Is Our Healthcare System Broken, or Badly Bent?

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thelivyjr
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Is Our Healthcare System Broken, or Badly Bent?

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THE CAPE CHARLES MIRROR March 29, 2020

Opinion: Is Our Healthcare System Broken, or Badly Bent?


Opinion by Paul Plante

As we American people watch this incredible spectacle unfolding around us, with panic spreading and chaos looming large on the horizon as the lights of America blink out and the nation gets literally shut down, with people in San Francisco ordered to “shelter in place,” and New York City threatening to follow suit, this in response to a virus that has so far killed one hundred and eight (108) people in America out of a population of some 330 million, with some 6300 diagnosed cases as of this writing, in all likelihood we missed an article in Marketwatch entitled “Norwegian university urges students to return home from the U.S., cites ‘poorly developed health services’” by Shawn Langlois published March 15, 2020, wherein was stated as follows, to wit:

The U.S. health-care system?

The Norwegian University of Science and Technology clearly isn’t impressed, so it’s urging students studying there to come home immediately.

The university later tweaked the language in the Facebook post so as not to single out the United States, but by then, the slight emerged as a top-trending topic across social media:

“In accordance with the recommendations from the Ministry of Foreign Affairs NTNU strongly recommends that all NTNU students who are outside Norway return home,”

“This applies especially if you are staying in a country with poorly developed health services and infrastructure and/or collective infrastructure, for example, the USA.”

The U.S. health-care system has come under increased scrutiny in recent days as the coronavirus outbreak spreads across the country.

end quotes

So, is the US getting a bad rap there, with Norway accusing us of being a country with poorly developed health services?

Is that unfair?

Should we institute some real serious sanctions against the Norwegians to make them real sorry they ever thought to think that way, let alone state it in public, as they have chosen to do?

Or my goodness gracious me, could it possibly be true?

Are we really living in a country with poorly developed health services as the Norwegians say?

Or is it a question of them simply not understanding or comprehending how protection of the public’s health in this country was supposed to be provided, if we didn’t have a public health protection system in this country, especially here in corrupt New York state to the north of Cape Charles, where Democratic Socialist “strongman” Young Andy Cuomo is running around in a frightful panic calling on Trump to send in the Army, that was either broken, as is the case in New York and has been since the 1970s, when Democrat Hugh Carey was governor, or badly bent?

Given that life in America has literally come to a screeching halt, and we are not really going any place, especially on a cruise right now, as a qualified associate level public health engineer knowledgeable of the history of public health, not only in America, but throughout history, going back to the Cloaca Maxima (lit. Greatest Sewer), one of the world’s earliest sewage systems constructed in Ancient Rome in order to remove the waste of one of world’s most populous cities initially constructed around 600 BC under the orders of the king of Rome, Tarquinius Priscus, I thought this a good time to delve into the serious question of who really is responsible for protecting the public’s health here in the United States of America, and it is not the federal government, as we clearly see from our own history, to wit:

Health Care: Constitutional Rights and Legislative Powers

Kathleen S. Swendiman Legislative Attorney

April 5, 2010

Congressional Research Service 7-5700 www.crs.gov R40846

Summary

The health care reform debate raises many complex issues including those of coverage, accessibility, cost, accountability, and quality of health care.

Underlying these policy considerations are issues regarding the status of health care as a constitutional or legal right.

This report analyzes constitutional and legal issues pertaining to a right to health care, as well as the power of Congress to enact and fund health care programs.

The United States Constitution does not set forth an explicit right to health care.

As a major component of many health care entitlement statutes, Congress has provided funding to pay for the health services provided under law.

Most of these statutes have been enacted pursuant to Congress’s authority to “make all Laws which shall be necessary and proper” to carry out its mandate “to … provide for the … general Welfare.”

The power to spend for the general welfare is one of the broadest grants of authority to Congress in the U.S. Constitution.

The Supreme Court accords considerable deference to a legislative decision by Congress that a particular health care spending program provides for the general welfare.

A number of state constitutions contain provisions relating to health and the provision of health care services.

State constitutions may provide constitutional rights that are more expansive than those found under the federal Constitution since federal rights set the minimum standards for the states.

end quotes

And how many people in America are aware of that reality, one must wonder, especially in the wake of all this hysteria and pandemonium unleashed by these hysteria mongers like Young Andy Cuomo of New York state?

And what of the people of Virginia?

Are they aware that the Commonwealth of Virginia has its own state Board of Health, which is a 15-member independent agency that regulates health facilities in the Commonwealth of Virginia, two members of which shall be members of the Medical Society of Virginia, one member shall be a member of the Virginia Pharmaceutical Association, one member shall be a member of the State Dental Association, one member shall be a member of the Virginia Nurses’ Association, one member shall be a member of the Virginia Veterinary Medical Association, one member shall be a representative of local government, one member shall be a representative of the hospital industry, one member shall be a representative of the nursing home industry, one member shall be a representative of the licensed health carriers responsible under Title 38.2 for a managed care health insurance plan, one member shall be a corporate purchaser of health care, two members shall be consumers, one member shall have public environmental health expertise, and one member shall be a representative of the emergency medical services community recommended by the State Emergency Medical Services Advisory Board?

Are they aware that Board is the policy-making arm of the Virginia Department of Health and the law gives the Board a variety of important duties such as establishing the framework for Virginia’s public health services as well as also approving regulations for the Department of Health?

Would they know that it works, or is supposed to work if the system is not broken, with the Virginia Health Planning Board to consider issues of health care policy and financing and issues formal studies on these subject?

And of importance to this specific subject of public health protection, would they know that the Board is supposed to promote health education and outreach, for example, by setting the Department of Health’s program of patient and community health education services to include services addressing health promotion and disease prevention, and encouraging the coordination of local and private sector health education services?

As to COVID, this latest public health “threat” that seems right now overblown with reports coming in today of people in Los Angeles in long lines outside of supermarkets waiting to get in to find the shelves empty of what they need to survive, the Board has the emergency authority to issue “orders and regulations to meet any emergency, not provided for by general regulations, for the purpose of suppressing nuisances dangerous to the public health and communicable, contagious and infectious diseases and other dangers to the public life and health.”

So, have they done that?

Does anyone have a clue?

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thelivyjr
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Re: Is Our Healthcare System Broken, or Badly Bent?

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THE CAPE CHARLES MIRROR March 30, 2020 at 6:44 pm

Paul Plante says :

First of all, with respect to this COVID CRISIS HYSTERIA swirling around us and getting more hysterical by the day, thanks to the main stream media who are stoking this crisis to put New York governor Andy Cuomo in the White House in November to replace Trump, let me sincerely say as somebody from the last century who was born with an exceptionally low tolerance for BULL**** which age has done nothing to improve, that we all have to thank the Cape Charles Mirror for its diligence in bringing these important issues forward for public discussion, and Wayne Creed for his courage and patriotism for making a place for that discussion to be able to happen, because it is not going to happen on CNN, nor will it happen in the New York Times or the Albany, New York Times Union.

And getting back on topic here, by now, we know that at least in New York, our system of public health has been dismantled and made ineffective by Andy Cuomo, himself, for political reasons related to denial of honest services, and thus, public corruption, which brings us to the essential existential question of, is there anything beyond my opinion to support a judgment that our system of public health protection in this country is not functioning properly, and since I never express an opinion on something as important to us all, especially to our grandchildren for those of us who care about them, let’s go to a National Institute of Health (NIH) publication titled “The Future of the Public’s Health in the 21st Century – The Governmental Public Health Infrastructure,” where we are informed as follows:

Weaknesses in the nation’s governmental public health infrastructure were clearly demonstrated in the fall of 2001, when the once-hypothetical threat of bioterrorism became all too real with the discovery that many people had been exposed to anthrax from letters sent through the mail.

Communication among federal, state, and local health officials and with political leaders, public safety personnel, and the public was often cumbersome, uncoordinated, incomplete, and sometimes inaccurate.

Laboratories were overwhelmed with testing of samples, both real and false.

Many of these systemic weaknesses were well known to public health professionals, but resources to address them had been insufficient.

A strong and effective governmental public health infrastructure is essential not only to respond to crises such as these but also to address ongoing challenges such as preventing or managing chronic illnesses, controlling infectious diseases, and monitoring the safety of food and water.

The fragmentation of the governmental public health infrastructure is in part a direct result of the way in which governmental roles and responsibilities at the federal, state, and local levels have evolved over U.S. history.

This history also explains why the nation lacks a comprehensive national health policy that could be used to align health-sector investment, governmental public health agency structure and function, and incentives for the private sector to work more effectively as part of a broader public health system.

end quotes

Just another gummint report sitting on a shelf somewhere getting dust on it, and today, in real time and in real life, thanks to the goodness of Al Gore’s heart and Wayne Creed and the Cape Charles Mirror, we are getting to talk about and prepare an After-Action Report about how miserably that fragmented and intentionally-broken governmental public health infrastructure has failed us in our times with respect to what is now known in upstate New York as the CUOMO COVID CLUSTER**** CIRCUS, and with good reason.

As to responsibilities, that report continues as follows:

From a historical and constitutional perspective, public health is largely a local and state function.

The role of the states and localities is a primary and important one.

The federal government, however, has the resources, expertise, and the obligation to assess the health of the nation and to make recommendations for its improvement.

Ensuring a sound public health infrastructure is an urgent matter, and the committee urges the federal government to engage in planning for national and regional funding to accomplish this.

end quotes

And clearly, as we are witnessing right now in real time, that was never done, and it is We, the People who suffer for it!

Getting back to that report:

PRIOR ASSESSMENTS OF THE PUBLIC HEALTH INFRASTRUCTURE

In 1988, The Future of Public Health (IOM, 1988) reported that the American public health system, particularly its governmental components, was in disarray.

end quotes

Actually, by 1988, it was one big ******* mess, as we can clearly see from the CCM thread “Should Sonia Sotomayor resign in disgrace,” and now it is worse, which takes us right back to that report, to wit:

Limited Progress

Despite this progress, the committee found that in many important ways, the public health system that was in disarray in 1988 remains in disarray today.

Many of the recommendations from The Future of Public Health have not been put into action.

Finding continued disarray in the public health system is especially disturbing because the nation faces increasingly diverse threats and challenges.

The early detection of and the response to these threats will depend on capacity and expertise within the public health system at every level.

The gaps in the system warrant urgent remediation.

This support has not been forthcoming from elected or appointed government officials (including those in control of budgets), and stakeholders in the broader public health system — who should have been partners in the vision of creating a healthier nation — have yet to be effectively mobilized in this effort.

end quotes

Except those gaps were never plugged and with a grid-locked federal government, truly can anyone be surprised that our public health system is grossly inadequate to the task facing us today, after the anthrax debacle we have already experienced, which takes us back to that report one last time as follows:

Organization of the Federal Public Health Infrastructure

At the federal level, the lead entity responsible for public health activities is DHHS.

The U.S. Congress oversees the activities of federal agencies through committees that review the authorization of programs and the appropriation of funds.

Multiple committees in both the House of Representatives and the Senate have jurisdiction over DHHS programs and health-related activities in other departments.

These multiple authorities and congressional jurisdictions are an important reason for the “disarray” noted in previous IOM reports.

end quotes

And there is why we have such a serious problem on our hands today with a public health system in this country not even as good as what one would find in such third-world countries as Haiti and Somalia.

God bless America, but ain’t it just great!

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thelivyjr
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Re: Is Our Healthcare System Broken, or Badly Bent?

Post by thelivyjr »

THE CAPE CHARLES MIRROR April 2, 2020 at 9:52 pm

Paul Plante says :

To give us all a much-needed wake-up call as to just how embarrassingly pathetic the system of PUBLIC HEALTH PROTECTION is here in New York state, the epicenter of this COVID CRISIS, which helps to explain why NY is the epicenter, let us go to a New York Daily News article entitled “Trump and Cuomo accuse each other of not doing enough to combat coronavirus: ‘Do something!’” by Denis Slattery and Chris Sommerfeldt on 16 March 2020, where we are treated to the following spectacle involving NY’s Andy Cuomo, to wit:

President Trump and Gov. Cuomo turned the coronavirus crisis into a political punching bag Monday, accusing each other of not doing enough to combat the fast-spreading pandemic.

“Cuomo of New York has to ‘do more,’” Trump tweeted without elaborating.

Cuomo was quick to punch back.

“I have to do more?”

“No — YOU have to do something!”

“You’re supposed to be the president,” the governor posted in response.

end quotes

Ah, Andy, in case you were out sick that day, or were on vacation, or simply lost in space, Trump IS the president and has been since being inaugurated in 2017.

And protection and promotion of the public’s health in New York is NOT Trump’s responsibility!

Pursuant to § 201 of the New York State Public Health Law, “Functions, powers and duties of the department, it is the responsibility of the New York State Department of Health, to wit:

1. The department shall, as provided by law:

(a) supervise the work and activities of the local boards of health and health officers throughout the state, unless otherwise provided by law;

****

(c) supervise the reporting and control of disease;

****

(g) promote education in the prevention and control of disease;

end quotes

Except that is not happening and has not been happening since the mid-1970s in New York State, especially with respect to control of disease, as we are seeing all to clearly with this pathetic and incompetent response to COVID.

New York State Public Health Law § 206, entitled “Commissioner; general powers and duties,” then provides:

1. The commissioner shall:

a) take cognizance of the interests of health and life of the people of the state, and of all matters pertaining thereto and exercise the functions, powers and duties of the department prescribed by law.

end quotes

The functions, powers and duties of the department prescribed by law include the control of disease, and yet, as this crisis mounts, the New York State Health Commissioner, referred to by Trump a few weeks ago on local political radio as “Cuomo’s representative,” has been invisible.

New York State Public Health Law § 206 further states thusly:

(d) investigate the causes of disease, epidemics, the sources of mortality, and the effect of localities, employments and other conditions, upon the public health.

end quotes

Again, that is not being done.

Getting back to the Daily News article:

Cuomo sent an open letter to Trump Sunday asking for assistance before the state’s hospitals are overrun.

“You will have people on gurneys in hallways,” Cuomo said during a press conference in Albany Monday morning.

“That is what is going to happen now if we do nothing.”

“That is what is going to happen now if we do nothing.”

“And that, my friends, will be a tragedy.”

end quotes

Yes, governor Andy, it will be, and who we have to thank for that is YOU, not Trump, despite your foolish and childish “pass the blame” game here to deflect attention away from the fact that by dismantling the New York State Department of Health system of public health protection here in New York State, which dereliction of duty is detailed in a series of some 70 separate essays by myself labeled collectively as the TALK-1300 REPORT ( viewtopic.php?f=16&t=139&p=22498&hilit= … ury#p22498 ).

Getting back to the Daily News:

“I want federal guidance,” Cuomo said.

“This is a national pandemic, but there are no national rules.”

end quotes

And that is simply a very stupid and ignorant statement by Cuomo, because there are indeed national rules easily accessible by anyone with a computer, as we can clearly see by going to the National Conference of State Legislatures website under “Responsibilities in a Public Health Emergency” on 10/29/2014, to wit:

The preservation of the public health has historically been the responsibility of state and local governments.

Clarity in leadership is crucial in a joint federal, state, and local response to any event which could cause harm to the public’s health.

The public health authority of the states derive from the police powers granted by their constitutions and reserved to them by the 10th Amendment to the U.S. Constitution.

The basis for the federal governments’ authority to prescribe a quarantine and other health measures is based on the Commerce Clause, which gives Congress exclusive authority to regulate interstate and foreign commerce.

To be specific, a comprehensive public health response to avert the spread of highly contagious diseases may call for the isolation of people, the quarantining of a community exposed to the infectious disease or both.

Quarantine typically refers to the “separation of individuals who have been exposed to an infection but are not yet ill from others who have not been exposed to the transmissible infection.” In contrast, isolation refers to the “(s)eperation of infected individuals from those who are not infected.”

Primary quarantine authority typically resides with state health departments and health officials; however, the federal government has jurisdiction over interstate and foreign quarantine.

In addition, the federal government may assist with or take over the management of an intrastate incident if requested by a state or if the federal government determines local efforts are inadequate.

end quotes

One would think that a real hot-shot lawyer like Andy Cuomo would not only be able to read that, but to actually comprehend it as well, since it is written is real, plain, easy-to-understand English language.

So what is really going on here?

For that answer, let us go to an Albany Times Union article entitled “As Legislature returns to Albany, $6 billion deficit awaits” by Cayla Harris on January 5, 2020, to wit:

Budget deficit

New York is facing a $6.1 billion problem.

It’s the largest state budget gap since the Great Recession, mostly attributed to $4 billion in Medicaid overspending.

end quotes

Hmmmm, Medicaid overspending?

Now, before we go further, Andy Cuomo has been governor of New York since 2011, and before him, his father Mario was Secretary of State of New York from 1975 to 1978, and Lieutenant Governor of New York from 1979 to 1982, and Governor of New York for three terms, from 1983 to 1994.

As to Medicaid overspending in New York, we have a long history going back at least to 1976, and a New York Times article on the subject of “Medicaid Mills” in New York entitled “New York’s Medicaid ‘Mills’: A Growing Number of Inquiries, With Patients Caught in the Middle” by Pranay Gupte on Nov. 23, 1976, which detailed the fraud and corruption in the system at that time.

From there we go to an NBC article entitled “Suspected ‘Medicaid Mills’ Raided in Harlem, Bronx: AG” published October 18, 2016, as follows:

State investigators raided a pair of New York City clinics Tuesday under suspicion that they were operating as so-called “Medicaid Mills.”

Investigators said that health care providers at both offices are suspected of talking patients into taking unnecessary tests so they could bill Medicaid for the procedures.

Investigators said that many of the doctors and nurses at the two facilities were not qualified to conduct some of the procedures.

end quotes

Moving forward in time to thr reign of Andy Cuomo as governor, we then come to a New York Daily News article entitled “Health care hacks charged in ‘Medicaid mill’ scam that conned thousands of needy New Yorkers with promise of free shoes” by Oren Yaniv on Mar 31, 2015, to wit:

The other shoe has dropped.

Nearly two dozen people, including nine dirty doctors, were fingered in a so-called Medicaid mill scam that netted millions of dollars over several years — by luring in needy New Yorkers with the promise of free tennis shoes.

Thousands of people were fooled into taking part in unnecessary medical tests while fraudsters overcharged state welfare programs for the unnecessary exams, prosecutors charged on Tuesday.

“At the heart of this welfare fraud scheme was the exploitation of poor people,” said Brooklyn District Attorney Kenneth Thompson.

“These people were used as pawns because they wanted footwear.”

The plot netted nearly $7 million in improper reimbursements between October 2012 and September 2014, according to a 199-count indictment against 23 defendants and eight firms.

Eric Vainer, 43, and his mother, Polina Vainer, 66, ran the illegal enterprise out of a Sunset Park medical equipment company where the matriarch served as a manager.

The younger Vainer sent recruiters to homeless shelters and soup kitchens hawking free shoes for Medicaid and Medicare patients, prosecutors charged.

Unassuming clients were then shuttled by van to “corrupt clinics” in Brooklyn and the Bronx, where they allegedly received unnecessary tests and procedures before being fitted with generic insoles or braces from the Vainers warehouse while Medicaid was billed hundreds of dollars for custom devices, prosecutors said.

The podiatrists, cardiologists and one vascular specialist ensnared in the scheme are accused of only giving cursory exams.

The basement in at least one clinic resembled an off-brand shoe store with piles of footwear boxes, Thompson said on Tuesday.

“This was a Medicaid mill,” Thompson added, estimating that thousands of patients went through the program, which has likely been around for years.

During the undercover operation, which included surveillance and wiretaps, Eric Vainer was heard saying, “We can use the same patients as guinea pigs for everything we want.”

At the height of the scam, Vainer’s chief recruiter, Bernard Rorie, 59, regularly circled low-income neighborhoods looking for clients.

“Free sneakers, free shoes,” he can be heard shouting outside a Brooklyn soup kitchen in a secretly-recorded video.

Meanwhile, advertisements promised a Metrocard, “a nutritional meal” and “nails cut” for those using the participating podiatric facilities, prosecutors said.

Authorities said Vainer shared the profits with physicians who worked with him.

“The alleged conduct here is absolutely disgraceful,” said Human Resources Administration Commissioner Steven Banks, whose agency took part in the probe.

“This is absolutely unacceptable.”

end quotes

And people are wondering why we now have a public health crisis in this state which has expanded to cover a good part of the whole nation.

Go figure.

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Re: Is Our Healthcare System Broken, or Badly Bent?

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THE CAPE CHARLES MIRROR April 4, 2020 at 9:57 pm

Paul Plante says :

If there was any doubt about the public health protection system in the corrupt third-world socialist ****hole of New York being intentionally broken, that doubt is easily dispelled by going to a POLITICO article entitled “Here’s every law and regulation Cuomo had suspended during coronavirus crisis” by Bill Mahoney on 03/19/2020, where we have as follows:

ALBANY — When Gov. Andrew Cuomo declared a state of emergency in response to the coronavirus crisis on March 7, he gained extraordinary powers over the everyday lives of the state’s 19.5 million residents.

Thanks in part to a statutory change which the Legislature approved at the beginning of March, Cuomo’s declaration means he can change or suspend laws unilaterally, so long as doing so assists the state in its disaster response.

Some of Cuomo’s subsequent actions, such as the forced closings of restaurants and schools, have since made international headlines.

But the bulk of his executive orders, which have been issued at dizzying speed and some of which amend dozens of laws, have received far less notice.

POLITICO has sorted through all of the laws and regulations that Cuomo has suspended and translated them into plain English.

Here’s a look at what he had done as of early Thursday evening.

HEALTH

Medical facilities


— Department of Health regulations governing the discharge of patients have been suspended.

Hospitals, for example, will no longer need to explain to a patient or a patient’s family member why a decision has been made to remove them from a bed.

— The requirements for assessing patients entering long-term care have been relaxed.

So have the requirements for screening patients entering nursing homes.

— A regulation requiring patients entering nursing homes to have gotten approval from a physician first is no longer effective, and initial patient visits with individuals receiving home care no longer need to occur immediately.

— A massive section of regulations on the “minimum standards” governing hospitals — dealing with everything from patients’ rights to the maintaining of records — has been suspended “to the extent necessary to maintain the public health with respect to treatment or containment of individuals with or suspected to have COVID-19.”

— Regulations governing the physical space occupied by clinical laboratories is no longer effective “to the extent necessary to permit [them] to operate temporary collecting stations to collect specimen from individuals suspected of suffering from a COVID-19 infection.”

— The Office for People With Developmental Disabilities can now increase the occupancy of residential facilities for the disabled without going through an approval process or notifying local governments.

These facilities will no longer need to create written treatment plans for individuals who have newly come under their care if they need to focus on providing immediate treatment.

Facilities can take actions that limit their developmentally disabled residents’ ability to receive visitors or go on community actions.

They can also “temporarily deviate from an individual’s service plan” if doing so protects that individual.

And people hired to work in OPWDD facilities can receive “abbreviated training.”

Medical staff

— The Commissioner of Health will be able to establish a new training program that will let individuals who are not currently registered as nurses engage in tasks that one currently needs to be licensed for.

They’ll be able to “collect throat or nasopharyngeal swab specimens” from potentially infected individuals and will generally be able to perform all other tasks “otherwise limited to the scope of practice of a licensed or registered nurse” as long as they’re being supervised by a nurse.

— A series of regulations dealing with nursing supervision is suspended to let “visits for personal care services provided to individuals affected by the disaster emergency” occur more quickly than they otherwise would be.

— People who are not licensed in the state as clinical laboratory technicians, but do “meet the federal requirements for high complexity testing,” will be allowed to preform Covid-19 tests.

— Doctors and nurse practitioners will be able to give nurses blanket authority to perform Covid-19 tests without supervision.

— Physicians who are licensed anywhere in the country are now eligible to practice in New York without getting a state license.

The same goes for nurse practitioners, physicians assistants and nurses.

And individuals applying to work at hospitals can skip much of the rigorous screening process mandated by law if they’re already credentialed to work at a hospital in another state.

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