds to send the Blue Devils to the fourth quarter with a 54-50 lead.

Mesa Byom hit a 3-pointer with 7:38 left to play to pull South Dakota State even at 59. Donovan answered with another rebound basket and a jumper, and the Blue Devils stayed in front from there.

The Jackrabbits stayed within striking distance by hitting 8 of 16 shots from beyond the arc while Duke sank just 3 of 11.

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The Blue Devils return home to play Belmont on Thursday.

—— Get poll alerts and updates on the AP Top 25 throughout the season. Sign up here. AP women’s college basketball: https://apnews.com/hub/ap-top-25-womens-college-basketball-poll and https://apnews.com/hub/womens-college-basketball



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