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Health care providers detail struggles of telehealth access to Missouri lawmakers

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Health care providers detail struggles of telehealth access to Missouri lawmakers

JEFFERSON CITY, Mo. – Hundreds of thousands of Missourians have met with their doctor through telehealth over the past year but health care providers said access to the internet is still a problem for patients.

Roughly 20% of Missouri’s population doesn’t have access to high-speed internet, according to the Federal Communications Commission (FCC). Most of those Missourians live in rural parts of the state, which can make it tough for patients to take to their doctors.

“Even with all the changes in technology, broadband is still one of the biggest barriers,” Senior Program Director of Missouri Telehealth Network Rachel Mutrux told a House committee Monday. “These issues create technology deserts, which creates the digital divide between rural and urban areas.”

For the past 18 months, health care providers and patients have relied heavily on telehealth, but for Missourians without internet access, those virtual appointments are no easy task.

“Before the pandemic, BJC did about 4,000 video visits and in 2020, during the pandemic, we did 190,000,” Dr. Michele Thomas from BJC said.

Thomas said BJC is on track to complete about 120,000 virtual doctor visits in 2021.

A handful of lawmakers were back in the Capitol Monday for a committee hearing on broadband development. The committee was formed earlier this summer with the hopes of using some federal COVID-relief money to expand internet access. Missouri currently ranks 32nd in the nation for broadband access but there are more than a million Missourians with no access to the internet.

“The most vulnerable Missourians were not able to access these services due to the lack of connectivity and, or the technology ownership,” Mutrux said.

Mutrux told the committee the network started a program offering hotspots for patients in need. The program started in July 2020 and ends later this month. This past June, 8,000 hotspots were delivered to patients.

“Once we started closing our clinics, we started transitioning to video visits and the patients who were doing telephone only because that’s the only way they could do it, those were the patients that they provided the hotspots.”

She also said health care providers are noticing a decrease in no-shows because they don’t have to find a way to the appointment or worry about their job. It also is easier for the doctor or nurse to access medical records and input documentation.

In August, Gov. Mike Parson announced more than $400 million from the American Rescue Plan Act (ARPA) would be allocated to increasing internet access.

Marie Davis, executive treasurer for the Missouri FFA Association, said she visited an agriculture class at a school in Lewis County two weeks ago. Of the 20 seventh-graders in the class, Davis told representatives, only three of them had internet outside of their cell phones, at their parents’ house.

“We suggested to numerous students throughout 2020 and 2021 to seek alternatives sites or local businesses to do their interviews,” Davis said. “How do we make ag education, which we say is hands-on, not hands-on? The other limiting factor with that is how to make virtual accessible to students who don’t have accessible internet?”

Rep. Cyndi Buchheit-Courtway (R-Festus) said she works in a hospital and agrees telehealth is now a key to healthcare moves forward in the state.

“I do see more people miss their appointments all the time just because they don’t want to leave their house or they can’t catch a ride, so I know telehealth is so important to us,” Buchheit-Courtway said.

Besides health care, the Department of Elementary and Secondary Education (DESE) said students also lack internet access. Missourians with developmental disabilities say they too feel the ramifications.

“Without access to broadband and support to use devices, people with developmental disabilities in Missouri could be left behind,” Chris Fagan with the Missouri Developmental Disabilities Council said. “Many programs like food stamps and social security are applied online. If developmental disability communities don’t have access to broadband and a source to use it, even basic needs are hard to meet.”

Deputy director for public affairs at Kansas City Public Library Carrie Coogan said throughout the pandemic libraries were required to close, but workers stepped up to make sure those without access to the internet could get connected with hotspots. She told lawmakers roughly 30,000 Missourians in the Kansas City area lack broadband.

Using an emergency federal fund for COVID, Coogan said the library plans to purchase 1,500 more laptops for residents to check out. The next step, making a space available for patients to talk to their doctors.

“Finding HIPPA safe locations where people can go in and have an online conversation with a doctor or a nurse, that’s definitely something that’s in the future for us,” Coogan said.

Health care providers told the House committee that fewer patients are using telehealth this year than last, but it tends to fluctuate with the number of cases.

Members plan to meet again next month before submitting a report to the General Assembly in December.

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Ravens’ Week 15 game vs. Packers pushed back to late-afternoon kickoff

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Ravens’ Week 15 game vs. Packers pushed back to late-afternoon kickoff

The Ravens’ Week 15 home game against the Green Bay Packers has been pushed back to a 4:25 p.m. kickoff, the NFL announced Tuesday. Fox’s telecast of the game had been scheduled to start at 1 p.m. on Dec. 19.

The NFL uses “flexible scheduling” in Weeks 11-18, meaning that, after consultation with its broadcast partners, it can move games into prime-time or late-afternoon slots. The announcements are made no later than 12 days before the game.

The Ravens are 3-0 against NFC North teams this season, edging the Detroit Lions, Minnesota Vikings and Chicago Bears, but Green Bay should be the division’s stiffest test. The 9-3 Packers, led by reigning NFL Most Valuable Player Aaron Rodgers, have the NFC’s second-best record. On Sunday, they knocked off the Los Angeles Rams, 36-28, in Green Bay.

The Ravens’ Week 15 game will be second of three late-afternoon kickoffs in a five-week span. On Sunday and in Week 17, they face the Pittsburgh Steelers and Los Angeles Rams at 4:25 p.m.

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Denver’s homelessness response includes permanent cleanup zone in Five Points, safe outdoor space in Clayton

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Denver’s homelessness response includes permanent cleanup zone in Five Points, safe outdoor space in Clayton

The city of Denver has quietly stepped up its efforts to prevent encampments of homeless people from forming in one downtown neighborhood while also working to provide city land for a sanctioned camping site a few miles away.

City crews are now clearing unhoused people and their belongings from sidewalks and other public rights of way at least three times a week in a roughly 10-block area in the Five Points neighborhood, officials said.

“Permanent, regular cleanups are needed in this area to consistently promote the health and safety of everyone in the area, including those experiencing homelessness … ” Nancy Kuhn, spokeswoman for the city’s Department of Transportation and Infrastructure, said in an emailed statement.

The area identified by officials in late September is bounded by Broadway, Park Avenue, Welton and 20th streets. It’s dotted with signs that mark it a permanent zone for what opponents to the camping ban refer to as sweeps. The permanent cleanup zone was first reported by Westword.

Kuhn said the cleanup actions make the sidewalk accessible so people don’t have to walk in the street and help to mitigate public health risks created by trash, decomposing food, discarded needles, human waste and flammable materials such as propane and gasoline.

RJ Sangosti, The Denver Post

The city of Denver has posted signs marking a new permanent no-camping zone in a portion of Five Points in Denver on Nov. 22, 2021.

Unlike in most encampments cleanups, the city does not provide notice to people camping in the area seven days in advance. The notice rule was established by a federal injunction earlier this year.

“It’s an attempted end-run around the requirements of the preliminary injunction,” Andy McNulty, the attorney who filed the federal lawsuit against the city’s camping ban, said last week. “They are putting up a zone that essentially says you can’t exist here if you’re an unhoused person.”

McNulty and Assistant City Attorney Conor Farley delivered arguments in a hearing with a panel of judges on the U.S. Court of Appeals for the 10th Circuit last week about the merits of the preliminary injunction. The city’s goal was to have the restrictions on its camping ban enforcement powers lifted.

Farley noted in his comments there is a process through which the city can speed up enforcement actions to a 48-hour timetable if an emergency public health risk exists in an encampment but said that is still not soon enough. He also acknowledged the public record is thin on examples of public health emergencies that require a speedier response.

A representative for the City Attorney’s Office declined to comment on the arguments which are still being considered by the judges on the panel. McNulty said the hearing was a demonstration that the city has been disingenuous about its motives for clearing encampments.

“They just want the power to do whatever they want whenever they want with no consequences and they are not happy that someone is actually holding them accountable for once,” he said.

The permanent cleanup area the city marked out in September is the second of its kind, Kuhn said. Another area, roughly outlined by Larimer, Arapahoe, 22nd and 24th streets, is also subject to regular enforcement, she said.

In her emailed statement, Kuhn encouraged people who are homeless to embrace the city services available to them rather than stay on the streets.

“Our shelters have capacity; they are open 24/7, many do not require sobriety, they are safe and clean, and provide essential services to exit homelessness, including case management and rehousing,” she wrote.

Kuhn emailed The Denver Post her statement before a Denver Rescue Mission employee was fatally stabbed at the organization’s shelter for men at 4600 E. 48th Ave. Saturday night.

The potential for violent episodes is just one thing that can keep unhoused people from using the city’s shelter network. Cathy Alderman, chief public policy officer for the Colorado Coalition for the Homeless, noted that sleeping in a large, open room with other people is not ideal for everyone and the environment can be triggering for people struggling with post-traumatic stress disorder.

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Tiger Woods has little to offer on past accident or future in golf

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Tiger Woods has little to offer on past accident or future in golf

NASSAU, Bahamas — Tiger Woods had nothing to say about the February car crash that shattered his right leg and even less of an idea what his future in golf holds for him except that he’s a long way from deciding whether he can compete against the best.

“I can show up here and I can host an event, I can play a par-3 course, I can hit a few shots, I can chip and putt,” he said Tuesday. “But we’re talking about going out there and playing against the world’s best on the most difficult golf courses under the most difficult conditions.

“I’m so far from that.”

Woods addressed the media for the first time since his Feb. 23 crash on a winding road in the Los Angeles coastal suburbs. Police said he was driving at least 84 mph when he crossed a median and his SUV tumbled down a hill.

Asked his recollection of the accident, Woods said curtly, “All those answers have been answered in the investigation, so you can read about all that there in the police report.” When asked if he had any flashbacks to the trauma, he replied: “I don’t, no. Very lucky in that way.”

He also felt lucky to be alive and to still have his right leg, and to be able to walk into the press center at Albany Golf Club without a noticeable limp.

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