The parents of an eighth-grade girl killed in the Tennessee school bus crash last month filed a $5-million wrongful death lawsuit alleging distraction and recklessness on the part of the driver and negligence and lack of oversight on the part of the Clarksville-Montgomery County School System.

Zoe Davis was 13 and a student at Kenwood Middle School when she died in the March 27 collision. Her classmate Arianna Peterson, 13, also died.

The lawsuit filed April 2 calls for a jury trial and seeks the maximum dollar amount allowed but not to exceed $5 million plus court costs.

Tennessee tort law generally caps the amount a school district can be held liable for at $700,000 for bodily injury or death of all persons in any one accident or $300,000 for any one person. School district employees are  immune from lawsuits including those involving negligent operation of motor vehicles, unless proven that the employee failed “to exercise or perform a discretionary function, whether or not the discretion is abused.”

The Davis family’s lawsuit names school bus driver Sabrina Ducksworth. The lawsuit claims she failed to follow her training and “acted with less than and/or failed to act with ordinary and reasonable care in the operation of the school bus.”

The filing also claims Ducksworth operated her school bus while fatigued or distracted and failed to exercise due care, obey traffic laws and keep in the proper lane.

Investigation Continues Amid Lawsuit

The Tennessee Highway Patrol and the National Transportation Safety Board continue to investigate. NTSB said on its website a preliminary report is expected by the end of this month. Duckworth reportedly remains hospitalized following several surgeries. School Transportation News learned Duckworth broke both of her legs and suffered internal injuries.

Ducksworth’s family told local reporters she may have suffered a stroke when the school bus veered across a double yellow line, into the oncoming lane and collided nearly head-on with a Tennessee Department of Transportation dump truck. A local news report also indicates a review of Duckworth’s personnel file shows a current prescription for blood pressure medication. She had driven for Clarksville-Montgomery County School System since July 2021.

The Davis family’s lawsuit also claims the school district did not perform an adequate pre-employment inquiry into Ducksworth’s fitness for employment as a school bus driver and that the hiring practices “fell below the applicable standard of care.” The lawsuit also alleges the school district failed to adequately train or supervise Ducksworth.

---

Related: First Responders Critical in School Bus Emergencies
Related: Tennessee School Bus Bursts Into Flames Moments After Children Evacuated
Related: Tennessee School Bus Driver Under Investigation After Leaving Children Unattended

The post Family’s Lawsuit Claims Distraction, Negligence in Fatal Tennessee School Bus Crash appeared first on School Transportation News.

The state Department of Health Services is planning to funnel over $30 million to programs and supplies to help combat the opioid epidemic across the state over the next two years. 

The post Wisconsin Department of Health Services releases $31M plan to combat opioid epidemic  appeared first on WPR.

Wisconsin is among at least 18 states that have recently made cuts to its drug assistance program for people with HIV. An analyst with KFF breaks down the trend and a longtime HIV researcher in Milwaukee details local impact.

The post Wisconsin is among at least 18 states cutting HIV safety net programs appeared first on WPR.

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.’”

Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

States are paying contractors such as Deloitte, Accenture, and Optum millions of dollars to help them comply with the One Big Beautiful Bill Act — a law that will strip safety-net health and food benefits from millions.

State governments rely on such companies to design and operate computer systems that assess whether low-income people qualify for Medicaid or food aid through the Supplemental Nutrition Assistance Program, commonly referred to as food stamps. Those state systems have a history of errors that can cut off benefits to eligible people, a KFF Health News investigation showed.

These benefits, provided to the poorest Americans, can mean the difference between someone obtaining medical care and having enough to eat — or going without.

States are now racing to update their eligibility systems to adhere to President Donald Trump’s sweeping tax and domestic spending law. The changes will add red tape and restrictions. They are coming at a steep price — both in the cost to taxpayers and coverage losses — according to state documents obtained by KFF Health News and interviews.

The documents show government agencies will spend millions to save considerably more by removing people from health benefits. While states sign eligibility system contracts with companies and work with them to manage updates, the federal government foots most of the bill.

The law’s Medicaid policies will cause 7.5 million people to become uninsured by 2034, according to the nonpartisan Congressional Budget Office. Roughly 2.4 million people will lose access to monthly cash assistance for food, including those with children.

In five states alone, company estimates developed for state officials and reviewed by KFF Health News show that changes will cost at least $45.6 million combined.

“This is a pretty big payday,” said Adrianna McIntyre, an assistant professor of health policy and politics at Harvard’s T.H. Chan School of Public Health.

The law, which grants tax breaks to the nation’s wealthiest people, requires most states to tie Medicaid coverage for some adults to having a job, and imposes other restrictions that will make it harder for people with low incomes to stay enrolled. SNAP restrictions began to take effect in 2025. Major Medicaid provisions begin later this year.

Documents prepared by consulting company Deloitte estimate that a pair of computer system changes for Medicaid work requirements in Wisconsin will cost nearly $6 million. Two other changes related to the state’s SNAP program will cost an additional $4.2 million, according to the documents, which Deloitte drafted for the Wisconsin Department of Health Services.

In Iowa, changes to its Medicaid system are expected to cost at least $20 million, according to an estimate prepared by Accenture, a consulting company that operates the state’s eligibility system.

Optum — which operates the platform Vermont residents use for Medicaid and marketplace health plans under the Affordable Care Act — estimated that it could cost roughly $1.8 million to evaluate and incorporate new health coverage restrictions.

Initial changes in Kentucky, which has had a contract with Deloitte since 2012, have cost the state $1.6 million. And in Illinois, Deloitte estimated modifications will cost at least $12 million.

A historic mandate

For six decades after President Lyndon Johnson created the government insurance program in 1965, Congress had never mandated that Medicaid enrollees have a job, volunteer, or go to school.

That will change next year. The tax and spending law enacted by Trump and congressional Republicans requires millions of Medicaid enrollees in 42 states and the District of Columbia to prove they’re working or participating in a similar activity for 80 hours a month, unless they qualify for an exemption. The CBO projected, based on an early version of the bill, that 18.5 million adults would be subject to the new rules — nearly half of those enrolled.

Vermont Medicaid officials expect it will cost $5 million in fiscal 2027 to implement changes in response to the federal law, said Adaline Strumolo, deputy commissioner of the Department of Vermont Health Access. About $1.8 million is for Optum to make eligibility system adjustments. Optum is a subsidiary of UnitedHealth Group.

The One Big Beautiful Bill Act will subject nearly 55,000 Vermont Medicaid recipients to work requirements — about a third of the state’s enrollees.

The law forced the state “to essentially drop everything else we were doing,” Strumolo said in an interview. “This is a big, big lift.”

Optum’s contract with the state was worth $125.6 million as of October.

Nearly two-thirds of adult Medicaid enrollees nationally are already working, according to KFF. Advocacy groups for Medicaid recipients say work requirements will nonetheless cause significant coverage losses. Enrollees will face added red tape to prove they’re complying. And eligibility systems already prone to error will have to account for employment, job-related activities, and any exemptions.

An estimated 5.3 million enrollees will become uninsured by 2034 due to work requirements, the CBO reported.

In Wisconsin, state officials estimate roughly 63,000 adults could lose coverage after work requirements take effect. Not covering those people would save $532.6 million in Medicaid spending for one year.

Wisconsin’s eligibility system for Medicaid and SNAP — known as CARES — was implemented statewide in 1994, and initially was a transfer system from Florida, according to a 2016 state document.

Deloitte submitted its cost estimates for Medicaid and SNAP changes to the state in September and December. Elizabeth Goodsitt, a spokesperson for the Wisconsin Department of Health Services, declined to answer questions about whether additional changes will be needed, how much it will cost to make all eligibility system changes to comply with the new federal law, and whether the state negotiated prices with Deloitte.

Bobby Peterson, executive director of the public interest law firm ABC for Health, said Wisconsin has invested “very little” to help people navigate the Medicaid eligibility process, which soon will become more difficult.

“But they’re very willing to throw $6 million to their contractors to create the bells and whistles,” Peterson said. “That’s where I feel a sense of frustration.”

New hurdles for vets and homeless people

Medicaid work requirements are only one change required by Trump’s tax law that will make it harder to obtain safety-net benefits.

Starting in October, the law prohibits several immigrant populations from accessing Medicaid and ACA coverage, including people who have been granted asylum, refugees, and certain survivors of domestic violence or human trafficking. Beginning Dec. 31, states must verify eligibility twice a year for millions of adults — doubling state officials’ workload. And the law restricts SNAP benefits by requiring more adult recipients to work and by removing work exemptions for veterans, homeless people, and former foster youth.

Days after Trump signed the bill in July, Kentucky health officials raced to make changes to the state’s integrated eligibility system, which verifies eligibility for Medicaid, SNAP, and other programs. Deloitte operates the system under a five-year contract worth more than $157 million. According to documents obtained by KFF Health News, initial changes costing $1.6 million were labeled a “high priority” and approved on an “emergency” basis, with some of the changes to the nation’s largest food aid program going into effect almost immediately.

Officials with Kentucky’s Cabinet for Health and Family Services declined to answer a detailed list of questions, including how much it will cost to make all the modifications needed.

Deloitte spokesperson Karen Walsh said the company is working with states to implement new requirements but declined to answer questions about cost estimates in several states. “We are delivering the value and investments we committed to,” Walsh said.

In most states, government agencies rely on contractors to build and run the systems that determine eligibility for Medicaid. Many of those states also use such computer systems for SNAP. But the federal government — that is, taxpayers — covers 90% of state costs to develop and implement state Medicaid eligibility systems and pays 75% of ongoing maintenance and operations expenses, according to federal regulations.

“Five, 10 years ago, I’m not sure if you would hear much mention of SNAP from a Medicaid director,” Melisa Byrd, Washington, D.C.’s Medicaid director, said in November at an annual conference of Medicaid officials. “And particularly for those with integrated eligibility systems — as D.C. is —­ I’m learning more about SNAP than I ever thought.”

The federal law was the topic du jour at last year’s gathering in Maryland, held at the Gaylord National Resort and Convention Center, the largest hotel between New Jersey and Florida.

Consulting companies had taken notice. Gainwell, an eligibility contractor and one of the conference’s corporate sponsors, emblazoned its logo on hotel escalators. Companies set up booths with materials promoting how they could help states and handed out snacks and swag.

“Conduent helps agencies work smarter by simplifying operations, cutting costs and driving better outcomes through intelligent automation, analytics, and innovation in fraud prevention,” read one such handout from another contractor. “Together, we can better serve residents at every step of their health journeys.” Conduent holds Medicaid eligibility and enrollment contracts in Mississippi and New Jersey, their Medicaid agencies confirmed to KFF Health News.

In handouts, Deloitte touted its role in “building a new era in state health care” and as “a national leader in Medicaid program and technology transformation, building a strong track record across the federal, state, and commercial health care ecosystem.” KFF Health News found that Deloitte, a global consultancy that generated $70.5 billion in revenue in fiscal 2025, dominates this slice of government business.

“With Medicaid Community Engagement (CE) requirements, states are tasked with adding a new condition of Medicaid eligibility to support state and federal objectives,” added another brochure. “Deloitte offers strategic outreach and responsive support to help states engage communities, lower barriers, and address access to coverage.”

A $20.3 million bill in Iowa

Before Trump signed the One Big Beautiful Bill Act, Iowa lawmakers wanted to impose their own version of work requirements. They would have applied to 183,000 people before any exemptions. The new law would necessitate a change to Iowa’s Medicaid eligibility system, according to documents prepared by Accenture, which operates Iowa’s system through a contract worth more than $60 million.

Adding the ability to verify work status would cost up to $7 million, an Accenture estimate from March 2025 showed. By July, the cost to implement the One Big Beautiful Bill Act’s work requirements and other Medicaid provisions skyrocketed to roughly $20.3 million. Accenture’s analysis said the federal law necessitated additional changes to Iowa’s system. Making employment a condition of Medicaid benefits could cause an estimated 32,000 Iowans to lose coverage, according to a 2025 state document.

Cutting 32,000 people from coverage could save $183 million in one year, a fraction of the $8.9 billion Iowa and the federal government spend on Medicaid in a given year.

In Cedar Rapids, most of Eastern Iowa Health Center’s patients rely on Medicaid, CEO Joe Lock said. He questioned the government’s logic of spending tens of millions of dollars on a policy to remove Iowans from Medicaid.

Most of the health center’s patients live at or below the federal poverty level — currently $33,000 for a family of four.

“There is no benefit to this population,” Lock said.

Danielle Sample, a spokesperson for Iowa’s Department of Health and Human Services, did not answer questions about how much it will cost to implement changes to the state’s separate SNAP eligibility system.

In Illinois, the state’s work this year is largely focused on meeting major provisions of the One Big Beautiful Bill Act. The state estimates that as many as 360,000 residents could lose Medicaid, largely due to the work requirements, said Melissa Kula, a spokesperson for the Illinois Department of Healthcare and Family Services.

Kula confirmed that most of the work detailed in one of Deloitte’s estimates — priced at $12 million — is related to Trump’s law. The estimate also mentions other work. Kula said Deloitte is charging the state a $2 million fixed fee related to work requirements.

The Trump administration has acknowledged that the work is coming at a cost. In January, top officials for the Centers for Medicare & Medicaid Services said government contractors, including Deloitte, Accenture, and Optum, have promised to offer discounts and reduced rates through 2028 to help states incorporate system changes.

“The companies were extremely excited to do this,” said Daniel Brillman, the top CMS Medicaid official. “Everyone’s really focused on getting to work.”

CMS spokesperson Catherine Howden declined to answer questions about the discounts.

Goodsitt, the Wisconsin Medicaid spokesperson, declined to answer questions about whether Deloitte has discounted its rates. Officials with Kentucky’s Cabinet for Health and Family Services did not answer a detailed list of questions, including whether Deloitte extended discounts to make these changes.

It’s unclear what discounts, if any, Deloitte and Accenture have offered to individual states. Walsh, the Deloitte spokesperson, declined to answer detailed questions about the discounts the Trump administration announced this year. Accenture did not respond to repeated requests for comment.

Strumolo, the Vermont health official, said state officials discussed the announcement with Optum “in detail.”

Optum pledged to offer discounts for a specific module related to Medicaid work requirements. That product is unworkable for Vermont because it would mean “moving to a new system when we don’t have to.” When asked about whether the company offered discounts, Strumolo said “not explicitly.”

In a statement, UnitedHealth Group spokesperson Tyler Mason said Optum supports state implementation of new federal requirements “with a range of options to meet their unique cost and policy needs.”

He declined to specify whether Optum discounted Vermont’s rates and how it calculated the costs of doing its work. “Optum is helping mitigate upfront implementation expenses so states can focus on approaches that reduce duplication, accelerate implementation, and manage costs over time — supporting better outcomes for individuals covered by Medicaid,” Mason said.

Strumolo said Optum’s initial changes in Vermont cover items that take effect this year and in 2027 — Medicaid work requirements, checking eligibility every six months, and prohibiting certain immigrants from qualifying for health programs.

“There’s a lot more that could come,” she said.

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—an independent source of health policy research, polling, and journalism. Learn more about KFF.

Subscribe to KFF Health News’ free Morning Briefing.

This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License. 

When an Alabama clinic’s only OB-GYN left the state to provide abortion care in Colorado, the head of operations thought the facility would have to close.

But Robin Marty, executive director at WAWC Healthcare in Tuscaloosa, hired a doctor in August who she called a “unicorn” — someone who’s from Alabama and, after training outside of the state, returned home to practice medicine.

Marty said Alabama’s near-total abortion ban could cause physicians to practice elsewhere after they finish their residencies.

“Doctors don’t want to worry about surveillance, potential arrests and other legal issues,” she said.

A study published in March found that applications to medical residency programs in states with abortion restrictions have declined compared to states where abortion remained mostly legal. The findings are an “early signal” that the U.S. Supreme Court’s decision nearly four years ago overturning federal abortion rights protections may exacerbate health care shortages, said lead author Dr. Anisha Ganguly.

A majority of doctors end up practicing medicine in states where they trained. Obstetrician and gynecology training programs typically take four years to complete, so the full scope of how abortion restrictions affect where physicians work after they complete their residencies remains to be seen.

Still, experts said the findings could spell trouble for the future of the reproductive health care workforce in states with abortion restrictions, some of which are already plagued with maternity care deserts.

Doctors say bans limit training, standards of care

OB-GYNs affiliated with Physicians for Reproductive Health who either trained or work in states with abortion bans told States Newsroom that restrictions after the Supreme Court decision hamstrung their ability to offer reproductive care and affected the education of medical residents.

Dr. Neha Ali grew up in Texas and trained there, too. But by the end of her OB-GYN residency’s second year, the state enacted SB 8, a six-week abortion ban that allowed residents in the state to sue providers or anyone who helped someone terminate a pregnancy. After the Dobbs decision in June 2022, a near-total abortion ban took effect in Texas.

“I knew I wanted to be an abortion provider before I started OB-GYN residency, and I chose to be in Texas for my residency training because I wanted to experience what that’s like in a state with barriers. But ultimately, the barriers became too large,” Ali said.

After she finished residency in 2024, Ali moved to Colorado, a state with strong abortion-rights protections, where she practices complex family planning.

Ali said she talks to medical students about her experience training in Texas, where she was not able to perform any dilation and evacuations — a second-trimester abortion procedure — during residency.

“I do think it’s very valuable to see what it’s like to be in a restrictive state and understand what that is like to be a provider there, but that doesn’t sell people on a residency for four years,” she said.

OB-GYN Dr. Louis Monnig trained in Kentucky before the state banned abortion.

“Making it difficult or putting up barriers to that training just limits the abilities of any doctor who provides reproductive care to have opportunities to get exposure and experience, and just get better at what they’re doing,” he said.

Monnig completed his residency in June 2023 and moved back to his home state of Louisiana because of his connections to the region and its health care disparities. “It felt like it was worth it to come back,” he said.

In October 2024, a Louisiana law classifying mifepristone and misoprostol as controlled dangerous substances took effect.

“It made me lose faith that lawmakers were doing any of these things to actually protect patients or patient safety,” he said.

The medications are used not only for abortions, but miscarriages and other conditions, too. The law has sowed confusion among health care providers and led some to practice emergency drills to access the drugs during obstetric emergencies, Louisiana Illuminator reported. Monnig said the law has “changed some of the day-to-day operational workflow for patient care,” especially for situations where misoprostol is used, such as labor induction and postpartum hemorrhaging.

Patients have faced issues when trying to get prescriptions filled: Pharmacists have called Monnig’s office to make sure a patient wasn’t having an abortion after he prescribed misoprostol for conditions such as cervical stenosis — when it’s difficult to insert a medical instrument in the cervical canal.

Drop in applications to ban states’ residency programs

Out of more than 22 million applications to 4,315 residency programs across the U.S., 67% were submitted to programs in states without abortion restrictions between 2018 and 2023, the new research showed. Thirty-three percent went to programs in states with restrictions.

Fewer women than men applied to train in states with abortion restrictions before the Supreme Court’s landmark abortion ruling, according to the study, and that disparity widened after more than a dozen states enacted abortion bans. The number of men applying to residency programs in states with abortion restrictions — mostly in the South and the Midwest — also decreased significantly.

“When there’s a decreased level of interest in these states, it suggests to us that there’s an evolving health care workforce shortage in these states,” said Ganguly, an internal medicine physician and an assistant professor at University of North Carolina’s Division of General Medicine and Epidemiology.

Many states with abortion bans — Idaho, Iowa and Georgia, for example — are also facing labor and delivery unit closures, particularly in rural areas where hospitals struggle with provider recruitment. Health officials in these states listed improvements to maternal health as a priority in their applications to the federal Rural Health Care Transformation Program, but solutions will take years to implement.

Shortages affect more than one specialty. Ganguly said OB-GYNs have historically offered the bulk of abortion-related care in the U.S., but it’s increasingly important in emergency medicine, family medicine and internal medicine. Primary care providers and emergency medicine doctors often diagnose pregnancy complications such as miscarriages, and internists help women who have chronic disease manage and plan for pregnancy.

Dr. Hector Chapa, an OB-GYN who teaches obstetrics and gynecology at Texas A&M University and is a member of the American Association of Pro–Life Obstetricians and Gynecologists, took issue with the study’s approach.

“It’s essential to understand that this study is not specific to OB‑GYN residency programs, and by grouping OB‑GYN with family medicine, internal medicine and emergency medicine, the study assumes that all specialties are affected equally, despite their very different levels of involvement in abortion. This broad grouping risks introducing bias into the results,” he said in a statement.

Ganguly said her team did examine applications to OB-GYN residency programs in isolation to affirm findings of a decline among applicants in abortion-restricted states. Looking at other specialties, too, was meant to provide clarity about how bans affect the health care workforce more broadly.

OB-GYN education and the maternal health care workforce

The latest study adds to a body of research examining how the Supreme Court’s decision on abortion in 2022 affected training after medical school, particularly for those specializing in reproductive health care.

In the 2023-2024 application cycle, the number of applicants to training programs in states with abortion bans decreased by 4.2% compared to the previous cycle, while there was less than a 1% decrease in applications to residency programs in states where abortion is legal, according to the American Association of Medical Colleges.

In some states, abortion bans have definitively led to an exodus of OB-GYNs and maternal fetal medicine specialists. Idaho lost 35% of its doctors who provide obstetrics between August 2022 and December 2024, according to a study published in July.

Having reproductive health providers flee states with abortion bans is “devastating,” according to Pamela Merritt, the executive director of Medical Students for Choice.

“It’s a public health disaster that we’re going to see the consequences of decades to come,” she said.

Merritt’s organization has chapters at several medical schools in states with abortion bans. She said students are not getting adequate training, and some are even discouraged from discussing abortion.

In February, Texas Tech University Health Sciences Center canceled a Medical Students for Choice chapter’s talk with an OB-GYN who wrote a book about providing abortion care later in pregnancy. School officials told The Texas Tribune hosting the event on campus was not in the university’s best interests.

“Everybody who graduates from medical school in Texas should know that there’s this thing called third-trimester abortion, that when the life of the mother is at risk, you legally can provide this care,” Merritt said.

Republican Gov. Greg Abbott signed legislation last year clarifying that doctors can offer pregnant women abortions during medical emergencies. The Texas Medical Board released guidelines for the abortion law this year, nearly half a decade after the state banned most abortions and at least four Texans died after being denied prompt abortion care, ProPublica reported.

Program helps residents in restrictive states get abortion care training

“Every single physician, nurse and health care provider needs to be educated about abortion care,” said Dr. Jody Steinauer, an OB-GYN and the director of the Bixby Center for Global Reproductive Health at the University of California in San Francisco. “This is a huge crisis in OB-GYN specifically: All OB-GYNs must have the competence and the skill to safely empty the uterus. Even if the individual is personally uncomfortable providing abortion care, they have to be able to empty the uterus to save someone’s life in an emergency.”

Steinauer leads the Ryan Residency Training Program, which works with OB-GYN residencies across the country to ensure comprehensive abortion and family planning rotations. Nearly a dozen states lack Ryan programs, and most of them have near-total abortion bans.

She said residencies in states with abortion bans are struggling to make sure their students have the skills to provide abortion: “We’re at risk of having a whole generation of OB-GYN graduates who are not skilled to provide the care they need to provide.”

To remedy this issue, the Ryan Program has helped to establish 20 partnerships with schools in abortion-restrictive states to train OB-GYN medical residents in states with reproductive rights protections.

Steinauer said the rotations are between two to four weeks and complicated to plan, but they help doctors learn procedural skills, how to manage medication abortions and counseling.

The rotations also help OB-GYNs navigate pain management during obstetric procedures, communicate effectively with abortion patients and familiarize themselves with ultrasounds, she said. These skills are important for providing the full spectrum of reproductive health care, from inserting IUDs to treating miscarriages, the doctor said.

“It’s such a refreshing experience for them to be working in a state without a ban, and they get to see abortion as normal health care,” she said.

Stateline reporter Elisha Brown can be reached at ebrown@stateline.org.

A leader of Wisconsin's state disease laboratory says a recent reduction in federal testing won't immediately impact the state's ability to test for infectious diseases, including rabies.

The post As CDC pauses some disease testing, Wisconsin lab leader says states are ready to fill the gaps appeared first on WPR.

Wisconsin is part of a coalition of 21 states and local governments suing the Environmental Protection Agency for weakening standards on coal-fired power plants tied to emissions of mercury and other harmful pollutants.

The post Wisconsin and groups sue Trump EPA for rollback of mercury standards appeared first on WPR.

Traditional diets can be ineffective. But as a UW-Madison researcher recently told Larry Meiller that an eco-friendly diet can bring about long-lasting benefits for both individual and planetary health.

The post How to sustain an eco-friendly diet appeared first on WPR.

The city of Milwaukee is suing one of the area’s most delinquent landlords, calling the company's properties “public nuisances.”

The post Milwaukee sues out-of-state landlord for tax delinquency, code violations appeared first on WPR.

More prisons and jails in Wisconsin now provide access to medication for people with substance use disorders, according to a new report. 

The post Wisconsin’s incarcerated have more access to medications that fight addiction, report finds appeared first on WPR.

WASHINGTON — Mikayla Pivec said she worked more than 50 hours per week as a women’s college basketball player, but earned less than $8 an hour from a $1,600 monthly stipend.

The professional basketball player and former star at Oregon State University said she was testifying at Thursday’s U.S. Senate panel hearing on reshaping college athletics because “the NCAA has failed and continues to fail to protect and respect college athletes.” 

Pivec, who worked for a food delivery service and “collected cans” to make ends meet in college, played for Oregon State prior to the NCAA’s 2021 guidelines that allowed student-athletes to profit from their name, image and likeness, or NIL.

“NIL has helped some players, but most still earn less than $10 an hour and struggle to pay for basic necessities,” she told the Senate Committee on Health, Education, Labor and Pensions. 

Pivec said “the lack of protections goes way beyond money,” noting that she had a foot injury that needed surgery and was denied an MRI “every single time” she requested one.

She is the co-founder and organizing director of the United College Athletes Association, a players’ association that aims to ensure college athletes are protected, educated and fairly compensated. 

Another ‘unfair system’

The college sports landscape continues to grapple with gender inequity in NIL deals, a patchwork of state NIL laws, booster collectives and the NCAA’s controversial transfer portal, among other issues. 

Just last year, a federal judge approved the terms of a nearly $2.8 billion antitrust settlement that paved the way for schools to directly pay athletes.

At a White House roundtable this month, President Donald Trump vowed to imminently deliver an executive order aimed at reshaping college sports. 

“The current landscape is just replacing one unfair system for another,” said Sen. Bill Cassidy, chair of the Senate HELP Committee.

“Short-term financial gain with NIL deals is overshadowing the value of an education and the value of Olympic and women’s sports,” the Louisiana Republican said. 

Employees?

The fierce debate over whether college athletes should be considered employees took center stage Thursday, drawing mixed attitudes from senators, experts, leaders and athletes. 

“I think the political dynamic is that Republicans and Democrats aren’t that far off from what we agree on — it’s just this one small issue that gets in the way from us passing something related to unionization and how we treat students-athletes, whether we treat them as employees or not,” said Sen. Jim Banks, an Indiana Republican. 

A bipartisan bill on pause in the U.S. House looks to create a national framework for college athletes’ compensation and would prohibit college athletes from being classified as employees. 

The measure would also give broad antitrust immunity to the NCAA and college sports conferences.

Sen. Chris Murphy, who has advocated for collective bargaining, said he does not want Congress “in the business of micromanaging college athletics and how compensation works.”

“That just doesn’t feel like our role,” the Connecticut Democrat said, while blasting the bipartisan bill as an “effort to put the big schools back in a position where they can collude and wage-suppress.” 

Trayvean Scott, vice president of Intercollegiate Athletics at Grambling State University in Louisiana, pointed to a “strain” that athletic departments, and under-resourced institutions in particular, would begin to face as a consequence of student-athletes becoming employees.

“When you look at that, my belief is that roster spots will start to be reduced, specifically to those non-revenue sports, specifically on the men’s side,” he said. “For an institution at Grambling State University, where we have 15 Division I sports, that means baseball is probably going to go first.”

After a "rollercoaster" of twists and turns in local politics, supporters of restoring fluoride to DeForest's water are turning their focus to an April 7 election.

The post After board votes down re-fluoridation, what’s next for DeForest water? appeared first on WPR.

Reading Time: 3 minutes

State Rep. Lisa Subeck, D-Madison, this month introduced legislation requiring crisis pregnancy centers to obtain permission from clients before sharing their sensitive health information.

Crisis pregnancy centers (CPCs), also known as unregulated pregnancy centers or pregnancy resource centers, provide some services for pregnant people but largely aim to dissuade clients from choosing abortion care. Importantly, most CPCs are not licensed medical facilities and are intentionally vague about their inability and unwillingness to provide abortions or make referrals. They attract clients with targeted advertising that promises free pregnancy testing, ultrasounds and options counseling.

Without the restrictions proposed by Subeck and more like it, Wisconsinites will continue to be victimized by this industry.

Since CPCs are not medical providers and do not charge for services,they are not subject to the same consumer protection laws and licensing requirements, including the Health Insurance Portability and Accountability Act, or HIPAA.

Without confidentiality protections, CPCs are not required to protect sensitive client information and may misuse private client data with no accountability. Subeck’s bill would help close this loophole and ensure that client information is secure.

While this legislation would be a step in the right direction, privacy is just one of many instances in which CPCs violate medical ethics.

With the funding they receive from faith-based organizations, anti-abortion advocacy groups and taxpayer dollars, CPCs may present themselves in ways that resemble medical settings. Staff and volunteers may wear white coats, visit with clients in exam rooms and adopt language used by clinicians. But many of their services fail to meet evidence-based standards of care.

For example, CPCs have been reported to overestimate gestational age to convince clients they are too far along in pregnancy to legally access abortion. They also readily share medically inaccurate information about abortion.

CPCs across Wisconsin claim that abortion can lead to depression, substance abuse, nightmares, and future fertility issues. Major medical organizations say there is no evidence that abortion leads to mental illness or negative impacts on future fertility. In fact, research suggests that denying people abortion care is associated with worse outcomes to their long-term health and well-being.

Many CPC websites list “abortion reversal” as a service. This involves taking progesterone to “reverse” the effects of mifepristone, the first medicine used in medication abortion. University of California-Davis researchers attempted to test the effectiveness of this treatment, but the study was stopped early due to ethical and safety concerns. The American College of Obstetricians and Gynecologists has determined that abortion reversal is “not supported by science.”

Despite their questionable practices, CPCs in Wisconsin continue to benefit from public funding, and some state legislators want them to receive even more. In 2023, Sen. Robert Quinn, R-Birchwood, proposed legislation that would give $1 million a year to Choose Life Wisconsin, a statewide network of CPCs.

Funds raised through Choose Life license plates are also directed to CPCs. Meanwhile, some of Wisconsin’s legislative Republicans have not supported measures that would benefit pregnant people and new parents. Assembly Speaker Robin Vos, R-Rochester, repeatedly blocked proposals to expand postpartum Medicaid coverage, calling it “an expansion of welfare,” until the Assembly this session finally sent the bill to Gov. Tony Evers’ desk.

In Wisconsin, legitimate providers of abortion care must navigate a litany of restrictions. Targeted Regulation of Abortion Providers, or TRAP laws, are widely criticized by medical groups and exist only to make obtaining and providing abortion care harder. Yet CPCs are free to operate under limited regulations while they enjoy our tax dollars.

In other states, efforts to regulate CPCs have failed on the grounds that these organizations are protected under the First Amendment. But these centers are a growing public health risk, and protecting people’s health and safety should take priority. This is especially important as the network of CPCs continues to grow. In Wisconsin, there are just five clinics that provide abortion care, compared to an estimated 60 CPCs.

When pregnant people reach out for support, they deserve to be met with compassion, honesty and the opportunity to consider all of their options. The ongoing failure of our lawmakers to regulate these facilities is an affront to evidence-based sexual and reproductive healthcare. It is time that Wisconsin’s lawmakers uphold respect and humanity, not deception and manipulation.

Layne Donovan was born and raised in Wisconsin and holds a degree from Barnard College. She has studied the history of abortion in the United States, and currently works in reproductive health, rights, and justice. 

Opinion: Wisconsin must regulate crisis pregnancy centers to protect patients  is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

Wisconsin women will have access to preventive breast cancer screenings under a new law signed Thursday by Gov. Tony Evers. 

The post Evers signs ‘Gail’s Law’ to require coverage of preventive breast cancer screenings appeared first on WPR.

Veterinary experts are urging owners of commercial and backyard flocks to take steps to protect their birds as the nation sees an increase in bird flu outbreaks during spring migration.

The post Uptick in bird flu outbreaks expected in Wisconsin and nationwide appeared first on WPR.

Thousands of mothers in Wisconsin will now have access to postpartum medicaid coverage after Gov. Tony Evers signed a bill extending the program from 60 days to one year.

The post Gov. Tony Evers signs law extending postpartum medicaid coverage to 1 year appeared first on WPR.

Bacteria can cause illness and death, UW-Madison professor Timothy Paustian said on "The Larry Meiller Show," but they could also help us to sleep better or find the motivation to exercise. 

The post The tiny, hidden world of mighty bacteria appeared first on WPR.

In an extraordinary break from the federal government, the public health departments of at least three states and New York City are joining the global alert network of the World Health Organization, spurred by President Donald Trump’s decision to remove the United States from the United Nations agency responsible for coordinating international public health.

So far, the state public health departments in California, Illinois, New York, as well as the public health agency in New York City, have joined the Global Outbreak Alert and Response Network (GOARN), which is part of the World Health Organization (WHO). The U.S. officially left the WHO this past January.

California joined GOARN in January, while Illinois, New York state and New York City joined last month.

GOARN, which includes more than 310 national public health agencies, United Nations agencies, academic institutions, and nongovernmental groups, helps identify and manage infectious disease outbreaks worldwide. Since it was established in 2000, GOARN says it has helped manage more than 175 global health emergencies across 114 countries.

GOARN maintains relationships with some medical and research institutions in the U.S., including the Tulane University School of Public Health and Tropical Medicine in New Orleans and university medical centers in Nebraska and Texas. Until now, however, state public health agencies have not been members, because they relied on the U.S. government’s participation in GOARN for information on global outbreaks.

Dr. Ali Khan, a medical epidemiologist who is the dean of the College of Public Health at the University of Nebraska Medical Center and a former member of the GOARN steering committee, said the COVID-19 pandemic highlighted how “disease has no borders” and the importance of sharing information globally to quash the spread of contagious diseases.

Khan said the Trump administration’s withdrawal from the WHO “throttles the information from WHO to the U.S. government, specifically the [federal Centers for Disease Control and Prevention], and which then flows to states. Those states are now left in a position where they’re joining the GOARN.”

“Let’s be clear, it doesn’t substitute for the U.S. withdrawal from the WHO, but it does allow states to directly get information about what’s going on globally that may impact their own citizens. So it allows them to sort of keep their own radar on when the U.S. has decided to no longer participate in this global information sharing.”

In explaining its decision to withdraw from WHO, the Trump administration said the U.S. had “for decades carried a disproportionate share of the organization’s financial burden.” It insisted the country would “continue to ensure detection and response to infectious disease outbreaks” without being a member of the organization.

“These are the same democrat-led states and cities that imposed unscientific school closures, toddler mask mandates, and vaccine passports during the COVID era,” Andrew Nixon, a spokesperson for the U.S. Department of Health and Human Services, wrote in an email.

“They are the ones who destroyed public trust in public health that we are now restoring. We are working with the White House in a deliberative, interagency process on the path forward for global health and foreign assistance that first and foremost protects Americans.”

Dr. James McDonald, commissioner of the New York State Department of Health, told Stateline that the department’s decision to partner with GOARN was apolitical, and that it makes sense for New York because the state is “the world’s gateway to the country.”

“Everybody comes to the United States. Many come through JFK [John F. Kennedy International Airport], but an outbreak in the Democratic Republic of Congo does matter to me, so learning about it sooner helps protect New Yorkers and also helps protect the United States,” McDonald said.

McDonald added that New York is a part of a new public health consortium of Northeast states — the Northeast Public Health Collaborative — and plans to share any information it gathers from GOARN with fellow members Connecticut, Delaware, Maine, Maryland, Massachusetts, New Jersey, Pennsylvania, Rhode Island, and Vermont. New York City also is a member of the consortium.

“One of the things about scientists and health care providers is we’re used to just sharing information with each other, sharing knowledge. It’s not political,” McDonald said.

Doua Yang, a spokesperson for the California Department of Public Health, said that even before officially joining GOARN in January, the agency had been attending weekly operational calls for several months, and even made a presentation on how it has handled bird flu outbreaks.

“As the fourth-largest economy in the world, California cannot afford to let down its guard, or its people,” Yang wrote in an email. “Participating with GOARN is one step California is taking to maintain uninterrupted communication with WHO and protect the state from potential health threats.”

Stateline reporter Shalina Chatlani can be reached at schatlani@stateline.org.

Health care students at UW-Madison can take an improvisational theater class designed to help them better engage with patients. The class instructor visited WPR's "The Larry Meiller Show" to discuss the healing powers of improv.

The post Prescribing improv to improve patient-doctor relationships appeared first on WPR.