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Picketing began Wednesday at Kaiser Permanente hospitals as some 75,000 health care workers went on strike in Virginia, California and three other states over wages and staffing shortages, marking the latest major labor unrest in the United States.

Kaiser Permanente is one of the country’s larger insurers and health care system operators, with 39 hospitals nationwide. The nonprofit company, based in Oakland, California, provides health coverage for nearly 13 million people, sending customers to clinics and hospitals it runs or contracts with to provide care.

The Coalition of Kaiser Permanente Unions, representing about 85,000 of the health system’s employees nationally, approved a strike for three days in California, Colorado, Oregon and Washington, and for one day in Virginia and Washington, D.C.

A cheer went up from union members outside Kaiser Permanente Los Angeles Medical Center when the strike deadline arrived before dawn.

The strikers include licensed vocational nurses, home health aides and ultrasound sonographers, as well as technicians in radiology, X-ray, surgical, pharmacy and emergency departments.

Doctors are not participating, and Kaiser says its hospitals, including emergency rooms, will remain open during the picketing. The company said it was bringing in thousands of temporary workers to fill gaps during the strike. But the strike could lead to delays in getting appointments and non-urgent procedures being rescheduled.

It comes amid unprecedented worker organizing — from strike authorizations to work stoppages — within multiple industries this year, including, transportation, entertainment and hospitality.

Wednesday’s strike is the latest one for the health care industry this year as it continues to confront burnout with the heavy workloads — problems that were exacerbated greatly by the pandemic.

Unions representing Kaiser workers in August asked for a $25 hourly minimum wage, as well as increases of 7% each year in the first two years and 6.25% each year in the two years afterward.

They say understaffing is boosting the hospital system’s profits but hurting patients, and executives have been bargaining in bad faith during negotiations.


A federal judge on Saturday blocked two portions of North Carolina’s new abortion law from taking effect while a lawsuit continues. But nearly all of the restrictions approved by the legislature this year, including a near-ban after 12 weeks of pregnancy, aren’t being specifically challenged and remain intact.

U.S. District Judge Catherine Eagles issued an order halting enforcement of a provision to require surgical abortions that occur after 12 weeks — those for cases of rape and incest, for example — be performed only in hospitals, not abortion clinics. That limitation would have otherwise taken effect on Sunday.

And in the same preliminary injunction, Eagles extended beyond her temporary decision in June an order preventing enforcement of a rule that doctors must document the existence of a pregnancy within the uterus before prescribing a medication abortion.

Short of successful appeals by Republican legislative leaders defending the laws, the order will remain in effect until a lawsuit filed by Planned Parenthood South Atlantic and a physician who performs abortions challenging the sections are resolved. The lawsuit also seeks to have clarified whether medications can be used during the second trimester to induce labor of a fetus that can’t survive outside the uterus.

The litigation doesn’t directly seek to topple the crux of the abortion law enacted in May after GOP legislators overrode Democratic Gov. Roy Cooper’s veto. North Carolina had a ban on most abortions after 20 weeks before July 1, when the law scaled it back to 12 weeks.

The law, a response to the 2022 U.S. Supreme Court ruling that struck down Roe v. Wade, also added new exceptions for abortions through 20 weeks for cases of rape and incest and through 24 weeks for “life-limiting” fetal anomalies. A medical emergency exception also stayed in place.

On medication abortions, which bill sponsors say also are permitted through 12 weeks of pregnancy, the new law says a physician prescribing an abortion-inducing drug must first “document in the woman’s medical chart the ... intrauterine location of the pregnancy.”

Eagles wrote the plaintiffs were likely to be successful on their claim that the law is so vague as to subject abortion providers to claims that they broke the law if they can’t locate an embryo through an ultrasound because the pregnancy is so new.


States that declared themselves refuges for transgender people have essentially issued an invitation: Get your gender-affirming health care here without fearing prosecution at home.

Now that bans on such care for minors are taking effect around the country — Texas could be next, depending on the outcome of a court hearing this week — patients and their families are testing clinics’ capacity. Already-long waiting lists are growing, yet there are only so many providers of gender-affirming care and only so many patients they can see in a day.

For those refuge states — so far, California, Connecticut, Colorado, Illinois, Massachusetts, Maryland, Minnesota, New Jersey, New Mexico, Washington and Vermont, plus Washington, D.C. — the question is how to move beyond promises of legal protection and build a network to serve more patients.

“We’re trying our best to make sure we can get those kids in so that they don’t experience an interruption in their care,” said Dr. Angela Kade Goepferd, medical director of the gender health program at Children’s Minnesota hospital in the Twin Cities. “For patients who have not yet been seen and would be added to a general waiting list, it is daunting to think that it’s going to be a year or more before you’re going to be seen by somebody.”

Appointment requests are flooding into Children’s from all over the country — including Texas, Montana and Florida, which all have bans. Requests have grown in a year from about 100 a month to 140-150. The program hopes to hire more staff to meet demand, but it will take time, Goepferd said.

More than 89,000 transgender people ages 13 to 17 live in states that limit their access to gender-affirming care, according to a research letter published in late July in the Journal of the American Medical Association, though not all trans people choose or can afford gender-affirming care.

Rhys Perez, a transmasculine and nonbinary 17-year-old, is preparing to move this month from Houston to Los Angeles to start college. The teen, who said they’re “escaping Texas in the nick of time,” said California’s protection for gender-affirming care was one of the main factors in their decision on where to go for college.

Perez has just begun their search for a provider in Southern California but already has encountered several clinics with waits for an initial consultation between nine and 14 months. They were disappointed to learn they likely could not begin hormone replacement therapy until their sophomore year.


Wyoming Gov. Mark Gordon has signed into law the nation’s first explicit ban on abortion pills since the U.S. Supreme Court overturned Roe v. Wade last summer.

Gordon, a Republican, signed the bill Friday night while allowing a separate measure restricting abortion to become law without his signature.

The pills are already banned in 13 states that have blanket bans on all forms of abortion, and 15 states already have limited access to abortion pills. Until now, however, no state had passed a law specifically prohibiting such pills, according to the Guttmacher Institute.

A group seeking to open an abortion and women’s health clinic in Casper said it was evaluating legal options.

“We are dismayed and outraged that these laws would eradicate access to basic health care, including safe, effective medication abortion,” Wellspring Health Access President Julie Burkhart said in a statement Saturday.

The clinic, which a firebombing prevented from opening last year, is one of two nonprofits suing to block an earlier Wyoming abortion ban. No arrests in the arson have been made, and organizers say the clinic is now tentatively scheduled to open in April, depending on abortion’s legal status in Wyoming then.

Currently Wyoming has only one abortion provider, a physician in Jackson who performs only medication abortions.

The Republican governor’s decision on the two measures comes after the issue of access to abortion pills took center stage this week in a Texas court. A federal judge there raised questions about a Christian group’s effort to overturn the decades-old U.S. approval of a leading abortion drug, mifepristone.

Medication abortions became the preferred method for ending pregnancy in the U.S. even before the Supreme Court overturned Roe v. Wade, the ruling that protected the right to abortion for nearly five decades. A two-pill combination of mifepristone and another drug is the most common form of abortion in the U.S.


A sexual assault survivor chooses sterilization so that if she is ever attacked again, she won’t be forced to give birth to a rapist’s baby. An obstetrician delays inducing a miscarriage until a woman with severe pregnancy complications seems “sick enough.” A lupus patient must stop taking medication that controls her illness because it can also cause miscarriages.

Abortion restrictions in a number of states and the Supreme Court’s decision to overturn Roe v. Wade are having profound repercussions in reproductive medicine as well as in other areas of medical care.

“For physicians and patients alike, this is a frightening and fraught time, with new, unprecedented concerns about data privacy, access to contraception, and even when to begin lifesaving care,” said Dr. Jack Resneck, president of the American Medical Association.

Even in medical emergencies, doctors are sometimes declining immediate treatment. In the past week, an Ohio abortion clinic received calls from two women with ectopic pregnancies — when an embryo grows outside the uterus and can’t be saved — who said their doctors wouldn’t treat them. Ectopic pregnancies often become life-threatening emergencies and abortion clinics aren’t set up to treat them.


Nine health care workers who sued Democratic Maine Gov. Janet Mills over the state’s COVID-19 vaccine mandate have until Money to reveal their identities.

The workers have so far remained anonymous, but on Thursday, a federal appeals court in Boston rejected a motion by the workers and gave them until Friday to file an amended complaint with their names, the Portland Press-Herald reported.

The plaintiffs were later given an extension until Monday.

Attorneys for Liberty Counsel, a law firm representing the health care workers, said in a court filing Friday that the one-day extension is needed to give lawyers time to speak with each plaintiff about whether they want to move forward with the lawsuit.

The plaintiffs filed their complaint in federal court last August, before the state’s COVID-19 vaccine mandate for health care workers at Maine care facilities went into effect on Oct. 20, 2021.

In the complaint the workers argued that it was their religious right to refuse the vaccine over their belief that fetal stem cells from abortions are used to develop the vaccines.

Maine’s vaccine mandate does not allow for religious exemptions.

The lawsuit prompted several Maine newspapers, including the Portland Press Herald, to intervene in an effort to force the plaintiffs to be identified.

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