FORT KENT, Maine (AP) — Maine health officials obtained a 24-hour court order restricting Kaci Hickox's movement after the nurse repeatedly defied the state's quarantine for medical workers who have treated Ebola patients.
A judge granted the order Thursday limiting Hickox's travel, banning her from public places and requiring a 3-foot buffer until there's a further decision Friday.
The state went to court Thursday, following through with a threat to try to isolate her until the 21-day incubation period for Ebola ends no Nov. 10. In court documents, the judge indicated further action was anticipated Friday.
Police remained outside her home Friday. Fort Kent Police Chief Tom Pelletier went inside the home briefly Friday morning and said afterward, "We just had a good conversation." He said he was not there to arrest or detain her.
Police were under orders to monitor her movements after she twice let home, once to talk to reporters Wednesday and again for a bike ride with her boyfriend on Thursday.
The legal action is shaping up as the nation's biggest test case yet in the struggle to balance public health and fear of Ebola against personal freedom.
Hickox, who treated Ebola patients in Sierra Leone, says confinement violates her rights. She says that she has no symptoms and poses no risk to the public.
Hickox, 33, stepped into the media glare when she returned from treating Ebola patients in Sierra Leone to become subject to a mandatory quarantine in New Jersey. After being released from a hospital there, she returned to this small town, where she was placed under what Maine authorities called a voluntary quarantine.
She said she is following the federal Centers for Disease Control and Prevention recommendation of daily monitoring for fever and other signs of the disease.
"I'm not willing to stand here and let my civil rights be violated when it's not science-based," she said Wednesday evening.
Some states like Maine are going above and beyond the CDC guidelines to require quarantines. So is the U.S military.
President Barack Obama, the nation's top infectious-disease expert and humanitarian groups have warned that overly restrictive measures could cripple the fight against the disease at its source by discouraging volunteers like Hickox from going to West Africa, where the outbreak has sickened more than 13,000 people and killed nearly 5,000 of them.
"These kinds of restrictions could dissuade hundreds, if not thousands, of skilled volunteers from helping stop Ebola's spread, which is in the national interest of every one of our countries," Samantha Power, U.S. ambassador to the United Nations, said Thursday in Brussels.
WASHINGTON (AP) — Call it drugs for the departed: Medicare's prescription program kept paying for costly medications even after patients were dead.
The problem was traced back to a head-scratching bureaucratic rule that's now getting a second look.
A report coming out Friday from the Health and Human Services Department's inspector general says the Medicare rule allows payment for prescriptions filled up to 32 days after a patient's death — at odds with the program's basic principles, not to mention common sense.
"Drugs for deceased beneficiaries are clearly not medically indicated, which is a requirement for (Medicare) coverage," the IG report said. It urged immediate changes to eliminate or restrict the payment policy.
Medicare said it's working on a fix.
Investigators examined claims from 2012 for a tiny sliver of Medicare drugs — medications to treat HIV, the virus that causes AIDS — and then cross-referenced them with death records. They found that the program paid for drugs for 158 beneficiaries after they were already dead. The cost to taxpayers: $292,381, an average of $1,850 for each beneficiary.
Medicare's "current practices allowed most of these payments to occur," the report said.
Of 348 prescriptions dispensed for the dead beneficiaries, nearly half were filled more than a week after the patient died. Sometimes multiple prescriptions were filled on behalf of a single dead person.
Investigators don't know what happened to the medications obtained on behalf of dead people, but some may have been diverted to the underground market for prescription medicines. The report said HIV drugs can be targets for fraud since they can be very expensive; one common HIV drug costs about $1,700 for a month's supply, it said.
Medicare is the government's premier health insurance program, providing coverage to about 55 million seniors and disabled people. Prescription coverage delivered through private insurance plans began in 2006 as a major expansion of the program. But it's also been a target for scams.
The report did not estimate the potential financial impact across the $85 billion-a-year Medicare prescription program known as Part D. But investigators believe the waste may add up to millions of dollars.
"The exposure for the entire Part D program could be significant," said Miriam Anderson, team leader on the report. "The payment policy is the same for all drugs, whether they are $2,000 drugs to treat HIV or $4 generic drugs."
In a formal response, Medicare agreed with the investigators' recommendations.
"After reviewing this report, (Medicare) has had preliminary discussions with the industry to revisit the need for a 32-day window," wrote Marilyn Tavenner, the Obama administration's Medicare chief.
Medicare had originally maintained that the date of service listed in the billing records could instead reflect when a pharmacy submitted bills for payment. That billing date might have actually occurred after a prescription was filled, since some nursing home and institutional pharmacies submit their bills in monthly bundles.
However, the inspector general's investigators found that about 80 percent of the prescriptions for dead beneficiaries were filled at neighborhood pharmacies, undercutting Medicare's first explanation. As for the remainder, the investigators said they didn't see any reason pharmacies can't report an accurate date of service.
Investigators said they stumbled on the problem during an examination of coverage for AIDS drugs dispensed to Medicare beneficiaries. Sexually transmitted diseases are an increasingly recognized problem among older people.
That earlier investigation raised questions about expensive medications billed on behalf of nearly 1,600 Medicare recipients.
Some had no HIV diagnosis in their records, but they were prescribed the drugs anyway. Others were receiving excessively large supplies of medications. Several were getting prescriptions filled from an unusually large number of pharmacies.
Prescription drug fraud has many angles. When the high price of a drug puts it out of reach for certain patients, it can create an underground market. And some medications, like painkillers and anti-anxiety pills, are constantly sought after by people with substance-abuse issues.
PORTLAND, Ore. (AP) — A terminally ill woman who expects to take her own life under Oregon's assisted-suicide law says she is feeling well enough to possibly postpone the day she had planned to die.
Brittany Maynard said in early October she expected to kill herself Nov. 1, less than three weeks before her 30th birthday. She emphasized that she wasn't suicidal, but wanted to die on her own terms and reserved the right to move the date forward or push it back.
While she hasn't completely ruled Saturday out, Maynard says in a new video she feels she has some more of her life to live.
"I still feel good enough, and I still have enough joy — and I still laugh and smile with my friends and my family enough — that it doesn't seem like the right time right now," she says in the video.
"But it will come because I feel myself getting sicker. It's happening each week."
Maynard said she was diagnosed with incurable brain cancer earlier this year. Because her home state of California does not have an aid-in-dying law, she moved to Portland and has become an advocate for getting such laws passed in other states.
Maynard's story, accompanied by photos from her pre-illness wedding day, broke hearts across the globe while igniting a national debate on the issue of physician-assisted suicide.
One opponent is Philip Johnson, a 30-year-old Catholic seminarian from the Diocese of Raleigh, North Carolina. He, like Maynard, has inoperable brain cancer and is plagued by headaches and seizures.
After learning of learning of Maynard's choice, he wrote an article explaining his view that "suffering is not worthless," and it's up to God to take life.
"There is a card on Brittany's website asking for signatures 'to support her bravery in this very tough time,'" Johnson wrote on the diocese website. "I agree that her time is tough, but her decision is anything but brave. I do feel for her and understand her difficult situation, but no diagnosis warrants suicide."
Oregon was the first U.S. state to make it legal for a doctor to prescribe a life-ending drug to a terminally ill patient of sound mind who makes the request. The patient must swallow the drug without help; it is illegal for a doctor to administer it.
Oregon voters approved the Death with Dignity Act in 1994, then reaffirmed it — 60 percent to 40 percent — in 1997. It took more than a decade for another state to join Oregon, but four other states now have such laws.
More than 750 people in Oregon used the law to die as of Dec. 31, 2013, most of them elderly.
WICHITA, Kan. (AP) — Work begins Friday to recover the remains of the four people who died when a small plane crashed into a flight training facility at a Kansas airport, authorities said.
Jet fuel from the plane burned so hot during the blaze after the crash Thursday morning at Wichita Mid-Continent Airport that portions of the building remained unsafe all day and emergency officials voiced concerns about the stability of the structure. Late Thursday night, smoke continued to rise from the wreckage.
Heavy equipment will be brought in Friday to remove portions of the building so firefighters can reach the victims, Wichita Fire Chief Ronald Blackwell said. Crews are expected to be at the site for at least a couple of days.
"The real work begins at daylight," Blackwell said Thursday.
National Transportation Safety Board investigator Leah Yeager said the pilot reported a problem with the left engine of the twin-engine Beechcraft King Air soon after taking off from the airport.
According to witness reports, the plane was "flying low and slow before it entered a left turn," Yeager said.
"It continued to turn left and then impacted the building," she said.
The plane, which was manufactured in 2000, struck the top of the building and ignited a horrific fire, Blackwell said. The aircraft remains in pieces, with parts scattered on the roof and on the ground of the training facility.
NTSB investigators at the scene will try to determine what caused the engine failure. Peter Knudson, an NTSB spokesman, told The Associated Press early Friday that there are procedures for pilots to land with an engine out but that he had no information on why those procedures were not applied.
Officials said only one person was onboard the plane and that everyone else inside the building had been accounted for. Doug Nolte, city police spokesman, said in a news release that three of the victims were from the Wichita area and one was from another country. Their names and ages have not been released pending notification of family members.
Five people were hurt in the crash. One patient was in serious condition at Via Christi Hospital St. Francis and four others have been treated and released, hospital spokesman Roz Hutchinson said.
Wichita Police Deputy Chief John Speer said the crash was an accident and "not an intentional act."
The crash did not significantly disrupt passenger traffic at the airport.
The aircraft was headed to Mena, Arkansas, for painting and interior refurbishing work with Rose Aircraft Services Inc., according to that company's CEO, Keith Rose, who offered his condolences to the victims' families.
Rose provided no further details on the plane or its pilot.
A tail number shows the plane is registered to Beechcraft Corp. Beechcraft spokeswoman Nicole Alexander confirmed in an email that the aircraft was registered to the company but said it was recently sold. She said she couldn't comment further and referred additional questions to the NTSB.
Located several miles west of downtown, Wichita Mid-Continent is used by private aircraft and served by several national airlines and their regional affiliates. It saw more than 13,000 departures and about 1.4 million passengers last year, according to the U.S. Department of Transportation.
The crash is the latest in a string of incidents at the airport. In December, an avionics technician was arrested and accused of trying to drive a van filled with inert explosives onto the tarmac. In January, an Oklahoma man rammed his pickup truck through a security gate at the airport.
Reporters Heather Hollingsworth, Margaret Stafford and Greg Moore in Kansas City, Missouri, contributed to this story.
NEW YORK (AP) — The sight is so surprising that Americans are sharing photos of it, along with all those cute Halloween costumes, sweeping vistas and special meals: The gas station sign, with a price under $3 a gallon.
"It's stunning what's happening here," says Tom Kloza, chief oil analyst at the Oil Price Information Service. "I'm a little bit shocked."
The national average price of gasoline has fallen 33 cents in October, landing Friday at $3.00, according to AAA, and will soon dip under $3 for the first time in four years.
When the national average crossed above $3 a gallon in December of 2010, drivers weren't sure they'd ever see $2.99 again. Global demand for oil and gasoline was rising as people in developing countries bought cars by the tens of millions and turmoil was brewing in the oil-rich Middle East.
Now demand isn't rising as fast as expected, drillers have learned to tap vast new sources of oil, particularly in the U.S., and crude continues to flow out of the Middle East.
Seasonal swings and other factors will likely send gas back over $3 sooner than drivers would like, but the U.S. is on track for the lowest annual average since 2010 — and the 2015 average is expected to be lower even still.
Trisha Pena of Hermitage, Tennessee, recently paid $2.57 a gallon to fill up her Honda CRV. Like many around the country these days, she was so surprised and delighted by the price she took a photo and posted it on social media for her friends to see. "I can't remember the last time it cost under $30 to put 10 or 11 gallons in my tank," she said in an interview. "A month ago it was in the $3.50 range and that's where it had been for a very long time."
Here are a few things to know about cheap gas:
— Crude prices came off the boil. Oil fell from $107 a barrel in June to near $81 because there's a lot of supply and weak demand. U.S. output has increased 70 percent since 2008, and supplies from Iraq and Canada have also increased. At the same time, demand is weaker than expected because of a sluggish global economy.
— In the past, a stronger economy in the U.S., the world's biggest consumer of oil and gasoline, typically meant rising fuel demand. No longer. Americans are driving more efficient vehicles and our driving habits are changing. Michael Sivak of the University of Michigan Transportation Research Institute calculates that the number of miles travelled per household and gallons of fuel consumed per household peaked in 2004.
— The drop from last year's average of $3.51 per gallon will save the typical U.S. household about $50 a month.
— The drop will save the U.S. economy $187 million a day, and also boost the profits of shippers, airlines, and any company that sends employees out on sales calls or for deliveries.
— It will take an extra 1.5 years of savings on gasoline to make purchasing a Toyota Prius instead of a Toyota Corolla pay off.
— New York's average of $3.37 is the highest in the continental U.S. South Carolina and Tennessee are the lowest, with an average of $2.75.
— Politicians are either going to take the credit for lower gasoline prices or blame the other party for not helping them fall further. Don't listen. There are small things politicians can do over long time horizons, like implement fuel economy standards or ease drilling regulations, but the decline in prices is mainly due to market forces.
— Gasoline is cheaper than milk again. In September the national average price of milk was $3.73 per gallon. The annual average for milk is on track to be more expensive than the annual average for gasoline for the first time since 2011. The gap is even bigger for some bottled water lovers. A case of a dozen 1.5 liter bottles of Evian on Amazon.com costs $38.99, which makes for a price per gallon of $8.20.
States have broad authority to quarantine people to prevent the spread of disease, and several are exercising that right to go beyond the safety recommendations of the Centers for Disease Control for containing the deadly Ebola virus.
The CDC says mandatory quarantines of those without symptoms are unnecessarily severe and will discourage health workers from going to West Africa to fight the epidemic. It says people at the highest risk of contracting Ebola but who have no symptoms — such as those who came into direct contact with an Ebola patient's body fluids — should avoid public transportation and public places like shopping centers and movie theaters, even if they have no symptoms. Activities like jogging, in which the person maintains a 3-foot distance from others, are allowed.
The military has imposed the toughest rules for troops returning from affected countries, requiring 21-day quarantines even for those whose jobs do not require them to be in contact with any infected people.
Here's a look at the variety of ways states are responding to the health threat:
THE TOUGHEST STATE RULES:
New York and New Jersey have imposed mandatory, blanket quarantines of 21 days for health care workers returning from the disease's hotspots and travelers who have had contact with Ebola victims.
Maine officials have called for voluntary quarantines for health care workers in contact with Ebola patients. But Gov. Paul LePage says he is ready to exercise the "full extent" of his authority to protect the public after a nurse who returned from Sierra Leone but has shown no symptoms went on a bike ride with her boyfriend and held a news conference before her Nov. 10 incubation period ends. Maine health officials have gone to court try to limit the movements of nurse Kaci Hickox.
In Georgia, travelers arriving from West Africa who have had direct contact with an infected person will be considered high risk and will be placed in quarantine at a designated facility to be monitored, while health care workers who have been treating Ebola patients but show no symptoms will be closely monitored by state health officials using video or home visits.
Travelers who have been to an affected country but have had no known exposure to the disease will have to sign an agreement stating they will do temperature and symptom checks twice a day and will report results electronically or by phone. Failure to report will result in a mandatory quarantine order if necessary.
In Illinois, the governor has ordered "high-risk" individuals stay at home for 21 days and undergo daily checkups.
SOME STATES SEEKING MIDDLE GROUND BETWEEN SAFETY AND CIVIL RIGHTS
The California Department of Public Health on Wednesday ordered people returning from Ebola-stricken areas who have had contact with infected patients to be monitored for the disease and left it up to county officers to decide how, including a 21-day quarantine.
Connecticut has announced plans to quarantine people on a case-by-case basis.
MANY STATES MONITORING THOSE WITH NO SYMPTOMS
In several states, health officials are monitoring anyone who has returned from Guinea, Liberia, and Sierra Leone for 21 days. That monitoring process varies: In Michigan that means calling people to check on them, while Florida authorities say they visit the people twice daily to take their temperature.
In Delaware, people considered to have "some risk," such as health care workers who have had direct patient contact but have no symptoms themselves, would be expected to sign agreements outlining restrictions of their activities, such as refraining from attending meetings, avoiding use of public transportation, and not engaging in activities that would put them in "arms' length" of contact with others.
Under Minnesota's monitoring program, travelers from West African countries that are Ebola hotspots provide twice-daily details on their temperature and health condition, keep contact journals and face restrictions from taking long trips on public transit. Health care workers who treated virus patients abroad are subject to home quarantines, which the state considers voluntary. Officials say they would consider legal action to order a quarantine if public safety was deemed at risk.
Texas, where the first U.S. Ebola case was diagnosed, calls for anyone with symptoms who arrived within the past three weeks from the virus hotspots to be rapidly isolated and transported to a health care facility. People considered to be high risk would be directed to stay home. Lower risk cases would be closely monitored and anyone coming in from countries with widespread Ebola cases would be checked twice daily for 21 days.
OTHER STATES DRAFTING PLANS:
State health officials in Alaska are finishing a plan that will outline the steps for when to put someone in quarantine or how to manage a patient who is off Alaska's limited road system, said Dr. Joe McLaughlin, the state's chief epidemiologist.
Anyone who traveled to the hardest hit West African nations within the last three weeks would be interviewed and asked about their histories, such as whether they cared directly for Ebola patients. From there, officials would determine that person's exposure risk and decide what quarantine measures are appropriate.
Kentucky officials are still hammering out an Ebola protocol but said it would likely be unnecessary given the small number of people who arrive to the state from affected countries.
Associated Press writers Brian Bakst in St. Paul, Minnesota; Adam Beam in Frankfort, Kentucky; Nancy Benac in Washington; Becky Bohrer in Anchorage, Alaska; Robert F. Bukaty in Fort Kent, Maine; Randall Chase in Dover, Delaware; David Eggert in Lansing, Michigan; Jamie Stengle in Dallas; and Judy Lin in Sacramento, California; contributed to this report.