After a summer under the sun, my patients’ skin is telling me the story of their beach days and backyard gatherings, especially for those who spend weekends at the Jersey Shore. What started as cute freckles in June now appear as stubborn brown spots; fine lines deepen; redness and rough texture emerge; and that “sun-kissed glow” begins to look more like early aging.
In my dermatology clinic, I call the fall months our laser season.
I tell patients that fall is the perfect time to reduce the harmful effects of summer sun and prepare their skin to look its best for the holidays and the year ahead. The cooler weather, shorter days, and slower pace create the perfect conditions for skin renewal, allowing us to repair damage and restore radiance.
Why fall is the sweet spot for laser treatments
Lasers and energy-based treatments are among the most effective tools for improving skin tone, pigmentation, texture, and fine lines — but timing is everything. After any laser or energy-based procedure, the skin becomes temporarily more sensitive to UV rays. That’s why fall is a sweet spot: the UV index drops, we spend more time indoors, and therefore recovery is easier and more comfortable.
Cooler weather also makes it easier to protect healing skin with hats, scarves, and cozy layers which help shield it from the sun. The conditions will stay good all winter, but many of my patients prefer to start treatments now, giving their skin time to fully recover by the holidays.
What can we address with lasers?
Lasers and energy-based treatments can treat a variety of skin concerns:
Resurfacing lasers stimulate collagen production and improve fine lines, brown spots, acne scars, and uneven tone. They can also treat precancerous skin changes and help prevent the development of skin cancer.
Vascular lasers target redness, rosacea, and broken capillaries for a clearer complexion.
Pigment-specific lasers address brown spots, post-inflammatory hyperpigmentation, and unwanted tattoos.
Radiofrequency devices provide subtle skin tightening and enhance collagen production.
Downtime can range from none at all to about a week, depending on the treatment. Most patients need a series of sessions to achieve their desired results.
One of my patients, a 42-year-old marketing executive from the Philadelphia suburbs, came to see me after a summer filled with travel. “My freckles have gotten so dark, and my rosacea is flaring,” she said. “What can I do to make my skin look better?”
We created a combination plan to target pigmentation, fine lines, and redness using both a fractional resurfacing laser and a vascular laser. The procedure took less than an hour, and after a week of mild downtime, her skin looked brighter, smoother, and more even.
After a month, the collagen stimulation was starting to become noticeable and her skin appeared plumper, firmer, and healthier. She told me, “I feel like all that sun damage was aging me 10 years. Now I finally look like myself again.”
Not just cosmetic
Beyond cosmetic procedures, certain lasers can remove or treat precancerous lesions called actinic keratoses, which are rough, sun-damaged patches that sometimes progress to skin cancer if untreated.
By gently removing these damaged cells and stimulating healthy new growth, laser resurfacing not only improves the skin’s appearance but also reduces future skin cancer risk.
As a cosmetic dermatologist and Mohs surgeon, I approach each patient not only from the perspective of how they can look better, but also how we can enhance skin quality and skin health.
Finding that intersection, where beauty meets prevention, is one of my favorite parts of practicing dermatology. Ultimately, healthy skin simply looks better: free of pigmentation, redness, fine lines, and rough texture.
We’re now in the peak of what I call laser season, and my advice to patients is to seize the pause between the intensity of summer and the rush of the holidays to help their skin recover from UV exposure.
Alternatives to lasers
Of course, laser treatment isn’t for everyone. Lasers offer a safe, medical approach to address damage before it worsens, but some people can’t tolerate downtime associated with some lasers. Others are looking for a more affordable option, as lasers can range in cost from $450-1200 per session, depending on the laser and location, with multiple sessions typically recommended.
Another powerful option is a regimen known as the “ABC’s plus sunscreen.” This means using products with vitamin A (a retinoid) to boost cell turnover and promote collagen production, vitamin B (niacinamide) to calm inflammation and support the skin barrier (and for some patients, an oral form may be appropriate after discussing with their dermatologist), and vitamin C to brighten and protect against environmental stress.
Protection is always the best prevention. I consider daily sunscreen a nonnegotiable, even on cloudy days. I recommend a broad-spectrum sunscreen with SPF 30 or higher, and UPF clothing adds another reliable layer of protection. A consistent skincare routine can meaningfully prevent and even reverse signs of sun damage and skin aging, no lasers required.
May Elgash is a board-certified dermatologist and Mohs surgeon practicing at the Jefferson Laser Surgery and Cosmetic Dermatology Center.
The science: Everyone loves a good cold remedy — vitamins, homemade concoctions, nasal irrigation systems. And zinc, a mineral, is a popular one, sold over the counter as lozenges, quick-dissolve tablets, and nasal sprays.
While there’s no conclusive evidence that zinc can prevent a cold, there is research suggesting it might help shave a little time off the duration of a cold, which usually runs for seven to 10 days.
“If you’re trying to get better, say, before you go see your brand-new grandchild or because you have a big presentation coming up at work, it may cut a day or two off your cold but you might still have persistent symptoms,” said Rebecca Andrews, a professor at the University of Connecticut School of Medicine and chair of the Board of Regents for the American College of Physicians.
Scientists have hypothesized that zinc may prevent rhinoviruses — which are common viruses thatcauseabout 50% of colds — from infecting ourcells, said Roy Gulick, the chief of the Division of Infectious Diseases at Weill Cornell Medicine and attending physician at New York Presbyterian Hospital in New York City.
The mineral also enhances immune function and responses to infection, among other things, he said.
In a 2024 Cochrane review, researchers analyzed 34 trials using zinc to prevent and treat colds. The authors found little to no evidence that zinc, when taken proactively, can prevent a cold or reduce the number of colds a person gets.
For people who already have a cold, the reviewers found some evidence that zinc might shorten the duration of symptoms by about two days compared with a placebo. However, they also found that zinc was associated with mild side effects such as nasal and oral irritation, problems with taste, stomach pain, constipation, diarrhea, and vomiting, among others.
Outside those trials, some people who use certain zinc nasal products have reported a loss of smell. It prompted the Food and Drug Administration to issue a public health advisory in 2009, warning people about the link between some zinc nasal products and long-lasting or permanent loss of smell.
Our bodies don’t produce zinc, which we need for proper immune system and metabolism functioning and wound healing. Adult women should get 8 milligrams of zinc from their diets each day and men 11 mg, according to federal health authorities. Zinc-rich foods include meat, fish, and seafood such as oysters.
The optimal zinc dose for the treatment of colds is uncertain because researchers conduct studies in different ways, and test different forms of zinc and different doses. However, a number of studies on zinc as cold treatments use doses of 80 mg or more per day. Many over-the-counter zinc lozenges are supposed to be taken every few hours, which amounts to about 80 mg.
But Andrews said that if you exceed 50 mg of zinc per day, you increase your likelihood of side effects. And don’t use it to prevent a cold — only to treat an ongoing one, she said.
“When you supplement, you’re going to get a lot more than what you need in your diet, which is more likely to cause stomach upset and send you either into my office or an urgent care, where you might get treated for something that you don’t have because the symptom could be from the zinc,” she said.
What else you should know
Before taking zinc, speak with your healthcare provider, as the mineral can interact with some medications. For instance, high zinc intake may make certain chemotherapy drugs less effective, Andrews said.
If you want to try zinc to treat a cold, consider these suggestions:
Don’t use zinc supplements as a preventive, only a treatment. Because there’s little to no evidence that zinc can prevent a cold and it’s associated with a number of side effects, use it only when you have symptoms of a cold.
Try lozenges, but in moderation. Most studies have evaluated the effectiveness of zinc lozenges over other formulations, probably because they are easy to take and may help ease sore throats, a common symptom of a cold, Andrews said. But don’t overdo it. If you exceed 50 mg daily, you increase your risk of stomach upset and other side effects, she said.
Don’t take zinc with certain foods. High-fiber foods, legumes, and grains, foods rich in calcium and iron, and excessive alcohol, among other things, can reduce zinc absorption.
Zinc aside, build up your immune system. Eating a healthy, well-balanced diet, drinking plenty of water, and getting enough sleep are key for ensuring your immune system “is top-notch from a cold-fighting perspective,” Andrews said.
The bottom line: While zinc is unlikely to prevent a cold, it may help reduce the duration of a cold by a day or two. But potential benefits of zinc, particularly at higher levels, may be offset by adverse reactions, including irritation in the nose and mouth, an upset stomach, and other side effects.
Children’s Hospital of Philadelphia was the most profitable nonprofit health system in Southeastern Pennsylvania during the three months that ended Sept. 30, according to an Inquirer review of financial filings.
CHOP reported $70 million in operating income in the first quarter of fiscal 2026, up from $67 million the same period a year ago. The nonprofit’s revenue climbed nearly 9% to $1.3 billion.
The biggest loss in percentage terms was at Redeemer Health, the region’s smallest health system and the only remaining operator with a single hospital. Redeemer had an $11.7 million operating loss on $103.4 million in quarterly revenue. That was an improvement over an $18.9 million loss last year.
Jefferson Health had the most patient revenue following its acquisition last year of Lehigh Valley Health Network. The 32-hospital system had $2.9 billion in patient revenue, $100 million more than the $2.8 billion at the University of Pennsylvania Health System, which has seven hospitals.
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Here’s a recap of selected systems’ results for September quarter:
Jefferson Health
Jefferson Health reported a $104 million operating loss, as its insurance business continued to drag down results. The loss included $19.4 million in restructuring charges for employee severance related to earlier job cuts and moves designed to make the system more efficient.
University of Pennsylvania Health System
University of Pennsylvania Health System had an operating gain of $109.3 million, up from $49.3 million in the same period a year ago. This year’s results include Doylestown Health, which Penn acquired April 1. Total revenue was $3.3 billion, up from $2.8 billion a year ago.
Temple University Health System
Temple University Health System’s loss in the quarter was $15 million, an improvement over a $17 million loss last year. Total revenue was $800 million, up 13% from $712.5 million a year ago. Outpatient revenue increased by nearly $62 million, much of it from the health system’s specialty and retail pharmacy business.
Scientists have discovered the oldest evidence of ancient humans igniting fires: a 400,000-year-old open-air hearth buried in an old clay pit in southern England.
The study, published in the journal Nature, is based on a years-long examination of a reddish patch of sediment excavated at a site in Barnham. It pushes back the timeline on fire-making by about 350,000 years.
The nebulous question of how far back human ancestors conjured fire is deeply intertwined with some of the biggest outstanding mysteries about human evolution. The ability to reliably set fires would have allowed humans to cook food, expanding the range of what they could eat and making meals more digestible. That, in turn, could have supported bigger brains that consumed more energy, catalyzing new social behaviors as humans gathered around campfires.
But campfires don’t leave fossils. It takes painstaking work to reconstruct these ephemeral uses of technology. And what remains unclear is who set them. No telltale bones have been recovered at Barnham, but researchers think it was Neanderthals, close cousins of our species who interbred with our ancestors.
“The evidence of fire is incredibly difficult to preserve. If you get to ash and charcoal, it can wash away. Sediment can get washed away,” said Nicholas Ashton, curator of Paleolithic collections at the British Museum and one of the leaders of the work. “We just found this one pocket — quite a large site — where it happens to be preserved.”
Even when traces of fire remain, the task of distinguishing incidental flames sparked by lightning strikes or wildfires from those set by people is difficult. Perhaps most challenging is distinguishing between fires ignited by humans with the know-how from those produced by scavenging embers from wildfires.
The study could spark more debate.
“The authors did an excellent job with their analysis of the Barnham data, but they seem to be stretching the evidence with their claim that this constitutes the ‘earliest evidence of fire making,’” Wil Roebroeks, an archaeologist at Leiden University, said in an email, calling the evidence “circumstantial.”
Ségolène Vandevelde, an archaeologist and adjunct professor at the University of Quebec at Chicoutimi, praised the multidisciplinary approaches the authors used and said the finding was “solid.”
Pyroarchaeology
In the Paleolithicera, the Barnham site would have been a woodland with a seasonal pond — set away from the main river valley, where predators might have roamed, according to Robert Davis, an archaeologist at the British Museum and one of the authorsof the study. The wildlife would have included elephants, lions, deer, fish and other small mammals.
Despite the fleetingnature of fire, it can leave traces under the right conditions. At the site in Barnham, where artifacts such as heat-shattered flint hand axes were also found, researchers were intrigued by a layer of reddish sediment — a result of iron-rich sediments being heated to produce a mineral called hematite. For four years, they studied it, trying to determine whether it was the result of a wildfire or deliberate human activity.
One of the first questions they asked was whether this was a one-time blaze or something closer to a fireplace that was lit and relit many times.
To deconstruct this question, scientists studied the magnetism of the sediment, which is altered by heating. They conducted modern experiments, to see if they could come up with an estimate of how many heating events might have resulted in the magnetic profile of the sediment — and found that after about a dozen heating events, each one four hours long, their modern samples mimicked the archaeological one.
Then they examined the chemistry of the site — scrutinizing particular chemical compounds left behind. The patterns they found suggested humans had been using these fires.
The last element was small pieces of cracked flint scattered about the site — as well as two bits of pyrite, which can create a spark when struck together. A geological study of the area showed that pyrite was scarce in the local landscape, leading the authors to argue that the inhabitants had carried it there for the specific purpose of making fire.
Scavenging sparks vs. setting fires
The archaeological record with examples of fires used by hominins — the ancestors of humans — stretches back more than a million years ago in Africa.
But what interests scientists is not just the ability to successfully scavenge sparks from wildfires or lightning strikes, but also the ability to reliably create it — possibly by striking flint and pyrite together to create sparks.
The oldest accepted evidence of fires purposefullyset are from a Neanderthal site dated to 50,000 years ago in France. That evidence is considered convincing in part because there are chunks of flint showing “microwear traces of having been struck” to create sparks, Roebroeks said. But at Barnham, there are no microwear traces, leaving room for disagreement.
“It’s a very contentious debate that’s been going on for some time,” Davis said.
Early hominins would have learned to harvest fire by collecting embers, harvesting the right fuel and tending the fire. And eventually, they had to learn how to make it on demand — which would allow them to live in colder places, cook, fend off predators and socialize after dark.
The study does not suggest that Barnham was where fire originated; it was probably widespread across the ancient world. But it does offer a rare, preserved snapshot of prehistoric life.
“The maintenance of fire requires social cooperation, cultural rules and work coupled with knowledge of wood types, and means that a complicated tradition is at play,” said John Hawks, a paleoanthropologist at the University of Wisconsin at Madison.
Several Philadelphia-area violence prevention efforts will benefit from nearly $3 million in newly released state funding to help hospitals address a leading cause of death and injury.
The new funding for hospital-based violence intervention programs (HVIP) was announced by Pennsylvania Lt. Gov. Austin Davis on Wednesday at Penn Presbyterian Medical Center. One of the recipients, the Penn Trauma Violence Recovery Program, is based at the Penn Medicine hospital in University City.
Other local awardees includeTemple University Hospital in North Philadelphia and the Philadelphia-based nonprofit Urban Affairs Coalition. The coalition received funding on behalf of the Chester Community Coalition to relaunch a program that had been at the now-shuttered Crozer-Chester Medical Center.
The University of Pittsburgh Medical Center also received funding. The amounts awarded to each program were not announced.
The Pennsylvania Commission on Crime and Delinquency, which Davis chairs, received 15 applications in total seeking nearly $12 million in funding — four times what was available.
“Addressing the epidemic of gun violence is a top priority for our administration,” Davis said.
Lieutenant Governor Austin Davis speaks at a press conference announcing the $3 million in grants for hospital-based violence intervention programs.
The programs aim to connect patients at risk of repeat violence with resources while they are in a hospital, so they leave with a safety plan. Services can include long-term community-based case management, mentoring, and home visits.
Since the first HVIP was established in the mid-1990s, dozens have spread around the country and abroad, including in Philadelphia.
Several local institutions have these programs, including Temple Health, Children’s Hospital of Philadelphia, Penn Medicine, Jefferson Health, and Drexel University. The City of Philadelphia, in conjunction with the area’s Level 1 trauma centers, launched an HVIP Collaborative in 2021.
Studies have shown these programs reduce rates of repeat violent injuries and recidivism among participants.
After shootings spiked during the COVID-19 pandemic, gun violence is now declining in Philadelphia. As of July, shootings for the year were at their lowest total since at least 2015.
Davis noted that Philadelphia has seen a 15% decrease in homicides this year, with roughly four in fivegunshot victims surviving their injuries.
The new funding will allow the Penn Trauma Violence Recovery Program to increase its community presence and mental health programming, said its director, trauma surgeon Elinore Kaufman.
Through her experience treating victims of violence, she has learned that injuries can be deeper than the physical wounds.
The program was launched to address social factors often involved in violence by providingpsychosocial support and connecting patients with services to help with education,job training, and housing.
“We’ve worked with patients long enough now that we have high school graduation photos, we have baby pictures,” Kaufman said. “We have patients who want to give back and have joined our patient advisory board to help push us forward.”
Recovery Centers of America, a prominent addiction rehab provider, will pay $2 million to settle claims by the federal government that it illegally dispensed strictly regulated medications and billed Medicaid for services it did not provide.
The DEA said RCA “dispensed controlled substances in an unlawful matter” and did not comply with federal recordkeeping rules for drugs and other substances that are closely regulated due to their potential for abuse.
Federal officials did not specify the controlled substances involved.
In a settlement agreement, federal authorities said that the DEA found a number of recordkeeping issues at an RCA facility in Devon, including that the facility did not maintain records showing that it had received controlled substances, and did not record the number of containers of the substances or the date they had been received. Some prescriptions for controlled substances were issued to “house stock” instead of named patients, authorities said.
The facility also did not keep accurate records of the controlled substances on hand at the site, authorities allege.
They also found recordkeeping issues at another RCA facility in Maryland.
In 2017, a whistleblower who was once employed at RCA filed a lawsuit alleging that some facilities had admitted patients on Medicaid, but had not complied with state and federal regulations on providing them with rehab services.
Under federal law, whistleblowers can sue on behalf of the government when they believe a company has submitted false claims for government funding, federal authorities said.
Federal authorities said that between 2017 and 2019, some RCA facilities billed the Federal Employees Health Benefits Program and Medicaid for care that they did not document and did not actually provide.
The settlement will resolve the whistleblower’s lawsuit.
RCA did not immediately return a request for comment.
The company has agreed to pay $1 million to resolve the controlled substance claims and $1 million to resolve the billing claims. RCA did not admit liability as part of the settlement agreement.
Federal law also enables whistleblowers to receive money from the settlement. The former employee will receive $230,000, authorities said.
RCA will also pay the employee $450,000 and $75,000 to cover attorney’s fees, according to the settlement agreement.
“Drug and alcohol treatment facilities must prescribe and store controlled substances in a manner that comports with rules designed to ensure that dangerous drugs do not fall into the wrong hands. They also must provide treatment services that comply with all governing laws and regulations,” U.S. Attorney David Metcalf said in a statement.
“When they fail in either of those critical duties they will face significant consequences.”
Nancy Hunt arrived at an emergency room from a Genesis HealthCare nursing home in Pennsylvania in such dreadful shape, including maggots infesting her gangrened foot, that the hospital called an elder abuse hotline and then the police, her son alleged in a lawsuit.
Hunt died five days later. Her death certificate said the foot injury was a “significant” factor. Genesis denied wrongdoing but agreed to pay $3.5 million in a settlement Hunt’s son signed in August 2024.
Yet Genesis hasn’t paid most of that debt, court records show. It may never have to.
Once the nation’s largest nursing home chain, Genesis says it was spending $8 million a month defending and settling lawsuits over resident injuries and deaths in recent years. But the company is now poised to wipe the liability slate clean by seeking refuge in the most protective corner of the legal system for the nursing home industry: bankruptcy court.
The Genesis case, one of 11 large senior care bankruptcies this year, illustrates how healthcare companies can dodge public and financial accountability for alleged negligence through delays, confidentiality clauses, and bankruptcy maneuvers, a KFF Health News investigation found.
When it filed for bankruptcy in Dallas in July, Genesis estimated its total liability for nearly a thousand settled and pending lawsuits at $259 million. A KFF Health News review of the terms of 155 settlement agreements and corporate financial statements shows Genesis officials knew insolvency was possible yet included provisions in its settlement agreements allowing it to defer payment, often for a year or more.
As a result, the company headquartered in Kennett Square paid nothing in 85 cases and only a portion in the other 70, according to civil court records and bankruptcy claims made available through people with access to them. It still owes $41 million of the $58 million it had agreed to pay in those cases, the records show.
Nellie Betancourt, shown in a photo with her husband, Gabe, had planned a trip to Las Vegas before she fractured her hip at a Genesis HealthCare rehabilitation center — an injury the medical examiner’s report said led to her death. “When she went into that place, I said, ‘Well, she’s going to be taken care of for a few more days and I’ll take her home,’” Gabe says. (Adria Malcolm for KFF Health News)
“It just feels like they killed my mom and got away with it,” said Vanessa Betancourt, whose mother, Nellie Betancourt, a retired nurse, fractured her hip at a Genesis home in Albuquerque, N.M. — an injury the medical examiner’s report said led to her death. Genesis agreed to a $650,000 settlement with Betancourt’s family in April under the condition it would not need to pay the first of seven installments for another year, according to the settlement document.
Genesis denied wrongdoing in all lawsuits and settlements. In a written statement, the company did not answer questions about individual personal injury cases. The statement said Genesis remained “focused on delivering high-quality, compassionate care to our patients and residents without disruption” during bankruptcy.
One lawsuit Genesis settled for nearly $1 million alleged nursing home managers ignored repeated warnings about a male resident’s behavior before he sexually assaulted a female Alzheimer’s patient, according to court records. In a case the company resolved for $500,000, a Genesis nursing home was accused of delaying the hospitalization of a resident who had vomited brown mucus. He died of a bowel obstruction. Genesis has paid nothing for either settlement, according to bankruptcy claims.
Creditors, including families of the deceased, are expected to salvage a fraction of what they were promised, if anything. On Dec. 10, the company’s owners were scheduled to seek approval by the U.S. Bankruptcy Court for the Northern District of Texas to sell its nursing homes and other assets to its largest investor, a private equity firm. In court papers, lawyers for residents and other creditors say the complex plan will prevent them from pursuing Genesis’ new ownership and other companies they blame for the company’s collapse.
John Anthony, a bankruptcy attorney representing 340 personal injury claims against Genesis, said, “They never had any intention to honor these deals.”
Low ratings and fines
During years of financial turmoil, Genesis has frequently struggled to provide top-notch care, federal records show. Using its five-star system, the Centers for Medicare & Medicaid Services rated 58% of homes affiliated with Genesis as below average or much below average. CMS has fined Genesis homes $10 million for violating federal health standards over the past three years.
In its Chapter 11 filing, Genesis said it cared for about 15,000 residents in 165 nursing homes and 10 assisted living facilities in 18 states. They are centered in Pennsylvania, West Virginia, New Mexico, New Hampshire, New Jersey, Maine, Alabama, Maryland, and North Carolina, according to the bankruptcy filing.
The company said it owed $709 million in secured debt to lenders and the IRS. Under bankruptcy rules, those debts, backed by Genesis collateral, take precedence over the $1.6 billion in unsecured debt Genesis said it owes. Unsecured creditors include a pension fund; contractors that provided health services and equipment; Pennsylvania, New Mexico, and West Virginia for unpaid provider taxes; and former residents and their families who sued.
Dangers in memory care
Sandia Ridge Center, a Genesis home in Albuquerque, was repeatedly faulted by health regulators for not preventing sexual misbehavior in its memory care unit. In November 2021, CMS cited the home for lacking enough nurses to prevent sexual abuse among residents. An inspection report the following August identified more inappropriate sexual contact. Police were called to investigate sexual assault allegations in February and March of 2023, police reports show; neither resulted in criminal charges.
Then in April 2023, a 61-year-old male resident with alcohol-related dementia sexually assaulted a female resident with Alzheimer’s in the dining room, according to a police report and an inspection report. When the resident screamed for him to stop and that he was hurting her, he responded “shut up bitch I know you like this,” according to a lawsuit brought on behalf of the woman, identified in court papers as R.S.
Sandia Ridge management had been aware of the male resident’s behavioral issues for months, according to employee depositions in the case. Police had investigated a prior sexual assault allegation against him the previous year without bringing charges. In one deposition, a former activities assistant testified he hit her and twice pushed her into a bathroom while announcing, “I want to have sex with you.” When she reported him to a senior Genesis manager, she said in the deposition, the manager put his finger over his lips and said, “Shhh.”
The activities worker testified that R.S. used to happily sing along with Elvis Presley songs. After the assault, the worker said, R.S. “don’t sing anymore.”
Inspectors cited the home for failing to protect R.S. The same report said the home didn’t provide a therapist for another female resident who was being sexually harassed. Medicare fined Sandia Ridge Center $91,247. Genesis denied liability but settled R.S.’ lawsuit for $925,000 in May, according to the bankruptcy claim.
“We just felt we have to hold them accountable,” R.S.’ daughter said in an interview, speaking on the condition that she and her mother not be identified, because of the nature of the assault. “Maybe I’m wrong, maybe I’m naive, but the only way to do that is to sue someone, right?”
Genesis has not paid any of the settlement, according to the family’s claim filing.
Growth and debt
Genesis’ downfall can be traced to 2007, when affiliates of two private equity firms acquired the company in a $1.5 billion leveraged buyout, taking on substantial debt, according to its bankruptcy filing. Private equity also has been involved in other healthcare bankruptcies, including those of the HCR ManorCare nursing home chain, the prison healthcare contractor Corizon Health, and two for-profit hospital systems, Steward Health Care and Prospect Medical Holdings.
In 2011, Genesis raised $2.4 billion by transferring substantially all its nursing home buildings and other real estate to Welltower, a publicly traded real estate investment trust, according to Genesis’ bankruptcy filing. Genesis then rented the buildings back from Welltower, which made leasing costs a significant expense.
Genesis went on a nationwide buying spree. At its peak in 2016, it had grown to more than 500 nursing homes. In a court declaration, Louis Robichaux IV, a consultant overseeing Genesis’ bankruptcy restructuring, wrote that as the company expanded, it became harder to manage and “mired in corporate inefficiencies.” Robichaux wrote that Genesis’ financial woes were exacerbated by rapidly increasing labor costs and lawsuits, including some predating the COVID pandemic.
But Genesis continued to teeter on the edge of insolvency. In audited financial statements for 2022 and 2023 submitted to a California oversight agency, management and auditors said rent and debt obligations raised “substantial doubt about the company’s ability to continue as a going concern.”
In a court filing, a committee appointed by the U.S. Trustee’s Office to represent the unsecured creditors in the bankruptcy accused Landau and Welltower of orchestrating a covert plan that allowed Welltower to keep getting its rents while Landau could run the company and “siphon value to himself.” The committee alleged their efforts forced the company into insolvency while “staffing levels and patient care declined precipitously.” Landau and Welltower did not respond to requests for comment.
Drawn-out lawsuits
Erin Pearson sued Genesis over the death of her father, James Sanderson, a retired mining company executive who died in 2018 after spending less than a month at Bear Canyon Rehabilitation Center in Albuquerque. In the memory care unit, Sanderson fell repeatedly, suffered medication errors made by nursing home staff, and developed a bowel obstruction and sepsis, according to the lawsuit, filed in 2019. Pearson’s lawyers said he was not hospitalized until eight days after nurses noticed he was vomiting brown mucus.
After the judge rejected Genesis’ request to force Pearson into arbitration, Genesis appealed. It took 2½ years before an appeals court affirmed the original decision to let the case go forward in court, records show.
This past May, more than five years after suing, Pearson reached a $500,000 settlement, with the first payment required by November, according to a copy of the agreement. Nothing was paid, according to the bankruptcy claim.
“It was so drawn out and for so long,” Pearson said in an interview, calling Genesis’ bankruptcy “despicable.”
Payouts postponed
Jennifer Foote, an Albuquerque attorney who represents clients in multiple lawsuits against Genesis, including Pearson’s, said the company frequently filed appeals. “They did not usually win them on these issues,” she said, “and our sense was that they were doing it as a delay tactic.”
Genesis started using installment payments around 2018, said Dusti Harvey, Foote’s law partner. “The payments wouldn’t start for several months out,” Harvey said. Foote said Genesis’ lawyers often wanted to time the payments to start the month the trial in the case was scheduled to occur.
Families had to wait even when comparatively small amounts of money were involved, settlement agreements show. Genesis’ settlement agreements also included a confidentiality clause prohibiting discussion of the incidents.
Genesis agreed to pay $42,000 in a November 2024 settlement, but the first payment was not due until nine months later. It was not paid, according to the bankruptcy claim.
A $250,000 settlement signed in October 2023 did not start paying out until the following September. When Genesis declared bankruptcy — 21 months after the case was resolved — it still owed $100,000, according to the family’s claim.
‘We never found out the truth’
Settling cases allowed Genesis to avoid the expense and publicity of a trial, at which details of how its nursing homes functioned might have been revealed. In October 2020, Margarett Johnson, a retired school bus driver, fell out of her wheelchair at a Genesis nursing home in Waldorf, Md., fracturing her jawbone, nose, and neck, according to a lawsuit brought by her family. Johnson was sent to a trauma center and placed on a ventilator. She died three months later, at age 76, from ventilator-associated pneumonia, the lawsuit said.
“It looked like she was hit by a truck,” Angelina Harley, one of her daughters, said in an interview. “I knew my mom was not going to come home. I knew the Lord was not going to punish her more.”
The company denied negligence and blamed the accident on Johnson’s jacket getting tangled in the wheel of her wheelchair, according to the lawsuit. Harley and her sister Angela Swann were dubious.
“We never found out the truth,” Harley said. “They wanted to settle out of court.”
The company denied liability but agreed to a $950,000 settlement in October 2024. It never paid the final $112,500 installment, according to a letter Johnson’s five children sent to the bankruptcy judge.
“If you settle out of court, you know doggone well you did something wrong,” Harley said.
Maddening judges
By summer 2025, judges in some civil cases had run out of patience.
Alma Brown, a retired daycare manager and accordion teacher living in a Genesis nursing home in Clovis, N.M., suffered falls, infections, bedsores, and other neglect that hastened her death in 2023, according to her estate’s lawsuit. In Santa Fe District Court, Judge Kathleen McGarry Ellenwood castigated Genesis after it failed to pay $2 million of the $3 million settlement to Brown’s estate or explain the delay.
Genesis “obviously benefited by not having to go to trial,” McGarry Ellenwood said in one hearing, according to a court transcript. “They assure me that they’re not trying to renege on their contract, but it certainly seems like they haven’t lived up to what the bargain was.”
Genesis declared bankruptcy the day McGarry Ellenwood announced she would impose more than $100,000 in fines, plus $10,000 more each day until the settlement was paid.
In Pennsylvania, Greg Hunt petitioned a judge to punish Genesis after it stopped payments of the $3.5 million settlement after the death of his mother, Nancy, the resident with the gangrenous foot. She had spent eight months in 2019 at Brandywine Hall, a Genesis facility in West Chester that was later sold and renamed.
In a filing with the Common Pleas Court of Montgomery County, Genesis admitted it was in arrears but asked the judge for more time, citing “unforeseen and exigent financial challenges.” Genesis said care for patients at its nursing homes would suffer if it had to pay immediately.
Unswayed, Judge Richard Haaz in June ordered Genesis to pay up, along with punitive interest. But the bankruptcy court stayed that order. Genesis still owes $1.4 million of the $2 million it was supposed to pay, according to Hunt’s claim. (The rest of the $3.5 million settlement is supposed to be paid by an insurer in January 2026.) Ian Norris, Hunt’s lawyer, declined to comment, citing confidentiality provisions in the settlement.
Court records indicate Genesis lawyers never disclosed in either case that it was preparing to declare bankruptcy.
‘Bankruptcy as a tool’
In the first nine months of 2025, 10 other senior living companies with liabilities over $10 million entered Chapter 11 bankruptcy, according to Gibbins Advisors, a consulting firm.
Hamid Rafatjoo, a bankruptcy lawyer representing nursing homes who is not involved in the Genesis bankruptcy case, said filings may increase as the industry has become costlier to run and class action lawsuits have become a fixture.
“Nursing homes get sued all the time for everything,” Rafatjoo said. “A lot of operators wait too long to use bankruptcy as a tool.”
On Dec. 1, Genesis announced the results of its auction, saying it had elected to sell its assets to a private equity firm controlled by Landau. In a court filing, Anthony, the attorney for the personal injury claimants, alleged the auction was stacked in Landau’s favor despite an “objectively better and higher competing bid” from another private equity investor that would have provided more money to creditors. Genesis said in its statement that Landau’s group had increased its bid during the auction.
Sen. Elizabeth Warren (D-Mass.) and two other senators last month asked the U.S. Trustee’s Office to intervene in the case, out of concern that “individuals who already own or control Genesis are trying to sell it to themselves, wiping away legal and other creditor debts in the process.” Lawyers representing those in charge of the auction did not respond to a request for comment.
Families of former Genesis residents said they fear the capacity to purge lawsuits through bankruptcy emboldens nursing homeowners who provide deficient care.
“They can file bankruptcy again,” said Gabe Betancourt, whose wife, Nellie, died after her stay at Uptown Rehabilitation Center in Albuquerque. “And we’re the ones that will pay for it, with our memories, our lives.”
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New Jersey is among the 10 states that allow physicians to assist terminally ill patients in ending their own lives, under certain conditions. But those patients must be New Jersey residents, a federal appeals court ruled.
The U.S. Court of Appeals for the Third Circuit said last week that New Jersey’s limit of the aid-in-dying law to state residents is constitutional, keeping on the books a significant hurdle for people from neighboring states — including Pennsylvania and Delaware — where the practice is not permitted.
“In our federal system, states are free to experiment with policies as grave as letting doctors assist suicide. Other states are free to keep it a crime,” U.S. Circuit Judge Stephanos Bibas wrote in the opinion. “This novel option does not appear to be a fundamental privilege, let alone a fundamental right, that states must accord visitors.”
Jess Pezley, a staff attorney at the legal arm of Compassion and Choices, a nonprofit advocacy organization that brought the lawsuit challenging the residency requirement, said aid in dying “remains a critically important option for all terminally ill people who wish to receive healthcare in the state of New Jersey.”
The “ruling means that terminally ill patients who do not live in an authorized jurisdiction will continue to have to travel”to states like Oregon and Vermont that permit the practice for nonresidents, Pezley said in a statement.
Aid in dying is a controversial concept. While some argue the law creates a pathway for empowerment over end of life, others worry that it can lead to coercion and expansion beyond the terminally ill in a country that has a dark history in how it treats people with disabilities.
The residency requirement is meant to protect physicians from liability in states where assisting in suicide is a criminal offense, proponents of the restriction argue, and to prevent medical tourism in states with the option.
The law does not specify how long a person must live in New Jersey but sets other qualifying requirements: A patient must have a New Jersey driver’s license, be registered to vote in the state, have filed income taxes as a New Jersey resident in the last year, or have another official government record that confirms residency.
The law allows adults who are residents of New Jersey and are expected to die within six months to obtain a prescription for a lethal drug cocktail. They must be able to make their own decisions and administer the medication by themselves.
The ruling is the latest development in a lawsuit filed in August 2023 by a Camden County physician, Paul Bryman, who assists terminally ill patients in ending their lives on their own terms. He challenged the residency requirement, saying the law prohibits him from treating all patients equally because of where they live.
Bryman’s suit originally included another New Jersey physician, Deborah Pasik, and two cancer patients, Judith Govatos of Delaware and Andy Sealy of South Philadelphia. Pasik has since retired, and Govatos, 81, and Sealy, 44, died before the court made its ruling.
The lawsuit argued the prohibition “discriminates” againstpatients like Govatos and Sealy by not allowing them to receive “specific medical care after crossing State lines into New Jersey, even though they would otherwise qualify for this care.”
New Jersey officials asked a federal district judge to dismiss the case, arguing that no court has recognized aid in dying as a constitutional right. The state further said that the residency requirement was among the “safeguards” in a policy that has “extraordinarily high stakes.”
The judge tossed out the lawsuit in 2024.
“And the residence requirement makes sense: While medical aid in dying is permitted in New Jersey, it is indistinguishable from the criminal act of assisted suicide in neighboring states,” District Judge Renee Marie Bumb wrote in her opinion. “By limiting the pool of eligible patients to State residents, the requirement is rationally related to the legitimate objective of protecting from out-of-state liability providers and advocates who assist terminally ill patients in seeking medical aid in dying.”
Compassion and Choices appealed the ruling to the Third Circuit, where the plea met a similar fate.
“The Constitution leaves moral questions like these to the states,” Bibas wrote. “New Jersey has answered them carefully.”
In the spring of her senior year at college, Annie Sedoric woke up with jaw pain. It was March 2020, and there was a lot to worry about at the start of the COVID pandemic, so she tried to ignore the pain, even as it grew worse.
“My jaw kept popping and popping and popping,” said Sedoric, who was 22 at the time. “The pain was getting more intense, less bearable, to the point that I had to do something.”
A visit to the dentist ended with a referral to an oral surgeon, who concluded that Sedoric had developed a TMJ disorder from grinding her teeth due to stress. Fixing the problem required a procedure under anesthesia to manipulate her jaw back into position, doctors told her. The recovery extended over several weeks, she said, and during that time opening her mouth was difficult.
“I remember shoving soft food between the cracks of my teeth,” Sedoric added.
But the “fix” didn’t last. The pain persisted and her jaw popped out of place again, later requiring a second procedure by the oral surgeon. In the meantime, Sedoric stopped getting her period.
“It was concerning for me,” Sedoric said. “I’d always been regular, never on birth control.”
Her gynecologist suggested Sedoric’s running and workouts — and stress – were the culprits. But that didn’t make sense: Sedoric had been a three-varsity-sport athlete in high school and continued working out with her college sports teams, so she hadn’t been exercising any more than usual. The doctor ordered a blood test, which showed slightly low estrogen levels. She was prescribed progestin, a form of the hormone progesterone, for a week to reset her menstrual cycle. When that failed, the doctor said it might take some time and to “come back in a few months.”
But a few months later, still without her period, Sedoric began experiencing severe hip pain.
Odd, disparate symptoms continued to accrue, including pelvic floor pain, for which she received a series of nerve-blocker injections through her vagina, and leg pain, which required physical therapy. And the jaw pain never stopped. A new oral surgeon suggested “breaking my jaw and putting it back in place,” she said.
Then, after moving from her parents’ home in New Hampshire to an apartment in Lower Manhattan, Sedoric noticed subtle changes in her body: Her face seemed to be broadening, her lips got puffier, and her fingers swelled to the point that the cherished gold ring belonging to her grandmother that she always wore snapped. “My body was deforming before my eyes,” she said. She attributed the shifts to routine aging, living in New York City, drinking with friends, and the ongoing stress of the pandemic.
After two years, several misdiagnoses and some painful treatments that didn’t help, Sedoric was about to give up on solving her health problems. Then, in desperation, she decided to seek help at a private medical clinic, which, for a hefty fee, conducted an exhaustive battery of tests. What emerged from those tests eventually put her on the path to figuring out that she had a rare, life-altering condition that would undermine her sense of self in profound ways.
“I lived in pain and was gaslit for years,” Sedoric said. “But the experience gave me a different perspective, like, you almost died but now you get to live.”
Desperate for answers
In 2021, during a Christmas holiday in New Hampshire, Sedoric said her best friend’s father, an orthopedic surgeon, recommended a privately run clinic in Colorado that conducts comprehensive testing and full physical workups for people with difficult-to-diagnose conditions. The catch: a price tag that would ultimately top $21,000 — no insurance accepted. Sedoric’s parents agreed to pay, and in February 2022, she flew to the Resilience Code headquarters in Englewood, Colo., for four days of testing.
She met with neurosurgeon Chad J. Prusmack, the company’s founder and CEO, for about 90 minutes to review her medical history. Then she spent the following days undergoing tests. She had an MRI of her brain and a biomarker panel looking at thousands of conditions. Blood work tested her for a variety of potential problems, including viral and gut conditions, as well as inflammatory, immune, and hormone imbalances.
“When you get a whole bunch of labs, it tells a story of the patient,” Prusmack said. “It doesn’t take a snapshot and leave out some of the important details.”
Before the results came in, she said, Prusmack told her he predicted she had Lyme disease, and then prescribed several medications to treat her symptoms. None of the pain medicines worked, she said.
“Except for the ketamine: For 30 minutes I was in no pain but I couldn’t function, so it wasn’t really a long-term solution.”
One month later, on a Zoom call with Prusmack, she got the news: It wasn’t Lyme disease. It was, most likely, a condition related to the substantially elevated level of IGF-1, a marker for growth hormone, picked up on a test Sedoric had not previously been given. The upper limit of IGF-1 for a person Sedoric’s age is about 200, Prusmack said, but hers was 523, which suggested an endocrine-related problem.
In addition, the MRI showed a tumor on Sedoric’s pituitary gland, a pea-size structure that sits at the base of the brain and is often called the “master gland” because it releases hormones responsible for many critical functions, including growth, metabolism, sex and reproduction, and the body’s response to stress.
The news stunned her. She said it was a relief to pinpoint the problem, but “not in my wildest dreams did I think I had a brain tumor, and I had no idea how bad it was.” Sedoric texted her roommates, and together they ran through the streets of the Lower East Side, screaming and crying.
The next day, she started interviewing surgeons.
Sedoric secured an appointment with Tim Smith, a neurosurgeon at Brigham and Women’s Hospital in Boston.
Smith said a follow-up MRI showed that Sedoric’s tumor was a 1.4-cm “macroadenoma.” Doctors also finally gave her an official diagnosis that explained her years of frustration and pain. She had acromegaly, a rare condition that, in adults, causes certain bones, organs, and other soft tissue in the face, jaw, hands, and feet to grow far beyond what is typical. In children, whose growth plates have not yet closed, the condition can cause excessive height and is known as “gigantism.” Among the most famous people with gigantism was André the Giant.
Smith said Sedoric did not appear with many of the telltale signs of acromegaly, which afflicts about 30 to as many as 120 people out of a million, according to various analyses that show prevalence to be higher than previously thought. She didn’t have an obviously prominent jaw, for example, or a massively larger shoe size. Still, her arthritislike joint pain was unusual for a fit, young adult, he said.
“At her age, and with her athleticism, this [collection of symptoms] was just very strange,” Smith said.
She did display some classic symptoms, he said, including swelling in her face and hands and what’s known as frontal bossing, a prominent or bulging forehead.
This happens, Smith said, because the excessive growth hormone secreted by the pituitary causes overgrowth of cartilage, bone, and a form of connective tissue called synovium, which first makes the joints look bigger and then causes them to stop working normally.
On April 26, Smith successfully removed Sedoric’s tumor. About an hour after the operation, however, Sedoric said she got out of bed to use the bathroom and suddenly felt nauseated and off-balance. The next thing she remembers is waking up covered in vomit with about a dozen medical professionals staring at her.
She had apparently thrown up and breathed it in through her nose, causing the vomit to travel up through the surgical cavity. Soon, she was in the intensive care unit with a high fever and throwing up blood; a spinal tap confirmed she had bacterial meningitis. Bacteria from her gut had infected her brain and spinal fluid; doctors performed a second surgery to clear out the infected area.
Sedoric returned home after two weeks.
Living with uncertainty
It hasn’t been an easy recovery. She has less jaw pain, and the swelling and puffiness in her body transitioned back to normal. But she’s developed headaches, still has pain in her legs and suffers lingering trauma from the surgery complications.
And her future remains uncertain. An analysis of Sedoric’s tumor found she has a more aggressive form of the disease; there’s a 20-40% risk of a recurrence within 10 years, Smith said, and a lifetime risk “close to 100%.”
Sedoric sees endocrinologist Nidhi Agrawal, the director of pituitary disease at the Holman Division of Endocrinology, Diabetes and Metabolism at NYU Langone Health, every six months to closely monitor her symptoms.
Agrawal says in certain ways, Sedoric is lucky. While some of the bone growth she experienced is irreversible, much of the soft tissue expansion has resolved because her acromegaly was diagnosed just a couple of years after symptoms began. The typical diagnostic delay for acromegaly is generally about five to six years, Agrawal said, which is an improvement from a few years ago, when the delay was closer to 15 years.
“These are patients who have been just hopping around seeing different practitioners and just not getting the diagnosis,” she said.
Agrawal said she now tries to educate medical students, dentist groups, and other specialists to let them know that if patients come in complaining of unexplained pain in disparate body parts, it could be acromegaly.
Sedoric, now 28, has tried to integrate her illness into daily life. She remains active — she ran the New York and Chicago marathons recently, and plans on completing the Boston Marathon in April — and enjoys her job as a sustainability consultant. Currently she’s not taking medication for her condition.
From the outside, her life looks fairly typical.
“I hang with friends, run marathons, look pretty normal,” she said. “But it’s hard when you have an invisible disease with no cure that comes with constant pain and could deform your body at any time.”
She is learning to live with uncertainty.
“The most difficult thing is trusting myself,” Sedoric said. “Like having to look in the mirror and decide if I have a swollen face because I didn’t get enough sleep or if I have a tumor. It’s trusting when to take it seriously and when to let go.”
Just before this story was published, Sedoric learned that the tumor is growing back. She is working with her endocrinologist on a treatment plan that could include surgery, life-long medication, or radiation.
Rachel Zimmerman is a journalist and writer based in Cambridge, Mass. Her book, “Us, After: A Memoir of Love and Suicide,” was published in 2024.
A Philadelphia-area infant named Baby KJ made international headlines after doctors at Children’s Hospital of Philadelphia and Penn Medicine successfully treated his rare, life-threatening liver condition with a gene-editing drug earlier this year.
Now back home with his family in Drexel Hill after more than 300 days in the hospital, KJ Muldoon has been named one of 10 people who helped shape medicine in 2025 by Nature, a British scientific journal.
Nature’s 10 is rounded out by career scientists and public health champions, including a neurologist treating brain disorders, an entomologist unearthing new details about mosquito-borne illnesses, and a data researcher who drew attention to troubling patterns in research retractions. The publication honored Baby KJ as a “trailblazing baby.”
KJ was born with a rare disorder that prevented his liver from processing protein. He was at risk of dangerous levels of ammonia, a byproduct of protein, building up in his bloodstream, traveling to his brain, and causing irreparable damage. The condition, called severe carbamoyl phosphate synthetase 1 (CPS1) deficiency, is deadly in more than half of cases.
With few treatment options and limited time, KJ’s doctors proposed a novel treatment using experimental gene-editing technology: They would analyze KJ’s genetic profile to find the genetic mutation that prevented his body from producing a key enzyme that breaks down protein. Then they would infuse a medication laced with bits of genetic code to find the misspelling and fix it, dramatically improving his chances of recovery.
Within six months, researchers at CHOP and Penn had developed a customized drug specifically for KJ using CRISPR, the buzzy shorthand for a scientific tool that works like a find-and-replace command. It is named after a stretch of genetic code utilized — clustered regularly interspaced short palindromic repeats.
KJ received three doses of the medication, and in June, he returned home after 307 days in the hospital. He will need ongoing care, but doctors say the treatment has dramatically improved his liver function.
“This is the future of medicine, a step toward using gene-editing for diseases for which there are few treatments,” Kiran Musunuru, director of the Penn Cardiovascular Institute’s Genetic and Epigenetic Origins of Disease Program and one of the lead doctors on KJ’s case, said during a call with reporters in May.
Baby KJ’s treatment was a first-of-its-kind drug customized to a unique genetic mutation. It will never be used for another patient, but Philadelphia researchers believe the CRISPR framework could be used to customize drugs for other patients.
Musunuru and Rebecca Ahrens-Nicklas, the director of CHOP’s Gene Therapy for Inherited Metabolic Disorders Frontier Program, are developing a new clinical trial to test the CRISPR framework for treating customized gene therapies for urea cycle disorders related to any one of seven genes.
The mechanism will remain the same, but the injection each patient receives will be customized to target their unique genetic mutation.
They are hopeful that their work will make bespoke treatments available to more people with rare diseases, Ahrens-Nicklas told Nature.
“Everyone saw the possibility and thought, ‘Why isn’t this available for my child?’”
