https://hoodline.com/2026/04/msu-shakes-up-med-schools-in-big-bet-on-detroit-grand-rapids/

MSU Shakes Up Med Schools in Big Bet on Detroit, Grand Rapids
By Marcus Taylor - April 3, 2026

Michigan State University is pulling its two medical schools under one leadership roof and doubling down on Grand Rapids and Detroit as its main research and clinical hubs. The overhaul is meant to better align the MD and DO degree tracks, centralize administration, and widen access to clinical rotations and translational research sites across Michigan. University leaders say the shift is about becoming a stronger partner to large health systems and a tougher contender for grants and private investment.

As reported by Crain's Detroit Business, the change folds the College of Human Medicine and the College of Osteopathic Medicine into a more coordinated structure that highlights MSU's footprint in the state's two biggest cities. Crain's describes the move as both an administrative consolidation and a strategic wager on Detroit and Grand Rapids as growth engines, with centralized back-office work paired with an expansion of clinical sites and research partnerships.

MSU is branding the shift under its "One Team, One Health" strategy, which explores a "One College of Medicine, Two degree pathways" model that keeps MD and DO identities intact while syncing curriculum oversight, research priorities, and institutional strategy, according to MSU. The planning materials outline task forces on accreditation, college structure, and research that will recommend a path forward, and MSU says town halls and community conversations will continue as the work moves along.

Anchors in Grand Rapids and Detroit

On the west side, Grand Rapids remains the key anchor. The College of Human Medicine is based at the Secchia Center on the Medical Mile, which MSU touts as a hub for preclinical education, simulation, and growing research activity, according to MSU College of Human Medicine. In Detroit, MSU's clinical integration has been speeding up through a multi-year partnership with Henry Ford Health that features shared services, an electronic health record migration, and plans for a Detroit research center, according to a Henry Ford Health press release. Together, the two hubs give MSU a stronger foothold in both of Michigan's largest health care markets.

Why Students, Hospital Partners and Patients Should Care

University officials say the unified approach could open up more clinical rotation slots for students and smooth out recruitment pipelines for hospitals, a core part of MSU's broader strategic pitch highlighted by MSUToday. Hospital systems could see tighter clinical networks and shared hiring pipelines, while researchers are eyeing a combined college as a way to boost MSU's odds for federal grants and philanthropic funding. At the same time, hospital leaders, faculty, and students are waiting to see how governance, budgets, and the split of clinical revenue and overhead are sorted out.

Accreditation and governance are still unresolved. The university has created an accreditation task force and promised more analysis before landing on a final structure, according to MSU. Any change to how the MD and DO programs are run will need careful review from accrediting bodies and campus stakeholders, and MSU has signaled there will be more community conversations in the months ahead.

For now, MSU is stressing that both degree pathways will remain in place and that the goal is to amplify its statewide presence, not close campuses. The finer points, including timelines, projected savings, and what all of this means for day-to-day clinical placements, are expected to surface as task forces report back and more town halls take place.

https://www.justice.gov/usao-cdca/pr/8-arrested-health-care-fraud-takedown-including-owners-hospices-billed-taxpayers

8 Arrested in Health Care Fraud Takedown, Including Owners of Hospices that Billed Taxpayers Millions of Dollars to Serve the ‘Dying’
Thursday, April 2, 2026; Updated April 3, 2026
For Immediate Release
U.S. Attorney's Office, Central District of California Press Release

More Than $50 Million in Intended Health Care Fraud Losses Charged

LOS ANGELES – In coordination with the Vice President’s Task Force to Eliminate Fraud, eight defendants, including three nurses, a chiropractor, and a purported psychologist, have been arrested on federal charges that they schemed to defraud the nation’s health care system out of more than $50 million – including by running sham hospice care facilities that bilked Medicare by using people without terminal illnesses as beneficiaries, the Justice Department announced today.

Six of the defendants arrested today are expected to make their initial appearances this afternoon in United States District Court in downtown Los Angeles. One defendant is expected to make his initial appearance in U.S. District Court in Idaho.

“We are enforcing a zero-tolerance policy for criminals who defraud American taxpayers,” said First Assistant United States Attorney Bill Essayli. “The defendants arrested this morning who are charged with stealing millions of dollars of health care benefits got caught and now face years in federal prison.”

“The Southern California region is a high-risk environment for hospice-related and many other forms of health care fraud,” said Akil Davis, the Assistant Director in Charge of the FBI’s Los Angeles Field Office. “The United States loses hundreds of billions of dollars annually to healthcare fraud at the expense of all American taxpayers, whose benefits decrease as premiums, co-payments and taxes grow. Our aim is to reverse that trend with ‘Operation Never Say Die’ and others like it.”

“The defendants charged today allegedly turned hospice care into a cash producing operation, resulting in more than $50 million in losses to taxpayers. The magnitude of the losses underscores a deliberate abuse of the authority and trust afforded to health care providers,” said Inspector General T. March Bell of the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG). “Today’s takedown reflects HHS-OIG’s commitment to deploy every tool at our disposal, and collaborate with our law enforcement partners, to dismantle hospice operations built on deception. Anyone who seeks to weaponize hospice care to bilk Medicare should expect to be held accountable.”

“Today’s arrests are another decisive strike in our war on fraud,” said U.S. Department of Labor Inspector General Anthony P. D’Esposito. “My office is relentlessly pursuing those who target union benefit plans and exploit employee healthcare programs for personal gain. Working side-by-side with the FBI, the Department of Labor’s Employee Benefits Security Administration, and our law-enforcement partners, we are aggressively dismantling fraud schemes and taking down those who exploit American workers. Let this be a warning: If you steal from workers or taxpayers, your time is up. We will find you, investigate you, and hold you accountable.”

“When employee benefit plans become targets for fraud, it’s not just the plans that are hurt – everyday working Americans who earned those benefits honestly, their families, and the communities they live in are hurt,” said Robert Prunty, Acting Regional Director U.S. Department of Labor Employee Benefits Security Administration’s Los Angeles Regional Office. “In the Trump Administration, we will relentlessly seek out fraud and ensure those responsible are brought to justice.”

“Health care fraud undermines federal programs, threatens public trust, diverts resources away from legitimate patient care, and is a calculated attack on programs meant to protect the vulnerable,” said Tyler Hatcher, Special Agent in Charge, IRS‑CI Los Angeles Field Office. “The enforcement actions taken today demonstrate IRS‑CI’s commitment to uncovering the financial lies behind these schemes and holding accountable those who profit at the expense of taxpayers and patients. Our agents will continue to work alongside our law‑enforcement partners to protect the integrity of our healthcare system and ensure that those who abuse it are brought to justice.”

MEDICARE HOSPICE CARE FRAUD

USA v. Minerd

Lolita Beronilla Minerd, 65, a.k.a. “Lolita Beronilla Rice,” of Anaheim, a licensed vocational nurse, was arrested today on a federal criminal complaint charging her with health care fraud.

According to court documents, Minerd owned and operated the Artesia-based Topanga Hospice Care Inc. From July 2020 to April 2025, Minerd used this company to submit more than $9,174,117 in fraudulent hospice claims to Medicare, which paid more than $8,510,448 on these claims.

Through Topanga, Minerd billed Medicare for hospice services for beneficiaries who were not terminally ill. Numerous beneficiaries had common addresses and lived far from the facility, which is consistent with being recruited by marketers. The investigation further revealed that Minerd paid kickbacks to beneficiaries and marketers for the referral of purported hospice patients to her company.

One beneficiary couple was approached at a market about signing up and then were visited at home by Minerd and three other Topanga employees, who promised them if they signed up everything would be free, and they each would receive $300 per month. The money was delivered in an envelope in cash: $600 per month for six months. Neither beneficiary stated they had a terminal illness, which their physician confirmed. The couple also reported receiving unneeded items such as nutritional shakes, non-prescription vitamins, and wheelchairs.

Topanga had a non-death discharge rate of approximately 85%, nearly five times the national average of 17.2% from 2021.

The FBI is investigating this matter along with the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG).

Assistant United States Attorney Alexandra M. Michael of the Major Frauds Section is prosecuting this case.

USA v. Gill, et al.

Gladwin Gill, a 66-year-old purported psychologist, and his wife, Amelou Gill, a 70-year-old registered nurse, both of Covina, were arrested today on a federal criminal complaint charging them with health care fraud.

According to an affidavit filed with the complaint, the Gills owned and operated the Glendale-based 626 Hospice Inc., which did business as St. Francis Palliative Care.

The Gills allegedly schemed to defraud Medicare by paying illegal kickbacks for the referral of patients who were not dying. The Gills also submitted more than $5.2 million in fraudulent claims to Medicare for hospice services that either were not medically necessary or were not provided. Medicare paid the Gills more than $4 million on these fraudulent claims.

They then laundered the scheme’s proceeds and spent their ill-gotten gains on personal expenses such as mortgage payments, car payments, international flights, restaurants, and personal bills.

The Gills are expected to make their initial appearance this afternoon in U.S. District Court in downtown Los Angeles.

HHS-OIG, the FBI, IRS Criminal Investigation, and the Food and Drug Administration are investigating this matter with assistance from United States Trustee, Region 16, Los Angeles Field Office.

Assistant United States Attorney David Y. Pi of the Major Frauds Section is prosecuting this case.

USA v. Palma, et al.

Nita Almuete Paddit Palma, 76, a thrice-convicted health care fraudster now incarcerated at a federal prison in Seattle, and her husband, Adolfo Cezar Catbagan, 68, of Glendale, are charged in an 11-count indictment with operating at least three fraudulent hospice care facilities – including while Palma was free on bond awaiting a hospice fraud trial. Law enforcement arrested Catbagan this morning.

Palma, who is a lawful permanent resident from the Philippines, and Catbagan are charged in an indictment with one count of conspiracy to commit wire fraud and health care fraud and 10 counts of health care fraud.

According to the indictment, from June 2022 to April 2024, Palma and Catbagan opened three Glendale-based hospice care facilities despite Palma being legally barred from doing so: One Up Hospice Care Inc., Rosewood Hospice and Palliative Care Inc., and Advance Hospice and Palliative Care Inc.

Catbagan was named as the nominal owner and CEO of the three hospices when Palma in fact owned and exercised operating control of them – despite her exclusion – so Medicare would not deny the companies’ claims. The defendants submitted false claims to Medicare for beneficiaries who were not terminally ill and the physicians supposedly providing hospice services did not treat the patients.

Palma and Catbagan submitted at least $4.8 million in fraudulent claims through these companies, resulting in Medicare payments of at least $4.2 million.

HHS-OIG and the FBI are investigating this matter.

Assistant United States Attorneys Andrew M. Roach and Roger A. Hsieh of the Major Frauds Section are prosecuting this case. Assistant United States Attorney Alexander Su of the Asset Forfeiture and Recovery Section is handling asset forfeiture matters for this case.

USA v. Tindimobuna

Evelyn Tindimobuna, 51, a licensed vocational nurse from Chatsworth, is charged in a federal criminal complaint with health care fraud. According to an affidavit filed with the complaint, from January 2022 to September 2025, Tindimobuna used the Tarzana-based Comfort Choice Hospice Inc. to submit to Medicare hundreds of fraudulent claims for purported hospice services to dozens of beneficiaries. For those claims, Comfort Choice sought more than $3.8 million, of which Medicare paid approximately $3.4 million.

For example, in November 2022, Comfort Choice submitted a claim to Medicare in the amount of $7,021, for reimbursement of hospice services for a beneficiary. Law enforcement later interviewed this beneficiary and other Comfort Choice patients who said they were not terminally ill, a requirement to qualify for hospice care.

Tindimobuna allegedly also paid kickbacks to marketers for their referral of hospice patients to Comfort Choice in violation of the Anti-Kickback Statute.

HHS-OIG is investigating this matter.

Special Assistant United States Attorney Yervant P. Hagopian of the Major Frauds Section is prosecuting this case.

USA v. Lauritzen

Ivan Verne Lauritzen, 50, of Simi Valley, was arrested Tuesday on a federal criminal complaint charging him with health care fraud. According to court documents, Lauritzen was the CEO and CFO of the Simi Valley-based Valley Pacific Hospice Inc., whose Medicare enrollment was revoked in August 2024.

In 2022, the live discharge rate of Valley Pacific patients was more than 75%, vastly higher than the national average that year of approximately 17%. Based on an audit examining 18 Valley Pacific Medicare claims from August 2023 to March 2024, CMS determined the company had a pattern and practice of submitting claims that failed to meet Medicare’s hospice standards and requirements. To facilitate this fraud, Lauritzen forged the signature of at least one physician on the Medicare enrollment forms.

During the alleged scheme, Valley Pacific billed Medicare more than $580,000 and was paid more than $526,000.

Lauritzen made his initial appearance Tuesday and was ordered released on $10,000 bond. His arraignment is scheduled for April 27.

HHS-OIG is investigating this matter.

Assistant United States Attorney Neil P. Thakor of the Major Crimes Section is prosecuting this case.

PRIVATE HEALTH CARE PLAN FRAUD

USA v. Aulava-Moala, et al.

Four defendants with South Bay ties – one of them a licensed chiropractor – have been charged in a two-count information with conspiracy to commit health care fraud and wire fraud in connection with a $19 million scheme to defraud a labor union’s health plan via false claims for chiropractic services and physical therapy that weren’t needed or never provided.

The defendants charged are:

• Tolu Aulava-Moala, 51, of Carson, who was the director of the facilities;
• John Nicola, 77, of El Segundo, a licensed chiropractor;
• Crysta Richter, 40, of Torrance, who owned a medical billing company; and
• John Keohuloa, 49, of Long Beach.

These defendants will be summonsed into Los Angeles federal court and are expected to make their initial appearances in the coming weeks.

According to court documents, from January 2010 to September 2023, they fraudulently submitted at least $19,005,463 in claims to International Longshore and Warehouse Union Pacific Maritime Association and other private health insurers on behalf of several chiropractic and physical therapy service companies: Ohana Wellness Center, Ohana Management Corp., and R3New Wellness – all based in Carson – and the Huntington Beach-based One Life Acupuncture APC.

Aulava-Moala and Keohuloa induced beneficiaries to visit clinics to receive medically unnecessary services, such as massages or endoscopies, in exchange for kickback payments. Nicola knowingly created fake client notes for beneficiaries, and Aulava-Moala, Nicola, and Richter submitted false and fraudulent claims to health insurers for reimbursement for medical services.

In August 2022, the former owner of the Ohana companies testified under oath at a civil trial that the companies falsified patient chart notes and billed claims under chiropractors’ names and insurance numbers without their knowledge. A state court later that month found the Ohana companies liable for the fraud scheme.

In addition, from March 2016 to June 2023, Aulava-Moala and Keohuloa conspired to submit approximately $700,000 in fraudulent receipts for a charity donation program operated by a Los Angeles-based oil refinery for which the company paid at least $500,000.

The FBI, the U.S. Department of Labor Office of Inspector General (DOL-OIG), and the U.S. Department of Labor – Employee Benefits Security Administration are investigating this matter with assistance from Homeland Security Investigations (HSI) and the United States Secret Service.

Assistant United States Attorney Jason C. Pang of the Transnational Organized Crime Section is prosecuting this case.

USA v. Cartmell; USA v. Surace

Gregory Cartmell, 62, of Coeur D’Alene, Idaho, a licensed chiropractor, was arrested today on a four-count indictment charging him with two counts of health care fraud and two counts of aggravated identity theft. He is expected to make his initial appearance today in U.S. District Court for the District of Idaho. He will be arraigned in Los Angeles in the coming weeks.

According to the indictment, from December 2018 to November 2022, Cartmell submitted approximately $9.14 million in fraudulent claims to the ILWU-PMA health plan for chiropractic services – including for services not rendered – and received approximately $6.43 million in payment from the union’s health plan, which had terminated him from the plan in December 2020.

To circumvent his termination, Cartmell arranged with a co-conspirator – Vincent Surace, 87, of McKinney, Texas – to bill ILWU-PMA’s health plan under the co-conspirator’s name and identification number. In exchange for allowing his name and ID number to be used in the scheme, Cartmell paid Surace a portion of the proceeds the union’s plan paid for the fraudulent claims.

Surace is charged via information with one count of conspiracy to commit health care fraud. He will be summonsed to Los Angeles federal court in the coming weeks.

The FBI, the U.S. Department of Labor Office of Inspector General (DOL-OIG), and the U.S. Department of Labor Employee Benefits Security Administration (DOL-EBSA) are investigating this matter.

Assistant United States Attorneys Jason C. Pang of the Transnational Organized Crime Section and William M. Larsen of the Criminal Appeals Section are prosecuting this case with assistance from Assistant United States Attorney Christopher C. Kendall of the Transnational Organized Crime Section.

USA v. Griffen

Sonia Griffen, 51, of Lakewood, was arrested today on a five-count indictment charging her with health care fraud. From April 2019 to May 2024, Griffen allegedly submitted nearly $5 million in fraudulent claims to ILWU-PMA’s health care plan through her wellness company, Bee Well Holistic Wellness Center, for purported chiropractic services given to union members, even though the plan had previously terminated Bee Well and barred it from submitting claims.

According to the indictment, to circumvent Bee Well’s termination from the ILWU-PMA plan and obtain payments, Griffen concealed Bee Well’s identity and involvement by arranging with two chiropractors to bill the plan under their names and at fictitious addresses. She also submitted false claims billing the plan for chiropractic services that were never rendered.

In total, Griffen submitted approximately $4.9 million in fraudulent claims to the ILWU-PMA plan, resulting in payments of approximately $2.5 million.

The FBI, the United States Department of Labor Office of Inspector General (DOL-OIG), and the Department of Labor – Employee Benefits Security Administration (DOL-EBSA) are investigating this matter.

Assistant United States Attorney Jing Yan of the General Crimes Section is prosecuting this case.

IMMIGRATION HEALTH CARE FRAUD

USA v. Ko

Young Joo Ko, 59, of East Hollywood and a lawful permanent resident from South Korea, was arrested today on a federal criminal complaint charging her with fraud and misuse of visas, permits, and other documents.

According to an affidavit filed with the complaint, Ko engaged in a medical fraud scheme exploiting the green card application process by creating fraudulent immigration documents. Civil surgeons designated by U.S. Citizenship and Immigration Services (USCIS) and operating in the Los Angeles area did not examine green card applicants as required by law.

Instead, Ko – for a fee – fraudulently prepared the required forms by presenting herself as a nurse or doctor and indicating false compliance with medical examination requirements necessary for immigration applicants to register permanent residence or adjust their immigration status.

If convicted, Ko would face a statutory maximum sentence of 10 years in federal prison.

HSI, IRS Criminal Investigation, and USCIS are investigating this matter.

Assistant United States Attorney Brenda N. Galván of the General Crimes Section is prosecuting this case.

Health care fraud-related charges in these cases carry a statutory maximum sentence of 10 years in federal prison. Wire fraud is punishable by up to 20 years in federal prison. Aggravated identity theft carries a mandatory two-year consecutive prison sentence.

Complaints and indictments contain allegations that a defendant has committed a crime. Every defendant is presumed to be innocent until and unless proven guilty in court.

Contact
Ciaran McEvoy
Public Information Officer
ciaran.mcevoy@usdoj.gov
(213) 894-4465

https://michiganadvance.com/2026/04/04/repub/its-a-safe-space-mobile-midwifery-clinics-meet-patients-where-they-are/

‘It’s a safe space’: Mobile midwifery clinics meet patients where they are
By Nada Hassanein - April 4, 2026

MIAMI — Midwife Sheila Simms Watson leaned to gently press on the pregnant woman’s belly. Me’Asia Taylor lay on a bed fitted with tie-dyed purple printed sheets in the corner of the RV.

Far from a typical camper, this RV houses a mobile midwifery clinic for prenatal, postpartum and women’s general health care.

“Roll when you’re getting up, and we can help you. You can sit there for a moment, all right, so you’re not lightheaded, not dizzy,” said Watson, whom patients and doulas call “Mama Sheila.”

Calm and slow, led by Watson’s soothing and attentive demeanor, the appointments are unrushed.

Run by the Southern Birth Justice Network, the mobile midwifery clinic brings care to majority-Black and Latino neighborhoods across Miami-Dade County several times a month. The clinic aims to offer a more relaxed setting, where women are comfortable and heard, their cultures are integrated, and they can connect with doulas from diverse backgrounds.

On the half-moon bench inside the RV, Watson, a doula and a midwife in training sit with patients. They take blood pressures and draw blood. They ask the women about their lives: How is their mental health and sleep? Do they have support at home? Do they want to give birth at a hospital or birth center with a midwife?

Taylor said pre-eclampsia, a dangerous pregnancy condition, runs in her family. She wanted to make sure she had space and time to express her concerns about her first pregnancy.

Taylor said she wants a midwife for her delivery. Many women of color have reported feeling marginalized or dismissed in medical settings. “I’ve just seen too many people have bad experiences,” Taylor told Watson.

The U.S. has markedly higher maternal mortality and infant mortality rates compared with other high-income countries, and women and babies of color fare the worst. Black women’s maternal death rates are three times higher than those of white women, and American Indian and Alaska Native women’s rates are twice that of white women. Researchers point to implicit bias, less regular access to prenatal care and higher rates of poverty.

OB-GYN shortages and labor and delivery units closing continue to make getting care harder. Last year, more than two dozen hospital labor and delivery units across the nation closed, including some in South Florida. And pregnant patients living miles away, or feeling uneasy about going to the doctor, may even forgo care.

Midwives can help fill gaps, maternal health equity advocates say, and mobile clinics can meet patients where they are.

“It really helps to disrupt this idea that patients must navigate these complex systems to receive care — and instead, (mobile midwifery) reimagines care as something that should be responsive to the needs of patients and should be community-centered,” said Tufts University professor and maternal health scholar Ndidiamaka Amutah-Onukagha.

But mobile units are not as common for midwifery as they are for other areas of care, such as dentistry or family medicine, the American College of Nurse-Midwives told Stateline. Other prenatal mobile outreach efforts in the state include an OB-GYN-run mobile unit by the University of Florida that serves areas around north-central Alachua County and an operation called The Midwife Bus in Central Florida.

To increase access to care, maternal health advocates are also pushing states to change regulations that restrict midwifery. The American College of Nurse-Midwives recently filed a lawsuit against Mississippi for requiring nurse-midwives to have agreements with physicians in order to practice. This week, Jamarah Amani, a midwife and the executive director of the Southern Birth Justice Network, joined other plaintiffs in filing a lawsuit against Georgia over its restrictions. But supporters of the rules say they are meant to protect patients and foster communication between clinicians.

Offering culturally centered prenatal care that women are more inclined to use can help address inequities in maternal health, Amani said. The group trains doulas, offers telehealth, provides referrals such as to mental health therapists, and advocates for equitable policies across the South.

Most of the mobile clinic’s clients — about 70% — are on Medicaid or uninsured, and the clinic is funded through federal and university grants, as well as donations.

“(Midwifery) presents like a luxury concierge-type of service,” Amani said. “Our goal is to really change that and to bring it back to the community in a very grassroots way.”

Preserving tradition

The Southern Birth Justice Network keeps a small drum on a table at a nearby booth. It represents the heartbeat, and ancestral reverence, Amani said. Drums are a universal language, and the instrument is meant to symbolize culture.

For doulas and many midwives like Amani and Watson, bringing their profession to communities today is the continuation of a significant part of Black American heritage.

Throughout history, Black midwives were venerated in their communities. Many practices were rooted in West African traditions. These midwives were the keepers of Black ancestral records, and delivered many white women’s babies. Enslaved women who were midwives traveled for deliveries. Some routes, long and traversed by foot, were dangerous in the deep rural South. During the Jim Crow era, Black Americans were denied care at hospitals or given inferior care.

“They only had protection if someone would send a carriage for them if they were going to deliver a white woman’s baby. But to care for the Black families, they often had to go in the middle of the night, alone,” Amani said. “We talk about the legacy of Black midwives as health care providers, but also as social pillars, as community leaders, as resistors of oppression.”

In the 20th century, medical institutions began to oppose midwifery, sometimes using racist and sexist campaigns to target the practice. They argued it was unhygienic and lobbied across states to dismantle midwifery. At the same time, while developing the field of obstetrics, doctors conducted gynecological experiments on Black women. The American College of Obstetricians and Gynecologists has acknowledged this history and said it’s committed to fighting racism and inequities.

Dr. Jamila Perritt, an OB-GYN and president and CEO of Physicians for Reproductive Health, said that in order to address structural barriers and close gaps, policies have to prioritize access to care, such as allowing midwives to expand their practices. Throughout the South especially, states still restrict midwives from practicing independently, despite widespread maternal health care deserts. She also pointed to research showing midwifery is associated with fewer C-sections, less preterm labor and better patient satisfaction.

“Expanding access to midwifery care, and expanding collaborations between physicians and midwives, only improves outcomes,” Perritt said.

Cultivating trust

On a recent breezy and brisk Saturday morning, the Southern Birth Justice Network’s midwives and doulas were stationed in the parking lot of the Freedom Lab, a local community center that hosts food and clothing distribution and a free urgent care center.

At the booth by the mobile clinic, under the shade of a royal-purple awning, meditation music, low-key and mellow, reverberated from a small speaker. There was a cooler filled with oranges, water and other snacks for the clinic’s pregnant patients.

“I’m going to keep giving you food. You need to eat enough,” one doula told a patient, handing her an orange and a liter of spring water.

Staff had surveys to help assess a new patient’s needs, and Florida-specific pamphlets on pregnant patients’ rights. The group is working on other state-specific guides for Louisiana, Massachusetts, Tennessee and Texas.

The table also held a portrait of the late midwife Ada “Becky” Sprouse, who started the mobile midwife clinic around 2008. She’d drive it to the city of Homestead, an agricultural hub in Miami-Dade County. There, she offered free midwifery care to migrant farmworkers, many of whom couldn’t afford care throughout their pregnancies.

Sprouse passed the clinic on to Amani, who relaunched the mobile unit and broadened the scope of the Southern Birth Justice Network.

Patients told Stateline trust was one of the main reasons they sought out the clinic. One patient said she spent 2 1/2 hours on public transit that day so that she could see the team.

For now, deliveries take place at hospitals or neighboring birth centers, where some of the group’s midwives also work. But the organization recently bought a building to open its own freestanding birth center, aiming for next year, along with a larger RV.

One patient, Isis Daaga, turned to Amani to deliver her other children after her first birth at a hospital. Despite the pressure she felt and her need to push during labor, Daaga recalled, hospital staff prevented her from delivering.

“They literally held my knees together,” Daaga said. “They were like, ‘the doctor’s not here yet,’ and the nurses were scared to deliver the baby.” In many hospitals, protocol is to wait for the doctor in case an emergency occurs.

By the time the doctor came, Daaga had a severe perineal tear, and she delivered the baby in one push. She had been in labor for 15 hours.

“I was in pain, I was upset,” said Daaga, a mental health therapist who is 35 weeks pregnant.

At the mobile clinic and with the midwives, Daaga said she feels supported.

“They make me feel the way I try to make my clients feel, like, it’s a safe space. You’re not judged here. I have a lot going on,” she said. “If I’m MIA or something, most of them will call and text me and (say), ‘Girl, you need to come in.’”

https://www.bls.gov/news.release/empsit.nr0.htm

Health care added 76,000 jobs in March. Employment in ambulatory health care services rose by 54,000, reflecting an increase of 35,000 in offices of physicians as workers returned from a strike. Employment also increased in hospitals (+15,000). Over the prior 12 months, health care had added an average of 29,000 jobs per month.

Go to the extensive charts and text at the hyperlink, above, for more information and data.  Table B-1. Employees on nonfarm payrolls by industry sector and selected industry detail tells the health care story:

https://www.bls.gov/news.release/empsit.t17.htm

https://www.whitehouse.gov/fact-sheets/2026/04/fact-sheet-president-donald-j-trump-bolsters-national-security-and-strengthens-u-s-supply-chains-by-imposing-tariffs-on-patented-pharmaceutical-products/

Fact Sheet: President Donald J. Trump Bolsters National Security and Strengthens U.S. Supply Chains by Imposing Tariffs on Patented Pharmaceutical Products
The White House
April 2, 2026

• President Trump imposed a 100% tariff on patented pharmaceutical products and ingredients.
• The tariffs will come into effect in 120 days for certain large companies, and 180 days for smaller companies.
• Trade Deal Countries:
• If a pharmaceutical product is from the European Union, Japan, Korea, or Switzerland and Liechtenstein, a 15% tariff will apply. If a pharmaceutical product is from the United Kingdom, a lower tariff will apply, subject to the recently concluded UK pharmaceutical agreement.Onshoring and pricing agreements:
• For companies that enter into Most Favored Nation (MFN) pricing agreements with the Department of Health and Human Services (HHS) and onshoring agreements with the Department of Commerce, a 0% tariff will apply through January 20, 2029. For companies that only enter into onshoring agreements with the Department of Commerce, a 20% tariff will apply.The Department of Commerce and HHS will provide pathways for companies to enter into onshoring and MFN pricing deals with the U.S. Government.
• Generic pharmaceuticals: Generic pharmaceutical products, biosimilars, and associated ingredients are not subject to tariffs at this time. This will be reassessed in one year.
• Specialty pharmaceutical products: Orphan drugs, drugs for animal health, and certain other specialty pharmaceutical products will be exempt, if they are from trade deal countries or meet an urgent public health need.
• The Proclamation establishes strong monitoring and enforcement mechanisms, including external audits and tariff increases on future and past imports.

• President Trump imposed these tariffs following an extensive investigation conducted by the Secretary of Commerce under Section 232 of the Trade Expansion Act of 1962, as amended, to determine the effects on national security of imports of pharmaceuticals, pharmaceutical ingredients, and related products.
• The investigation found that patented pharmaceuticals and associated pharmaceutical ingredients are being imported into the United States in such quantities and under such circumstances as to threaten to impair our national security.
• The impending Section 232 tariffs have already spurred approximately $400 billion in new investment commitments from U.S. and foreign pharmaceutical companies, which will be spent in the United States during President Trump’s current term in office.
• A self-sufficient domestic manufacturing and industrial base for pharmaceutical products is vital for the ability to support national defense requirements and public health.
• Despite being the world leader in research and development for most innovative pharmaceuticals, the U.S. is heavily reliant on imports, threatening to limit U.S. access to life-saving medications in the event of global supply chain disruption.

• In May 2025, President Trump signed an Executive Order to remove regulatory barriers and facilitate the restoration of a robust domestic manufacturing base for prescription drugs, including key ingredients and materials necessary to manufacture prescription drugs.
• In August 2025, President Trump signed an Executive Order to ensure American pharmaceutical supply chain resilience by filling the strategic active pharmaceutical ingredients reserve.
• President Trump’s Administration has launched Section 232 investigations in adjacent sectors such as personal protective equipment, medical consumables, and medical equipment and devices, as well as robotics. These investigations will help ensure that harmful imports in any strategic sector do not compromise national security.

The Centers for Disease Control and Prevention listed on Monday 27 types of testing that have been suspended.  Andrew Nixon, an HHS spokesman, called the pause temporary and attributed it to “a routine review to uphold our commitment to high quality laboratory testing.”  “We anticipate some of these tests will be available through CDC labs again in the coming weeks. In the meantime, CDC stands ready to support our state and local partners to access the public health testing they need.”

Go to the CDC ID Laboratories page to see the tests which have been suspended:

https://cdc.gov/infectious-diseases-labs/php/test-directory/index.html

Note that the CDC is in an interregnum.  Jay Bhattacharya, MD, PhD. is the current acting director of the Centers for Disease Control and Prevention (CDC) after Susan Monarez was canned.

https://s3.documentcloud.org/documents/27926757/cms-memorandum-on-dietary-guidelines.pdf

This memorandum reminds hospital providers of their obligations related to patient food and nutrition services. On January 7, 2026, HHS and USDA released the Dietary Guidelines for Americans, 2025–2030 (DGAs), which place heightened emphasis on diet quality — including limiting ultra-processed foods, sugar-sweetened beverages, refined carbohydrates, and added sugars, while prioritizing whole and minimally processed foods. These updates reflect the latest federal nutrition policy and are encouraged to be used to inform patient nutrition services and related hospital protocols. Given the scale of Medicare’s investment in inpatient care, CMS has a responsibility to ensure that hospital food and nutrition services support high-quality, evidence based care and improved health outcomes.

Hospitals must comply with Conditions of Participation at 42 CFR §482.28, including ensuring menus and diets meet individual patient nutritional needs in accordance with recognized dietary practices, qualified dietitian oversight, maintenance of a current therapeutic diet manual, and integration of dietary services into Quality Assessment and Performance Improvement (QAPI) processes. As consistent with 42 CFR §482.28 and CMS guidance, hospitals should review and revise food and nutrition service policies, standard menus, therapeutic diet protocols, and food procurement practices to align with the 2025–2030 DGAs.

Discussion:
Diet Quality and Health Outcomes

The United States spends approximately $5 trillion per year on health care. Ninety percent of those expenditures are on patients with chronic disease. Since Medicare represents approximately 40% of health care spending on chronic health conditions in the United States, the impact on American taxpayers and the Federal deficit is significant.

Given these dynamics, it is an urgent priority for hospitals who treat Medicare patients to ensure their policies and practices provide those patients with high-quality and clinically appropriate dietary options. Emerging high-quality epidemiologic evidence strengthens the case for prioritizing minimally processed, whole foods in institutional settings. Large prospective cohort studies and updated systematic reviews have found that higher intake of ultra-processed foods is associated with increased risks of cardiovascular disease, type 2 diabetes, and all-cause mortality. For example, an updated 2025 dose–response meta-analysis found a 15% higher risk of all-cause mortality among individuals with the highest ultra-processed food intake.

A growing body of peer-reviewed evidence further demonstrates that diet quality—not simply caloric adequacy—substantially affects cardiometabolic outcomes, mortality, and chronic disease progression. High consumption of sugar-sweetened beverages has been associated with increased risk of type 2 diabetes, cardiovascular disease, and mortality in large prospective cohort studies and meta-analyses. Similarly, ultra-processed foods, including sweetened beverages and processed meats, have been associated with increased risk of diabetes and cardiometabolic disease.

Conversely, higher intake of whole grains and fiber-rich foods have been associated with lower risk of type 2 diabetes and improved long-term health outcomes. Replacement analyses further demonstrate improved outcomes when sugar-sweetened beverages are replaced with water, coffee, or tea.

Read the entire CMS CCSQ memo in pdf format at the hyperlink, above.

https://thehill.com/policy/healthcare/5808929-healthcare-concerns-top-issue/

Health care polling as top issue for first time since 2020: Gallup
By Sophie Brams - March 31, 2026

Americans are more concerned about the availability and cost of health care than any other domestic issue, with it reclaiming the top spot for the first time since 2020, according to a new Gallup poll.

The poll, released Tuesday, found that 61 percent of the 1,000 adults surveyed said they worry a “great deal” about accessing and affording health care, while 23 percent expressed a “fair amount” of concern.

That is compared to 51 percent of respondents who said they were concerned a “great deal” about the economy and 50 percent who said the same about inflation — two issues that dominated public anxiety over the past several years, according to the survey.

Easing worries about the economy, inflation and Social Security meant health care reemerged as Americans’ leading concern, where it ranked consistently between 2015 and 2020 before being overtaken by economic issues during former President Biden’s term.

The percentage of people highly anxious about economic issues grew in the early months of President Trump’s second term but has since returned to 2024 levels, Gallup noted.

Those core issues were separated by just 1 percentage point in 2025, but the cost of health care now leads by 10 points, according to the survey.

The poll also found that what people were the most anxious about varied by political affiliation, with 80 percent of Democrats and 66 percent of independents expressing a “great deal” of concern about health care and 55 percent of Republicans saying they are greatly concerned with illegal immigration.

The poll was conducted March 2-17. It has a margin of error of plus or minus 4 percentage points.

The fresh polling comes as tens of millions of Americans are grappling with the rising cost of health care and insurance following the expiration of ObamaCare subsidies.

The enhanced premium tax credits, first enacted during the COVID-19 pandemic and later expanded under the Biden administration, expired at the end of 2025 over the objection of Democrats, resulting in higher out-of-pocket costs and fewer Americans enrolling in coverage.

The House passed legislation in January to extend the subsidies for three years, but negotiations have stalled in the Senate.

Separate West Health/Gallup polling conducted earlier this month found that many Americans have changed their habits to afford health care, with roughly one-third of 19,535 respondents cutting back on expenses elsewhere.

https://www.michigandaily.com/news/research/michigan-medicine-study-shows-emoji-usage-increasing-in-electronic-health-records/

Michigan Medicine study shows emoji usage increasing in electronic health records
By Sarayu Bongale - March 29, 2026

A Michigan Medicine study published Jan. 14 analyzed 218.1 million clinical notes from 1.6 million patients’ electronic health records and found that both clinicians and patients used emojis more often in medical records from January 2020 to September 2025. Out of all the notes analyzed during this time period, 372 distinct emojis appeared across 4,162 notes from both patients and health care professionals.

In an interview with The Michigan Daily, David Hanauer, clinical associate professor of pediatrics and learning health science at Michigan Medicine, said the idea originated from him noticing emoji use in electronic health records and wanting to raise awareness about the increased usage.

“It was mostly out of interest, just trying to explore if anything was there at all,” Hanauer said. “Our understanding had been that emojis and other symbols are actually not supposed to be used in a medical record, so we were wondering: Were there any there at all, and how often were they being used, and which ones?”

Hanauer said the growing use of diverse emojis in EHRs risks misinterpretation and confusion.

“Most of the concerns that people have is that it’s hard to understand from an emoji what is being conveyed,” Hanauer said. “Maybe a smiley face is pretty obvious to most people, but there’s a lot of different faces with nuances and other symbols. I think there can be a lot of miscommunication, misinterpretation.”

In an interview with The Daily, Kim Ford, health information business systems analyst lead on the revenue cycle mid-service team at Michigan Medicine, said the risk of misinterpretation increases across age groups, as different generations may understand and use emojis in different ways.

“If you have older patients who may not be familiar with emojis, it’s almost like a foreign language to them,” Ford said. “(For) our younger generation — or those people that have grown up with technology — it’s a second language for them that they understand very well. That’s my biggest concern.”

Hanauer said the growing variety of emojis may present a barrier to communication specifically for individuals with poor eyesight

“For older people, having small emojis might actually be hard for them to see and make out, so they might see its face but they can’t tell what the specific expression is,” Hanauer said. “I think we found over 300 different kinds of emojis being used. That’s a lot of different symbols that people would have to understand what they mean.”

Hanauer said he worries emoji misinterpretations can lead to bad patient care outcomes.

“We hope that doesn’t happen, but I think because of that concern, there’s probably going to be a little bit more oversight ,” Hanauer said. “I don’t think we would easily be able to find a circumstance in which there was actually some sort of better or negative outcome from an emoji being misinterpreted.”

LSA sophomore Leah Beel, a medical assistant at American Family Care in Ann Arbor, told The Daily she believes that the EHRs are supposed to be objective and emoji usage detracts from that.

“From my experience, EHRs are used to get quick information and try to communicate with each other in a fast and reliable way,” Beel said. “The only thing I would use is an exclamation point, which, even then, is kind of out there. It’s a good thing that emojis can show enthusiasm or certain reactions, but I also think to a degree — it’s not unprofessional but just someone might take it the wrong way. My perspective on EHR is that you write very objectively.”

Elizabeth Rossmann Beel, a pediatric anesthesiologist at Texas Children’s hospital, said emojis can be an easier way for health care professionals to communicate.

“It’s a way to react to something without putting as much effort into it, or into making that person who’s reading it feel like they need to reply,” Rossmann Beel said. “I think it can cut down a little bit on the burden of replying to and responding to messages in the EHR, which is nice. However, it’s definitely more casual, and so sometimes that’s not the best tone to be setting in a medical record.”

Ford said she plans to use the information from this study to learn more about the impacts of emojis on patient outcomes and potentially create regulations.

“Maybe emojis are an acceptable means of communication,” Ford said. “The other piece is, should there be a governance process around what emojis can be used? And in what situations? I need to think a little bit about what their structure might look like — what department should be involved in reviewing and approving those, what should be the process to submit an emoji for consideration for use? There’s a lot of pieces to the governance process that need to be figured out there.”

Refreshing commentary from the macro-economic side rarely expressed openly. Growers and manufacturers are assumed to be speaking from self-interest. Too often, whistle-blowers seem easy to dismiss as hysterical.

https://www.dailysignal.com/2026/03/20/the-truth-about-glyphosate-genuine-concerns-and-sobering-realities/

The Truth About Glyphosate: Genuine Concerns and Sobering Realities

Miles Pollard   |   March 20, 2026

The use of the agricultural input glyphosate may be one of the most hotly contested issues within public health right now. For some, glyphosate is proof that modern agriculture is poison. For others, it is an example of anti-science panic.

Both reactions avoid the hard truth: glyphosate is a critical agricultural input with contested cancer literature, collapsing public trust, and a set of policy tradeoffs that are too often ignored.

The large scale skepticism of glyphosate safety started in 2015 when the WHO’s International Agency for Research on Cancer classified glyphosate as probably carcinogenic (Group 2A), based on “limited” evidence in humans alongside animal and mechanistic evidence.

However, this legitimate concern is based more on potential theoretical hazards rather than an assessment of real-world exposure levels. Regulating agencies ask a different question: whether a substance poses an unacceptable risk when used as labeled.

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In the U.S., the Environmental Protection Agency has maintained that glyphosate is “not likely to be carcinogenic to humans.” However, it has since withdrawn its 2020 interim decision following U.S. Court of Appeals Ninth Circuit litigation and is now revisiting parts of its analysis.

Across the pond, the European Food Safety Authority said in 2023 that it found no “critical areas of concern,” and the European Commission renewed glyphosate’s approval through 2033. Similarly, the European Chemicals Agency concluded that the available evidence did not justify classifying glyphosate as carcinogenic, mutagenic, or reprotoxic.

As for the studies used to justify such decisions, one of the strongest prospective cohorts in the debate, the Agricultural Health Study. The study followed more than 54,000 licensed pesticide applicators in North Carolina and Iowa. An analysis from 2018 found no overall association between glyphosate and non-Hodgkin lymphoma but did report some evidence of increased acute myeloid leukemia risk in the highest exposure groups.

Later, a pooled AGRICOH analysis from 2019 covering more than 316,000 farmers and agricultural workers in France, Norway, and the U.S. similarly found no association, though it reported a borderline elevation for diffuse large B-cell lymphoma among long-term users of glyphosate.

When looking at meta-analyses, which are literature reviews of several studies to ascertain patterns, the data is still contested. In 2019, a meta-analysis of the Agricultural Health Study’s highest exposure cohort found a 41% increased relative risk of non-Hodgkin lymphoma.

However, in 2020 another meta-analysis and its follow up in 2021 came to more restrained conclusions, cautioning readers about the literature’s publication bias but confirming that diffuse large B-cell lymphoma cannot be ruled out.

An honest summary of the literature neither exonerates nor condemns glyphosate. High exposure individuals, like farmers with specific lymphoma subtypes, are worth monitoring.

This scientific uncertainty should give policymakers pause. Glyphosate has become the most used pesticide (specifically as an herbicide) in the US, sprayed on over 100 crops.

U.S. glyphosate usage has risen from less than 5,000 to over 80,000 metric tons per year between 1987 and 2007. This more than 15-fold increase was accompanied by the deployment of glyphosate-tolerant crops and reduced tillage practices.

Most prevalent among these was Roundup by Monsanto, which was purchased by Bayer in 2018. Whatever one thinks of glyphosate and Bayer’s acquisition of Monsanto, banning such a prevalent pesticide may create regrettable substitutions.

In fact, Bayer actually stopped selling glyphosate-based Roundup for the U.S. residential market in 2023, citing ongoing litigation issues rather than safety concerns. As of February, 2026 the company has paid $11 billion for civil suits. Some Roundup formulations were replaced with diquat dibromide, which is banned in the EU due to its higher toxicity.

According to the U.S. Agency for Toxic Substances and Disease Registry, glyphosate’s chronic intake threshold is 1 milligram per kilogram of body weight per day while the European Food Safety Administration sets their threshold at 0.5 milligram per kilogram of body weight per day.

Comparatively, diquat dibromide’s threshold is between .002 and .005 milligram per kilogram of body weight per day, which is 100-500 times lower than glyphosate. However, it is worth noting that actual formulations containing diquat may be substantially lower than glyphosate, mitigating some risk.

Evidence aside, the decision to restrict glyphosate usage also depends on safe, efficient, and effective alternatives. One important insight to consider is how glyphosate itself replaced more dangerous pesticides used prior to its introduction.

Agent Orange, the infamous defoliant used during the Vietnam War, contained one of glyphosate’s predecessors, 2,4,5-T. This compound was unfortunately contaminated with dioxin, a potent neurotoxin, due to inconsistent chemical treating. Dioxin’s threshold is .0000000007 milligram per kilogram of body weight per day, which is around a billion times more toxic than glyphosate.

This formulation has thankfully been banned since the mid-1980s, accompanying glyphosate’s rise in popularity. Glyphosate was detected in about 81% of Americans, with an average concentration of 0.000411 mg/liter of urine, which is thousands of times lower than the chronic intake threshold.

This is not to dismiss concerns over glyphosate toxicity, as many have raised questions about glyphosate’s effect on the gut microbiome. Others also have germane concerns about glyphosate mixed with other “enhancing” chemicals that increase toxicity.

Neither extreme should dominate the debate. Advocating for banning or restricting a well-used pesticide may lead to alternative pesticide regimes with more chemical alternatives, more over-applications, more tillage and soil erosion, or higher costs shifted onto families.

Glyphosate’s path forward demands nuanced, evidence-based policy including rigorous ongoing monitoring (especially for high-exposure populations), innovation in alternatives, transparent risk communication, and balanced regulation that takes these genuine concerns seriously and analyzes the realities of tradeoffs soberly.