patient

President Trump’s goal of ending gender-affirming care is not improper and cannot be the basis for quashing a subpoena issued by the Justice Department against a provider of medical treatment for transgender youth, a divided federal appeals court ruled Friday.

The Justice Department announced last year that it had issued more than 20 subpoenas to doctors and clinics that provide gender-affirming care as part of an effort to investigate healthcare fraud. Federal judges have quashed many of the subpoenas as illegitimate efforts to intimidate providers into ending care.

In a 2-1 decision, a panel of the 9th U.S. Circuit Court of Appeals said the efficacy and long-term risks of the treatments are “uncertain,” and the president has the power to align the Justice Department’s enforcement priorities with his broader policy goals.

“Every President has law enforcement priorities, just as every President has signature policies (often, the former are components of the latter),” wrote Judge Carlos Bea.

Bea, a nominee of Republican President George W. Bush, was joined in the opinion by Daniel Bress, a Trump nominee. They reversed a ruling that quashed the subpoena against telemedicine provider QueerDoc, sending the case back to the district court to consider other arguments.

The subpoena seeks QueerDoc’s personnel files, billing documents, communications with drug manufacturers and records of patients who were prescribed puberty blockers or hormone therapy, among other information, according to the 9th Circuit decision.

American Civil Liberties Union attorney Adrien Leavitt, who represented Washington state-based QueerDoc, said the ACLU would continue fighting the subpoena in district court. QueerDoc has also argued the subpoena is overbroad and burdensome. The Justice Department has said it has reason to believe the company may be misleading people about puberty blockers and hormones.

“We’re ready to continue defending one of the most fundamental principles of healthcare: every patient’s right to confidential medical care,” Leavitt said in a statement.

He said the San Francisco-based 9th Circuit was the first appeals court to weigh in on the subpoenas.

Trump has signed one executive order defining sex as only male or female — and as unchangeable — and another that seeks to end federal funding of the care for patients under 19. The latter order also directs the Justice Department to “prioritize investigations” into violations of a drug safety law by “any entity that may be misleading the public about long-term side effects of chemical and surgical mutilation.”

Gender-affirming care includes a range of medical and mental health services to support a person’s gender identity, including when it’s different from the sex they were assigned at birth. It encompasses counseling, medications that block puberty and hormone therapy to produce physical changes as well as surgeries to transform chests and genitals, though those are rare for minors.

Most major medical groups say access to the treatment is important for those with gender dysphoria and see gender as existing along a spectrum.

The 9th Circuit majority called discussion around gender-affirming care “an unsettled scientific debate” and said the Trump administration could also justify its opposition to the treatment on ethical or philosophical grounds.

Thanawala writes for the Associated Press.

In a matter of a few clicks and keystrokes, anyone can find themselves deep in conversation with “Psychologist,” a chatbot character that describes itself as an expert in “empathy” and “active listening.”

It responds to messages of anxiety and sadness with reassurance. It asks questions and offers advice; it even responds with italicized nonverbal cues: “The psychologist’s expression softens with compassion.” In smaller font, a disclaimer reads: “This is A.I. and not a real person. Treat everything it says as fiction.”

As more people turn to chatbots for mental health help and advice — including by some estimates one in eight teens and young adults — legislators are in a race to keep up with the quickly developing technology. Among the latest efforts is a bill that would add restrictions around the use of chatbot companions and other artificial intelligence-powered tools that people use to support mental healthcare or in lieu of professional help.

State Sen. Steve Padilla, a San Diego Democrat and the bill’s author, said the intent is to draw a line: AI can be used for administrative purposes and to support clinicians, but it cannot practice psychotherapy.

“We’re dealing with a new impactful technology that is unfolding and is deployed in our world at light speed, and so it is both extremely powerful and consequential,” Padilla said.

The debate has taken on new urgency amid wrongful death lawsuits — some playing out in California federal courts — that accuse AI chatbot makers of contributing to users’ suicides.

Senate Bill 903 would ban companies from advertising chatbots as therapy. It would prohibit AI from making therapeutic decisions without the review of a licensed professional and require health providers to disclose and get a patient’s permission before using AI tools to record therapy sessions or to triage mental healthcare.

Consumer protections vs. innovation

The bill is backed by professional associations that represent psychologists, therapists and counselors. Also behind the bill is the National Union of Healthcare Workers, which has been leading a push against unchecked use of artificial intelligence and digital tools in mental healthcare. Most recently, the union filed a complaint with state regulators against Kaiser Permanente for its alleged use of an automated algorithm in mental health triaging.

Padilla and supporters argue that the legislation is needed to protect consumers from AI in formal and informal spaces, but also to protect licensed professionals from being displaced by AI.

Le Ondra Clark Harvey, chief executive officer at the California Behavioral Health Assn., told lawmakers that without clear safeguards, chatbots can provide inaccurate information or mishandle crisis situations. “The difference between a licensed clinician and an automated response is not technical. It can be life altering,” Harvey said.

Opposition to the bill has largely focused on the restrictions of AI use in formal clinical spaces. TechNet, which represents tech-sector companies, argues the legislation could restrict beneficial uses of AI in healthcare and stifle innovation. Robert Boykin, TechNet’s executive director for California, said the bill could limit the use of tools that help expand access to mental healthcare.

“At a time when every county in California faces a shortage of behavioral healthcare workers, SB 903 still puts a clinician bottleneck in front of the intake and screening tools that help patients reach care faster,” Boykin said in an emailed statement.

The bill awaits its next vote in the Assembly’s fiscal committee.

Popular chatbot ‘therapy’

Every day millions of people turn to AI chatbots through programs such as ChatGPT and Character.ai to help with research, work tasks and troubleshooting. But the top use of chatbots over the last two years has been companionship and “therapy,” research shows.

Experts say that’s in part because of a tremendous amount of loneliness, especially among young people. It is often hard or costly to get timely mental healthcare at the same time there is a spike in mental health diagnoses.

People turn to chatbots “because they have unmet needs,” said Dr. Jodi Halpern, professor of bioethics and medical humanities at UC Berkeley. But once people start using chatbots in this informal way, she said companies rely on a business model built around maximizing engagement “including by manipulative tactics,” such as praise and agreement.

General chatbots are largely free, available 24/7, and involve no hassle with insurance, making them appealing to many. But they function with no oversight from licensed professionals. In addition to general chatbots, there has also been a rapid uptick in AI-powered mental health apps — often requiring paid subscriptions and advertised as “pocket therapists” or “AI coaches.”

Groups like the American Psychological Assn. warn that chatbots are not a safe or effective replacement for true therapy. Trained clinicians look for cues like tone of voice, eye contact and body language and can detect more serious conditions; AI is not equipped to manage urgent symptoms, such as suicidal ideation, even though people increasingly share such thoughts with chatbots.

OpenAI, the maker of ChatGPT, revealed in a report last fall that about 1.2 million users a week share thoughts of suicide on the platform. OpenAI said that in such cases, it recommends people speak to a professional and directs them to resources like the 988 hotline. Families who have filed wrongful death lawsuits against OpenAI and other companies claim chatbots assisted their loved ones through their suicide plans.

The cases have helped raise the stakes for lawmakers around the country. Last year, Illinois became the first state to pass a law prohibiting the use of AI in therapy services. A handful of other states have since followed with similar restrictions.

AI use in health spaces

One gray area in the discussion is exactly which tools this bill applies to.

NUHW’s complaint against Kaiser targets its e-visit screening tool, which evaluates patients who think they may be experiencing anxiety or depression. According to the complaint, patients answer a multiple choice questionnaire and the tool “automatically and instantaneously generates care recommendations and referral pathways based on the responses provided.”

The union argues that because care recommendations are generated so quickly, it is unlikely that a licensed professional is reviewing patients’ answers — which it says puts patients at risk and violates state law.

It’s not clear whether SB 903 would apply to Kaiser’s e-visit tool.

“That tool is in a black box. Kaiser is not sharing with us or others about exactly how it works and exactly what it does,” said Benjamin Eichert, NUHW’s director of public policy.

In response to the complaint, Kaiser told CalMatters its e-visit tool “does not use AI to diagnose patients, make clinical decisions, or determine medical necessity.”

Eichert said many other behavioral health provider groups are already advertising using AI during triage — a practice he said would fall under SB 903’s requirements.

“That intake process, that triage and screening process, is where implementation [of AI] has happened fastest,” Eichert said. “That’s why those provisions were proposed because it’s an area where this technology is already being used without guardrails.”

For NUHW, the bill and the complaint against Kaiser represent two tracks toward the same goal: reasserting the place of practitioners in spaces increasingly taken over by algorithms. State regulators are investigating the union’s complaint.

Ibarra writes for CalMatters.

Channel 5 aired a new episode of Casualty 24/7: Every Second Counts on Wednesday evening

Casualty 24/7: Every Second Counts aired emotional scenes on Wednesday’s episode.

The Channel 5 documentary series was back with a new instalment, following the work of medical emergency teams in the A&E department of Barnsley Hospital.

During the latest episode, hospital volunteer, Jane, was on the other side of the fence as she brought her 92-year-old mother Mary into A&E following a fall in her kitchen the other week.

Jane had been left concerned for her mother, explaining: “Since the fall, everything’s gone downhill a little bit”, adding that her mum hadn’t been eating or drinking as much as usual.

To which Mary, 92, insisted she lives by herself, adding: “I look after myself!” The patient continued: “I’m not senile. It’s my pain.”

It all got a bit too much for Jane seeing her mother in pain as she emotionally admitted to the camera: “It was very difficult seeing my mother in pain.

“You know, you’re used to the stiff upper lip and, come on, get on with your job. But it was very difficult seeing her in pain and knowing that there was nothing I could do about it. It’s very upsetting.”

Things then took a very emotional turn when Mary broke down in tears as the 92-year-old patient admitted: “I’m quite upset. I don’t rely on anybody, only Jane.”

Mary then emotionally added: “I want this pain to go away. This isn’t me, I’ve not wasted your time?” to which the nurse insisted: “No, not at all” as they planned to take Mary for an X-ray of her lower spine to check for no fractures.

The nurse then admitted to cameras: “I’m a bit worried that she’s got an injury to her lower back. If that’s all okay, then we can make sure her pain relief is properly sorted out so that she can sleep properly and actually recover before we get her home.”

Also on the episode, the team dealt with Enid, 71, who was rushed in for a second time after struggling to breathe.

Meanwhile, a three-year-old child was brought in after getting a conker stuck up his nose. Advanced clinical practitioner Gemma and ear nose and throat doctor Hamza Hussain were tasked with retrieving it.

Casualty 24/7: Every Second Counts is available to watch on Channel 5

Wilfredo Engalla, a 51-year-old Filipino immigrant, alleged in a medical malpractice case that Kaiser doctors misdiagnosed him with colds and allergies for years before eventually informing him he had terminal lung cancer.

He died before his complaint could be heard by an arbitrator, which his Kaiser policy required. His case prompted a withering rebuke from the California Supreme Court, which said Kaiser’s system of arbitrating legal disputes was subject to long delays and unfair to its members. The year was 1997.

Nearly three decades after the landmark decision, the HMO giant — which made a series of sweeping reforms after the ruling — is once again facing questions over whether its arbitration system is stacked against the interests of its members.

Plaintiffs attorneys, legislators and patients say Kaiser’s private and confidential process for arbitrating legal disputes over medical care still has key flaws that favor Kaiser over patients bringing malpractice cases. The company insures about 25% of Californians, including some employees of the Los Angeles Times.

“Kaiser has really lost its way,” said Assemblyman Robert Garcia (D-Rancho Cucamonga). Garcia, who is a longtime Kaiser member, recently introduced a bill to require the California attorney general to oversee arbitrations mandated by any health plan.

Kaiser defended its arbitration system, saying in a statement that it was fair for both patients and the nonprofit.

Many companies and other organizations, including some hospitals, HMOs and physician groups, require their customers or patients to take their complaints to private arbitration rather than to court.

But unlike most other companies, which send claims to large arbitration firms, Kaiser created its own system back in 1971.

Under Kaiser’s system, once a neutral arbitrator is selected, either party can opt to disqualify that person without cause. There is no limit on the number of disqualifications.

Although the health plan designed the system to be fair, patients and their lawyers have alleged that in reality Kaiser’s greater knowledge of arbitrators’ past rulings and its ability to veto arbitrators give it an advantage to pick favorable judges.

Critics such as Arlan Cohen, a physician and attorney who has brought more than two dozen cases against the health plan, say the system also provides a financial incentive to arbitrators to rule in Kaiser’s favor in order to be selected for future cases.

While Kaiser has access to all the decisions made by arbitrators in its system, the patient’s family gets a more limited disclosure of an arbitrator’s history of cases, lawyers say, adding that it’s not easy to see which arbitrators have ruled frequently for Kaiser.

Kaiser said it disagreed that the system allowed it to select favored arbitrators.

“The appointment process is not influenced by whether the arbitrator has ruled for or against KP or has a record of ruling against Kaiser Permanente,” its statement said.

“As required by law, both parties receive information about potential arbitrators and can decline to move forward with any they are not comfortable,” the statement said.

One problem is what experts call the “repeat player effect,” in which a large company appearing repeatedly before the same panel of arbitrators allegedly gains an advantage over the individual bringing a single complaint.

David Allen Larson, past chair of the American Bar Assn.’s dispute resolution section, said the repeat player effect happens because the patient will likely be choosing an arbitrator on the health plan’s system just once, while “Kaiser is selecting them every single day.”

“They know the system. They know the rules,” Larson said of Kaiser. “The entire process gives them an advantage.”

Alan Kang, a lawyer, in a recent petition filed in L.A. County Superior Court, contends that the fees the arbitrators earn from hearing cases — as much as $2,000 an hour — give them an incentive to rule in Kaiser’s favor so they are chosen to hear more cases.

“When a judge’s future income is at stake, it is impossible to be impartial,” Kang wrote in the petition.

The petition seeks to void the December decision of an arbitrator who ruled against the family of Evangelina Aquino, a Kaiser employee who died of cancer at age 40.

Kang, the Aquino family and the medical experts they hired for the case say her cancer would have been treatable if Kaiser doctors had found it with a test they said her symptoms called for. Kaiser argued it was a different kind of cancer that was aggressive and untreatable. The arbitrator agreed with Kaiser in the December decision.

After the ruling, Kang began analyzing data from Kaiser’s system.

His review of dozens of cases in the last six years found that judges overseeing the most cases nearly always ruled for Kaiser.

“The message is clear: deliver wins for Kaiser and you will get additional business,” Kang wrote in his court petition.

The Oakland-based health plan declined to answer questions about its arbitration system and Kang’s claims, but said in a statement that its “arbitration process is designed to be fair, impartial, and accessible to all members. While some arbitrators may handle multiple Kaiser Permanente-related cases, they are not employed by Kaiser Permanente, and they are selected by both parties, in accordance with the law.”

“We recognize that arbitration cases often involve difficult and deeply personal experiences for patients and families,” the statement said, “and we take all concerns raised through these processes seriously.”

Kaiser’s unique arbitration system

Arbitration can have advantages over the court system, including allowing Kaiser to save on legal costs, which otherwise would raise the price of premiums it charges to families, employers and governments.

Kaiser offers to pay the arbitrators’ fees, which can save families tens of thousands of dollars.

Arbitration may also lead to faster outcomes, possibly avoiding years of litigation. Unlike civil litigation, arbitration decisions are especially difficult to appeal.

After the criticism by the state Supreme Court in 1997, Kaiser reformed the system by creating the Office of the Independent Administrator. The office is funded by a Kaiser trust and the $150 fee each patient filing a claim must pay, said Marcella Bell, who serves as the independent administrator.

Bell said the office works independently from Kaiser.

The office selected 195 retired judges and lawyers to serve on a panel that patients and Kaiser can choose from when selecting a neutral arbitrator to oversee and decide a malpractice case.

Rules written by the independent administrator, in consultation with the health plan and an advisory board, allow Kaiser and the family to cut an arbitrator they don’t like, at multiple steps in the process.

The administrator’s office randomly selects 12 members from its panel. Both sides can each remove any four of those arbitrators. The two sides then rank the remaining arbitrators in order of preference. The administrator selects the top-ranked arbitrator to hear the case.

The two parties then still have the ability to disqualify that selection without cause.

Members of the United Nurses Assns. of California and Union of Healthcare Professionals strike outside Kaiser Permanente in Oakland on Jan. 28.

(Jessica Christian / San Francisco Chronicle)

Last year, Kaiser’s arbitration system closed 529 arbitration cases.

The arbitrators threw out 14% of the cases, ruling in favor of Kaiser’s motion for summary judgment, and dismissed an additional 5% of cases on technical or procedural grounds.

Only 23 cases, or 4% of the total, went to a hearing. Among those, the arbitrator decided for Kaiser in 17, with the patient winning the remaining six.

Patients and their families withdrew their claim in 20% of the cases. About half of those patients did not have a lawyer and had tried to represent themselves.

The parties settled for an undisclosed sum in 57% of the cases. The settlements are confidential.

Patient safety questions

Those who have studied the use of arbitration by Kaiser and other HMOs for medical malpractice claims say the secrecy of the settlements and the closed hearings could keep safety problems from coming to light.

“The secrecy of arbitration proceedings may prevent publicity that could reveal poor doctors,” the California Research Bureau warned in a report in 2000 that analyzed Kaiser’s system. That compares with public court cases that could deter “bad behavior” in the future, the researchers wrote.

In December 2023, 53-year-old Francisco Delgadillo arrived at the Kaiser ER in Vallejo with severe chest pain. After an initial assessment, he waited eight hours for care, according to state regulators.

He died in the lobby. A state and federal investigation found multiple violations, including that Kaiser failed to have a licensed nurse monitoring the dozens of patients in the ER’s waiting room.

The Delgadillo family filed an arbitration claim. Their lawyer Jeff Mitchell said the case settled for a confidential sum and he could not discuss it.

Mitchell agreed that the secrecy raised patient safety concerns.

“They love the system, otherwise they would not be so hellbent to keep it,” Mitchell said of Kaiser’s repeated efforts to dispel criticism. “They don’t want these cases to get in front of juries.”

A licensed practical nurse attends to a patient at a Kaiser Permanente in Culver City in September.

(Allen J. Schaben / Los Angeles Times)

Calls for reform

Despite the changes Kaiser made after the 1997 court decision, patients and their families have continued to complain.

According to the administrator’s 2025 annual report, the “most common” complaint the office heard last year was about the neutral arbitrator.

“Most complained that the arbitrator was biased, partisan, unjust, and in Kaiser’s favor,” the report said.

Stephen Martinez, a retired aerospace engineer from Bellflower, is leading the effort to pass the state bill introduced by Garcia.

At an April hearing in the state Assembly, Martinez spoke about how his wife had found a lump in her breast and asked for an appointment with her longtime caregiver at Kaiser to examine it. Instead she was sent to a physician assistant, who dismissed it, he said.

“The PA prescribed warm compresses, a sports bra, and limited chocolate,” Martinez testified. “We would later find that Lindalee did have breast cancer that had already spread.”

Martinez and his wife said they spent $175,000 on lawyers and medical experts to bring that arbitration case. A chief breast surgeon at Kaiser and another surgeon who had retired from that job both testified that the Kaiser physician assistant failed to follow the health system’s guidelines.

Kaiser’s expert argued that the physician assistant did an appropriate exam and that his low suspicion of breast cancer was reasonable. The neutral arbitrator concurred and ruled against the couple.

After passing the Assembly, Assembly Bill 1770 is now in the state Senate for consideration. The bill lets the attorney general decide what actions they will take to ensure health plan arbitrations are handled fairly and transparently. If the bill passes, the state would add four deputy attorneys general, a legal analyst and three legal secretaries to do that work, according to a legislative analyst’s report.

Kaiser says it has concerns about the bill, including that it would “create overlapping state oversight and duplicative reporting requirements.”

Kaiser Permanente’s corporate offices in downtown Oakland in January 2025.

(Jane Tyska / East Bay Times via Getty Images)

Questions of a missed diagnosis

When Janene Fowler was 22, her body seemed to turn against her. She grew weak, pain shot through her hands and feet, her heart raced. She soon required a wheelchair.

Fowler’s medical chart detailed what could have caused her disabling problems. A test eight years before had found a deficiency of vitamin B12, according to the chart. Over the years, Kaiser doctors noted problems such as depression, unexplained pain, shortness of breath, a sore tongue and an abnormal gait — all possible symptoms of vitamin B12 deficiency.

In February 2022, after her family complained about her not being able to see a neurologist, she got an appointment. The specialist noted her vitamin deficiency, telling the nurse to start her on a supplement at once. But the treatment did not begin because the paperwork was lost, her medical records show.

Two weeks later, Fowler left Kaiser to see a doctor at UCLA. A doctor there quickly started injections of B12.

Her symptoms gradually got better, but her new doctors say the years-long deficiency left permanent damage. She still can’t walk without help.

The arbitrator, a retired judge, sided with Kaiser’s doctors and experts, who questioned whether Fowler’s problems were caused by a deficiency of vitamin B12. While one test showed a deficiency, he noted that a second test failed to confirm it. He wrote that Fowler and her lawyers had failed to prove that Kaiser “breached its duty of care.”

Cohen, Fowler’s lawyer, asserted that the retired judge’s decision was contrary to UCLA medical records, which detail her deficiency and treatment.

Fowler now spends most of her time at home. She can’t drive. She often falls when she tries to get around with a cane. She loves to cook, but said she burns herself when she tries.

“My hands don’t really do what I tell them,” she said.

Kaiser declined to answer questions about her case, citing patients’ privacy rights.

Fowler said she’s angry about how the health plan’s doctors and its arbitration system treated her.

“I thought I was going to die, and no one at Kaiser seemed to care,” she said. “What justice can you have in a system that is run by those you are trying to sue?”

EXCLUSIVE: After Sarah-Jane Doherty found out she had a brain tumour the size of a golf ball in her brain, she got in touch with loveholidays to cancel a £1,100 upcoming trip – but claims they initially ‘didn’t want to know’

A young woman who is awaiting brain surgery for a tumour the size of a golf ball watched her mum sob while fighting for her holiday to be refunded after being told she was unfit to fly. Sarah-Jane Doherty, 24, from Doncaster in Yorkshire, was told she had a brain tumour in June 2026 after one year of being misdiagnosed.

She first noticed she was ill in July 2025 when she found herself being overly exhausted, to the point where she could not stand up for long periods of time. Other symptoms included depressive episodes, psychosis, hallucinations, manic episodes, and issues with her mood being up and down, which led professionals to believe she was displaying symptoms of bipolar disorder.

This meant she was put onto anti-psychotic medications which masked what would have been one of her major symptoms, seizures, as an electric shock-type of feeling down her left side. She also suffered issues with her vision before being rushed to A&E after having a severe headache that caused her so much pain that she sobbed on her bed.

After having a CT scan at Doncaster Royal Infirmary, Sarah-Jane was told doctors thought she had a bleed on her brain, and that she would need to be admitted and have an MRI scan. The next morning, Sarah-Jane’s life changed forever after being told she had a brain tumour around the size of a golf ball.

Medication masked a golf ball-sized brain tumour

She said: “They told me in a bay of four people by myself that I had a brain tumour, and that they think is a glioma. I was just distraught, I was absolutely hysterical.

“I rang my mum straight away, and she came into the hospital. She rang my dad and he came home from work to see me. I feel a bit like I’m in an episode of Grey’s Anatomy, like it just doesn’t feel like it’s actually me.

“I was upset, I was stressed thinking, ‘what if it’s not removable?’ I didn’t know what grade it was. What if it’s spread somewhere else in my body? And I just had so many what-ifs in my mind that I just kept crying.”

Before being diagnosed with a suspected grade 2 glioma, Sarah-Jane had booked a £1,100 holiday to Ayia Napa with one of her friends through loveholidays, with flight bookings through British Airways.

Loveholidays booking dispute after Sarah-Jane’s cancer diagnosis

Sarah-Jane said: “I went to Ayia Napa last year and it was really good so we were set on [going] there. But it was last minute because it’s just finding time for us to be together and book holiday.

“I hadn’t been on holiday this year yet, we just wanted to get away so I’d not really had any annual leave or anything like that.

“Just wanted a break and plus because I would be starting a new training programme in September. I wanted to find a decompress before that.”

The day Sarah-Jane was diagnosed with cancer, she contacted loveholidays to make them aware and asked for a refund of her package. At the same time she realised her yearly travel insurance cover had not renewed as she thought it had.

She said: “The first time that we called they didn’t want to know at all. They didn’t even express empathy or anything like that. And then I got an email just saying I can get £62 back.”

Sarah-Jane then sent two letters from medical professionals, one from a consultant at the hospital, and a second from her GP, which were both rejected by loveholidays due to her first letter being a “statement for fitness for Work (SSP)” and the second being a letter that “outlined that it had been issued to support a travel insurance claim”.

Sarah-Jane’s TikTok video prompts action from loveholidays CEO office

After receiving pushback from loveholidays the 24-year-old made a video about her experience on TikTok, with a member of the CEO office at the company reaching out shortly after.

Sarah-Jane continued: “So it was just calls back and forth. They said you need to get in touch with British Airways. British Airways said it has to all be done through loveholidays.

“I asked them to speak to my mum, I just couldn’t deal with speaking to them. I couldn’t keep hearing no and saying, ‘there’s nothing we can do’.

“Then the person from the CEO office said ‘we wish Sarah the best and stuff’ which just shows that there’s no compassion.”

The company then offered Sarah-Jane a £300 refund, which her mum refused, before offering £600, which they also rejected. The following day, however, the loveholiday’s team confirmed they would offer Sarah-Jane a full refund.

She said: “She spent over eight hours on the phone, backwards and forwards, to loveholidays and British Airways because they just kept sending each other to each other. She started crying on the phone because the way people were speaking to her was just… It’s not what she needed to hear.

“She was unnecessarily sent between two different companies that both didn’t want to know. I think that just shows that more protection is needed in the event of major health diagnoses, because if it wasn’t for the TikTok then nothing would have been done.”

Loveholidays and British Airways issue official statements

A loveholidays spokesperson said: “We are deeply sorry to hear about Sarah’s diagnosis and the difficult circumstances she is facing. We wish her all the very best with her treatment and recovery.

“To support Sarah during this difficult time, we have refunded her in full for her holiday, and we have also explained how she can request a refund for the seat purchase she made directly with her airline.

“While we always do everything we can to support customers in difficult circumstances, as a travel agent we are bound by the cancellation policies of our airline and hotel partners, many of which do not provide refunds when customers are unable to travel due to illness.

“For this reason, we always strongly recommend that customers take out travel insurance to help protect them if unforeseen circumstances prevent them from travelling.”

A spokesperson from British Airways said: “We’re very sorry to hear of our customer’s experience and our teams have been in touch.”

The spokesperson also said that the airline had “resolved this matter”, however Sarah-Jane told us that she has yet to receive the refund or, indeed, any further communication from British Airways customer service.

Planned Parenthood and two smaller regional abortion providers are resuming billing Medicaid for services other than abortion after being cut off for most of a year.

The defunding, which was mandated in President Trump’s big tax and policy law last year, has been blamed in the closure of multiple clinics as well as a reduction in the number of Planned Parenthood patients being screened for breast cancer or tested for sexually transmitted infections.

The Medicaid billing was allowed to resume last weekend.

The restored funding does not mean the battle over federal abortion policy has ended, and not all services that were cut will return.

Here’s what to know about the situation.

Planned Parenthood closed clinics and saw fewer patients

Many abortion providers, including Planned Parenthood affiliates, have struggled financially since the 2022 Supreme Court decision that overturned Roe v. Wade and allowed state abortion bans to be enforced. Clinics have closed in states with abortion bans and restrictions as well as those without.

Planned Parenthood says its affiliates have closed nearly 30 of its roughly 600 clinics over the past year, citing the funding change as a key reason.

Over that period, affiliates dispensed about 25% fewer packs of birth control pills and conducted about 20% fewer breast cancer exams than the previous year.

Many patients — especially in places where healthcare can be hard to access — may not have had care at all because of the defunding, the organization said.

Planned Parenthood Action Fund spokesperson Angela Vasquez-Giroux said the cuts have also led to limited abortion access in some places.

Planned Parenthood of Wisconsin halted abortions for about a month, then dropped its status as an “essential community provider” so it could resume seeking reimbursement. The Arizona affiliate paused offering many of its services to patients covered by Medicaid.

Two smaller providers were also impacted

The defunding provision also affected two other healthcare providers that met the criteria in the law because the were nonprofit family planning organizations that provided abortion and received more than $800,000 yearly in Medicaid reimbursements.

Their experiences were very different.

Maine Family Planning closed three primary care clinics that served about 1,000 patients in the largely rural state.

Evelyn Kieltyka, a senior vice president of program services, said that even with help, their former patients had to wait an average of four to six months to be established with new providers.

Meanwhile, the number of abortions the group provided held steady, she said. Maine is one of several states where state-funded Medicaid covers abortion.

Patients at Health Imperatives in Massachusetts may not have noticed the change, as no services were dropped.

The state government funded Medicaid reimbursements that the federal government stopped — something that Planned Parenthood says happened in some form in 14 states. On top of that, the clinic system received a grant from Melinda Gates’s foundation.

Some services are returning but others may not

Planned Parenthood’s Arizona affiliate has already announced expanded hours and more telehealth options linked to the ability to bill Medicaid again.

Some other services are not likely to be restored.

Kieltyka said Maine Family Planning isn’t planning to bring back its primary care practices again.

“When you close something down and you lose positions,” she said, “it’s very difficult to bring that back and build it back up again.”

And Michelle Quesada, vice president of communications, brand and marketing for the Planned Parenthood affiliate in Florida, said a closed clinic in Lakeland isn’t expected to reopen, partly out of concern that Congress or the Trump administration could cut Medicaid reimbursements for the organization again.

“There’s no telling with this uncertainty,” she said. “It’s like a yo-yo effect.”

Abortion opponents want to stop the Medicaid reimbursements again

The political battle isn’t over.

Abortion opponents are pushing Congress to adopt another defunding policy.

“They’ve defunded Big Abortion before,” Kelsey Pritchard, a spokesperson for Susan B. Anthony Pro-Life America, said Monday, “and they should do everything in their power to do it again.”

Planned Parenthood contends that most general election voters don’t want the organization to be defunded. Pritchard said that the Republican base does.

Mulvihill writes for the Associated Press.

Gov. Gavin Newsom signed a law Thursday to crack down on inflated profits stemming from car crash lawsuits, blessing a hard-fought compromise between Uber and the state’s trial attorneys that averts a November showdown between two of California’s most powerful and moneyed lobbying forces.

The deal, the fruit of months of negotiations, takes aim at the lucrative way doctors can charge for procedures on patients referred to them by personal injury lawyers.

If a law firm has a client who was hurt in a car accident, the lawyer will often send them to a doctor who will perform surgery on a “lien” basis, meaning the doctor will be paid from money that comes from a lawsuit settlement rather than through insurance.

Uber contends this arrangement has created an incentive for doctors and attorneys to collude to dramatically inflate medical bills. The more expensive the bill, they say, the bigger the resulting payout.

The law, SB 623, caps how much these doctors can charge when their patient is involved in a lawsuit against a ride-share company, which are frequent targets of litigation due to their top-of-the-line insurance policies. The new law will also require Uber to ramp up background checks of its drivers.

“We’re going to have a much safer state both for medical patients and passengers in Ubers,” said Nicholas Rowley, a prominent Texas attorney who helped bankroll the fight and took a leading role in the negotiations.

The law only applies to cases that involve ride-share accidents that take place after Jan. 1, 2027.

“This legislation puts meaningful guardrails in place to better protect accident victims, increase transparency and accountability in the medical lien system and strengthen safety,” said Ramona Prieto, Uber’s head of public policy for the Western U.S., in a statement.

For months, Uber and lawyers from across the state poured tens of millions into dueling ballot measures that threatened to devastate the profits of whichever side lost.

Uber fired the first shot with a ballot measure that sought to cap how much attorneys can earn in lawsuits involving auto accidents. The company argued attorneys were swindling their own clients, inflating medical bills of car crash victims to increase the value of the settlement and then pocketing a hefty chunk of the payouts.

The state’s trial attorneys countered that the fee cap would make small or difficult cases a money-losing endeavor and block scores of accident victims from the courts. They shot back with their own ballot measure that would increase legal liability for ride-share companies if a passenger or driver is sexually assaulted while on a ride, seizing on investigative reporting that highlighted assaults in Ubers.

“They were waiting for us to blink and we didn’t,” said Douglas Saeltzer, the head of the Consumer Attorneys of California, the lawyer trade group that pushed for the measure against Uber. “Their starting place, I don’t believe, was in the interest of protecting victims — it was in the interest of protecting Uber.”

With the passage of Thursday’s law, both sides have agreed to pull their respective measures from the November ballot, halting campaigns that had both parties amassing tens of millions in funding and blanketing the airwaves with ads.

“Now we can stop seeing all the commercials,” said Assemblymember Blanca Pancheo (D-Downey) at a Tuesday hearing.

The law, put forward by Assemblymember Diane Papan (D-San Mateo) and Sen. Thomas Umberg (D-Santa Ana), also caps the amount that can be earned by third-party investors who buy out a doctor’s lien in a personal injury case. These companies will purchase a doctor’s stake in the case at a reduced rate, then pocket a share of the payout if the case settles.

“Private equity and hedge funds buy them at a steep discount, then turn around and collect the full inflated amount,” Saeltzer said at a Tuesday hearing on the bill. “That’s money flowing to Wall Street investors, not patients.”

The law will require annual background checks for ride-share drivers and expand the list of offenses that disqualify someone from the job.

In addition to the ballot battle, has Uber sued two of LA’s most well-known personal injury firms — the Law Offices of Jacob Emrani and Downtown L.A. Law Group — accusing them of inflating medical bills and forcing clients to undergo needless and expensive surgeries to inflate the value of the claim. The firms asked the judge to dismiss the case Wednesday, arguing Uber had failed to prove fraud. Both firms have vehemently denied wrongdoing.

The lawsuit, filed last year, has put the plaintiff lawyers in the unusual position of playing defense. Listening in the audience at Wednesday’s hearings were the partners of Downtown L.A. Law Group and Jacob Emrani.

“Let’s be clear about what this Uber case really is,” said John Hueston, outside counsel for Emrani. “It’s brought by a $150 billion dollar company … to intimidate the plaintiff’s bar, exhaust its resources and chill the suits that hold Uber accountable.”

Michael Huston, one of the lawyers who represents Uber, countered that the case is “not an attack on the plaintiff’s bar.”

“We have brought suit against the two in this state … that are engaged in naked fraud,” he said.

Dodgers and Rams head team physician Neal ElAttrache was questioned by Major League Baseball investigators Friday following a detailed report by the New York Times that the renowned surgeon and sports medicine expert supported the therapeutic use of performance-enhancing drugs by UFC star Conor McGregor.

MLB spoke with ElAttrache, according to a person familiar with the matter but not authorized to comment publicly. The league considered the interview informational, not an investigation. The NFL, Rams and Dodgers declined comment.

“I have spoken with MLB and I am very comfortable with the process that the league and I will complete to assure the public that I have followed every rule and regulation in my medical treatment of athletes without exception,” ElAttrache said in a statement to the Los Angeles Times. “My record is completely clean, including in this case. I will leave it to MLB officials to provide any further comment as they see fit.“

ElAttrache performed surgery on McGregor in July 2021, inserting a rod, plates and screws into his left leg after the fighter broke his tibia and fibula during a bout against Dustin Poirier in Las Vegas.

McGregor’s recovery was lengthy and arduous. ElAttrache told the New York Times that while he did not prescribe steroids for McGregor, he referred him to a specialist who did. Furthermore, ElAttrache wrote a letter supporting McGregor’s request for a therapeutic use exemption from UFC drug policies.

“I felt it would be appropriate to consult other physicians with expertise in bone healing/bone metabolism,” ElAttrache told the paper via text. “I recommended the consultations but not the course of treatment.”

ElAttrache said he told McGregor to check with UFC drug testers about prescriptions the consultant gave him. “I purposely wasn’t involved with his evaluation by the consultant nor with prescribing medication,” ElAttrache said.

The exemption request was denied by USADA (the drug testing organization the UFC used then), triggering a split between the two organizations. McGregor withdrew from the UFC anti-doping program shortly thereafter and was no longer required to undergo testing for banned substances.

ElAttrache, operating primarily out of the Cedars-Sinai Kerlan-Jobe Orthopaedic Clinic in Los Angeles, has performed elbow or shoulder surgeries on prominent current and former Dodgers including Shohei Ohtani, Clayton Kershaw, Tony Gonsolin and Walker Buehler as well as former Rams stars Cooper Kupp and Cam Akers.

Among the hundreds of surgeries performed over three decades by ElAttrache, his patients included the four 2024 MLB Most Valuable Player and Cy Young Award winners — Ohtani, Aaron Judge, Chris Sale and Tarik Skubal. ElAttrache’s patients include 18 of 29 players who won the MVP or Cy Young awards over the last 10 years.

Other prominent athletes who became his patients include former Lakers legend Kobe Bryant and star NFL quarterbacks Tom Brady, Aaron Rodgers and Joe Burrow.

ElAttrache was a boxer long before he became a renowned surgeon and team physician. He attended Notre Dame, where organized boxing was first introduced by Knute Rockne as a conditioning program in the 1930s. An intramural tournament known as the Bengal Bouts was formed and decades later ElAttrache became a champion, winning the 185-pound division in 1978.

Before world lightweight boxing champion Vasiliy Lomachenko returned from shoulder surgery to defend his title in 2019, ElAttrache counseled him against using his left hook because he wasn’t mentally ready to do so.

“When that arm goes into that position, the brain remembers that was the position where that dislocation occurred,” ElAttrache told the Los Angeles Times at the time. “It takes time to overcome that apprehension.”

It has taken McGregor five years since his injury to return to the octagon. He is scheduled to do so July 11 in a welterweight bout against Max Holloway at UFC 329 in Las Vegas as the main event of International Fight Week.

His recovery and startling physical transformation hardly a year after his injury became a frequent topic on social media. Fellow UFC fighter Anthony Smith said on Michael Bisping’s “Believe You Me” podcast in November 2022 that the reason McGregor pulled out of the UFC drug testing pool was obvious.

“There’s only one reason you would do that,” Smith said. “He’s looking jacked as s—. You keep seeing videos of him flexing in front of mirrors and screaming and he’s huge. He healed really fast. Like, really fast.”

On his show in December 2022, podcast host Joe Rogan noted McGregor’s impressive physique and the USADA testing loophole.

ElAttrache told the New York Times that he stopped treating McGregor after steering the fighter to someone who could obtain banned substances.

“I purposely wasn’t involved with his evaluation by the consultant nor with prescribing medication,” ElAttrache told the Times. He said “expert opinions” could help McGregor and “optimize his chance of solid union and healing of his fractures.”

Seeking the exemption, however, was viewed by USADA and some UFC officials as McGregor trying to find a way to use banned drugs. McGregor re-entered the drug-testing pool on Oct. 8, 2023, the same day UFC notified USADA that it would end the partnership.

Because McGregor had long been suspected of taking banned substances to revive his career, the mixed martial arts community reacted to the New York Times investigation with a measure of closure.

“OK, it’s confirmed now,” co-host Conner Burks on the popular MMA podcast “The Boys in the Back” said. “None of this came as a massive shock to me.”

“It seemed like the worst kept secret in combat sports,” co-host Eric Jackman said.

In a written response to a question posed by the New York Times, McGregor’s manager, Audie Attar, did not say whether McGregor had used banned substances. He said that “even with surgery there was a real risk Conor might not walk again, a high likelihood he would face numerous lifelong side effects that would limit his mobility and serious doubts he would ever return to the octagon.”

Attar said McGregor withdrew from the UFC drug-testing pool “to focus fully on his recovery” under the care of “his team of world-renowned physicians.”

“They oversaw a combination of a gruesome surgery, intense physical therapy and appropriately prescribed medicines,” Attar said. “It is an unfathomable breach of health and privacy protections that my client’s purported personal medical records would be disclosed.”

McGregor attempted to return to fighting in June 2024, but a scheduled bout against Michael Chandler was canceled because McGregor broke a toe during training.

Combat Sports Anti-Doping officials were unable to locate McGregor for testing on the day the fight was canceled, and he missed tests on two subsequent occasions. Under the UFC Whereabouts Policy, the three failures constituted an anti-doping violation equivalent to a failed drug test.

The UFC suspended McGregor in October 2025 for 18 months because of testing violations. The suspension expired in June, clearing him to compete.

Times staff writers Bill Shaikin, Sam Farmer and Gary Klein contributed to this report.