UW Medicine to reschedule some procedures; hospitals agree to share surge of COVID-19 patients

Responding to a surge in COVID-19 caseloads, UW Medicine has decided to postpone surgeries that are not urgent but would require hospitalization afterward, according to an internal email and confirmed by a spokesperson. 

UW Medicine’s action comes as Washington state’s hospitals earlier this week reached an agreement on how to handle the ongoing rise of COVID-19 patients statewide — committing to one another that “no hospital will go into crisis standards alone.” 

Crisis standards are when hospitals are so overwhelmed they cannot provide the typical standard of care, and they are left to triage resources and decide who will receive treatment and who will be left to die. 

The hospitals’ commitment — which expand on agreements reached before the first surge of COVID-19 in spring — says all of the state’s acute care hospitals will make “concrete plans” to scale back on elective procedures as needed, reserve intensive care units for COVID-19 or emergency cases, and readily accept patient transfers from other parts of the state.

It aims to ensure hospitals will work closely with one another and communicate to prevent individual facilities from becoming overwhelmed when others have capacity.  

“It’s essentially to try to manage — all across the system — the capacity,” said Cassie Sauer, of the Washington State Hospital Association (WSHA), which convened a videoconference Monday for the state’s hospital leaders. “In the places that have gone to crisis standards, those doctors and nurses, I’m not sure their soul will ever be the same.” 

Sauer said hospitals hope to create more slack in the system by collaborating closely together and establishing clear communication. Hospitals must document if they deny the transfer of a patient and inform their chief executive officer if a transfer is denied. 

Statewide, as of 4 p.m. Friday, 78% of acute care beds were occupied, according to WSHA. Nearly 84% of intensive care unit (ICU) beds and almost 75% of the ICU beds in airborne infection isolation rooms were in use — numbers higher than two weeks ago.

Sauer said many Washington hospitals, including UW Medicine and Swedish, are beginning to more aggressively scale back on elective procedures.  

“All non-urgent patients who need to occupy a bed [post-operation] for any length of time will be rescheduled,” wrote UW Medical Center CEO Cindy Hecker and Harborview Medical Center CEO Paul Hayes in a message to colleagues Nov. 19. The rescheduling will begin Nov. 23 and continue through Feb. 1, according to the message.  

Procedures for outpatients and in urgent or emergent cases will continue, Hecker and Hayes wrote. 

UW Medicine spokesperson Susan Gregg said the hospital system is “actively contacting” patients whose surgeries will be postponed. 

“Each individual case is being reviewed based on medical urgency and whether the patient would need to be hospitalized after the surgery,” Gregg said in a statement Friday.  

UW Medicine was caring for 77 COVID-19 patients across its campuses as of Thursday. On Oct. 1, the hospital system was caring for 20.  

Dr. Elizabeth Wako, chief medical officer at

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Medicare Fines Hospitals for Too Many Readmissions



 

Nearly half the nation’s hospitals, many of which are still wrestling with the financial fallout of the unexpected coronavirus, will get lower payments for all Medicare patients because of their history of readmitting patients, federal records show.

The penalties are the ninth annual round of the Hospital Readmissions Reduction Program created as part of the Affordable Care Act’s broader effort to improve quality and lower costs. The latest penalties are calculated using each hospital case history between July 2016 and June 2019, so the flood of coronavirus patients that have swamped hospitals this year were not included.

The Centers for Medicare & Medicaid Services announced in September it may suspend the penalty program in the future if the chaos surrounding the pandemic, including the spring’s moratorium on elective surgeries, makes it too difficult to assess hospital performance.

For this year, the penalties remain in effect. Retroactive to the federal fiscal year that began Oct. 1, Medicare will lower a year’s worth of payments to 2,545 hospitals, the data show. The average reduction is 0.69%, with 613 hospitals receiving a penalty of 1% or more.

Out of 5,267 hospitals in the country, Congress has exempted 2,176 from the threat of penalties, either because they are critical access hospitals — defined as the only inpatient facility in an area — or hospitals that specialize in psychiatric patients, children, veterans, rehabilitation or long-term care. Of the 3,080 hospitals CMS evaluated, 83% received a penalty.

The number and severity of penalties were comparable to those of recent years, although the number of hospitals receiving the maximum penalty of 3% dropped from 56 to 39. Because the penalties are applied to new admission payments, the total dollar amount each hospital will lose will not be known until after the fiscal year ends on July 30.

“It’s unfortunate that hospitals will face readmission penalties in fiscal year 2021,” said Akin Demehin, director of policy at the American Hospital Association. “Given the financial strain that hospitals are under, every dollar counts, and the impact of any penalty is significant.”

The penalties are based on readmissions of Medicare patients who initially came to the hospital with diagnoses of congestive heart failure, heart attack, pneumonia, chronic obstructive pulmonary disease, hip or knee replacement or coronary artery bypass graft surgery. Medicare counts as a readmission any of those patients who ended up back in any hospital within 30 days of discharge, except for planned returns like a second phase of surgery.

A hospital will be penalized if its readmission rate is higher than expected given the national trends in any one of those categories.

The industry has disapproved of the program since its inception, complaining the measures aren’t precise and it unfairly punishes hospitals that treat low-income patients, who often don’t have the resources to ensure their recoveries are successful.

Michael Millenson, a health quality consultant who focuses on patient safety, said the penalties are a useful but imperfect mechanism to push hospitals to improve their care. The designers of

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Sandoz ships first medicine in collaboration with Civica Rx to supply US hospitals

PRINCETON, N.J., Nov. 2, 2020 /PRNewswire/ — Sandoz Inc. today announced that it has shipped pantoprazole sodium for injection, 40 mg to Civica Rx to supply the hospitals it serves as part of a multiyear collaboration to help reduce supply shortages, with several other medicines on the way before the end of the year.

Pantoprazole is the first Sandoz medicine to ship to Civica since entering into the agreement in July. It is a proton pump inhibitor indicated in adults for the short-term treatment (7 to 10 days) of gastroesophageal reflux disease (GERD), associated with a history of erosive esophagitis1

Sandoz previously announced it will supply six injectable medicines under the Civica private label to its 1,200 US hospitals. The agreement is being expanded to include an additional medicine to regulate blood pressure, which is frequently used to treat COVID-19 patients in hospitals.

“Our collaboration with Civica is providing certainty for hospitals, doctors and patients who are too often frustrated by shortages of medicines. This is especially important as healthcare providers continue to manage the COVID-19 pandemic,” said Carol Lynch, President, Sandoz Inc. “We are committed to ensuring our medicines are there for the patients who need them when they need them.”

Civica, a non-profit, was founded in 2018 by leading US hospital systems concerned about generic drug shortages and philanthropic organizations passionate about improving healthcare. To date, more than 50 health systems are Civica members, representing more than 1,200 US hospitals and approximately 30 percent of all licensed US hospital beds including acute care. 

“Within a year since our first medication was administered in a hospital ICU, we’ve been able to help millions of patients,” said Martin VanTrieste, president and CEO of Civica. “With Sandoz, we look forward to helping millions more by providing critical medicines that have often been in short supply.”

INDICATIONS AND USAGE

Pantoprazole sodium is a proton pump inhibitor (PPI) indicated in adults for the following:

  • Short-term treatment (7 to 10 days) of gastroesophageal reflux disease (GERD) associated with a history of Erosive Esophagitis (EE).
  • Pathological hypersecretion conditions including Zollinger-Ellison (ZE) Syndrome.

IMPORTANT SAFETY INFORMATION

CONTRAINDICATIONS

  • Patients with a known hypersensitivity to any component of the formulation or to substituted benzimidazoles.
  • Patients receiving rilpivirine-containing products.

WARNINGS AND PRECAUTIONS

  • Gastric Malignancy: In adults, symptomatic response to therapy with pantoprazole sodium for injection does not preclude the presence of gastric malignancy. Consider additional follow-up and diagnostic testing.
  • Hypersensitivity and Severe Skin Reactions: Anaphylaxis and other serious reactions such as erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis (TEN) have been reported.
  • Injection Site Reactions: Thrombophlebitis is associated with the administration of intravenous pantoprazole.
  • Potential Exacerbation of Zinc Deficiency: Consider zinc supplementation in patients who are prone to zinc deficiency. Caution should be used when other EDTA containing products are also co-administered intravenously.
  • Acute Interstitial Nephritis: Observed in patients taking PPIs.
  • Clostridium difficile-Associated Diarrhea: PPI therapy may be associated with increased risk.
  • Bone Fracture: Long-term and multiple daily dose PPI therapy may
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Coronavirus surge sees US hospitals scramble for nurses

As the coronavirus pandemic surges across the nation and infections and hospitalizations rise, medical administrators are scrambling to find enough nursing help — especially in rural areas and at small hospitals.

Nurses are being trained to provide care in fields where they have limited experience. Hospitals are scaling back services to ensure enough staff to handle critically ill patients. And health systems are turning to short-term travel nurses to help fill the gaps.

Adding to the strain, experienced nurses are “burned out with this whole (pandemic)” and some are quitting, said Kevin Fitzpatrick, an emergency room nurse at Hurley Medical Center in Flint, Michigan, where several left just in the past month to work in hospice or home care or at outpatient clinics.

CORONAVIRUS CLAIMS LIFE OF MISSOURI BOY, 13, FAMILY CLAIMS

“And replacing them is not easy,” Fitzpatrick said.

As a result, he said, the ER is operating at about five nurses short of its optimal level at any given time, and each one typically cares for four patients as COVID-19 hospitalizations surge anew. Hospital officials did not respond to requests for comment.

But the departures are not surprising, according to experts, considering not only the mental toll but the fact that many nurses trained in acute care are over 50 and at increased risk of complications if they contract COVID-19, while younger nurses often have children or other family to worry about.

“Who can actually work and who feels safe working are limited by family obligations to protect their own health,” said Karen Donelan, professor of U.S. health policy at Brandeis University’s Heller School for Social Policy and Management. “All of those things have been factors.”

CORONAVIRUS FACE MASKS AT POLLS ENCOURAGED, BUT NOT REQUIRED IN SOME STATES 

Donelan said there is little data so far on how the pandemic, which has killed more than 231,000 people in the country, is affecting nursing overall. But some hospitals had a shortage even before the virus took hold, despite a national rise in the number of nurses over the past decade.

With total confirmed coronavirus cases surpassing 9 million in the U.S. and new daily infections rising in 47 states, the need is only increasing.

Wausau, Wisconsin-based Aspirus Health Care is offering $15,000 signing bonuses for nurses with at least a year of experience and hiring contract nurses through private staffing companies to handle a surge in hospitalizations that prompted the system to almost quadruple the number of beds dedicated to COVID-19 patients.

Aspirus, which operates five hospitals in Wisconsin and four in small communities in Michigan’s Upper Peninsula, also is moving nurses around between departments and facilities as hot spots emerge, said Ruth Risley-Gray, senior vice president and chief nursing officer at Aspirus.

ARE POLL WORKERS AT INCREASED RISK FOR CORONAVIRUS? 

Outside help still is needed, in part because some nurses have gotten sick from or were exposed to the cornavirus during the current wave, which “came with a vengeance” starting in August, Risley-Gray said. At

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Hospitals competing for nurses as US coronavirus cases surge

FENTON, Michigan (AP) — As the coronavirus pandemic surges across the nation and infections and hospitalizations rise, medical administrators are scrambling to find enough nursing help — especially in rural areas and at small hospitals.

Nurses are being trained to provide care in fields where they have limited experience. Hospitals are scaling back services to ensure enough staff to handle critically ill patients. And health systems are turning to short-term travel nurses to help fill the gaps.

Adding to the strain, experienced nurses are “burned out with this whole (pandemic)” and some are quitting, said Kevin Fitzpatrick, an emergency room nurse at Hurley Medical Center in Flint, Michigan, where several left just in the past month to work in hospice or home care or at outpatient clinics.

“And replacing them is not easy,” Fitzpatrick said.


As a result, he said, the ER is operating at about five nurses short of its optimal level at any given time, and each one typically cares for four patients as COVID-19 hospitalizations surge anew. Hospital officials did not respond to requests for comment.

But the departures are not surprising, according to experts, considering not only the mental toll but the fact that many nurses trained in acute care are over 50 and at increased risk of complications if they contract COVID-19, while younger nurses often have children or other family to worry about.

“Who can actually work and who feels safe working are limited by family obligations to protect their own health,” said Karen Donelan, professor of U.S. health policy at Brandeis University’s Heller School for Social Policy and Management. “All of those things have been factors.”

Donelan said there is little data so far on how the pandemic, which has killed more than 231,000 people in the country, is affecting nursing overall. But some hospitals had a shortage even before the virus took hold, despite a national rise in the number of nurses over the past decade.

With total confirmed coronavirus cases surpassing 9 million in the U.S. and new daily infections rising in 47 states, the need is only increasing.

Wausau, Wisconsin-based Aspirus Health Care is offering $15,000 signing bonuses for nurses with at least a year of experience and hiring contract nurses through private staffing companies to handle a surge in hospitalizations that prompted the system to almost quadruple the number of beds dedicated to COVID-19 patients.

Aspirus, which operates five hospitals in Wisconsin and four in small communities in Michigan’s Upper Peninsula, also is moving nurses around between departments and facilities as hot spots emerge, said Ruth Risley-Gray, senior vice president and chief nursing officer at Aspirus.

Outside help still is needed, in part because some nurses have gotten sick from or were exposed to the cornavirus during the current wave, which “came with a vengeance” starting in August, Risley-Gray said. At one point in mid-October, 215 staffers were in isolation after showing symptoms or being exposed to someone who tested positive, and some are just starting to return to

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Ransomware Surge Imperils Hospitals As Pandemic Intensifies

Hackers are stepping up attacks on health care systems with ransomware in the United States and other countries, creating new risks for medical care as the global coronavirus pandemic accelerates.

Alerts from US authorities and security researchers highlight a wave of cyberattacks on hospitals coping with rising virus infections.

An unusual warning this week from the FBI with the Departments of Homeland Security and Health and Human Services, underscored the threat.

The three agencies “have credible information of an increased and imminent cybercrime threat to US hospitals and health care providers,” said the alert issued Wednesday, calling on health systems to “take timely and reasonable precautions to protect their networks from these threats.”

Media reports have cited several US hospitals hit by ransomware.

Hospitals and other health facilities are increasingly being targeted by ransomware even as they try to ramp up for the acceleration in the pandemic Hospitals and other health facilities are increasingly being targeted by ransomware even as they try to ramp up for the acceleration in the pandemic Photo: AFP / DAMIEN MEYER

One of them, the University of Vermont Medical Center, said in a statement Thursday it was working with law enforcement on “a now confirmed cyberattack that has affected some of our systems” which has had “variable impacts” on patient care.

Daniel dos Santos of the computer security firm Forescout said cash-strapped medical centers are particularly attractive targets for hackers and that at least 400 hospitals had been hit in the past few weeks in the US and Britain.

Hackers are aware that “health care is the most likely to pay the ransom because their services are critical,” dos Santos said.

“Stopping services means that people will literally be dying.”

For hospitals unable or willing to pay, “it would mean going back to pen and paper, which can cause huge slowdowns,” he added.

Forescout said in a report that while many hospitals have upgraded computer systems, most use a variety of connected devices such as patient monitors or CT scanners which “act as the weak links in the network” because they transmit data over insecure channels.

Connected devices in hospitals can become weak points for hackers looking to launch ransomware attacks, according to security experts Connected devices in hospitals can become weak points for hackers looking to launch ransomware attacks, according to security experts Photo: POOL / Steve Parsons

In one sign of the troubles looming, dos Santos and fellow researchers said they discovered data on some three million US patients online, “unprotected and accessible to anyone who knows how to search for it.,” the Forescout report said.

Ransomware is a longstanding security issue and health care has been a frequent target. A September attack disrupted Universal Health Services, which operates hospitals in the US and Britain.

But security experts say the attacks are accelerating as the pandemic worsens.

Researchers at the security firm Check Point said its survey showed health care has been the most targeted industry by ransomware, with a 71 percent jump in attacks on US providers in October from a month earlier.

Check Point said there have been significant rises in ransomware attacks on hospitals in Asia, Europe and the Middle East as well. Globally, the firm said ransomware attacks were up 50 percent

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Here are the hospitals with the highest rate of COVID patients

Health workers wearing full personal protective equipment (PPE) on the intensive care unit (ICU) at Whiston Hospital in Merseyside as they continue deal with the increasing number of coronavirus patients. (Photo by Peter Byrne/PA Images via Getty Images)
Health workers wearing full personal protective equipment (PPE) on the intensive care unit (ICU) at Whiston Hospital in Merseyside. (Getty)

Several hospitals across England have seen the number of coronavirus admissions surge past levels seen in the first wave of the pandemic, newly released data shows.

Statistics compiled by Public Health England (PHE), shown to cabinet ministers last week ahead of Saturday’s lockdown announcement, shows there are currently scores of hospitals dealing with over 100 COVID positive inpatients.

The graph shows that the number of coronavirus patients at Doncaster and Bassetlaw Trust in Yorkshire and Blackpool Hospital Trust exceeded their first wave peak on 19 October.

Liverpool University Hospital Foundation Trust was next worst hit, with patients passing the highest first wave levels a day later on 20 October.

A Public Health England heat map shows hospital admissions for COVID have risen sharply. (PHE)
A Public Health England heat map shows hospital admissions for COVID have risen sharply. (PHE)
Britain's Prime Minister Boris Johnson speaks during a virtual press conference inside 10 Downing Street in central London on October 31, 2020 to announce new lockdown restrictions in an effort to curb rising infections of the novel coronavirus. - UK Prime Minister Boris Johnson on Saturday announced a new four-week coronavirus lockdown across England, a dramatic strategy shift following warnings hospitals would become overwhelmed under his current system of localised restrictions. (Photo by Alberto Pezzali / POOL / AFP) (Photo by ALBERTO PEZZALI/POOL/AFP via Getty Images)
The PM announced a second nationwide lockdown on Saturday. (Getty)

Several other hospitals, mainly in the north of England, have reported exceedingly high levels of coronavirus in the past week.

In total, 24 hospitals reported COVID patient levels at over half their previous peak during the first wave of the pandemic.

Read more: ‘Terrifying’ projections and concern over NHS capacity at heart of push for new lockdown

On Friday, figures released by the government showed that more than 10,000 Covid-19 patients are now being treated in hospitals across the UK.

But the number has yet to reach the 20,000 seen at the height of the first wave of the pandemic earlier this year.

Liverpool University Hospitals Foundation Trust had the highest number of beds occupied by coronavirus patients in England on Tuesday at 450, according to NHS England data.

Watch: Starmer blasts delay in imposing second nationwide lockdown

Pennine Acute Hospitals Trust in Greater Manchester was second on the list with 290 inpatients.

In Nottinghamshire, which has been subject to Tier 3 lockdown restrictions, the number of hospitalisations is 40 per cent higher than those seen in April.

And in Greater Manchester, most hospital trusts there will reportedly exceed their critical care capacity by next week due to high COVID-19 hospital admissions.

The county’s public health director Jonathan Gribbin said “even a well-organised NHS and care system will struggle to cope” with the sharp rise in patients in the county’s hospitals.

It comes as advisors from the Scientific Advisory Group for Emergencies (SAGE) said on Friday that England has breached its “reasonable worst-case” scenario for COVID-19 infections and hospital admissions.

Sage also warned that the number of daily deaths in England is in line with that scenario, but “is almost certain to exceed this within the next two weeks”.

Source Article

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Europe’s hospitals could soon hit capacity with covid-19 patients

Germany, Europe’s best-resourced nation, risks being swamped even after increasing its intensive care beds by a quarter over the summer. Belgium, which had doubled its intensive care capacity, is now preparing for decisions about which needy patient should get a bed.

“This huge capacity we’ve built gave a false impression of security. It gave a higher buffer, but ultimately it only represents a week when you’re in an exponential phase,” said Emmanuel André, a leading Belgian virologist who has advised the government on the pandemic — and has bitterly criticized leaders for acting too slowly this fall.

In retrospect, the warning signs could be seen as early as July, when cases in Europe started ticking up again after the relaxation of spring lockdowns. In absolute terms, the numbers were still tiny. Spanish emergency room doctors enjoyed a respite, after being hammered in March and April. Italian nurses headed to the beach. Central European leaders — among the worst hit now, but back then largely untouched — gathered at the end of August for a triumphant conference to discuss the post-pandemic era.

But the math for exponential growth is as simple as it is scary. When two coronavirus cases double to four, and four cases double to eight, it doesn’t take long for the numbers to reach the tens of thousands — and beyond.

“An exponential phenomenon starts with very small numbers, and it is not tangible for weeks and weeks and weeks for people out there,” André said. “If you look at the numbers, you have very strong indicators early on that things are going wrong, but it is only at the very end that things explode.”

Europe is now feeling the explosion.

The continent reported 1.5 million cases over the past week, the highest yet during the pandemic, the World Health Organization’s Europe director, Hans Kluge, told an emergency meeting of health ministers on Thursday. Deaths rose by a third in seven days. Occupancy of intensive care units doubled in 17 days leading up to Oct. 25 in countries tracked by the European Center for Disease Prevention and Control.

“Europe is at the epicenter of this pandemic once again,” Kluge said.

A week ago, French intensive care beds were half full. Now, they are more than two-thirds occupied, with more than 3,100 covid-19 patients. When President Emmanuel Macron on Wednesday announced a second national lockdown — something he and other European leaders have sought mightily to avoid — he warned that “at this stage, we know that whatever we do, nearly 9,000 patients will be in intensive care by mid-November, which is almost the entirety of French capacities.”

Top public health leaders echoed his dire message.

“We are going to have two to three extremely difficult weeks for the health-care system,” Jean-François Delfraissy, the head of the scientific council that advises the French government on the pandemic, told France Inter radio on Thursday. “We can’t allow it to crack. We are in a worse situation than in the beginning

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Exceptional Healthcare to Open New Community Hospitals Across Arizona

Exceptional Community Hospital Celebrates Groundbreaking for Maricopa Facility;
Additional Community Hospitals Already Planned for Yuma, Prescott, Other Communities

A Texas-based hospital group is making a strong entry into the Arizona marketplace, with a critically needed community hospital coming to Maricopa and other hospitals opening across Arizona in the near future.

Exceptional Healthcare is entering Arizona with its first facility in the City of Maricopa, in the Phoenix metro region. The 20,000-square-foot Phase 1 of the facility will be located in the heart of Maricopa on State Route 347, and will be the first facility of its kind in the community.

The state-of-the-art facility includes a specialty internal medicine hospital, a 24-hour emergency department, a digital imaging suite – including CT Scan, X-Ray, mobile MRI and ultrasound – an in-house laboratory, and outpatient and inpatient hospital beds for acute admissions and overnight observation of patients.

Additionally, in partnership with higher-level hospitals in the Phoenix area, Exceptional Healthcare will feature a landing area for air ambulances to ensure the fastest transfer of patients needing a higher level of care.

Exceptional Healthcare is already planning for additional facilities in Prescott and Yuma as well as locations in as many as six other communities throughout the state.

“We are very excited to be entering the Arizona marketplace and particularly the City of Maricopa with our first Exceptional Healthcare hospital in the state,” said Saeed Mahboubi, Chief Financial Officer for Exceptional Healthcare. “Arizona is facing a shortage of healthcare facilities and professionals, particularly in rural areas and smaller communities in the state. These new hospitals will fill a critical need and help strengthen the state’s overall healthcare infrastructure.”

Two socially distanced, invitation-only groundbreaking events will take place on Friday, November 13 at the Maricopa site. Members of the media are invited to attend either the 10:30 a.m. or 1:30 p.m. events. Media members who would like to attend should contact Tom Evans at the information above.

Neighborhood community hospitals are important because they offer residents of communities without large healthcare resources an alternative to driving long distances — often at times of medical emergency when seconds count. It also provides patients with the ability to stay closer to home for less significant internal medicine-related admissions, allowing patients to be closer to their families and loved ones.

At the Exceptional Healthcare facilities, each inpatient room will have accommodations for a family member to stay the night, as well as high-level concierge-style service. Plans include chef-prepared individualized meal service as well as complimentary toiletries, bath robe, and slippers for patients to increase their level of comfort.

As Maricopa continues to grow, the need for immediate lifesaving care is critical, and the ability for residents to be admitted to a hospital for basic inpatient care without having to leave Maricopa is a plus. The $18 million facility in Maricopa is expected to employ between 60-100 employees, and is scheduled to be completed in the fall of 2021.

Christian Price, Mayor of the City of Maricopa, welcomed

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More hospitals hit by ransomware as feds warn about cyberattacks

A recent wave of ransomware attacks has infected more hospitals than previously known, including a University of Vermont network with locations in New York and Vermont.

The University of Vermont Health Network is analyzing what appears to be a ransomware attack from the same cybercrime gang that has infected at least three other hospitals in recent weeks, according to two sources familiar with the investigation who weren’t authorized to comment about it before it is complete.

Several federal agencies warned Wednesday of “an increased and imminent cybercrime threat” to the country’s health care providers, particularly from a gang that uses a strand of ransomware called Ryuk. The U.S. has repeatedly hit record highs for daily confirmed coronavirus infections.

The FBI and the Cybersecurity and Infrastructure Security Agency, part of the Department of Homeland Security, sent an updated alert Thursday night with new technical information, adding that they have “credible information of an increased and imminent cybercrime threat to U.S. hospitals and healthcare providers.”

As many as 20 medical facilities have been hit by the recent wave of ransomware, said a person with knowledge of the matter, who spoke on the condition of anonymity because they weren’t authorized to speak publicly. The figure includes multiple facilities within the same hospital chain.

Three other hospital chains have recently confirmed cyberattacks, believed to be ransomware, by the same gang: the Sky Lakes Medical Center, with 21 locations in Oregon; Dickinson County Healthcare System in Michigan and Wisconsin; and the St. Lawrence Health System in northern New York. It was not clear how much of their systems or how many locations had been hit by the ransomware.

Tom Hottman, a spokesperson for Sky Lakes Medical Center, confirmed that the company had been infected with Ryuk and said its computers were inaccessible, halting radiation treatments for cancer patients.

“We’re still able to meet the care needs for most patients using work-around procedures, i.e. paper rather than computerized records. It’s slower but seems to work,” he said in an email.

Joe Rizzo, a spokesperson for Dickinson, said in an email that their hospitals and clinics are using paper copies for some services because computer systems are down.

Rich Azzopardi, senior adviser to New York Gov. Andrew Cuomo, said the state’s Division of Homeland Security and Emergency Services and other groups had been in communication about the St. Lawrence attack.

Details about a major wave of ransomware attacks on U.S. hospitals began to emerge at the end of September when computer systems for Universal Health Services, one of the biggest hospital chains in the country, were hit, forcing some doctors and nurses to use pen and paper to file patient information. Jane Crawford, the chain’s director of public relations, said in an email at the beginning of October that no one had died because of the attack.

Ransomware attacks often gain access to secure systems and then encrypt files. The people behind the attacks then demand money to decrypt the files.

Ryuk is transmitted through

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