WASHINGTON (AP) — U.S. defense officials say they are worried about an insider attack or other threat from service members involved in securing President-elect Joe Biden’s inauguration, prompting the FBI to vet all of the 25,000 National Guard troops coming into Washington for the event.

The massive undertaking reflects the extraordinary security concerns that have gripped Washington following the deadly Jan. 6 insurrection at the U.S. Capitol by pro-Trump rioters. And it underscores fears that some of the very people assigned to protect the city over the next several days could present a threat to the incoming president and other VIPs in attendance.

Army Secretary Ryan McCarthy told The Associated Press on Sunday that officials are conscious of the potential threat, and he warned commanders to be on the lookout for any problems within their ranks as the inauguration approaches. So far, however, he and other leaders say they have seen no evidence of any threats, and officials said the vetting hadn’t flagged any issues.

”We’re continually going through the process, and taking second, third looks at every one of the individuals assigned to this operation,” McCarthy said in an interview after he and other military leaders went through an exhaustive, three-hour security drill in preparation for Wednesday’s inauguration. He said Guard members are also getting training on how to identify potential insider threats.

About 25,000 members of the National Guard are streaming into Washington from across the country — at least two and a half times the number for previous inaugurals. And while the military routinely reviews service members for extremist connections, the FBI screening is in addition to any previous monitoring.

Multiple officials said the process began as the first Guard troops began deploying to D.C. more than a week ago. And they said it is slated to be complete by Wednesday. Several officials discussed military planning on condition of anonymity.

“The question is, is that all of them? Are there others?” said McCarthy. “We need to be conscious of it and we need to put all of the mechanisms in place to thoroughly vet these men and women who would support any operations like this.”

In a situation like this one, FBI vetting would involve running peoples’ names through databases and watchlists maintained by the bureau to see if anything alarming comes up. That could include involvement in prior investigations or terrorism-related concerns, said David Gomez, a former FBI national security supervisor in Seattle.

Insider threats have been a persistent law enforcement priority in the years after the Sept. 11, 2001, attacks. But in most cases, the threats are from homegrown insurgents radicalized by al-Qaida, the Islamic State group or similar groups. In contrast, the threats against Biden’s inauguration have been fueled by supporters of President Donald Trump, far-right militants, white supremacists and other radical groups. Many believe Trump’s baseless accusations that the election was stolen from him, a claim that has been refuted by many courts, the Justice Department and Republican officials in key battleground states.

The insurrection at the Capitol began after Trump made incendiary remarks at the Jan. 6 rally. According to McCarthy, service members from across the military were at that rally, but it’s not clear how many were there or who may have participated in the breach at the Capitol. So far only a couple of current active-duty or National Guard members have been arrested in connection with the Capitol assault, which left five people dead. The dead included a Capitol Police officer and a woman shot by police as she climbed through a window in a door near the House chamber.

Gen. Daniel R. Hokanson, chief of the National Guard Bureau, has been meeting with Guard troops as they arrive in D.C. and as they gather downtown. He said he believes there are good processes in place to identify any potential threats.

“If there’s any indication that any of our soldiers or airmen are expressing things that are extremist views, it’s either handed over to law enforcement or dealt with the chain of command immediately,” he said.

The insider threat, however, was just one of the security concerns voiced by officials on Sunday, as dozens of military, National Guard, law enforcement and Washington, D.C., officials and commanders went through a security rehearsal in northern Virginia. As many as three dozen leaders lined tables that ringed a massive color-coded map of D.C. reflected onto the floor. Behind them were dozens more National Guard officers and staff, with their eyes trained on additional maps and charts displayed on the wall.

The Secret Service is in charge of event security, but there is a wide variety of military and law enforcement personnel involved, ranging from the National Guard and the FBI to Washington’s Metropolitan Police Department, U.S. Capitol Police and U.S. Park Police.

Commanders went over every aspect of the city’s complicated security lockdown, with McCarthy and others peppering them with questions about how the troops will respond in any scenario and how well they can communicate with the other enforcement agencies scattered around the city.

Hokanson said he believes his troops have been adequately equipped and prepared, and that they are rehearsing as much as they can to be prepared for any contingency.

The major security concern is an attack by armed groups of individuals, as well as planted explosives and other devices. McCarthy said intelligence reports suggest that groups are organizing armed rallies leading up to Inauguration Day, and possibly after that.

The bulk of the Guard members will be armed. And McCarthy said units are going through repeated drills to practice when and how to use force and how to work quickly with law enforcement partners. Law enforcement officers would make any arrests.

He said Guard units are going through “constant mental repetitions of looking at the map and talking through scenarios with leaders so they understand their task and purpose, they know their routes, they know where they’re friendly, adjacent units are, they have the appropriate frequencies to communicate with their law enforcement partners.”

The key goal, he said, is for America’s transfer of power to happen without incident.

“This is a national priority. We have to be successful as an institution,” said McCarthy. “We want to send the message to everyone in the United States and for the rest of the world that we can do this safely and peacefully.”

<figure>
 <img src="https://media.eaglewebservices.com/public/2021/1/1610939789454.png" alt="H Street at Massachusetts Avenue and 3rd Street in the District of Columbia Sunday night-image DC traffic camera" />
 <figcaption>H Street at Massachusetts Avenue and 3rd Street in the District of Columbia Sunday night-image DC traffic camera</figcaption>
 </figure>WASHINGTON (AP) — U.S. defense officials say they are worried about an insider attack or other threat from service members involved in securing President-elect Joe Biden’s inauguration, prompting the FBI to vet all of the 25,000 National Guard troops coming into Washington for the event.The massive undertaking reflects the extraordinary security concerns that have gripped Washington following the deadly Jan. 6 insurrection at the U.S. Capitol by pro-Trump rioters. And it underscores fears that some of the very people assigned to protect the city over the next several days could present a threat to the incoming president and other VIPs in attendance.<figure>
 <img src="https://media.eaglewebservices.com/public/2021/1/1610835825899.png" alt="Army Secretary Ryan McCarthy meeting with National Guard Troops in Washington- Photo courtesy Secretary of the U.S. Army" />
 <figcaption>Army Secretary Ryan McCarthy meeting with National Guard Troops in Washington- Photo courtesy Secretary of the U.S. Army</figcaption>
 </figure>Army Secretary Ryan McCarthy told The Associated Press on Sunday that officials are conscious of the potential threat, and he warned commanders to be on the lookout for any problems within their ranks as the inauguration approaches. So far, however, he and other leaders say they have seen no evidence of any threats, and officials said the vetting hadn’t flagged any issues.”We’re continually going through the process, and taking second, third looks at every one of the individuals assigned to this operation,” McCarthy said in an interview after he and other military leaders went through an exhaustive, three-hour security drill in preparation for Wednesday’s inauguration. He said Guard members are also getting training on how to identify potential insider threats.About 25,000 members of the National Guard are streaming into Washington from across the country — at least two and a half times the number for previous inaugurals. And while the military routinely reviews service members for extremist connections, the FBI screening is in addition to any previous monitoring.Multiple officials said the process began as the first Guard troops began deploying to D.C. more than a week ago. And they said it is slated to be complete by Wednesday. Several officials discussed military planning on condition of anonymity.“The question is, is that all of them? Are there others?” said McCarthy. “We need to be conscious of it and we need to put all of the mechanisms in place to thoroughly vet these men and women who would support any operations like this.”In a situation like this one, FBI vetting would involve running peoples’ names through databases and watchlists maintained by the bureau to see if anything alarming comes up. That could include involvement in prior investigations or terrorism-related concerns, said David Gomez, a former FBI national security supervisor in Seattle.Insider threats have been a persistent law enforcement priority in the years after the Sept. 11, 2001, attacks. But in most cases, the threats are from homegrown insurgents radicalized by al-Qaida, the Islamic State group or similar groups. In contrast, the threats against Biden’s inauguration have been fueled by supporters of President Donald Trump, far-right militants, white supremacists and other radical groups. Many believe Trump’s baseless accusations that the election was stolen from him, a claim that has been refuted by many courts, the Justice Department and Republican officials in key battleground states.The insurrection at the Capitol began after Trump made incendiary remarks at the Jan. 6 rally. According to McCarthy, service members from across the military were at that rally, but it’s not clear how many were there or who may have participated in the breach at the Capitol. So far only a couple of current active-duty or National Guard members have been arrested in connection with the Capitol assault, which left five people dead. The dead included a Capitol Police officer and a woman shot by police as she climbed through a window in a door near the House chamber.Gen. Daniel R. Hokanson, chief of the National Guard Bureau, has been meeting with Guard troops as they arrive in D.C. and as they gather downtown. He said he believes there are good processes in place to identify any potential threats.“If there’s any indication that any of our soldiers or airmen are expressing things that are extremist views, it’s either handed over to law enforcement or dealt with the chain of command immediately,” he said.The insider threat, however, was just one of the security concerns voiced by officials on Sunday, as dozens of military, National Guard, law enforcement and Washington, D.C., officials and commanders went through a security rehearsal in northern Virginia. As many as three dozen leaders lined tables that ringed a massive color-coded map of D.C. reflected onto the floor. Behind them were dozens more National Guard officers and staff, with their eyes trained on additional maps and charts displayed on the wall.The Secret Service is in charge of event security, but there is a wide variety of military and law enforcement personnel involved, ranging from the National Guard and the FBI to Washington’s Metropolitan Police Department, U.S. Capitol Police and U.S. Park Police.Commanders went over every aspect of the city’s complicated security lockdown, with McCarthy and others peppering them with questions about how the troops will respond in any scenario and how well they can communicate with the other enforcement agencies scattered around the city.Hokanson said he believes his troops have been adequately equipped and prepared, and that they are rehearsing as much as they can to be prepared for any contingency.The major security concern is an attack by armed groups of individuals, as well as planted explosives and other devices. McCarthy said intelligence reports suggest that groups are organizing armed rallies leading up to Inauguration Day, and possibly after that.The bulk of the Guard members will be armed. And McCarthy said units are going through repeated drills to practice when and how to use force and how to work quickly with law enforcement partners. Law enforcement officers would make any arrests.He said Guard units are going through “constant mental repetitions of looking at the map and talking through scenarios with leaders so they understand their task and purpose, they know their routes, they know where they’re friendly, adjacent units are, they have the appropriate frequencies to communicate with their law enforcement partners.”The key goal, he said, is for America’s transfer of power to happen without incident.“This is a national priority. We have to be successful as an institution,” said McCarthy. “We want to send the message to everyone in the United States and for the rest of the world that we can do this safely and peacefully.”___

FBI vetting Guard troops in DC amid fears of insider attack

LOS ANGELES (AP) — California’s state epidemiologist is urging a halt to more than 300,000 coronavirus vaccinations using a Moderna vaccine version because some people received medical treatment for possible severe allergic reactions.

Dr. Erica S. Pan on Sunday recommended providers stop using lot 41L20A of the Moderna vaccine pending completion of an investigation by state officials, Moderna, the U.S. Centers for Disease Control and the federal Food and Drug Administration.

“Out of an extreme abundance of caution and also recognizing the extremely limited supply of vaccine, we are recommending that providers use other available vaccine inventory,” Pan said in a statement.

She said more than 330,000 doses from the lot arrived in California between Jan. 5 and Jan. 12 and were distributed to 287 providers.

Fewer than 10 people, who all received the vaccine at the same community site, needed medical attention over a 24-hour period, Pan said. No other similar clusters were found.

Pan did not specify the number of cases involved or where they occurred.

However, six San Diego health care workers had allergic reactions to vaccines they received at a mass vaccination center on Jan. 14. The site was temporarily closed and is now using other vaccines, KTGV-TV reported.

Moderna in a statement said the company “is unaware of comparable adverse events from other vaccination centers which may have administered vaccines from the same lot.”

The CDC has said COVID-19 vaccines can cause side effects for a few days that include fever, chills, headache, swelling or tiredness, “which are normal signs that your body is building protection.”

However, severe reactions are extremely rare. Pan said in a vaccine similar to Moderna, the rate of anaphylaxis — in which an immune system reaction can block breathing and cause blood pressure to drop — was about 1 in 100,000.

The announcement came as California counties continue to plead for more COVID-19 vaccine as the state tries to reduce its rate of infection, which has led to record numbers of hospitalizations and deaths.

California, with a population of 40 million, has shipped about about 3.2 million doses of the vaccine — which requires two doses for full immunization — to local health departments and health care systems, the state’s Department of Public Health reported Monday.

Only about 1.4 million of those doses, or around 40%, have been administered.

So far. the state has vaccinated fewer than 2,500 people per 100,000 residents, a rate that falls well below the national average, according to federal data.

Although Gov. Gavin Newsom announced last week that anyone age 65 and older would be eligible to start receiving the vaccine, Los Angeles County and some others have said they do not have enough doses to vaccinate so many people and are first concentrating on inoculating health care workers and the most vulnerable elderly living in care homes.

On Monday, the superintendent of the Los Angeles Unified School District sent a letter to state and county public health officials asking for authorization to provide COVID-19 vaccinations at schools for staff, local community members and for students once a vaccine for children has been approved.

“Doing so will help reopen schools as soon as possible, and in the safest way possible,” Superintendent Austin Beutner wrote.

California is nearing 3 million coronavirus cases and more than 33,600 people have died since the start of the pandemic last year, according to figures from Johns Hopkins University.

The death rate from COVID-19 in Los Angeles County — the nation’s most populous and an epicenter of the state pandemic — works out to about one person every six minutes.

On Sunday, the South Coast Air Quality Management District suspended some pollution-control limits on the number of cremations for at least 10 days in order to deal with a backlog of bodies at hospitals and funeral homes.

“The current rate of death is more than double that of pre-pandemic years,” the agency said.

LOS ANGELES (AP) — California’s state epidemiologist is urging a halt to more than 300,000 coronavirus vaccinations using a Moderna vaccine version because some people received medical treatment for possible severe allergic reactions.Dr. Erica S. Pan on Sunday recommended providers stop using lot 41L20A of the Moderna vaccine pending completion of an investigation by state officials, Moderna, the U.S. Centers for Disease Control and the federal Food and Drug Administration.“Out of an extreme abundance of caution and also recognizing the extremely limited supply of vaccine, we are recommending that providers use other available vaccine inventory,” Pan said in a statement.She said more than 330,000 doses from the lot arrived in California between Jan. 5 and Jan. 12 and were distributed to 287 providers.Fewer than 10 people, who all received the vaccine at the same community site, needed medical attention over a 24-hour period, Pan said. No other similar clusters were found.Pan did not specify the number of cases involved or where they occurred.However, six San Diego health care workers had allergic reactions to vaccines they received at a mass vaccination center on Jan. 14. The site was temporarily closed and is now using other vaccines, KTGV-TV reported.Moderna in a statement said the company “is unaware of comparable adverse events from other vaccination centers which may have administered vaccines from the same lot.”The CDC has said COVID-19 vaccines can cause side effects for a few days that include fever, chills, headache, swelling or tiredness, “which are normal signs that your body is building protection.”However, severe reactions are extremely rare. Pan said in a vaccine similar to Moderna, the rate of anaphylaxis — in which an immune system reaction can block breathing and cause blood pressure to drop — was about 1 in 100,000.The announcement came as California counties continue to plead for more COVID-19 vaccine as the state tries to reduce its rate of infection, which has led to record numbers of hospitalizations and deaths.California, with a population of 40 million, has shipped about about 3.2 million doses of the vaccine — which requires two doses for full immunization — to local health departments and health care systems, the state’s Department of Public Health reported Monday.Only about 1.4 million of those doses, or around 40%, have been administered.So far. the state has vaccinated fewer than 2,500 people per 100,000 residents, a rate that falls well below the national average, according to federal data.Although Gov. Gavin Newsom announced last week that anyone age 65 and older would be eligible to start receiving the vaccine, Los Angeles County and some others have said they do not have enough doses to vaccinate so many people and are first concentrating on inoculating health care workers and the most vulnerable elderly living in care homes.On Monday, the superintendent of the Los Angeles Unified School District sent a letter to state and county public health officials asking for authorization to provide COVID-19 vaccinations at schools for staff, local community members and for students once a vaccine for children has been approved.“Doing so will help reopen schools as soon as possible, and in the safest way possible,” Superintendent Austin Beutner wrote.California is nearing 3 million coronavirus cases and more than 33,600 people have died since the start of the pandemic last year, according to figures from Johns Hopkins University.The death rate from COVID-19 in Los Angeles County — the nation’s most populous and an epicenter of the state pandemic — works out to about one person every six minutes.On Sunday, the South Coast Air Quality Management District suspended some pollution-control limits on the number of cremations for at least 10 days in order to deal with a backlog of bodies at hospitals and funeral homes.“The current rate of death is more than double that of pre-pandemic years,” the agency said.

Health official urges stop to 300K vaccines after some fall ill

TOPEKA (AP) —Small groups of right-wing protesters — some of them carrying rifles — gathered outside heavily fortified statehouses around the country Sunday, outnumbered by National Guard troops and police brought in to prevent a repeat of the violence that erupted at the U.S. Capitol. As darkness fell, there were no reports of any clashes.

Security was stepped up in recent days after the FBI warned of the potential for armed protests in Washington and at all 50 state capitol buildings ahead of President-elect Joe Biden’s inauguration on Wednesday.

Crowds of only a dozen or two demonstrated at some boarded-up, cordoned-off statehouses, while the streets in many other capital cities remained empty. Some protesters said they were there to back President Donald Trump. Others said they had instead come to voice their support for gun rights or decry government overreach.

“I don’t trust the results of the election,” said Michigan protester Martin Szelag, a 67-year-old semi-retired window salesman from Dearborn Heights. He wore a sign around his neck that read, in part, “We will support Joe Biden as our President if you can convince us he won legally. Show us the proof! Then the healing can begin.”

As the day wore on with no bloodshed around the U.S., a sense of relief spread among officials, though they were not ready to let their guard down.

The heavy law enforcement presence may have kept turnout down. In the past few days, some extremists had warned others against falling into what they called a law enforcement trap.

Washington State Patrol spokesman Chris Loftis said he hoped the apparently peaceful day reflected some soul-searching among Americans.

“I would love to say that it’s because we’ve all taken a sober look in the mirror and have decided that we are a more unified people than certain moments in time would indicate,” he said.

The security measures were intended to safeguard seats of government from the type of violence that broke out at the U.S. Capitol on Jan. 6, when far-right Trump supporters galvanized by his false claims that the election had been stolen from him overran the police and bashed their way into the building while Congress was certifying the Electoral College vote.

The attack left a Capitol police officer and four others dead. More than 125 people have been arrested over the insurrection.

Dozens of courts, election officials and Trump’s own attorney general have all said there was no evidence of widespread fraud in the presidential race.

On Sunday, some statehouses were surrounded by new security fences, their windows were boarded up, and extra officers were on patrol. Legislatures generally were not in session over the weekend.

Tall fences also surrounded the U.S. Capitol. The National Mall was closed to the public, and the mayor of Washington asked people not to visit. Some 25,000 National Guard troops from around the country are expected to arrive in the city in the coming days.

The roughly 20 protesters who showed up at Michigan’s Capitol, including some who were armed, were significantly outnumbered by law enforcement officers and members of the media. Tensions have been running high in the state since authorities foiled a plot to kidnap Democratic Gov. Gretchen Whitmer last year.

At the Ohio Statehouse, about two dozen people, including several carrying long guns, protested outside under the watchful eyes of state troopers before dispersing as it began to snow.

Kathy Sherman, who was wearing a visor with “Trump” printed on it, said she supports the president but distanced herself from the mob that breached the U.S. Capitol.

“I’m here to support the right to voice a political view or opinion without fear of censorship, harassment or the threat of losing my job or being physically assaulted,” she said.

Ohio Gov. Mike DeWine, a Republican, said he was pleased with the outcome but stressed that authorities “continue to have concerns for potential violence in the coming days, which is why I intend to maintain security levels at the Statehouse as we approach the presidential inauguration.”

Utah’s new governor, Republican Spencer Cox, shared photos on his Twitter account showing him with what appeared to be hundreds of National Guard troops and law enforcement officers standing behind him, all wearing masks. Cox called the quiet protests a best-case scenario and said many ”agitating groups” had canceled their plans for the day.

At Oregon’s Capitol, fewer than a dozen men wearing military-style outfits, black ski masks and helmets stood nearby with semiautomatic weapons slung across their bodies. Some had upside-down American flags and signs reading such things as “Disarm the government.”

At the Texas Capitol, Ben Hawk walked with about a dozen demonstrators up to the locked gates carrying a bullhorn and an AR-15 rifle hanging at the side of his camouflage pants. He condemned the insurrection at the U.S. Capitol and said he did not support Trump.

“All we came down here to do today was to discuss, gather, network and hang out. And it got blown and twisted completely out of proportion,” Hawk said.

At Nevada’s Capitol, where demonstrators supporting Trump have flocked most weekends in recent months, all was quiet except for a lone protester with a sign.

“Trump Lost. Be Adults. Go Home,” it read.

More than a third of governors had called out the National Guard to help protect their capitols and assist local law enforcement. Several governors declared states of emergency, and others closed their capitols to the public until after Biden’s inauguration.

Some legislatures also canceled sessions or pared back their work for the coming week.

Even before the violence at the Capitol, some statehouses had been the target of vandals and angry protesters during the past year.

Last spring, armed protesters entered the Michigan Capitol to object to coronavirus lockdowns. People angry over the death of George Floyd under a Minneapolis police officer’s knee vandalized capitols in several states, including Colorado, Ohio, Texas and Wisconsin.

Last last month, crowds in Oregon forced their way into the Capitol in Salem to protest its closure to the public during a special legislative session on coronavirus measures.

Amid the potential for violence in the coming days, the building’s first-floor windows were boarded up and the National Guard was brought in.

“The state Capitol has become a fortress,” said Oregon Senate President Peter Courtney, a Democrat. “I never thought I’d see that. It breaks my heart.”

<figure>
 <img src="https://media.eaglewebservices.com/public/2021/1/1610934546602.png" alt="Photo courtesy Missouri State Highway Patrol" />
 <figcaption>Photo courtesy Missouri State Highway Patrol</figcaption>
 </figure>TOPEKA (AP) —Small groups of right-wing protesters — some of them carrying rifles — gathered outside heavily fortified statehouses around the country Sunday, outnumbered by National Guard troops and police brought in to prevent a repeat of the violence that erupted at the U.S. Capitol. As darkness fell, there were no reports of any clashes.Security was stepped up in recent days after the FBI warned of the potential for armed protests in Washington and at all 50 state capitol buildings ahead of President-elect Joe Biden’s inauguration on Wednesday.Crowds of only a dozen or two demonstrated at some boarded-up, cordoned-off statehouses, while the streets in many other capital cities remained empty. Some protesters said they were there to back President Donald Trump. Others said they had instead come to voice their support for gun rights or decry government overreach.“I don’t trust the results of the election,” said Michigan protester Martin Szelag, a 67-year-old semi-retired window salesman from Dearborn Heights. He wore a sign around his neck that read, in part, “We will support Joe Biden as our President if you can convince us he won legally. Show us the proof! Then the healing can begin.”As the day wore on with no bloodshed around the U.S., a sense of relief spread among officials, though they were not ready to let their guard down.The heavy law enforcement presence may have kept turnout down. In the past few days, some extremists had warned others against falling into what they called a law enforcement trap.Washington State Patrol spokesman Chris Loftis said he hoped the apparently peaceful day reflected some soul-searching among Americans.“I would love to say that it’s because we’ve all taken a sober look in the mirror and have decided that we are a more unified people than certain moments in time would indicate,” he said.The security measures were intended to safeguard seats of government from the type of violence that broke out at the U.S. Capitol on Jan. 6, when far-right Trump supporters galvanized by his false claims that the election had been stolen from him overran the police and bashed their way into the building while Congress was certifying the Electoral College vote.The attack left a Capitol police officer and four others dead. More than 125 people have been arrested over the insurrection.Dozens of courts, election officials and Trump’s own attorney general have all said there was no evidence of widespread fraud in the presidential race.On Sunday, some statehouses were surrounded by new security fences, their windows were boarded up, and extra officers were on patrol. Legislatures generally were not in session over the weekend.Tall fences also surrounded the U.S. Capitol. The National Mall was closed to the public, and the mayor of Washington asked people not to visit. Some 25,000 National Guard troops from around the country are expected to arrive in the city in the coming days.The roughly 20 protesters who showed up at Michigan’s Capitol, including some who were armed, were significantly outnumbered by law enforcement officers and members of the media. Tensions have been running high in the state since authorities foiled a plot to kidnap Democratic Gov. Gretchen Whitmer last year.At the Ohio Statehouse, about two dozen people, including several carrying long guns, protested outside under the watchful eyes of state troopers before dispersing as it began to snow.Kathy Sherman, who was wearing a visor with “Trump” printed on it, said she supports the president but distanced herself from the mob that breached the U.S. Capitol.“I’m here to support the right to voice a political view or opinion without fear of censorship, harassment or the threat of losing my job or being physically assaulted,” she said.Ohio Gov. Mike DeWine, a Republican, said he was pleased with the outcome but stressed that authorities “continue to have concerns for potential violence in the coming days, which is why I intend to maintain security levels at the Statehouse as we approach the presidential inauguration.”Utah’s new governor, Republican Spencer Cox, shared photos on his Twitter account showing him with what appeared to be hundreds of National Guard troops and law enforcement officers standing behind him, all wearing masks. Cox called the quiet protests a best-case scenario and said many ”agitating groups” had canceled their plans for the day.At Oregon’s Capitol, fewer than a dozen men wearing military-style outfits, black ski masks and helmets stood nearby with semiautomatic weapons slung across their bodies. Some had upside-down American flags and signs reading such things as “Disarm the government.”At the Texas Capitol, Ben Hawk walked with about a dozen demonstrators up to the locked gates carrying a bullhorn and an AR-15 rifle hanging at the side of his camouflage pants. He condemned the insurrection at the U.S. Capitol and said he did not support Trump.“All we came down here to do today was to discuss, gather, network and hang out. And it got blown and twisted completely out of proportion,” Hawk said.At Nevada’s Capitol, where demonstrators supporting Trump have flocked most weekends in recent months, all was quiet except for a lone protester with a sign.“Trump Lost. Be Adults. Go Home,” it read.More than a third of governors had called out the National Guard to help protect their capitols and assist local law enforcement. Several governors declared states of emergency, and others closed their capitols to the public until after Biden’s inauguration.Some legislatures also canceled sessions or pared back their work for the coming week.Even before the violence at the Capitol, some statehouses had been the target of vandals and angry protesters during the past year.Last spring, armed protesters entered the Michigan Capitol to object to coronavirus lockdowns. People angry over the death of George Floyd under a Minneapolis police officer’s knee vandalized capitols in several states, including Colorado, Ohio, Texas and Wisconsin.Last last month, crowds in Oregon forced their way into the Capitol in Salem to protest its closure to the public during a special legislative session on coronavirus measures.Amid the potential for violence in the coming days, the building’s first-floor windows were boarded up and the National Guard was brought in.“The state Capitol has become a fortress,” said Oregon Senate President Peter Courtney, a Democrat. “I never thought I’d see that. It breaks my heart.”___

Heavy fortified statehouses around the US see small protests

WAHOO, Neb. (AP) — Police seized 27 pounds of marijuana and arrested a New York woman in the eastern Nebraska town of Wahoo. 

Wahoo Police said a 61-year-old woman from Jamestown, New York, was arrested Friday after officers discovered the drugs. 

Police said the woman was traveling from New York to California when she was arrested. 

She was arrested on suspicion of possessing more than a pound of marijuana with the intent to sell it. 

WAHOO, Neb. (AP) — Police seized 27 pounds of marijuana and arrested a New York woman in the eastern Nebraska town of Wahoo. Wahoo Police said a 61-year-old woman from Jamestown, New York, was arrested Friday after officers discovered the drugs. Police said the woman was traveling from New York to California when she was arrested. She was arrested on suspicion of possessing more than a pound of marijuana with the intent to sell it. Police didn’t identify the woman.

Police seize 27 pounds of marijuana in Nebraska arrest

By CELIA LLOPIS-JEPSEN <a href="https://www.kcur.org/news/2021-01-11/you-now-have-the-right-to-know-your-hospitals-prices-and-heres-how-experts-hope-that-will-help">Kansas News Service</a>

A skin biopsy at <a href="https://www.lmh.org/patients-visitors/understanding-your-hospital-costs/" target="_blank">Lawrence Memorial Hospital</a>
 goes for anywhere from $95 to $600. It all depends on who receives the 
bill. Removing a skin lesion, anywhere from about $120 to $920.

Now, because hospitals <a href="https://www.cms.gov/hospital-price-transparency" target="_blank">had to release</a> millions of previously secret prices on Jan. 1, the public can see just how common price differences like these are.

Health
 care experts say the massive data dump — huge spreadsheets of 
headache-inducing medical jargon and arcane billing codes — will be 
difficult for people to translate into what they’d actually pay. You’d 
still need to understand copays and other factors.

“The vast majority of patients are not equipped to make use of this,” said Amanda Hunt, deputy director of the <a href="https://www.healthcarevaluehub.org/application/files/3015/6322/4395/RB_27_-_Revealing_the_Truth_About_Healthcare_Price_Transparency.pdf" target="_blank">Healthcare Value Hub</a>. “Consumers need to know what the cost of a service is to them.”

One
 saving grace: Hospitals had to put out more easily understandable, 
albeit much shorter price disclosures, to help the public look up 
hundreds of medical services. Some hospitals launched slick <a href="https://mychart.kansashealthsystem.com/MyChart/GuestEstimates/AcceptDisclaimer?svcArea=7kjTk8rQug28NWjTHRZ%2F%2FA%3D%3D&amp;isMultiSA=false" target="_blank">interactive tools</a>.
 You put in your insurance information to find out the price under your 
health plan, and how much might come out of your pocket.

But the 
even bigger news, some say, flows from the potential that employers — 
armed with help from analysts who specialize in making sense of millions
 of data points — could mine the unprecedented trove of prices to press 
for better deals.

The <a href="https://www.aha.org/news/headline/2020-12-18-cms-says-it-will-audit-some-hospitals-january-compliance-price" target="_blank">American Hospital Association</a>
 says the results could be “anticompetitive” once insurers and employers
 can see the rates that others get. Prices might even go up.

Health
 care researchers agree prices could rise in some situations. But 
overall they see potential for the transparency to help rein in 
eye-popping inflation.

“The information should be out there,” said
 Maanasa Kona, a professor at the Georgetown University Center on Health
 Insurance Reforms. “This transparency is an experiment worth 
undertaking.”

From 2003 to 2016, charges to employers <a href="https://www.kcur.org/news/2020-09-25/employers-compared-notes-on-secret-prices-at-kansas-hospitals-to-boost-their-leverage-on-costs" target="_blank">rose nearly 75%</a>
 for knee replacements and 135% for appendectomies, compared to broader 
economic inflation of about 30%, the Kaiser Family Foundation says. 
Higher prices, even when ostensibly footed largely by employers, 
ultimately hurt the little guy in the form of smaller paychecks or worse
 benefits.

Which prices became public on Jan. 1, and where can you find them?

Not
 all Kansas hospitals have complied with the Trump administration’s new 
price transparency rule. Some said they are working out the final kinks,
 all while dealing with a global pandemic that has hospitals 
understaffed and reeling.

Others didn’t respond to questions from the Kansas News Service about it.

A
 big caveat: All prices are estimates. Your situation can change. You 
could go in for a routine childbirth and end up having a C-section. The 
estimates also may not include a whole boatload of related fees.

If your hospital has posted the data, it can still be hard to find what you’re looking for.

“I
 looked around at a couple of hospital websites,” said Niall Brennan, 
CEO of the Health Care Cost Institute and former chief data officer for 
the Centers for Medicare and Medicaid Services. “I'm pretty data savvy 
and I was, like, ‘Jesus, this is hard.’”

“We’re a long way from achieving that goal,” Brennan said.

I
 ran price checks to see what giving birth costs at two different 
hospitals, because that’s a typical service that people have time to 
shop for in advance. Both websites got me quick answers that showed what
 I and my employer might expect to pay. (Specific to my insurance.)

<a href="https://www.lmh.org/patients-visitors/understanding-your-hospital-costs/" target="_blank">LMH Health</a> showed these options and prices:

<a href="https://mychart.kansashealthsystem.com/MyChart/GuestEstimates/AcceptDisclaimer?svcArea=7kjTk8rQug28NWjTHRZ%2F%2FA%3D%3D&amp;isMultiSA=false" target="_blank">The University of Kansas Health System</a> offered these:

The descriptions and billing codes didn’t match. And
 KU’s estimate displays physician fees, while the LMH site says its 
estimates are “for hospital charges only and (do) not include any 
physician or other professional fees.” A patient would clearly have to 
call the hospitals for more information.

“It’s important to know 
clearly what is included and excluded in the price,” said Bill Kampine, 
cofounder of Healthcare Bluebook. But the explanations aren’t always 
clear. “Many of the sites that I’ve reviewed so far are a little 
inconsistent.”

How might employers end up using this data?

Kampine’s
 company, as implied by its Bluebook name, has spent more than a decade 
piecing together prices from medical claims and other sources to help 
employers peer into the black box and get more for their money.

The
 biggest boon from this month’s data dump could come when companies like
 his, as well as policymakers, academics and nonprofit groups start 
mining the massive spreadsheets.

The data could eventually feed into price tools like those created by <a href="https://www.healthcarebluebook.com/explore-free-tool/" target="_blank">Healthcare Bluebook</a> or <a href="https://www.guroo.com/#!" target="_blank">The Health Care Cost Institute</a>. Researchers could uncover markets with unusually high prices, as <a href="https://www.kcur.org/news/2020-09-25/employers-compared-notes-on-secret-prices-at-kansas-hospitals-to-boost-their-leverage-on-costs" target="_blank">RAND</a> did in Indiana. Major employers and health plans could pressure the priciest hospitals to accept less for a hip replacement, <a href="https://www.healthcarevaluehub.org/application/files/3015/6322/4395/RB_27_-_Revealing_the_Truth_About_Healthcare_Price_Transparency.pdf" target="_blank">as the California Public Employees’ Retirement System did</a>. Employers could see when insurers aren’t getting them a good deal.

“Depending on which insurance policy you have,” Brennan said, “we are seeing five-, eight-, tenfold differences in prices.”

Medicare
 and Medicaid prices tend to be the bottom of the range. Prices charged 
to commercial insurers can be “sky high” he said, and vary a lot.

Insight will take time — assuming the prices remain public.

The
 American Hospital Association battled the Trump administration’s new 
rule in court, arguing that publishing prices wouldn’t help patients 
anyway. Billing is complex and so is health care. A surgery involves not
 just a surgeon, but many related expenses.

The group lost its court case, but it has called on the incoming Biden administration <a href="https://www.aha.org/lettercomment/2020-12-11-aha-outlines-initial-policy-priorities-biden-administration" target="_blank">to ditch</a> the requirement.

Celia
 Llopis-Jepsen reports on consumer health and education for the Kansas 
News Service. You can follow her on Twitter @celia_LJ or email her at 
celia@kcur.org.

<figure>
 <img src="https://media.eaglewebservices.com/public/2021/1/1610389572281.png" alt=" Carlos Moreno / KCUR" />
 <figcaption> Carlos Moreno / KCUR</figcaption>
 </figure>By CELIA LLOPIS-JEPSEN <a href="https://www.kcur.org/news/2021-01-11/you-now-have-the-right-to-know-your-hospitals-prices-and-heres-how-experts-hope-that-will-help">Kansas News Service</a>A skin biopsy at <a href="https://www.lmh.org/patients-visitors/understanding-your-hospital-costs/" target="_blank">Lawrence Memorial Hospital</a>
 goes for anywhere from $95 to $600. It all depends on who receives the 
bill. Removing a skin lesion, anywhere from about $120 to $920.Now, because hospitals <a href="https://www.cms.gov/hospital-price-transparency" target="_blank">had to release</a> millions of previously secret prices on Jan. 1, the public can see just how common price differences like these are.Health
 care experts say the massive data dump — huge spreadsheets of 
headache-inducing medical jargon and arcane billing codes — will be 
difficult for people to translate into what they’d actually pay. You’d 
still need to understand copays and other factors.“The vast majority of patients are not equipped to make use of this,” said Amanda Hunt, deputy director of the <a href="https://www.healthcarevaluehub.org/application/files/3015/6322/4395/RB_27_-_Revealing_the_Truth_About_Healthcare_Price_Transparency.pdf" target="_blank">Healthcare Value Hub</a>. “Consumers need to know what the cost of a service is to them.”One
 saving grace: Hospitals had to put out more easily understandable, 
albeit much shorter price disclosures, to help the public look up 
hundreds of medical services. Some hospitals launched slick <a href="https://mychart.kansashealthsystem.com/MyChart/GuestEstimates/AcceptDisclaimer?svcArea=7kjTk8rQug28NWjTHRZ%2F%2FA%3D%3D&amp;isMultiSA=false" target="_blank">interactive tools</a>.
 You put in your insurance information to find out the price under your 
health plan, and how much might come out of your pocket.But the 
even bigger news, some say, flows from the potential that employers — 
armed with help from analysts who specialize in making sense of millions
 of data points — could mine the unprecedented trove of prices to press 
for better deals.The <a href="https://www.aha.org/news/headline/2020-12-18-cms-says-it-will-audit-some-hospitals-january-compliance-price" target="_blank">American Hospital Association</a>
 says the results could be “anticompetitive” once insurers and employers
 can see the rates that others get. Prices might even go up.Health
 care researchers agree prices could rise in some situations. But 
overall they see potential for the transparency to help rein in 
eye-popping inflation.“The information should be out there,” said
 Maanasa Kona, a professor at the Georgetown University Center on Health
 Insurance Reforms. “This transparency is an experiment worth 
undertaking.”<figure>
 <img src="https://media.eaglewebservices.com/public/2020/9/1601308401778.png" alt="This story is part of the series, Bills of Health. Do you have a medical bill from Kansas that you want to share with a reporter? Email celia@kcur.org." />
 <figcaption>This story is part of the series, Bills of Health. Do you have a medical bill from Kansas that you want to share with a reporter? Email celia@kcur.org.</figcaption>
 </figure>From 2003 to 2016, charges to employers <a href="https://www.kcur.org/news/2020-09-25/employers-compared-notes-on-secret-prices-at-kansas-hospitals-to-boost-their-leverage-on-costs" target="_blank">rose nearly 75%</a>
 for knee replacements and 135% for appendectomies, compared to broader 
economic inflation of about 30%, the Kaiser Family Foundation says. 
Higher prices, even when ostensibly footed largely by employers, 
ultimately hurt the little guy in the form of smaller paychecks or worse
 benefits.Which prices became public on Jan. 1, and where can you find them?Not
 all Kansas hospitals have complied with the Trump administration’s new 
price transparency rule. Some said they are working out the final kinks,
 all while dealing with a global pandemic that has hospitals 
understaffed and reeling.Others didn’t respond to questions from the Kansas News Service about it.But hospitals should release:<ul>
 <li>Spreadsheets that reveal 
prices for each service under each health plan in their network. That’s 
where you’ll see that a single hospital can negotiate a wide variety of 
prices with insurers for the same exact brain scan or hernia patch. You 
should also see cash discount prices. Knowing those could help if you 
don’t have insurance or want to sidestep your insurance to get that 
discount.</li>
 </ul><ul>
 <li>A more user-friendly price list or tool that helps patients see what the hospital would charge for at least 300 procedures.</li>
 </ul>A
 big caveat: All prices are estimates. Your situation can change. You 
could go in for a routine childbirth and end up having a C-section. The 
estimates also may not include a whole boatload of related fees.If your hospital has posted the data, it can still be hard to find what you’re looking for.“I
 looked around at a couple of hospital websites,” said Niall Brennan, 
CEO of the Health Care Cost Institute and former chief data officer for 
the Centers for Medicare and Medicaid Services. “I'm pretty data savvy 
and I was, like, ‘Jesus, this is hard.’”Can you comparison shop?Not easily.“We’re a long way from achieving that goal,” Brennan said.I
 ran price checks to see what giving birth costs at two different 
hospitals, because that’s a typical service that people have time to 
shop for in advance. Both websites got me quick answers that showed what
 I and my employer might expect to pay. (Specific to my insurance.)<a href="https://www.lmh.org/patients-visitors/understanding-your-hospital-costs/" target="_blank">LMH Health</a> showed these options and prices:<ul>
 <li>“Vaginal delivery W O.R. proc except steril and/OR D&amp;C” ($5,866, of which I might pay an estimated $1,036)</li><li>“Vaginal delivery W sterilization/With complications” ($6,636.21, of which I might pay $1,114)</li><li>“Vaginal delivery W/O sterilization/without complications” ($5,471, of which I might pay an estimated $997)</li>
 </ul><a href="https://mychart.kansashealthsystem.com/MyChart/GuestEstimates/AcceptDisclaimer?svcArea=7kjTk8rQug28NWjTHRZ%2F%2FA%3D%3D&amp;isMultiSA=false" target="_blank">The University of Kansas Health System</a> offered these:<ul>
 <li>“Inpatient
 obstetric care for vaginal delivery, including pre and post-delivery 
care” ($26,173, of which I might pay an estimated $1,696)</li><li>“Inpatient
 obstetric care for vaginal delivery after prior cesarean delivery 
including pre and post-delivery care” ($30,874, of which I might pay 
$1,843)</li>
 </ul>The descriptions and billing codes didn’t match. And
 KU’s estimate displays physician fees, while the LMH site says its 
estimates are “for hospital charges only and (do) not include any 
physician or other professional fees.” A patient would clearly have to 
call the hospitals for more information.“It’s important to know 
clearly what is included and excluded in the price,” said Bill Kampine, 
cofounder of Healthcare Bluebook. But the explanations aren’t always 
clear. “Many of the sites that I’ve reviewed so far are a little 
inconsistent.”He thinks this will get better.How might employers end up using this data?Kampine’s
 company, as implied by its Bluebook name, has spent more than a decade 
piecing together prices from medical claims and other sources to help 
employers peer into the black box and get more for their money.The
 biggest boon from this month’s data dump could come when companies like
 his, as well as policymakers, academics and nonprofit groups start 
mining the massive spreadsheets.The data could eventually feed into price tools like those created by <a href="https://www.healthcarebluebook.com/explore-free-tool/" target="_blank">Healthcare Bluebook</a> or <a href="https://www.guroo.com/#!" target="_blank">The Health Care Cost Institute</a>. Researchers could uncover markets with unusually high prices, as <a href="https://www.kcur.org/news/2020-09-25/employers-compared-notes-on-secret-prices-at-kansas-hospitals-to-boost-their-leverage-on-costs" target="_blank">RAND</a> did in Indiana. Major employers and health plans could pressure the priciest hospitals to accept less for a hip replacement, <a href="https://www.healthcarevaluehub.org/application/files/3015/6322/4395/RB_27_-_Revealing_the_Truth_About_Healthcare_Price_Transparency.pdf" target="_blank">as the California Public Employees’ Retirement System did</a>. Employers could see when insurers aren’t getting them a good deal.“Depending on which insurance policy you have,” Brennan said, “we are seeing five-, eight-, tenfold differences in prices.”Medicare
 and Medicaid prices tend to be the bottom of the range. Prices charged 
to commercial insurers can be “sky high” he said, and vary a lot.Insight will take time — assuming the prices remain public.The
 American Hospital Association battled the Trump administration’s new 
rule in court, arguing that publishing prices wouldn’t help patients 
anyway. Billing is complex and so is health care. A surgery involves not
 just a surgeon, but many related expenses.The group lost its court case, but it has called on the incoming Biden administration <a href="https://www.aha.org/lettercomment/2020-12-11-aha-outlines-initial-policy-priorities-biden-administration" target="_blank">to ditch</a> the requirement.Celia
 Llopis-Jepsen reports on consumer health and education for the Kansas 
News Service. You can follow her on Twitter @celia_LJ or email her at 
celia@kcur.org.

You have the right to know hospital prices; here's how experts hope it helps

OMAHA, Neb. (AP) — Two major railroad workers unions have asked the Department of Homeland Security to beef up security on Amtrak and other passenger lines, including by creating a no-ride list akin to the no-fly list that prevents people identified as risks from boarding planes.

The unions said Wednesday that tougher security measures are needed in light of last week’s riot at the U.S. Capitol because people who took part in the insurrection and were subsequently placed on the no-fly list may turn to rail travel instead. The Sheet Metal, Air, Rail and Transportation Workers — Transportation Division, or SMART-TD, and the Brotherhood of Locomotive Engineers and Trainmen unions also urged federal regulators to add more security at train stations to screen passengers before they board.

“Even as of this hour, the only real requirement for a person to board a train is simply to have a ticket; nothing more, nothing less. There is no screening process. There is no TSA. And there are no significant statutes or regulations to penalize those willing to interfere with a train’s crew or to do harm on a train, especially not when compared to the airline industry,” the unions’ presidents, Jeremy Ferguson and Dennis Pierce, said in a joint statement, referring to the Transportation Security Administration.

Ferguson, of SMART-TD, acknowledged there would be a cost to creating a no-ride list, but he said it should be minimal considering that officials would simply be sharing the existing no-fly list with railroads.

The Department of Homeland Security has said it plans to enhance security at railroad stations in the Washington, D.C., area ahead of next Wednesday’s inauguration of President-elect Joe Biden, but it didn’t go into detail on its plans.

Jim Hall, who led the National Transportation Safety Board in the 1990s, said officials should take an in-depth look at railroad security now to ensure that passengers and the dangerous commodities that freight railroads haul are kept safe. He said the Capitol riot showed the threat posed by domestic terrorism.

“I really don’t think anybody could look at the Capitol scene that we all saw and not realize the potential is there for groups that do not have the interests of the United States at heart to affect our transportation system,” he said.

With more than 140,000 miles (225,300 kilometers) of track nationwide and hundreds of different railroads involved it would take time to determine how best to improve security across the network and likely billions of dollars to make the changes. Hall, though, said such a review is overdue.

“I think it’s time to take a hard look at that issue and not wait as we did in aviation to reform the system until after 9/11,” Hall said, referring to the Sept. 11 terrorist attacks. “I’d be surprised if anybody would debate that the current security system around our rail transportation in the United States is adequate to protect the people and the products.”

Amtrak CEO Bill Flynn said he supports the unions’ call for a no-ride list for railroads and that he thinks it should be a federal crime to assault a railroad worker, like it is to attack an airline industry worker. He said Amtrak plans to deploy additional police officers on its trains and at stations over the next few days.

“In addition to limiting ticket sales and requiring masks to be worn at all times, we are increasing our police enforcement to ensure strong compliance, remove noncomplying customers and ban those that don’t follow our policies,” Flynn said.

The unions also asked the Federal Railroad Administration to require more security, but that agency declined to intervene Thursday because the Department of Homeland Security has jurisdiction over such matters.

OMAHA, Neb. (AP) — Two major railroad workers unions have asked the Department of Homeland Security to beef up security on Amtrak and other passenger lines, including by creating a no-ride list akin to the no-fly list that prevents people identified as risks from boarding planes.The unions said Wednesday that tougher security measures are needed in light of last week’s riot at the U.S. Capitol because people who took part in the insurrection and were subsequently placed on the no-fly list may turn to rail travel instead. The Sheet Metal, Air, Rail and Transportation Workers — Transportation Division, or SMART-TD, and the Brotherhood of Locomotive Engineers and Trainmen unions also urged federal regulators to add more security at train stations to screen passengers before they board.“Even as of this hour, the only real requirement for a person to board a train is simply to have a ticket; nothing more, nothing less. There is no screening process. There is no TSA. And there are no significant statutes or regulations to penalize those willing to interfere with a train’s crew or to do harm on a train, especially not when compared to the airline industry,” the unions’ presidents, Jeremy Ferguson and Dennis Pierce, said in a joint statement, referring to the Transportation Security Administration.Ferguson, of SMART-TD, acknowledged there would be a cost to creating a no-ride list, but he said it should be minimal considering that officials would simply be sharing the existing no-fly list with railroads.The Department of Homeland Security has said it plans to enhance security at railroad stations in the Washington, D.C., area ahead of next Wednesday’s inauguration of President-elect Joe Biden, but it didn’t go into detail on its plans.Jim Hall, who led the National Transportation Safety Board in the 1990s, said officials should take an in-depth look at railroad security now to ensure that passengers and the dangerous commodities that freight railroads haul are kept safe. He said the Capitol riot showed the threat posed by domestic terrorism.“I really don’t think anybody could look at the Capitol scene that we all saw and not realize the potential is there for groups that do not have the interests of the United States at heart to affect our transportation system,” he said.With more than 140,000 miles (225,300 kilometers) of track nationwide and hundreds of different railroads involved it would take time to determine how best to improve security across the network and likely billions of dollars to make the changes. Hall, though, said such a review is overdue.“I think it’s time to take a hard look at that issue and not wait as we did in aviation to reform the system until after 9/11,” Hall said, referring to the Sept. 11 terrorist attacks. “I’d be surprised if anybody would debate that the current security system around our rail transportation in the United States is adequate to protect the people and the products.”Amtrak CEO Bill Flynn said he supports the unions’ call for a no-ride list for railroads and that he thinks it should be a federal crime to assault a railroad worker, like it is to attack an airline industry worker. He said Amtrak plans to deploy additional police officers on its trains and at stations over the next few days.“In addition to limiting ticket sales and requiring masks to be worn at all times, we are increasing our police enforcement to ensure strong compliance, remove noncomplying customers and ban those that don’t follow our policies,” Flynn said.The unions also asked the Federal Railroad Administration to require more security, but that agency declined to intervene Thursday because the Department of Homeland Security has jurisdiction over such matters.

Unions: Passenger rails need better security, no-ride list

TOPEKA (AP) —Responding to warnings of potentially violent demonstrations, governors across the nation are calling out National Guard troops, declaring states of emergency and closing their capitols to the public ahead of President-elect Joe Biden's inauguration.

Though details remain murky, demonstrations are expected at state capitols beginning Sunday and leading up to Biden's succession of President Donald Trump on Wednesday. State officials hope to avoid the type of violence that occurred Jan. 6, when a mob of Trump supporters stormed the U.S. Capitol, leaving a Capitol Police officer and four others dead.

The FBI has warned of the potential for violence at all state capitols and has said it is tracking an “&nbsp;<a href="https://apnews.com/article/biden-inauguration-capitol-siege-michael-pence-d3cc3004a5a1be9bd0a9cb8193d7d974">extensive amount of concerning online chatter,</a>&nbsp;” including calls for armed protests.

Governors across the country are sending thousands of National Guard troops to Washington, D.C., where the National Mall has been closed to the general public as part of an intense security effort. More than a dozen governors also have called out the Guard to protect their own state capitols and aid local law enforcement officers.

"We are prepared for the worst, but we remain hopeful that those who choose to demonstrate at our Capitol do so peacefully, without violence or destruction of property,” Michigan State Police Col. Joe Gasper said Friday, as Democratic Gov. Gretchen Whitmer announced the Guard's role.

Crews installed a six-foot fence around the Michigan Capitol ahead of expected protests, and ground-level windows were boarded up at a nearby building that houses the governor’s office. Gasper said an increased state police presence would remain at the statehouse at least through mid-February.

Some windows also were boarded at capitols in Wisconsin and Illinois, both of which activated the National Guard to help with security. Though the Wisconsin Capitol already was closed to the public because of the coronavirus, Democratic Gov. Tony Evers' administration told those who had been coming into the Capitol to instead work remotely for the rest of the month.

Law enforcement officials were reducing parking around the capitol building in Madison this weekend and urging people to avoid the area as they braced for potential unrest. There was only one known organized event for the day, an anti-fascist demonstration where free food, drinks and clothes were to be distributed.

California Gov. Gavin Newsom is mobilizing up to 1,000 National Guard members over concerns of civil unrest. State officials on Thursday erected a chain link fence around the Capitol, bolstering other temporary and permanent barriers. The California Highway Patrol is refusing to issue permits for rallies at the Capitol.

“We’re treating this very seriously and deploying significant resources to protect public safety, critical infrastructure and First Amendment Rights,” Newsom said in a video message. “But let me be clear: There will be no tolerance for violence."

Other governors were encouraging people to stay away from capitol buildings during the coming days. Ohio Gov. Mike DeWine, a Republican, closed the Capitol until after Biden's inauguration and activated hundreds of National Guard members.

Citing the possibility of armed protests, Kansas Gov. Laura Kelly on Friday began a one-week restriction on public access to the Capitol. Only those who have business with the Legislature or governor's office will be allowed inside, and they will have to provide an email showing they have a meeting or are testifying to a legislative committee.

Kelly and Pennsylvania Gov. Tom Wolf closed their Capitol buildings for a couple days next week, coinciding with the presidential inauguration. The Pennsylvania Capitol complex already had been closed to the general public because of the coronavirus pandemic, but the new order advises state employees who work in person to take off Tuesday and Wednesday; Monday is the Martin Luther King Jr. holiday.

“While we are not aware of any specific threats at this time, we want to act with an abundance of caution to keep employees safe,” Wolf’s administration said on its website.

Uncertainty heading into the weekend was a common theme among state officials and law enforcement officers. Many were enhancing security based on past demonstrations or general warnings but without specific expectations about how many protesters, if any, would show up outside state capitol buildings in the coming days.

The National Guard is supplementing security at Washington's capitol, where people broke a gate and entered the grounds of the governor's mansion last week. But Washington State Patrol spokesman Chris Loftis said Friday that there are “no known explicit threats" detailing the time, place and action of future demonstrations.

“We cannot be dismissive of the possible dangers but we should not be alarmists either,” Loftis said in an email to media. The state patrol “has been directed to meet this discomforting uncertainty with caution, preparedness, resolve, and calm — certainly, a wise course of action for all.”

Legislatures in several states, including Michigan, also were canceling or limiting their work next week.

Oregon’s Legislature will convene Tuesday. But the House and Senate have canceled floor sessions and committee hearings, and there will be no in-person meetings. Senate President Peter Courtney, a Democrat from Salem, said the decision was made after consulting with police. Last month, a violent crowd entered the Oregon Capitol, fought with police and damaged the building.

The Republican-led South Carolina House and Senate won't convene in full session next Tuesday or Wednesday, and committees will meet virtually. The Capitol building will be closed from Saturday through Wednesday “out of an abundance of caution,” state and local authorities said in a joint statement.

Republican leaders of the Missouri House also canceled session for next week. Though several House members had expressed security concerns following the unrest in the nation’s capitol, a written statement from GOP leadership cited a rising number of COVID-19 cases in the Capitol building as a reason for the cancellation.

New Mexico Gov. Michelle Lujan Grisham, a Democrat, and Utah Gov. Spencer Cox, a Republican, both declared states of emergency on Thursday ahead of potential demonstrations at their capitols. Fencing was installed in a wide radius around the New Mexico Capitol.

Cox’s order allows authorities to close the Utah Capitol grounds through next Thursday, the day after Biden’s inauguration.

“We respect the right of Utah residents to peaceably assemble as guaranteed in the U.S. Constitution,” Cox said in a statement. “But we draw the line at threats to physical safety or to the Utah Capitol building. No violence of any kind will be tolerated.”

<figure>
 <img src="https://media.eaglewebservices.com/public/2021/1/1610659131053.png" alt="Photo courtesy Kansas Capitol Police" />
 <figcaption>Photo courtesy Kansas Capitol Police</figcaption>
 </figure>TOPEKA (AP) —Responding to warnings of potentially violent demonstrations, governors across the nation are calling out National Guard troops, declaring states of emergency and closing their capitols to the public ahead of President-elect Joe Biden's inauguration.Though details remain murky, demonstrations are expected at state capitols beginning Sunday and leading up to Biden's succession of President Donald Trump on Wednesday. State officials hope to avoid the type of violence that occurred Jan. 6, when a mob of Trump supporters stormed the U.S. Capitol, leaving a Capitol Police officer and four others dead.The FBI has warned of the potential for violence at all state capitols and has said it is tracking an “&nbsp;<a href="https://apnews.com/article/biden-inauguration-capitol-siege-michael-pence-d3cc3004a5a1be9bd0a9cb8193d7d974">extensive amount of concerning online chatter,</a>&nbsp;” including calls for armed protests.Governors across the country are sending thousands of National Guard troops to Washington, D.C., where the National Mall has been closed to the general public as part of an intense security effort. More than a dozen governors also have called out the Guard to protect their own state capitols and aid local law enforcement officers."We are prepared for the worst, but we remain hopeful that those who choose to demonstrate at our Capitol do so peacefully, without violence or destruction of property,” Michigan State Police Col. Joe Gasper said Friday, as Democratic Gov. Gretchen Whitmer announced the Guard's role.Crews installed a six-foot fence around the Michigan Capitol ahead of expected protests, and ground-level windows were boarded up at a nearby building that houses the governor’s office. Gasper said an increased state police presence would remain at the statehouse at least through mid-February.Some windows also were boarded at capitols in Wisconsin and Illinois, both of which activated the National Guard to help with security. Though the Wisconsin Capitol already was closed to the public because of the coronavirus, Democratic Gov. Tony Evers' administration told those who had been coming into the Capitol to instead work remotely for the rest of the month.Law enforcement officials were reducing parking around the capitol building in Madison this weekend and urging people to avoid the area as they braced for potential unrest. There was only one known organized event for the day, an anti-fascist demonstration where free food, drinks and clothes were to be distributed.California Gov. Gavin Newsom is mobilizing up to 1,000 National Guard members over concerns of civil unrest. State officials on Thursday erected a chain link fence around the Capitol, bolstering other temporary and permanent barriers. The California Highway Patrol is refusing to issue permits for rallies at the Capitol.“We’re treating this very seriously and deploying significant resources to protect public safety, critical infrastructure and First Amendment Rights,” Newsom said in a video message. “But let me be clear: There will be no tolerance for violence."Other governors were encouraging people to stay away from capitol buildings during the coming days. Ohio Gov. Mike DeWine, a Republican, closed the Capitol until after Biden's inauguration and activated hundreds of National Guard members.Citing the possibility of armed protests, Kansas Gov. Laura Kelly on Friday began a one-week restriction on public access to the Capitol. Only those who have business with the Legislature or governor's office will be allowed inside, and they will have to provide an email showing they have a meeting or are testifying to a legislative committee.Kelly and Pennsylvania Gov. Tom Wolf closed their Capitol buildings for a couple days next week, coinciding with the presidential inauguration. The Pennsylvania Capitol complex already had been closed to the general public because of the coronavirus pandemic, but the new order advises state employees who work in person to take off Tuesday and Wednesday; Monday is the Martin Luther King Jr. holiday.“While we are not aware of any specific threats at this time, we want to act with an abundance of caution to keep employees safe,” Wolf’s administration said on its website.Uncertainty heading into the weekend was a common theme among state officials and law enforcement officers. Many were enhancing security based on past demonstrations or general warnings but without specific expectations about how many protesters, if any, would show up outside state capitol buildings in the coming days.The National Guard is supplementing security at Washington's capitol, where people broke a gate and entered the grounds of the governor's mansion last week. But Washington State Patrol spokesman Chris Loftis said Friday that there are “no known explicit threats" detailing the time, place and action of future demonstrations.“We cannot be dismissive of the possible dangers but we should not be alarmists either,” Loftis said in an email to media. The state patrol “has been directed to meet this discomforting uncertainty with caution, preparedness, resolve, and calm — certainly, a wise course of action for all.”Legislatures in several states, including Michigan, also were canceling or limiting their work next week.Oregon’s Legislature will convene Tuesday. But the House and Senate have canceled floor sessions and committee hearings, and there will be no in-person meetings. Senate President Peter Courtney, a Democrat from Salem, said the decision was made after consulting with police. Last month, a violent crowd entered the Oregon Capitol, fought with police and damaged the building.The Republican-led South Carolina House and Senate won't convene in full session next Tuesday or Wednesday, and committees will meet virtually. The Capitol building will be closed from Saturday through Wednesday “out of an abundance of caution,” state and local authorities said in a joint statement.Republican leaders of the Missouri House also canceled session for next week. Though several House members had expressed security concerns following the unrest in the nation’s capitol, a written statement from GOP leadership cited a rising number of COVID-19 cases in the Capitol building as a reason for the cancellation.New Mexico Gov. Michelle Lujan Grisham, a Democrat, and Utah Gov. Spencer Cox, a Republican, both declared states of emergency on Thursday ahead of potential demonstrations at their capitols. Fencing was installed in a wide radius around the New Mexico Capitol.Cox’s order allows authorities to close the Utah Capitol grounds through next Thursday, the day after Biden’s inauguration.“We respect the right of Utah residents to peaceably assemble as guaranteed in the U.S. Constitution,” Cox said in a statement. “But we draw the line at threats to physical safety or to the Utah Capitol building. No violence of any kind will be tolerated.”

States declare emergencies, close capitols ahead of rallies

WASHINGTON (AP) — By the busload and planeload, National Guard troops were pouring into the nation’s capital, as governors answered the urgent pleas of U.S. defense officials for more troops to help safeguard Washington even as they keep anxious eyes on possible violent protests in their own states.

Military leaders spent chunks of Thursday evening and Friday calling states in an unprecedented appeal for more National Guard troops to help lock down much of the city in the days before President-elect Joe Biden’s inauguration. In dribs and drabs, governors responded, some agreeing to send an extra dozen, 100 or even 1,000, while others said no.

Both Kansas and Missouri are sending National Guard troops to Washington, according to the Kansas Department of Emergency Management and Missouri Governor Mike Parson.

The calls reflect fears that violent extremist groups are targeting the city in the wake of the deadly insurrection at the U.S. Capitol on Jan. 6. The threats range from armed insurgents to possible attempts to plant explosive devices at so-called soft targets. But as Washington begins to resemble an armed camp, with more than 25,000 Guard due in the city by early next week, concerns about violence at state capitals has grown.

Oregon Gov. Kate Brown said she turned down the federal request to send at least 100 more National Guard troops to D.C. “I didn’t think that we could safely fill that commitment,” Brown said. Oregon has already agreed to send 30 to Washington, but state leaders are worried about violence at the state capitol in Salem.

Others agreed, setting off a dizzying torrent of military flights and convoys into the region.

“The peaceful transfer of power is a central tenet of American democracy, and Connecticut stands ready to aid in the protection of our country.” said Connecticut Gov. Ned Lamont, who had initially approved sending 100 Guard and on Friday agreed to send 200 more.

All told, more than 130 U.S. Air Guard flights in the past 72 hours have carried at least 7,000 Guard troops to Joint Base Andrews in Maryland, according to U.S. officials, who spoke on condition of anonymity to discuss internal numbers. Thousands more are in buses and military trucks, thundering up highways toward Washington.

Army Gen. Dan Hokanson, chief of the National Guard Bureau, called adjutants general around the country, and others, such as Army Secretary Ryan McCarthy, called governors to seek help. McCarthy praised the states, saying defense and military officials are keenly aware of the threats they also are facing.

“The governors and the TAGs have been great. They helped us a lot,” McCarthy told The Associated Press. “That’s the thing — that in the midst of a really horrible situation you’re seeing the greatness of this country, everybody coming together and help each other get through this.”

What began in early January as a routine deployment of about 350 members of the D.C. National Guard to help with expected protests exploded over the past two weeks into a vastly greater operation to protect the inauguration and the U.S. Capitol, and to shut down access to the city and many of its historical monuments.

As protesters stampeded their way into the Capitol on Jan. 6, only a bit more than 100 National Guard were scattered around the city, guarding checkpoints and Metro entrances. Hours later, five people were dead, the Capitol was in shambles and all 1,100 of D.C.’s Guard had been activated.

By the next day, as information came in about more violence being planned, requests went out for 6,200 Guard members from the surrounding states.

By Thursday night, as law enforcement and defense officials poured over maps and staged security drills, they concluded they would need at least 25,000 to adequately lock down the Capitol grounds and a wide swath of D.C., including the National Mall. And they agreed that the bulk of those Guard will be armed.

At that point, the new round of calls to the state governors and military leaders began.

Many governors were willing to help, but they made it clear that their own state capitals were their priority. Some agreed to send more, while others couldn’t. And the numbers varied widely.

Pennsylvania Gov. Tom Wolf doubled his initial commitment of 1,000 to 2,000. Other states were able to scrape up an additional dozen.

After reviewing the threats to its own state, Minnesota decided it could significantly increase its contribution and will send 850 Guard rather than the 130 initially tapped to go, according to the state’s adjutant general, Maj. Gen. Shawn Manke.

Ohio Gov. Mike DeWine had already agreed to send 700. On Friday, he announced he’d be sending 300 more — even as he ordered nearly 600 to secure the Ohio statehouse in Columbus. Similarly, North Carolina Gov. Roy Cooper initially agreed to send 200 Guard, and on Friday spokesman Ford Porter said the state will send 100 more. Iowa first said it was sending 250 and now the number is 265.

The vast military response comes as Congress and law enforcement authorities are trying to figure out how the U.S. Capitol was overrun so dramatically on Jan. 6. Leaders of four committees in the Democratic-controlled House sent a letter Saturday requesting briefings and documents from the FBI and other federal agencies as part of their review of the insurrection.

The appeals for more of America’s citizen soldiers also underscore the Pentagon’s limits on the use of active-duty troops. Under the law, they can’t be used for law enforcement, and officials are intent on avoiding the appearance of armed active-duty forces being used against U.S. citizens on American soil.

Active-duty forces are routinely prepared to respond to emergencies in Washington, such as flight violations in restricted airspace over D.C., and a quick reaction force is always on standby. Other active-duty units will take part in various inaugural ceremonies.

<figure>
 <img src="https://media.eaglewebservices.com/public/2021/1/1610835825899.png" alt="Army Secretary Ryan McCarthy meeting with National Guard Troops in Washington- Photo courtesy Secretary of the U.S. Army" />
 <figcaption>Army Secretary Ryan McCarthy meeting with National Guard Troops in Washington- Photo courtesy Secretary of the U.S. Army</figcaption>
 </figure>WASHINGTON (AP) — By the busload and planeload, National Guard troops were pouring into the nation’s capital, as governors answered the urgent pleas of U.S. defense officials for more troops to help safeguard Washington even as they keep anxious eyes on possible violent protests in their own states.Military leaders spent chunks of Thursday evening and Friday calling states in an unprecedented appeal for more National Guard troops to help lock down much of the city in the days before President-elect Joe Biden’s inauguration. In dribs and drabs, governors responded, some agreeing to send an extra dozen, 100 or even 1,000, while others said no.Both Kansas and Missouri are sending National Guard troops to Washington, according to the Kansas Department of Emergency Management and Missouri Governor Mike Parson.The calls reflect fears that violent extremist groups are targeting the city in the wake of the deadly insurrection at the U.S. Capitol on Jan. 6. The threats range from armed insurgents to possible attempts to plant explosive devices at so-called soft targets. But as Washington begins to resemble an armed camp, with more than 25,000 Guard due in the city by early next week, concerns about violence at state capitals has grown.Oregon Gov. Kate Brown said she turned down the federal request to send at least 100 more National Guard troops to D.C. “I didn’t think that we could safely fill that commitment,” Brown said. Oregon has already agreed to send 30 to Washington, but state leaders are worried about violence at the state capitol in Salem.Others agreed, setting off a dizzying torrent of military flights and convoys into the region.“The peaceful transfer of power is a central tenet of American democracy, and Connecticut stands ready to aid in the protection of our country.” said Connecticut Gov. Ned Lamont, who had initially approved sending 100 Guard and on Friday agreed to send 200 more.All told, more than 130 U.S. Air Guard flights in the past 72 hours have carried at least 7,000 Guard troops to Joint Base Andrews in Maryland, according to U.S. officials, who spoke on condition of anonymity to discuss internal numbers. Thousands more are in buses and military trucks, thundering up highways toward Washington.Army Gen. Dan Hokanson, chief of the National Guard Bureau, called adjutants general around the country, and others, such as Army Secretary Ryan McCarthy, called governors to seek help. McCarthy praised the states, saying defense and military officials are keenly aware of the threats they also are facing.“The governors and the TAGs have been great. They helped us a lot,” McCarthy told The Associated Press. “That’s the thing — that in the midst of a really horrible situation you’re seeing the greatness of this country, everybody coming together and help each other get through this.”What began in early January as a routine deployment of about 350 members of the D.C. National Guard to help with expected protests exploded over the past two weeks into a vastly greater operation to protect the inauguration and the U.S. Capitol, and to shut down access to the city and many of its historical monuments.As protesters stampeded their way into the Capitol on Jan. 6, only a bit more than 100 National Guard were scattered around the city, guarding checkpoints and Metro entrances. Hours later, five people were dead, the Capitol was in shambles and all 1,100 of D.C.’s Guard had been activated.By the next day, as information came in about more violence being planned, requests went out for 6,200 Guard members from the surrounding states.By Thursday night, as law enforcement and defense officials poured over maps and staged security drills, they concluded they would need at least 25,000 to adequately lock down the Capitol grounds and a wide swath of D.C., including the National Mall. And they agreed that the bulk of those Guard will be armed.At that point, the new round of calls to the state governors and military leaders began.Many governors were willing to help, but they made it clear that their own state capitals were their priority. Some agreed to send more, while others couldn’t. And the numbers varied widely.Pennsylvania Gov. Tom Wolf doubled his initial commitment of 1,000 to 2,000. Other states were able to scrape up an additional dozen.After reviewing the threats to its own state, Minnesota decided it could significantly increase its contribution and will send 850 Guard rather than the 130 initially tapped to go, according to the state’s adjutant general, Maj. Gen. Shawn Manke.Ohio Gov. Mike DeWine had already agreed to send 700. On Friday, he announced he’d be sending 300 more — even as he ordered nearly 600 to secure the Ohio statehouse in Columbus. Similarly, North Carolina Gov. Roy Cooper initially agreed to send 200 Guard, and on Friday spokesman Ford Porter said the state will send 100 more. Iowa first said it was sending 250 and now the number is 265.The vast military response comes as Congress and law enforcement authorities are trying to figure out how the U.S. Capitol was overrun so dramatically on Jan. 6. Leaders of four committees in the Democratic-controlled House sent a letter Saturday requesting briefings and documents from the FBI and other federal agencies as part of their review of the insurrection.The appeals for more of America’s citizen soldiers also underscore the Pentagon’s limits on the use of active-duty troops. Under the law, they can’t be used for law enforcement, and officials are intent on avoiding the appearance of armed active-duty forces being used against U.S. citizens on American soil.Active-duty forces are routinely prepared to respond to emergencies in Washington, such as flight violations in restricted airspace over D.C., and a quick reaction force is always on standby. Other active-duty units will take part in various inaugural ceremonies.——

Guard troops pour into Washington as states answer the call

By JULIE APPLEBY <a href="https://www.kcur.org/news/2021-01-14/private-practice-doctors-patients-wonder-when-its-their-turn-for-the-covid-19-vaccine">Kaiser Health News</a>

Dr. Andrew Carroll — a family doctor in Chandler, Arizona — wants to 
help his patients get immunized against covid, so he paid more than 
$4,000 to buy an ultra-low-temperature freezer from eBay needed to store
 the Pfizer vaccine.

But he’s not sure he’ll get a chance to use 
it, given health officials have so far not said when private doctor’s 
offices will get vaccine.

Not
 only are doctors having trouble getting vaccine for patients, but many 
of the community-based physicians and medical staff that aren’t employed
 by hospitals or health systems also report mixed results in getting 
inoculated. Some have had their shots, yet others are still waiting, 
even though health workers providing direct care to patients are in the 
Centers for Disease Control and Prevention’s top-priority group.

Many
 of these doctors say they don’t know when — or if — they will get doses
 for their patients, which will soon become a bigger issue as states 
attempt to vaccinate more people.

“The reason that’s important is 
patients trust their doctors when it comes to the vaccine,” said 
Carroll, who has complained on social media that his county hasn’t yet 
released plans on how primary care doctors will be brought into the 
loop.

Collectively, physicians in the county could vaccinate 
thousands of patients a day, he said, and might draw some who would 
otherwise be hesitant if they had to go to a large hospital, a 
fairground or another central site.

His concern comes as, 
nationally, the rollout of the vaccine is off to a slower start than 
expected, lagging far behind the initial goal of giving 20 million doses
 before the new year.

But Dr. Jen Brull, a family practice doctor 
in Plainville, Kansas, said her rural area has made good progress on the
 first phase of vaccinations, crediting close working relationships 
formed well before the pandemic.

This fall, before any doses 
became available, the local hospital, the health department and 
physician offices coordinated a sign-up list for medical workers who 
wanted the vaccine. So, when their county, with a population of 5,000, 
got its first 70 doses, they were ready to go. Another 80 doses came a 
week later.

“We’ll be able to vaccinate almost all the health care-associated folks who wanted it in the county” Brull said recently

Dr.
 Jason Goldman, an internist in Coral Springs, Florida, said he was able
 to get vaccinated at a local hospital that received the bulk of 
vaccines in his county and oversaw distribution.

In the weeks since, however, he said several of his front-line staff members still “don’t have access to the vaccine.”

Additionally,
 “a tremendous number” of patients are calling his office because 
Florida has relaxed distribution guidelines to include anyone over age 
65, Goldman said, asking when they can get the vaccine. He’s applied to 
officials about distributing the vaccines through his practice but has 
heard nothing back.

Patients “are frustrated that they do not have
 clear answers and that I am not being given clear answers to provide 
them,” he said. “We have no choice but to direct them to the health 
department and some of the hospital systems.”

Another troubling 
point for Goldman, who served as a liaison between the American College 
of Physicians and the expert panel drawing up the CDC distribution 
guidelines, is the tremendous variation in how those recommendations are
 being implemented in the states.

The CDC <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations-process.html" target="_blank">recommends</a>
 several phases, with front-line health care workers and nursing home 
residents and staff in the initial group. Then, in the second part of 
that phase, come people over 75 and non-health care front-line workers, 
which could include first responders, teachers and other designated 
essential workers.

By JULIE APPLEBY <a href="https://www.kcur.org/news/2021-01-14/private-practice-doctors-patients-wonder-when-its-their-turn-for-the-covid-19-vaccine">Kaiser Health News</a>Dr. Andrew Carroll — a family doctor in Chandler, Arizona — wants to 
help his patients get immunized against covid, so he paid more than 
$4,000 to buy an ultra-low-temperature freezer from eBay needed to store
 the Pfizer vaccine.But he’s not sure he’ll get a chance to use 
it, given health officials have so far not said when private doctor’s 
offices will get vaccine.“I’m really angry,” said Carroll.Not
 only are doctors having trouble getting vaccine for patients, but many 
of the community-based physicians and medical staff that aren’t employed
 by hospitals or health systems also report mixed results in getting 
inoculated. Some have had their shots, yet others are still waiting, 
even though health workers providing direct care to patients are in the 
Centers for Disease Control and Prevention’s top-priority group.Many
 of these doctors say they don’t know when — or if — they will get doses
 for their patients, which will soon become a bigger issue as states 
attempt to vaccinate more people.“The reason that’s important is 
patients trust their doctors when it comes to the vaccine,” said 
Carroll, who has complained on social media that his county hasn’t yet 
released plans on how primary care doctors will be brought into the 
loop.Collectively, physicians in the county could vaccinate 
thousands of patients a day, he said, and might draw some who would 
otherwise be hesitant if they had to go to a large hospital, a 
fairground or another central site.His concern comes as, 
nationally, the rollout of the vaccine is off to a slower start than 
expected, lagging far behind the initial goal of giving 20 million doses
 before the new year.But Dr. Jen Brull, a family practice doctor 
in Plainville, Kansas, said her rural area has made good progress on the
 first phase of vaccinations, crediting close working relationships 
formed well before the pandemic.This fall, before any doses 
became available, the local hospital, the health department and 
physician offices coordinated a sign-up list for medical workers who 
wanted the vaccine. So, when their county, with a population of 5,000, 
got its first 70 doses, they were ready to go. Another 80 doses came a 
week later.“We’ll be able to vaccinate almost all the health care-associated folks who wanted it in the county” Brull said recently<h2>Gaps in the Rollout</h2>But that’s not the case everywhere.Dr.
 Jason Goldman, an internist in Coral Springs, Florida, said he was able
 to get vaccinated at a local hospital that received the bulk of 
vaccines in his county and oversaw distribution.In the weeks since, however, he said several of his front-line staff members still “don’t have access to the vaccine.”Additionally,
 “a tremendous number” of patients are calling his office because 
Florida has relaxed distribution guidelines to include anyone over age 
65, Goldman said, asking when they can get the vaccine. He’s applied to 
officials about distributing the vaccines through his practice but has 
heard nothing back.Patients “are frustrated that they do not have
 clear answers and that I am not being given clear answers to provide 
them,” he said. “We have no choice but to direct them to the health 
department and some of the hospital systems.”Another troubling 
point for Goldman, who served as a liaison between the American College 
of Physicians and the expert panel drawing up the CDC distribution 
guidelines, is the tremendous variation in how those recommendations are
 being implemented in the states.The CDC <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations-process.html" target="_blank">recommends</a>
 several phases, with front-line health care workers and nursing home 
residents and staff in the initial group. Then, in the second part of 
that phase, come people over 75 and non-health care front-line workers, 
which could include first responders, teachers and other designated 
essential workers.States have the flexibility to design their own
 rollout schedule and priority groups. Florida, for example, is offering
 doses to anyone 65 and up. In some counties, older folks were told 
vaccines were available on a first-come, first-served basis, a move that
 has resulted in long lines.“To say right now, 65-plus, when you 
haven’t even appropriately vaccinated all the health care workers, is 
negating the phasing,” said Goldman. “There needs to be a national 
standard. We have those guidelines. We need to come up with some 
oversight.”On Thursday, the American Hospital Association echoed 
that concern in a letter to Health and Human Services Secretary Alex 
Azar. Hospitals — along with health departments and large pharmacy 
chains — are doing the bulk of the vaccinations.Calling for additional coordination by federal officials, the <a href="https://www.aha.org/system/files/media/file/2021/01/aha-hhs-leadership-actions-needed-expedite-administration-covid-19-vaccines-lettetr-1-7-20.pdf" target="_blank">letter</a>
 outlined what it would take to reach the goal of vaccinating 75% of 
Americans by the end of May: 1.8 million vaccinations every day. Noting 
there are 64 different rollout plans from states, cities and other 
jurisdictions, the letter asked whether HHS has “assessed whether these 
plans, taken as a whole, are capable of achieving this level of 
vaccination?”<h2>Making It Work</h2>Lack of direct national 
support or strategy means each county is essentially on its own, with 
success or failure affected by available resources and the experience of
 local officials. Most state and local health departments are 
underfunded and are under intense pressure because of the surging 
pandemic.Still, the success of vaccination efforts depends on planning, preparation and clear communication.In
 Lorain County, Ohio, population 310,000, local officials started 
practicing in October, said Mark Adams, deputy health commissioner. They
 set up mass vaccination clinics for influenza to study what would be 
needed for a covid vaccination effort. How many staff? What would the 
traffic flow be like? Could patients be kept 6 feet apart?“That 
gave us an idea of what is good, what is bad and what needs to change,” 
said Adams, who has had previous experience coordinating mass 
vaccination efforts at a county level.So, when the county got its
 first shipment of 500 doses Dec. 21, Adams had his plan ready. He 
called the fire chiefs to invite all emergency medical technicians and 
affiliated personnel to an ad hoc vaccination center set up at a large 
entertainment venue staffed by his health department. Upon arrival, 
people were greeted at the door and directed to spaced-apart “lanes” 
where they would get their shots, then to a monitoring area where they 
could wait for 15 minutes to make sure they didn’t have a reaction.Right
 after Christmas, another 400 doses arrived — and the makeshift clinic 
opened again. This time, doses went to community-based physicians, 
dentists and other hands-on medical practitioners, 600 of whom had 
previously signed up. (Hospital workers and nursing home staff and 
residents are getting their vaccinations through their own 
institutions.)As they move into the next phase — recipients 
include residents over 80, people with developmental disorders and 
school staff — the challenges will grow, he said. The county plans a 
multipronged approach to notify people when it’s their turn, including 
use of a website, the local media, churches, other organizations and 
word-of-mouth.Adams shares the concerns of medical providers 
nationwide: He gets only two days’ notice of how many doses he’s going 
to receive and, at the current pace of 400 or 500 doses a week, it’s 
going to take a while before most residents in the county have a chance 
to get a shot, including the estimated 33,000 people 65 and older.With
 10 nurses, his clinic can inject about 1,200 people a day. But many 
other health professionals have volunteered to administer the shots if 
he gets more doses.“If I were to run three clinics, five days a 
week, I could do 15,000 vaccinations a week,” Adams said. “With all the 
volunteers, I could do almost six clinics, or 30,000 a week.”Still,
 for those in the last public group, those age 18 and up without 
underlying medical conditions, “it could be summer,” Adams said.<a href="http://www.kaiserhealthnews.org/" target="_blank">Kaiser Health News</a>&nbsp;is a national health policy news service. It is an editorially independent program of the <a href="http://www.kff.org/" target="_blank">Henry J. Kaiser Family Foundation</a> which is not affiliated with Kaiser Permanente.