A registered nurse at the hospital who is pursuing a master’s degree in a behavioral health field said she can’t apply for financial aid before the next semester starts in January. While Children’s will still pay employees up to $5,250 a year for tuition, that won’t cover the full cost of her program, which the hospital previously had paid in full, she said.

“They gave us about a one-month notice,” said the nurse, who spoke to The Denver Post on the condition of anonymity over fears she could lose her job. “A lot of us don’t have five, six grand saved to pay for our next term.”

Children’s contracted with a third party to fully pay for some degree programs and partially cover others. The programs the hospital chose weren’t necessarily the cheapest ones, the nurse said, and she doesn’t think she can transfer to a less-expensive school two years into her degree.

Leila Roche, a spokeswoman for Children’s, said when the Aurora hospital conducted its annual benefits assessment, it found that far more people than anticipated had used the full-tuition option. She said the hospital has paid about $11 million for tuition since May 2022.

“This was a very difficult decision and one we did not make without serious consideration of various options,” she said. “Children’s Colorado remains dedicated to making a significant annual investment in this benefit and the education of more than 1,000 team members.”

The nurse said the financial blow of having to pay tuition next year was stacked on top of a sudden notice that she would have to pay taxes on this year’s tuition, which wasn’t clear when she signed up for the program. Children’s deducted it from her checks in December, rather than spreading it out over the full year, which would have been easier to manage, she said.

“I wasn’t able to pay rent this month, so I’m going into more credit card debt for that,” she said.

The Internal Revenue Service requires employees who receive more than $5,250 in tuition reimbursement to pay taxes on the amount above that threshold. In Colorado, the rate comes out to about 34% after including federal, state, Social Security and Medicare taxes.

A behavioral health specialist who is pursuing a degree in counseling said he managed to stay afloat on smaller checks after taxes, but this month wiped out his emergency savings. He plans to take a semester off to assess his finances and look at transferring to a different school, because he can’t afford to cover the tuition balance at Regis University.

People working in behavioral health already feel unappreciated and aren’t paid well, said the specialist, who also spoke on the condition of anonymity because he was worried about retaliation. Full tuition coverage gave him a chance to build a career in the field without adding to his existing student loan debt, he said.

“I felt like, for the first time, my future was laid out in front of me and goals were achievable,” he said. “My life has got completely turned upside down in a matter of days.”

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The sheet goes back 11 years, a third of Erin’s life. There are holes in the narrative: Her daughter is schizophrenic bipolar, Vassis said, and she’s moved around different parts of the country. Still, even incomplete, Vassis’ growing tracker provides a glimpse at the revolving doors that Erin and hundreds of other Coloradans are stuck in every year.

From April 2021 to April 2022, for instance, Erin spent 106 days bouncing between emergency rooms, detox facilities, hospital beds, homeless shelters and crisis centers. During that time, she never spent more than two weeks at a time in one hospital, Vassis said. Instead, she repeatedly was discharged within a fortnight, still unstable, thanks to a decades-old Medicaid rule that often forces the early discharge of low-income, mentally ill patients.

Vassis looks at the spreadsheet again. After one hospital stay in 2021, Erin was dropped at a bus stop. It was January, and other than a dog blanket that a passing stranger had given her, she was wearing only hospital scrubs.

“They just spit you out like you’re a throwaway human being,” Vassis said. “And that’s really tragic.”

Erin is one of 300 to 400 low-income Coloradans with severe mental illnesses who need longer hospital stays but don’t get them because Medicaid caps inpatient treatment at many psychiatric hospitals to 15 days per month, a requirement that advocates say is harming vulnerable patients and straining the broader public safety net. The patients, many of whom are homeless and are discharged before they’re fully stabilized, are left to tumble through jails and psychiatric evaluations, shelters and city streets, emergency rooms and nonprofit groups.

The details are maddening, providers and advocates said: If a patient stays at one facility for 10 days and another for six, neither hospital gets paid. Because the 15-day limit is based on a monthly clock, a patient’s length of stay is partially determined by when they are admitted. A patient admitted on Dec. 8 is likely to be out before Christmas, for instance. But a patient hospitalized on Dec. 18 can stay the rest of the month and then remain in the hospital when the countdown restarts on Jan. 1.

As the state broadly re-assesses its mental health system, a group of legislators, mental health advocates and parents are working to change the Medicaid mental health rule and provide 30 days of inpatient treatment to patients who need it. That requires a waiver from the federal government, plus $7.2 million in annual funding, according to projections provided to the Colorado Department of Health Care Policy and Financing earlier this year. Nineteen other states have secured or are awaiting a final answer on similar waiver applications, according to KFF, a health policy think-tank.

With state Medicaid officials on board, Gov. Jared Polis allocated $2.5 million in his recent budget proposal to ensure hospitals are paid for 15 days, even if a patient stays a bit longer. Now, legislators and advocates are calling on the legislature to find the remaining $5 million to extend the program to a full month.

“That just seems like money well-spent,” said Rep. Judy Amabile, a Boulder Democrat involved in the discussions. “That seems very inexpensive to me.”

The rule, advocates and lawmakers say, was well-intentioned: When Medicaid was established nearly 60 years ago, its architects didn’t want large mental hospitals to permanently warehouse vulnerable patients.

But as the decades have worn on, patients are increasingly bouncing between a series of institutions, like jails and emergency rooms, that were never intended to serve as regular pieces of the mental health puzzle. Psychiatric hospitals end up absorbing costs for longer patient stays, and some are cutting back on the number of beds they have available for the service because it isn’t economically viable, said Dr. Roderick O’Brien, the director of intensive treatment at Centennial Peaks Hospital in Louisville.

For patients who need more care, shorter stays exacerbate their illness. If they’re not fully stabilized, they may not understand the full breadth of their condition or the need to take medications, said Dr. Chelsea Wolf, the medical director for Denver Health’s inpatient psychiatric unit. Mental illnesses are “chronic, debilitating illnesses,” she said, and they will worsen over time if they’re not treated correctly and consistently.

Most patients don’t need lengthy inpatient treatment stays. But providers said it’s a vital option for those who do, especially if they’re unhoused or aren’t being treated elsewhere. O’Brien estimated that two-thirds of his patients with mental illnesses who decompensate — meaning their condition has worsened — need inpatient care for longer than two weeks.

“So the concern is that people’s health is not getting better,” said Vincent Atchity, the CEO and president of Mental Health Colorado. “They get discharged before they’re better and then, in short order, decompensate yet again and become vulnerable to other unfortunate outcomes, like prolonged periods of homelessness or harmful substance use or engagement in the criminal justice system.”

Those are the revolving doors that patients like Erin have been caught up in. The short stays then strain whichever institution next encounters the patient. Wolf, the Denver Health provider, said her hospital’s emergency room is “very, very, very frequently” filled with patients “who need ongoing psychiatric care and aren’t getting it.”

Others end up in jail. In one 12-month period several years ago, Vassis said, Erin was hospitalized nine times. In six of those cases, she was arrested within three days of being discharged. Erin was arrested again last year for breaking into her mother’s house. She is now waiting for a judge to determine if she’s competent to stand trial.

The state has a broader problem with delays within its competency system, through which people awaiting trial are psychiatrically evaluated. But that crisis overlaps with the Medicaid rule: Patients who were discharged early have ended up arrested and waiting in essentially the same hospital bed they’d been released from before, Amabile said. The difference is they were now caught up in the criminal justice system.

There are positive signs that legislators will set aside the needed money to give patients longer stays. Rep. Shannon Bird, a Westminster Democrat and the chair of the powerful Joint Budget Committee, said there was “great interest” in the idea. At a legislative meeting Thursday, she questioned the basic morality of discharging patients who need more care.

“Keeping people in the hospital for the time they need to get the care they need, instead of sending them out before they’re ready to go, only to recycle them and bring them right back when they relapse or something else happened… it seems like a good thing for us to do,” she said in an interview.

State Medicaid officials are on board with a change, too. They had discussed the problem before but didn’t pursue it because of the relatively small number of patients impacted by the rule — several hundred per year, though Amabile suspects it’s much higher.

But mounting frustration from advocates and hospitals, including from facilities with overwhelmed emergency rooms, prompted state regulators to throw their support behind expanding the rule. The health care policy and financing department can apply for a waiver from the federal Centers for Medicare and Medicaid Services this spring, depending on how much money is available. The approval process will take months.

“The reason we’re changing this policy is that we are concerned that the payment policy is driving clinical decisions,” Cristen Bates, the deputy Medicaid director here, said.

For Vassis, 30 days would be a good start. She doesn’t think it’s enough for people like her daughter, but it’s better than the status quo. Erin is creative, a painter. She’s curious about the world around her. When her illness is under control, she’s held jobs, lived on her own, gone to school. She just needs help staying stable.

“She’s someone who’s so at risk for recidivism and homelessness, it’s not even funny,” Vassis said. “If they can’t get her in the real world, she doesn’t have a chance.”

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Dr. Lisa Brenner, one the nation’s leading clinical research psychologists in suicidology, went over to a Black employee and grabbed a handful of the woman’s long “Poetic Justice”-style braids.

“If I were you,” Brenner said according to the employee, yanking slightly on her hair, “I’d rather be bald like one of those warrior women in ‘Black Panther.'”

The employee didn’t know what to say.

“You feel completely invisible,” the woman said, speaking on the condition of anonymity because she still works for the VA. “How do you respond when someone in a position of power says something like this?”

Department staff say the incident represents just one of many troubling encounters with Brenner. The union of Aurora VA workers in March compiled a report from 28 staffers, outlining the “emotional, mental and psychological abuse exhibited by Brenner” over the years.

The center — known as the MIRECC — provides research, education and treatment aimed at suicide prevention among veterans. But the union’s report, along with interviews with more than half a dozen current and former employees, paint the picture of a workforce that struggles mightily with their own mental health under a fearsome boss known for retaliation, intimidation and, they say, unequal treatment of people of color.

“The work culture there is very toxic,” said Dr. Brooke Dorsey Holliman, a former employee. “People are scared to speak up.”

The union asked the VA’s executive leadership to conduct a third-party investigation into Brenner. That hasn’t happened, according to the union.

But a day after The Denver Post sent the VA questions about Brenner’s tenure, leadership said it would investigate the union’s concerns. The same day, employees learned Brenner has been detailed to the VA’s national office for suicide prevention on a temporary assignment.

Brenner, through a VA spokesperson, declined an interview request for this story. Her attorney, in a statement, said Brenner would “cooperate fully in any investigation and hope the MIRECC’s work will benefit from the process.”

The VA also declined to answer a list of detailed questions from The Post.

Kayla Giuliano, an agency spokesperson, said in an email that the VA “is committed to ensuring a safe, welcoming, and harassment-free environment for all employees.”

The allegations inside the MIRECC come amid a turbulent time for the VA’s Eastern Colorado Health Care System, which provides services to 100,000 veterans across the Front Range and Eastern Plains.

VA leaders recently reassigned the system’s director, Michael Kilmer, and his chief of staff over concerns about “operational oversight, organizational health and workplace culture.” The agency refused to specify the exact concerns that led to the changes.

More than a dozen current and former doctors, nurses and administrators outlined to The Post last month a hostile work climate that closely mirrors the stories from Brenner’s employees — an environment where fear and retaliation run rampant.

The Post also found the VA’s prosthetics department chief was instructing employees to delete orders in order to eliminate a backlog.

The “Brenner tornado”

The mission of the MIRECC is to study suicide “with the goal of reducing suicidal ideation and behaviors in veteran population,” according to its website.

Staff work on clinical interventions — along with “cognitive and neurobiological underpinnings of suicidal thoughts and behaviors” — that could lead to promising prevention strategies. The center also provides educational materials and makes research being done across the country accessible.

Brenner has served as the center’s director since 2010, according to her LinkedIn profile, and is a professor of physical medicine and rehabilitation at the University of Colorado School of Medicine.

She is considered a leading expert in the field of suicidology, particularly the relationship between traumatic brain injury and negative mental health outcomes. She’s published extensively over her career and has earned several industry awards and recognitions.

“With that kind of recognition there is a lot of power,” said Dr. Samantha Farro, a psychologist who worked for Brenner.

Former employees say Brenner fostered a competitive, demanding work environment at the MIRECC. Staff would be pitted against one another.

“She demanded a high level of excellence,” Farro said. “It got very intense — definitely a level of intensity I have not seen in any of the places I’ve worked.”

Brenner held weekly all-staff meetings, where she stood in the front of the room and called on employees to report the amount of money they brought in or articles that had been accepted for publication. She publicly shamed those who hadn’t hit these goals, said Dr. Cynthia Grant, a former employee.

“People would leave this meeting in tears,” Grant said. “It was horrible. You could cut the tension with a knife in these meetings.”

Staff said Brenner’s leadership resembled a dictatorship. They even have a term — the “Brenner tornado” — for when the boss begins to get irritated.

“Emotional, mental, and psychological abuse”

On March 28, the American Federation of Government Employees Local 2241 — the union representing MIRECC employees — sent a seven-page memo to the VA’s executive leadership.

The report, compiled from over 28 respondents, outlines “several concerning themes and similarities which have been revealed to the union regarding Dr. Brenner and her leadership in MIRECC.”

Fifteen staffers said they do not feel safe “due to the emotional, mental, and psychological abuse exhibited” by Brenner. Eleven people said she creates a toxic environment and culture. Fourteen said she instills a culture of fear in employees and “threatens employment to control them.” Eight said Brenner is manipulative. Twenty-one said they have been embarrassed, humiliated or called out in front of others. Six called her “narcissistic.”

Others told the union that Brenner retaliates against employees by removing them from assigned projects, withholding step increases and earned bonuses and denying promotions.

“Dr. Brenner is well known in the community,” the memo states. “Constant fear by staff that she will ruin your career if you upset her or if she feels she has been betrayed by you.”

Nine people told the union that Brenner, despite working in suicide prevention, discourages mental health treatment for employees. She views mental health “as not important and as being weak and vulnerable for staff to engage in,” the memo states.

“You didn’t feel that was supported,” Holliman, a former employee, said. “It would have been laughed at.”

The union’s report also alleges Brenner mixes personal travel and business. The director allegedly used a government vehicle on trips to visit family and has been known to upgrade flights to first class, the union said. Brenner was also accused of misusing funds on trips to cover non-work expenses.

Staff had valid concerns about the risk to their careers if the issues persist, the memo states.

The union requested the VA’s executive leadership initiate a formal third-party, impartial investigation. The memo made its way to Kilmer, the VA’s Eastern Colorado director, who was reassigned in October amid oversight investigations. The memo also went to the VA’s regional Rocky Mountain Network, which oversees several health care systems across the West.

In June, a union steward sent an email to members, saying the executive leadership was unable to move forward with an investigation due to the anonymous nature of the allegations. As a result, the union filed an anonymous complaint with the U.S. Office of Special Counsel, an independent federal investigative and prosecutorial agency.

An attorney with the federal agency told the union that month that they did not believe they could prove the MIRECC’s actions constituted a prohibited personnel practice.

Giuliano, the VA spokesperson, told The Post this week that leadership is now investigating the union’s concerns.

“Whenever there are allegations of wrongdoing, we investigate thoroughly and take appropriate action,” she said in a statement.

On Tuesday, a day after The Post sent a list of detailed questions to the VA about Brenner’s alleged behavior, Eastern Colorado’s interim chief of staff, Mark Kadowaki, sent an email to MIRECC staff announcing major changes to the center.

Brenner, he said, would be moving to a temporary assignment as deputy director for the VA’s national suicide prevention program to support the suicide prevention annual report. There she will continue her research and will be available to the Rocky Mountain MIRECC as an adviser for local suicide prevention efforts, Kadowaki said in the email, which was reviewed by The Post.

Dr. Nazanin Bahraini, the center’s director of research, will become acting director. She told staff in an email Tuesday afternoon that she realized “that this is an unexpected shift and many of you may have a lot of questions.”

“I will do my best to fill her shoes while she is on detail,” Bahraini wrote in the email, which was reviewed by The Post.

Brenner’s attorney, David Schleicher, told The Post in an email that Brenner “looks forward to the opportunity to address the union’s concerns, and agrees about the importance of supporting workplace diversity and the value of providing safe space for raising staff concerns.”

“It was not unexpected that higher management would detail her to allow for an investigation,” Schleicher said.

A recent anonymous 360-degree performance evaluation by colleagues at various job levels shows Brenner scored “above expectations” on a variety of categories, including team building, leveraging diversity and accountability.

“It was horrifying”

The union’s memo doesn’t discuss racism. But multiple former Black employees told The Post they felt like they were treated differently from their straight, white counterparts.

The worker who had her braids pulled by Brenner said another high-ranking MIRECC leader, Dr. Lisa Betthauser, told her in 2017 that she had a bad attitude. In front of several other employees, Betthauser demanded the staffer give up her phone so she could call the woman’s mother to fix her behavior, the employee said.

This woman, upset, told Brenner what had happened.

Brenner, according to this person, said she had “resting bitch face” which may have contributed to Betthauser’s comments (a VA spokesperson did not answer questions about this incident).

“It was horrifying,” the individual said. “Every interaction with Lisa Brenner — she just knows how to make you feel like the smallest person in the room and then step on you even more.”

Holliman, another Black employee, said people in the office would call her and others the “Black girls.” She received her doctorate while working at the MIRECC, but always felt the message from leadership was that she wasn’t good enough.

“I started questioning myself,” Holliman said. “It made it really hard to do my job. You start to think, ‘Maybe she’s right — maybe I’m not cut out for this.'”

White colleagues acknowledged to The Post that they didn’t think the women of color were as supported as others in their ambitions.

Holliman and another former worker remember Brenner complaining that “everything would be so much easier if we could only hire straight white men.”

The implication, Holliman said, was that “diversity creates so many issues.”

After George Floyd’s murder in 2020, the department held a diversity, equity and inclusion listening session. An employee talked about growing up in poverty on an Indian reservation and the racism he still sees directed toward Native Americans.

Brenner interrupted, according to people in the room, making clear that this wasn’t what they were here to discuss.

Other employees recall bizarre, inappropriate behavior from Brenner.

Grant remembers meeting with Brenner with the door closed. Brenner realized that her dress shirt was on backward and proceeded to take it off in front of her subordinate and turn it the right way, Grant said.

“She definitely struggled with boundary violations,” Grant said.

The VA did not answer questions about any of these incidents.

Employees talked about the Stockholm Syndrome they felt working for the MIRECC. It was only once they moved on to other jobs did they fully realize the extent to which they had suffered in the Aurora VA.

Grant took a $50,000 pay cut to leave, she said. Farro said while she respected Brenner as a researcher, she had “no desire to work with her again.” Holliman said her professional life has thrived since she left the VA.

“It was a traumatic experience to work there,” she said.

Former workers said they were glad to see the VA taking their concerns more seriously. But they expressed dismay and confusion that Brenner had ultimately landed in a higher position with the national suicide prevention office. The VA did not answer questions about how many direct reports she’ll have in the new job, if any.

“It’s rewarding bad behavior,” Holliman said. “There’s no real consequence.”

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The Prescription Drug Affordability Board unanimously voted against declaring Trikafta — a drug to treat cystic fibrosis — unaffordable at a meeting Friday morning. If the state’s new board had determined the medication was unaffordable, it would have kicked off a process to set a maximum price that the drugmaker could charge Colorado health plans.

Six other states also have prescription drug affordability boards, but Friday’s meeting was the first time one of those boards decided whether a specific medication was unaffordable. Colorado went further than some of the other states, giving its board the power to set a maximum price that state-regulated insurance plans would pay for certain drugs.

The board’s staff reported that while Trikafta cost an average of $234,439 per patient annually, about half of patients reported they paid $50 or less out-of-pocket each month because either their insurance or assistance programs covered the rest.

Board chair Dr. Gail Mizner said that while drugmakers’ assistance programs aren’t guaranteed to continue in the future, the board’s job was to determine whether the drug was affordable for patients now. Trikafta is a “miracle drug,” she said, but the board still can consider setting a price limit in a future year if patients report they can’t access it.

“This is not the ultimate answer,” she said of Friday’s vote.

Manufacturers’ coupons take care of individual patients’ out-of-pocket costs, but raise costs for everyone paying for insurance because they allow drugmakers to keep charging high prices, said board member Dr. Sami Diab. But fixing that is beyond the scope of Colorado’s board, he said.

Cystic fibrosis is caused when a person inherits two copies of a mutated gene, causing sticky mucus to build up in the lungs and other organs. People with the disease are at higher risk from respiratory infections, and sometimes develop malnutrition because the mucus interferes with the digestive system.

The Cystic Fibrosis Foundation estimated about 700 people in Colorado have the disease.

Groups representing cystic fibrosis patients had raised alarms that setting a price limit on Trikafta could push manufacturer Vertex Pharmaceuticals to refuse to sell in Colorado. Supporters of the board’s process argued that companies were bluffing to avoid cuts to their revenue.

Trikafta works on a mutation shared by about 90% of patients with cystic fibrosis. Studies found that patients taking it had better lung function and fewer hospital admissions, and reported better quality of life. The drug has only been on the market for about four years, but some researchers project it could allow patients to have a near-normal lifespan. As of 2021, about half of people with cystic fibrosis who had died were 34 or younger, according to the Cystic Fibrosis Foundation.

Jennifer Reinhardt, a Denver woman whose 22-year-old daughter has cystic fibrosis, told the board that Trikafta gave her daughter hope and allowed her greater freedom, since she no longer needs to spend hours using a machine to break up the mucus in her chest. She said she also worries that limiting prices for rare-disease drugs could discourage companies from developing new treatments, such as Vertex’s new gene therapy for sickle cell disease.

“She was not able to plan for her future. Now she can,” Reinhardt said of her daughter. “She just wants to live.”

Rose Keller, who is in the minority of cystic fibrosis patients who have a mutation that doesn’t respond to Trikafta, told the board that while she would personally pay anything for a cure or treatment that improved her life, allowing drug companies to set their price means resources aren’t available for other priorities in society, such as education.

“If Vertex is allowed to charge whatever it wants, what is to stop whatever company comes up with my drug?” she said.

In the new year, the state’s Prescription Drug Affordability Board will consider four other drugs for possible price limits. It chose five drugs from a list of medications whose prices rose at least 10% in the last year, brand-name medications that cost at least $30,000 per year and generics that cost at least $100 per month.

The other drugs the board is evaluating are:

• Genvoya, a combination pill for HIV, with a list price of about $4,000 per month

• Enbrel, used for rheumatoid arthritis and other autoimmune diseases, with a list price of more than $6,800 per month

• Cosentyx, used for psoriatic arthritis and other autoimmune diseases, with a list price of more than $6,900 per month at typical doses

• Stelara, used for Crohn’s disease and other autoimmune conditions, with a list price of more than $12,000 a month

List prices may not reflect what health plans or individuals pay for drugs, because they don’t account for rebates.

Reid Porter, spokesman for the Pharmaceutical Researchers and Manufacturers of America, said the board responded to patients’ concerns that price-setting would cause them to lose access to medication.

“Creating bureaucratic barriers between patients and their doctors could make it very difficult for patients to access life-saving medications,” he said in a statement. “Instead of focusing on misguided price-setting, Colorado should address the root cause of the problem: health insurance practices and the self-serving actions of pharmacy benefit managers who control and often increase costs at the pharmacy counter.”

Priya Telang, communications manager for the Colorado Consumer Health Initiative, said the board went through an exhaustive process to determine whether Trikafta was affordable, which revealed important information, such as it costs $6,000 a year to produce the drug for each patient.

Vertex’s threat to pull out marred the process, though, and terrified patients unnecessarily, she said at a news conference after the board meeting.

“It’s completely unconscionable that a company that brings in billions of dollars would threaten to withhold medication that costs $6,000 to produce,” she said.

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Now, the family of 65-year-old Arthur Janis is seeking an apology.

“They continued to deny that they cut his hair,” said Keith Janis, a member of the Oglala Lakota Nation, of his brother. “They tried to make us all sound crazy.”

On Thursday, UCHealth officials released a statement saying they had determined through an investigation that Arthur Janis arrived at their hospital with shoulder-length hair that hospital staff cut shorter to prevent the intensive care patient from developing a pressure ulcer.

Dan Weaver, UCHealth’s vice president of communications, said the patient was not identified as someone with Native American roots before hospital staff cut his hair.

“Our medical team acted appropriately given the information they had available to them and the acute medical needs of the patient,” Weaver wrote in the statement. “We continue to work with the family to coordinate his ongoing care.”

Keith Janis said his brother was medically transported from Rapid City, South Dakota, to UCHealth University of Colorado Hospital in August after suffering severe chest and stomach pain. Arthur Janis experienced blood clotting and a stroke while at UCHealth, leaving him drifting in and out of consciousness, Keith Janis told The Post in an interview. Arthur remains hospitalized there.

Family members from across the country visited Arthur Janis in the hospital, but expenses kept them from staying long, his brother said.

In October, UCHealth staff arranged a video call between Arthur Janis and his sister so she could check in on him. Keith Janis said his sister noticed Arthur’s waist-length hair had been chopped short, seemingly haphazardly.

“All of us have long hair because it’s a part of our culture,” Keith Janis said. “In Lakota culture, hair has all the memories of your whole life. It has the love of your mother who brushed it and braided it and poured her love and strength into it.”

UCHealth’s Weaver said Arthur Janis had matted hair at the back of his head and that his medical team had to “carefully trim” for health reasons. He said the hospital could share some information about Arthur’s situation with permission from his sister, who is his medical decision-maker and has medical power of attorney.

When a Lakota tribal member dies, Keith Janis said their long hair is cut and becomes part of a memorial for their family members.

“The hair is so important to us and has real cultural significance,” Keith Janis said.

Seeing his brother’s hair cut was particularly gutting to Keith Janis because it transported him back to the memory of himself and Arthur being forcibly separated from their parents as children and taken to a Native American boarding school, where their hair was cut against their will.

“We have been growing it out since then,” Keith Janis said.

Upset by the haircut, Keith Janis raised money for himself and other Indigenous activists to travel to Colorado and learn about what had happened. In early November, Keith Janis and loved ones made the trip from South Dakota. Keith Janis said he and his group were met at UCHealth by “a security detail.”

“We didn’t come in stomping and yelling or making a scene,” Keith Janis said. “We’re all very humble people. We just wanted to see Arthur.”

Keith Janis met with UCHealth staff multiple times, asking what happened to his brother’s hair. He provided The Post with recordings of those meetings, which appear to show UCHealth officials telling the Janis family that Arthur had his long hair when he entered their care but returned to the hospital from the Center at Lowry, a medical recovery and rehabilitation facility, having had his hair cut.

A recording of a meeting with Center at Lowry staff that Keith Janis provided to The Post documented an employee there saying she was comfortable testifying under oath that Arthur did not have his hair cut at their facility.

UCHealth told Keith Janis in the recordings that the situation was under investigation and that staff would review surveillance footage and conduct employee interviews. But Keith Janis said he’s only been provided a couple of blurry still photographs from the security footage, and that UCHealth has not shown him any video.

As news of the situation spread, CU Regent Nolbert Chavez said he wanted answers from UCHealth about what happened, noting the connection between the university and the hospital on CU’s Anschutz Medical Campus.

Chavez said UCHealth officials offered two different explanations to him and other CU leaders, first saying they had video that showed Arthur Janis initially arriving at the hospital with short hair, then claiming to have footage showing Arthur leaving the hospital with long hair and returning from the rehab facility with shorter hair.

“UCHealth has lied to the Board of Regents, to the community and to the family that they have a video that proves their position,” Chavez said. “They continue to withhold it and therefore I believe that it either doesn’t exist or doesn’t show what they say it does. They have lied to everyone.”

Chavez said he plans to ask his fellow regents to review how UCHealth board members are appointed in light of this incident.

Before heading back to South Dakota, Keith Janis filed a report with the Aurora Police Department. Joe Moylan, a spokesman for Aurora police, confirmed the department is investigating the incident, but said he couldn’t share any additional information due to the active investigation.

Keith Janis said UCHealth officials eventually called his sister, Arthur Janis’s medical proxy, in November and admitted the hospital did cut their brother’s hair

“I decided I’d call an even bigger group together and get down there and demand from them an apology for the humiliation they put me and all my relatives through and them knowing they cut his hair and lying to us,” Keith Janis said.

Keith Janis and his loved ones traveled back to UCHealth on Thanksgiving — a day he noted represents loss and genocide to Native American people.

“We demanded an apology from them for what they have put us through,” Keith Janis said. “A public apology from that hospital because of all the lies and deception. They wouldn’t give it. We have not gotten our apology.”

The family is now looking into legal options, he said.

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Colorado officials say their plan to import cheaper medicines from Canada has been stymied by opposition from drugmakers and inaction by the Biden administration, according to a state report obtained by KFF Health News.

The Dec. 1 report, prepared for the state legislature by Colorado’s Department of Health Care Policy and Financing, says that state officials approached 23 drugmakers in the last year about an importation program. Only four agreed even to discuss the proposal; none expressed interest in participating.

“Generally, the challenges that remain are outside state authority and rely on action by FDA and/or drug manufacturers,” the report reads.

Lawmakers in both parties, at the state and national level, have sought for decades to legalize importing drugs from Canada. Since 2020, when President Donald Trump’s administration opened the door to Canadian drug imports with regulations issued just weeks before he lost reelection, only a few states have filed applications with the Food and Drug Administration to create importation programs.

The FDA hasn’t yet ruled on any of them. Colorado filed its application in December 2022. Florida, which applied in 2020, has been waiting nearly three years for a decision from the Biden administration on its importation plan, pushed by Gov. Ron DeSantis, now a Republican presidential candidate.

FDA spokesperson Cherie Duvall-Jones said the FDA has not acted on states’ importation applications because it has not determined whether they would save significant money for consumers without posing risks to public health.

U.S. consumers pay some of the highest prices in the world for brand-name pharmaceuticals. Drugs are generally less expensive in Canada, where the government controls prices.

Under Trump, the federal government declared that importing drugs from Canada could be done safely — satisfying for the first time a condition spelled out in a 2003 law.

But Colorado officials cited another catch: The rule didn’t take into account that states would have to negotiate directly with drug manufacturers, which oppose selling their brand-name drugs in the United States at Canadian prices.

“As the federal Final Rule did not contemplate the need for this negotiation step, we have urged FDA to release further guidance regarding how states can operationalize the program with this in mind, but to date, no guidance has been released,” the Colorado report said.

Unlike many other Trump administration health policies, Biden hasn’t revoked or revised the importation rule. But his administration hasn’t shown much support for the idea, either. Health and Human Services Secretary Xavier Becerra told KFF Health News last December that he wouldn’t commit to the FDA ruling on any state application in 2023.

The president has repeatedly suggested that under his watch Americans would be able to import drugs from Canada.

During his 2020 campaign, Biden said he’d allow for the importation of drugs the government certified as safe. In 2021, he ordered the FDA to work with states to import prescription drugs from Canada. In a 2022 speech about how he planned to reduce drug prices, he cited Colorado estimates of how much people in the state could save through importation.

FDA officials responded to Colorado’s application in March by asking for more information and a smaller list of drugs to target, to prove that importation could save money. Colorado’s initial application listed 112 high-cost drugs. The state estimates residents and employers could save an average of 65% on the costs of those medicines, including drugs for diabetes, asthma, and cancer.

Colorado said it plans to submit an updated application early next year. By then, it’s possible the FDA will have ruled on Florida’s application.

The Colorado and Florida importation proposals differ. Colorado’s program is intended to directly help consumers obtain cheaper medicines. Florida’s plan aims to cut spending on drugs in government programs such as Medicaid, the prison system, and facilities run by the state Department of Children and Families.

The drug industry has argued the Trump administration didn’t properly certify that drugs imported from Canada would be safe, jeopardizing Americans’ health. Canada’s government, too, has expressed concern that U.S. imports would lead to shortages and higher prices in its country.

Drug manufacturers “will do anything to protect their golden goose that is United States consumers and patients who pay the largest amount for drugs in the world,” said Colorado state Sen. Sonya Jaquez Lewis, a Democrat, pharmacist, and leading advocate for drug importation.

The White House and Congress, she said, should force drugmakers to negotiate with states to start importation programs.

In its initial response to Colorado’s application, the FDA listed several types of information it still needed, including plans on labeling and drug eligibility, according to a March letter from the FDA to the state. Another problem, the FDA said: The state planned to import medicines across the U.S. border in Buffalo, New York. The FDA said the only port of entry it allows for medicines is in Detroit.

Colorado officials told the FDA in March that without federal approval of its application, it was having difficulty securing commitments from drug manufacturers to obtain medicines.

“It has been made clear that potential partners will be more interested in committing to participate once our program has been approved by the FDA,” Kim Bimestefer, executive director of the Colorado Department of Health Care Policy & Financing, wrote to the FDA.

“While we understand the regulatory framework does not permit for a provisional approval, we know that showing progress towards an approved program will aid in our negotiations with drug manufacturers,” she added.

Another complication is that the FDA’s rule doesn’t allow states to buy drugs directly from secondary drug wholesalers. Instead, they must purchase medicines directly from manufacturers, said Marc Williams, a spokesperson for the Colorado agency.

That’s proven challenging because drug manufacturers have prohibited the export of products intended for sale in Canada to the U.S., Williams said.

“Without their permission and a supply agreement directly with a manufacturer, Colorado is unable to buy and import these lower-priced drugs that would save people money,” he said.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF–an independent source of health policy research, polling, and journalism. Learn more about KFF.

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The Colorado Department of Public Health and Environment reported 84 people were diagnosed with tuberculosis so far this year, which is higher than the pre-pandemic average of about 70 cases per year. Two people have died, which is on the lower end of what Colorado typically sees.

The increase was first reported by 9News.

The state defines elimination as fewer than one case of active disease for every million residents, state epidemiologist Dr. Rachel Herlihy said. This year, the health department has recorded about 20 cases for every million residents – a significant gulf in the world of infectious diseases.

“We do still have that goal of elimination,” she said. “We certainly do have some challenges ahead of us.”

Tuberculosis is the world’s top infectious disease killer, causing about 4,300 deaths per day worldwide. Most of those deaths happen in developing countries, where the disease is more common and treatment is harder to come by.

No one is sure why cases are rising now or whether this is a temporary or longer-term problem, Herlihy said. Most tuberculosis cases are in people who’ve been infected with the bacteria for some time, so it’s unlikely this represents a rebound of delayed infections, she said. Some other respiratory diseases did increase as COVID-19 controls loosened, creating short but intense periods as they spread through populations that hadn’t seen them for months or years.

One possibility is that people didn’t come in for health care during the pandemic, or that their doctors weren’t thinking about tuberculosis and didn’t order the right testing, said Dr. Larissa Pisney, medical director for infection prevention and control for UCHealth’s metro area hospitals. The people who came to UCHealth with active tuberculosis infections this year were sicker than usual, and in some cases, the disease had infiltrated their bones or other organs, she said.

The most common symptoms of tuberculosis are a persistent cough, night sweats and a low fever. Some people lose weight or cough up blood. Many people who are exposed to the bacteria that cause tuberculosis don’t develop symptoms and can’t spread the disease, because their bodies respond and force it into a latent form.

If the bacteria later awaken, though, they could get sick and become contagious. Those who have HIV, other conditions that suppress the immune system, or diabetes are more likely to become sick if exposed, according to the Centers for Disease Control and Prevention.

Before the pandemic, active tuberculosis cases were falling steadily, said Dr. Masae Kawamura, former tuberculosis controller for the city of San Francisco. When COVID-19 hit, however, public health departments had to redeploy their staff who had the most experience with an airborne virus – typically those working with tuberculosis, she said.

The bacteria that cause tuberculosis can linger in the air after a person coughs, but most people don’t need to worry about catching the disease. Typically, it spreads to people who live or work with someone who has an active infection.

“For most people in Colorado, this is still not a concern,” Pisney said.

The risk of having a latent tuberculosis infection is higher for people who spent significant time in a region of the world where it’s more common, such as Eastern Europe, much of Asia, Africa and parts of South America. People who worked or lived in tight quarters, such as jails and homeless shelters, also are at increased risk.

Drug treatments are available, but patients who have symptoms have to take them consistently for at least six months. The course is often shorter for people with latent infections.

The United States does have some advantages in beating back tuberculosis again, Kawamura said: new blood tests make screening significantly more convenient than it was with the old skin test, and the drug regimen is shorter than it used to be. Unfortunately, in the countries with the highest rates of tuberculosis, people with symptoms often go untreated, allowing the bacteria to leap borders as visitors return home, she said.

“TB anywhere is TB everywhere,” she said.

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Bailey Pate, a 36-year-old resident of the Denver area, sued Sima Sciences and Nuka Enterprises, both based in Henderson. She alleged that their “Midnight” sleep aid drops caused liver damage after she used them for about 16 months in 2020 and 2021.

She settled with the companies this week for an undisclosed amount.

Laura Browne, an attorney who represented Pate, said thousands of people in Colorado and a handful of other states may have claims, either for injuries they suffered or for the money they spent on a potentially unsafe product.

The drops, sold under the 1906 brand name, included cannabis and corydalis, a traditional Chinese herbal remedy. Corydalis contains tetrahydropalmatine, or THP, a chemical that can cause liver damage at high doses. The manufacturers recalled the products earlier this year.

Peter Barsoom, the CEO of Nuka Enterprises, told The Denver Post in a statement Wednesday that the company “received a small number of reports from customers” who experienced a rare side effect — elevated liver enzymes — from the drops in their latest formulation.

“In every case we are aware of, levels went back to normal after discontinuing use,” he wrote. “While thousands used Midnight every night without any side effects, we take our responsibility seriously and discontinued Midnight earlier this year. We deeply regret the suffering that some customers experienced.”

In July 2022, the Marijuana Enforcement Division and the Colorado Department of Public Health and Environment issued a warning that said the products could cause liver injury. The drops remained available for sale, however, because the manufacturers said they had replaced corydalis with stephania, another herb.

Another state announcement in June said the manufacturers were working to remove the drops from store shelves after reports of liver injuries from the stephania version. The Marijuana Enforcement Division routinely accepts complaints about harm from marijuana products investigating them with the state health department if the alleged health consequences are serious.

Evan Hoffman, a Denver lawyer, said he represents about 30 people who developed liver problems after using the drops. About half of his clients were hospitalized, usually between two and eight days, after developing jaundice, nausea and unexplained fatigue, he said.

His clients are in settlement talks with the company, and some others have reached their own settlements, Hoffman said. He estimated two to four people still reach out to him in a typical week as they realize what could have caused their sudden liver problems, he said.

“People are still just now putting the pieces together,” he said.

Hoffman said his clients are not only upset about the unknown health consequences of their liver damage but angry that the company seemed to know it was a possibility and didn’t warn them.

“They didn’t do anything about it because it was their best-selling product,” he said.

As of late November, the manufacturers were selling six other products under the 1906 label. Visitors to the site could click on a list of ingredients, but the only warnings stated that customers should consult their doctors about any dietary supplements, and that pregnant and breastfeeding women shouldn’t take these products.

Online searches for the ingredients turned up some that were linked to kidney damage and liver failure. Others could worsen autoimmune diseases or interfere with medications. Plant-based remedies generally aren’t studied extensively, however, so it’s not clear if the amount of herbs in the supplements could be dangerous.

The U.S. Food and Drug Administration doesn’t regulate supplements unless they state the product can treat, prevent, diagnose or cure a specific condition. That’s why so many products make nebulous claims, such as that they “boost immunity.”

Browne said the absence of meaningful regulation means that “you really need to take it upon yourself … to investigate the ingredients as much as you can.” She added: “But consumers shouldn’t have that put on them.”

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Xylazine, also known by its street names “tranq” and “zombie drug” — for the severe, rotting wounds it can cause in humans — spurred a warning from the U.S. Drug Enforcement Administration last spring about its potential lethality, especially when mixed with opioids such as fentanyl. The drug is not approved for human use.

The bipartisan bill, dubbed the Testing, Rapid Analysis and Narcotic Quality (TRANQ) Research Act, directs the National Institute of Standards and Technology to focus its research on existing and emerging illicit drugs containing xylazine and other emerging substances. NIST researchers have been helping to improve and develop technologies to get ahead of synthetic drugs, and Caraveo’s bill directs the agency to apply those efforts to xylazine as well.

The bill was the freshman congresswoman’s first bill to pass through both chambers of Congress. Introduced in March, it was approved by the Senate in June and came back to the House with minor changes for Monday’s vote.

Last year, 1,799 Coloradans died of a drug overdose, down slightly from the 1,881 overdose deaths recorded in the state the year before. Fentanyl and methamphetamine continue to push the state’s per-capita overdose rate to alarming levels.

“New illicit drugs like tranq are fueling an epidemic that is devastating American communities, including families here in Colorado,” Caraveo said in a statement issued shortly after the House gave final passage to her bill on a voice vote. “We need to head off these alarming new threats before they spread.”

Caraveo took office in January, becoming the first representative of Colorado’s newly formed 8th Congressional District, which covers parts of Adams, Weld and Larimer counties.

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The trial, involving scientists in Colorado, the United Kingdom and Italy, infused stem cells taken from the brain of a fetus that had died in a miscarriage into 15 Italian patients who already had significant disabilities caused by multiple sclerosis. In the year after the infusions, the patients’ multiple sclerosis didn’t get worse, and they didn’t have severe side effects from the stem cells.

It will take a bigger trial with a comparison group that didn’t receive the treatment to know whether the stem cells truly slowed down the disease’s progression, though, said Angelo D’Alessandro, a professor at CU’s Anschutz Medical Campus.

“The disease was overall stable,” he said.

In multiple sclerosis, the immune system attacks a substance called myelin that coats cells in the nervous system. As the myelin wears away, the nerve cells lose the ability to communicate with each other, gradually leading to problems with walking and other daily tasks, Alessandro said.

Some people’s illnesses progress much faster than others’, and not everyone has all of the symptoms, which can include vision problems, muscle weakness, pain or loss of sensation, fatigue and difficulty speaking.

Scientists have talked about stem cells as a possible solution to degenerative diseases like multiple sclerosis for decades, because while medication can prevent dramatic flare-ups of the disease, there’s no way to stop gradual loss of function over time, said Dr. Michael Sy, a neurologist at the University of California Irvine.

This particular study showed that infusing stem cells into the brain can be done safely, but didn’t suggest patients could expect dramatic improvement from these types of transplants any time soon, he said.

Commercialization of stem cell technology has gotten well ahead of science, though.

The only approved treatments using stem cells are bone marrow transplants, but in 2021, researchers found more than 2,700 clinics operated in the United States, offering to use embryonic stem cells or cells from patients’ own fat to treat a variety of diseases. Some patients have gone blind or developed tumors after receiving stem cell injections.

At the beginning of human development, stem cells could form any type of cell in the body, but they gradually take on specialties. The donated cells in the multiple sclerosis trial could only become brain tissue at that point, reducing the odds they’d develop into tumors.

Previous studies in rodents and non-human primates engineered to have a disease like multiple sclerosis found that the transplanted cells went to the parts of their brains that had lesions and appeared to partially repair them, Alessandro said. It’s not clear if the same thing would happen in humans, but those that received larger doses in the trial had more significant changes in the fluid surrounding their brains and spines that suggested their cells were healthier, he said.

It’s possible that a small percentage of the stem cells converted into cells in the brain, replacing damaged ones, Alessandro said. Stem cells can also give their mitochondria — the powerhouses of cells — to the existing neurons, which could reduce inflammation in the brain, he said.

All of the 15 patients in the trial were middle-aged and had advanced forms of multiple sclerosis, with significant disability. Even if subsequent trials find a benefit for that group, it’s not clear if different types of patients would find it helpful.

Stem cell transplants likely wouldn’t be a first line of treatment. To deliver the cells into the brain, doctors had to cut a hole in the patient’s skull, a process that comes with the risk of injury or introducing an infection.

It’s possible that this approach won’t pan out, but even in that case, it might advance the field for others to try something else, Alessandro said. The researchers are planning a second trial to quantify if the stem cells produced benefits, but aren’t enrolling patients in Colorado at this point.

“This can give hope to patients,” he said.

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