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Generate an explanation for the given claim using the provided supporting material from the paragraph. Please consider the following points while generating an output. 1) The claim will always have supporting proof in the paragraph, and the paragraph will have a clear point of view supporting the claim. 2) There can be instances where direct correlation to the claim is not available. Make use of the sentences in the paragraph to provide a corresponding output supporting the claim. 3) The explanation should be at least one and at most twelve sentences long.
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Paragraph: In its latest “report card,” the American College of Emergency Physicians said such reduced access earned the nation a “D+” — that’s down from the overall “C-“ grade from the group’s last report in 2009. Shortages and reduced hospital capacity make it more difficult to access emergency care, the group said. It also warned about the impact on disaster preparedness. While the report does not measure the actual quality of care provided, it does offer a snapshot of national and state policies affecting emergency medicine as seen by providers. Washington, D.C., was ranked the highest in the report, earning a “B-“ grade, while Wyoming ranked last and was the only state to earn an overall failing grade of “F.”  The group’s task force looked at scores of measure in five major categories — access to care, quality and patient safety, liability, injury prevention and disaster preparedness — and relied on data from the Centers for Disease Control and the Centers for Medicare and Medicaid Services, among others. The report comes just as the Affordable Care Act, known as Obamacare, comes into full effect this year. The 2010 law aims to expand access to health insurance and reduce the nation’s healthcare costs, but it has become a political flashpoint amid a troubled rollout of the federal insurance exchange website. While the physician’s report does not factor in all of the effects of the law — its grades are based on data from early 2013 — emergency rooms could be used even more as more Americans gain insurance coverage under Obamacare, it said. Some health experts have predicted that increasing the number of insured patients should reduce pressure on hospital emergency rooms because access to regular doctor care will improve, something that is hoped would prevent chronic conditions from spiraling out of control or help catch other problems before they worsen. But insurance coverage could also lead those who might have held off going to the emergency room to seek care, said Jon Mark Hirshon, an emergency medicine doctor and researcher at the University of Maryland who oversaw the group’s report card. Newly insured people also may have a hard time finding a regular doctor who accepts their plan, he said. “On top of that, emergency departments are open 24 hours a day, seven days a week. If I have a primary care provider but it’s 9 o’clock at night on a Friday and they’re closed, then people come to the emergency department,” Hirshon told Reuters. The group is asking for congressional hearings to probe whether the law puts “additional strains” on emergency rooms. Already, beds for patients have fallen from a rate of 358 per 100,000 people four years ago to about 330 beds per 100,000 people now, the report said. Wait times have increased to a median of 4.5 hours compared to four hours in 2009. Despite the dismal U.S. grade given by the group, it noted that policies and infrastructure varied widely by state. States with the best emergency care include Massachusetts, Maine, Nebraska and Colorado, while Kentucky, Montana, New Mexico and Arizona rounded out the bottom, just above Wyoming. States are also still grappling with the uninsured. By law, hospitals must provide emergency care regardless of patients’ ability to pay. Under Obamacare, states can expand access to Medicaid, the federal-state health insurance plan for the poor. Data shows that Medicaid patients use emergency rooms as much as other insured patients, but several recent studies have shown that Medicaid patients utilize them more than the uninsured. One study this month showed Oregon patients given Medicaid through a lottery increased their emergency room use by 40 percent compared to those not offered Medicaid. “We have to be leaner and more efficient, but it just becomes more and more challenging,” Hirshon said. Claim: Doctors say pressure on ERs may rise, give U.S. failing grade.
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People seeking urgent medical could face longer wait times and other challenges as demand increases under Obamacare, U.S. emergency doctors said in a report on Thursday that gives the nation’s emergency infrastructure a near failing grade.


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Paragraph: A recent count found 350 million purple sea urchins on one Oregon reef alone — more than a 10,000% increase since 2014. And in Northern California, 90% of the giant bull kelp forests have been devoured by the urchins, perhaps never to return. Vast “urchin barrens” — stretches of denuded seafloor dotted with nothing but hundreds of the spiny orbs — have spread to coastal Oregon, where kelp forests were once so thick it was impossible to navigate some areas by boat. The underwater annihilation is killing off important fisheries for red abalone and red sea urchins and creating such havoc that scientists in California are partnering with a private business to collect the over-abundant purple urchins and “ranch” them in a controlled environment for ultimate sale to a global seafood market. “We’re in uncharted territory,” said Scott Groth, a shellfish scientist with the Oregon Department of Fish and Wildlife. “You can’t just go out and smash them. There’s too many. I don’t know what we can do.” The explosion of purple sea urchins is the latest symptom of a Pacific Northwest marine ecosystem that’s out of whack. Kelp has been struggling because of warmer-than-usual waters in the Pacific Ocean. And, in 2013, a mysterious disease began wiping out tens of millions of starfish, including a species called the sunflower sea star that is the only real predator of the ultra-hardy purple urchin. Around the same time, the purple urchins had two excellent breeding years — and with no predators, those gametes grew up and are now eating everything in sight. “You can imagine all of these small urchins growing up, each one of them looking for food, desperate for food. They’re literally starving out there,” said Steven Rumrill, lead shellfish expert at Oregon’s wildlife agency. “I’ve seen some big-scale fluctuations in the populations of sea stars and urchins, but never on this magnitude.” Scientists are not yet sure if climate change is responsible for the sea urchin explosion, but they suspect it plays a role in the cascade of events that allowed the purple urchins to boom. And kelp, already under siege from warming waters, is not as resilient as it once was, said Norah Eddy, an associate director at the Nature Conservancy California’s oceans program. “We’re going to see climate change as a big driver of changes in kelp forest as we move forward, and we are already seeing that,” said Eddy, who is leading an effort to use drones to map and monitor Northern California’s last remaining kelp forests. The devastation is also economic: Until now, red abalone and red sea urchins, a larger and meatier species of urchin, supported a thriving commercial fishery in both states. But 96% of red abalone have disappeared from California’s northern coast as the number of purple sea urchins increased six fold, according to a study released this week by the University of California, Davis. Last year, California closed its red abalone fishery, which poured an estimated $44 million into the coastal economy per year, and Oregon suspended permits for its 300 abalone divers for three years. The commercial harvest of red sea urchins in California and Oregon also has taken a massive hit. “That’s a huge economic loss for our small coastal communities,” said Cynthia Catton, a research associate with the University of California, Davis Bodega Marine Lab. “In California, there were 30,000 to 40,000 participants in (the abalone) fishery every year for decades, and for the first time ever that fishery had to close.” And while the purple urchins have eaten themselves into starvation as well, unlike other kelp-dependent creatures, the species can go into a dormant state, stop reproducing and live for years with no food. That means the only way to restore the kelp is to remove or destroy the purple urchins. Scientists estimate that in Oregon alone, it would take 15 to 20 years to remove all 100 million pounds (45 million kilograms) of purple urchins recently surveyed on just one large reef. While urchins are in starvation mode, the edible part — known as roe — shrivels, making them commercially worthless. Against this backdrop, conservationists, commercial urchin harvesters, scientists and private interests are coming together with an unusual plan: Pay underemployed red sea urchin divers to collect the shriveled, but living, purple sea urchins and transfer them to carefully tended urchin “ranches” to be fattened up for sale to seafood markets around the world. One company, Urchinomics, is already working on urchin ranching projects in Japan, Canada and California and sees a future where the overwhelming demand for wild urchin roe is replaced by a taste for human-raised purple urchins collected from the seafloor, allowing kelp forests to rebound. “We’re turning an ecological problem into an ecological opportunity and an economic opportunity,” said Brian Takeda, the Urchinomics CEO. “It’s the first time we’ve ever had an economic incentive to get these destructive urchins out of the water.” In Oregon, red urchin divers are a tiny artisanal collective, but they are also exploring ways to try to turn the glut of destructive purple urchins to their advantage. Oregon’s urchin fishery had a boom year last year, when red urchins were scarce in California but before their purple cousins had spread north. Now, they too are hurting. Rumrill, the shellfish expert from Oregon, supports efforts to harvest excess urchins but strikes a less optimistic note when it comes to saving the kelp. “That’s a promising technique. But we shouldn’t fool ourselves into thinking that we’re going to solve this large-scale ecological problem, this literal perfect storm of events, by eating our way out,” he said. “It’s just too big a problem.” ___ Chea reported from Mendocino County, California. ___ Follow Gillian Flaccus on Twitter at http://www.twitter.com/gflaccus . Claim: Swarm of sea urchins wreaks destruction on US West Coast.
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Tens of millions of voracious purple sea urchins that have already chomped their way through towering underwater kelp forests in California are spreading north to Oregon, sending the delicate marine ecosystem off the shore into such disarray that other critical species are starving to death.


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Paragraph: As the criminal case moves toward possible trial this year, related pending lawsuits reflect a battle over blame. A look at where things stand: THE ALLEGATIONS  The Columbus-area Mount Carmel Health System determined William Husel ordered excessive doses for nearly three dozen patients over several years, though it said the doses likely weren’t what caused six of those deaths. Reviewers found that in many cases, the drugs were accessed by overriding a dispensing system. Husel was fired in December 2018, weeks after a concern was raised. Mount Carmel later said three patients died during those weeks after receiving excessive doses he ordered. ___ CRIMINAL CASE  Last June, Husel was charged with murder in 25 deaths and pleaded not guilty in one of the biggest cases of its kind ever brought against a U.S. health care professional. He was charged only in cases involving 500 to 2,000 micrograms of the powerful painkiller fentanyl – doses so unusually large that prosecutors said it indicated an intent to snuff out lives. His initial lawyer said Husel was providing comfort care to dying patients, not trying to kill them. Husel’s current lawyers in the criminal case — including Florida-based Jose Baez, who is known for successfully defending high-profile clients such as Casey Anthony and Aaron Hernandez — haven’t said much publicly about his motives. Husel’s lawyers in civil cases contend that he provided appropriate care and that Mount Carmel misled the public about what happened. Mount Carmel publicly apologized, tightened its drug policies, fired other employees and changed leadership but has stood by its investigation and subsequent decisions. “There is nothing more important to us than our patients’ safety and their trust in us — and we will do everything in our power to continue to improve,” it said in an emailed statement Tuesday. Trial for Husel, 44, is currently scheduled for June. _____ LOTS OF LAWSUITS  More than 30 lawsuits have been filed against Mount Carmel in the matter, and it has agreed to more than $13 million in related settlements so far. Husel and Mount Carmel unsuccessfully argued the remaining lawsuits should be put on hold until the criminal case is resolved. Husel also has filed lawsuits. One against Mount Carmel and its parent company, Michigan-based Trinity Health, alleges defamation. Another against Trinity and its insurer seeks to force them to cover costs of his defense in the criminal case, just as in civil cases against him. _____ FORMER COLLEAGUES  Authorities aren’t prosecuting those who administered the drugs, though they have faced other fallout. Mount Carmel said it fired 23 nurses, pharmacists and managers after its internal investigation. Ten of Husel’s former colleagues recently sued Mount Carmel for defamation and, in some cases, wrongful termination. The group of mostly nurses decried a “ false narrative of an evil rogue doctor and his complicit staff” and said the spread of that narrative damaged their lives and livelihoods regardless of whether they were fired. Three pharmacists and 25 nurses still face potential disciplinary action from their respective state boards and have administrative hearings scheduled in the coming months. Husel is in line for one, too, after the Ohio State Medical Board suspended his license. It hadn’t previously disciplined him. ___ Follow Franko on Twitter at http://www.twitter.com/kantele10. Claim: Amid doc’s murder case, lawsuits reflect battle over blame.
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In the year since an Ohio hospital system announced an intensive care doctor had ordered excessive painkillers for dozens of patients who then died, the allegations led to murder charges against him, lawsuits, firings and potential disciplinary action for some of his colleagues.