Imagine you are a 70-year old patient sitting in your oncologist’s office, processing a life-altering diagnosis. Your doctor prescribes a pill for your cancer that offers the best chance of survival. You arrive at the pharmacy, expecting a co-pay, but the bill looks more like a mortgage payment. “That will be $2,000 for the prescription,” the pharmacist says.
Now, imagine Medicare offers a payment plan to soften the blow. There’s just one catch: You need to know the program exists so you can sign up for it — which itself can be tricky. The Medicare Prescription Payment Plan (MPPP) may be the program’s best-kept secret, one that could help you or someone you love afford life-saving drugs. But most Medicare patients don’t know about it.
For millions of seniors, high costs for prescription drugs aren’t a hypothetical nightmare; they are a structural failure built into the Medicare Part D drug program. For years, the rules on coverage for the costliest drugs — for conditions like cancer, rheumatoid arthritis, and multiple sclerosis — have been an open scandal. Just a few years ago, many cancer patients had to pay $20,000 out-of-pocket annually for their medicines.
The Inflation Reduction Act (IRA) was designed to fix this. The law capped annual out-of-pocket drug costs at $2,000 in 2025 for all Medicare patients. This translates to an astounding 90% discount for many cancer patients. This annual maximum will slowly rise in future years.
On paper, this appears to be a long overdue fix. In reality, a critical flaw remains. While the total amount a patient owes in a year is lower, the timing of that expense can still be crippling. A patient needing an expensive cancer drug may owe their entire $2,000 annual maximum for a single prescription fill at the pharmacy.
Unless they pay upfront, patients must forgo treatment.
Our recent research reveals how the IRA’s annual out-of-pocket cap on its own falls short as an affordability fix. In 2024, as initial IRA protections phased in, fewer than half of Medicare patients filled their cancer prescription through their insurance. Nearly a decade ago, our team at Penn had warned that even with an annual cap, patients would still be hit with “too much too soon.” We proposed the idea that Medicare let patients “smooth” out these costs more evenly across the year.
Retailers like Best Buy and Walmart know how to make big-ticket items like televisions, laptops, or refrigerators affordable for consumers. They prominently advertise payment plans alongside any big purchase, allowing consumers to seamlessly enroll at the point-of-sale and spread the costs over longer periods.
We have built a financial bridge for patients but failed to put up signs directing them to it.
Patients must be informed about the MPPP and allowed to enroll at the point of purchase. If this level of convenience to improve affordability is standard for consumer products, it should not be out of reach for life-saving medications.
The earlier in the year a patient enrolls in the MPPP, the more months they have to spread out the costs. Enrolling in January means 12 smaller payments. Enrolling in November divides the payment by just two.
If they miss it, thousands of patients can expect sticker shock at the pharmacy counter, and too many will walk away without life-saving medication.
John Lin, MD, MSHP is assistant professor in the Department of Health Services Research at The University of Texas MD Anderson Cancer Center. Jalpa Doshi, PhD, is a senior fellow at the Leonard Davis Institute of Health Economics and is the Leon Hess Professor of Internal Medicine at the Perelman School of Medicine at the University of Pennsylvania.
Editor’s note: This story has been updated to note the role of a University of Pennsylvania team in proposing the idea behind Medicare’s payment plan.
Competition at Philadelphia-area medical schools intensified in 2025, with programs seeing about 50 applicants for every open spot.
That’s the highest demand since 2022, with the number of applications bouncing back after a three-year decline, recently released data from the Association of American Medical Colleges(AAMC) shows.
The annual report offers a look at the composition of the nation’s future doctors through the demographics of the applicants and enrollees at M.D. degree-granting medical schools across the United States and Canada.
It showed increased class sizes and strong female enrollment across the Philadelphia area’s five M.D. degree-granting schools: University of Pennsylvania, Thomas Jefferson University, Temple University, Drexel University, and Cooper Medical School of Rowan University.
And the fraction of first-year medical students from Pennsylvania who identified as Black or African American, excluding the mixed-race student population, fell from 6.9% to 5.4% between 2023 and 2025.
The racial demographics of entering studentsare seeing increased scrutiny in light of the 2023 Supreme Court decision that effectively ended affirmative action, barring race from being used in higher education admissions.
The percentage of first-year medical students from Pennsylvania who are Black is lower this year than the national average. Pennsylvania also lags behind the national average for first-year enrollment of Hispanic or Latino medical students.
This data reflects the results of the application cycle that concluded last spring. Next year’s prospective medical school students are currently in the thick of admissions season, awaiting interviews and offers.
Here’s a look at the key trends we’re seeing:
Applications back up
Demand for spots at Philadelphia area-medical schools is back up after a three-year decline. There were nearly 5,000 more applications last cycle, a 9.3% increase, with all schools except Cooper seeing a boost.
Jefferson’s Sidney Kimmel Medical College helped drive growth the most, with a 16% increase in applications compared to the previous year.
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More medical students being trained
Orientation icebreakers might take a bit longer to get through at area-medical schools as first-year classes continue to get bigger.
In 2025, Philadelphia-area schools enrolled 1,089new medical students, compared to 991 in 2017. Drexel University College of Medicine contributed to half of that growth, adding 49 seats to its recent entering class compared to that of 2017.
Penn’s Perelman School of Medicine was the only school that did not increase its class size in 2025.
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Female enrollment remains strong
More female students have entered Philly-area medical schools over the last decade.
In 2025, 55.4% of first-year enrollees at Philly-area medical schools were female, compared to 47.7% in 2017.
Drexel saw the biggest rise, with 181 women entering in 2025, compared to 120 in 2017.
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Lydia Romero strained to hear her husband’s feeble voice through the phone.
A week earlier, immigration agents had grabbed Julio César Peña from his front yard in Glendale, Calif. Now, he was in a hospital after suffering a ministroke. He was shackled to the bed by his hand and foot, he told Romero, and agents were in the room, listening to the call. He was scared he would die and wanted his wife there.
“What hospital are you at?” Romero asked.
“I can’t tell you,” he replied.
Viridiana Chabolla, Peña’s attorney, couldn’t get an answer to that question, either. Peña’s deportation officer and the medical contractor at the Adelanto ICE Processing Center refused to tell her. Exasperated, she tried calling a nearby hospital, Providence St. Mary Medical Center.
“They said even if they had a person in ICE custody under their care, they wouldn’t be able to confirm whether he’s there or not, that only ICE can give me the information,” Chabolla said. The hospital confirmed this policy to KFF Health News.
Family members and attorneys for patients hospitalized after being detained by federal immigration officials said they are facing extreme difficulty trying to locate patients, get information about their well-being, and provide them emotional and legal support. They say many hospitals refuse to provide information or allow contact with these patients. Instead, hospitals allow immigration officers to call the shots on how much — if any — contact is allowed, which can deprive patients of their constitutional right to seek legal advice and leave them vulnerable to abuse, attorneys said.
Hospitals say they are trying to protect the safety and privacy of patients, staff, and law enforcement officials, even while hospital employees in Los Angeles, Minneapolis, and Portland, Ore., cities where Immigration and Customs Enforcement has conducted immigration raids, say it’s made their jobs difficult. Hospitals have used what are sometimes called blackout procedures, which can include registering a patient under a pseudonym, removing their name from the hospital directory, or prohibiting staff from even confirming that a patient is in the hospital.
“We’ve heard incidences of this blackout process being used at multiple hospitals across the state, and it’s very concerning,” said Shiu-Ming Cheer, the deputy director of immigrant and racial justice at the California Immigrant Policy Center, an advocacy group.
Some Democratic-led states, including California, Colorado, and Maryland, have enacted legislation that seeks to protect patients from immigration enforcement in hospitals. However, those policies do not address protections for people already in ICE custody.
Julio Cesar Peña, who has terminal kidney disease, sits on his bike in the backyard of his home in Glendale, Calif. His family had a hard time locating him when he was hospitalized after being detained by Immigration and Customs Enforcement.
More detainees hospitalized
Peña is among more than 350,000 people arrested by federal immigration authorities since President Donald Trump returned to the White House. As arrests and detentions have climbed, so too have reports of people taken to hospitals by immigration agents because of illness or injury — due to preexisting conditions or problems stemming from their arrest or detention.
ICE has faced criticism for using aggressive and deadly tactics, as well as for reports of mistreatment and inadequate medical care at its facilities. Sen. Adam Schiff (D., Calif.) told reporters at a Jan. 20 news conference outside a detention center he visited in California City that he spoke to a diabetic woman held there who had not received treatment in two months.
While there are no publicly available statistics on the number of people sick or injured in ICE detention, the agency’s news releases point to 32 people who died in immigration custody in 2025. Six more have died this year.
The Department of Homeland Security, which oversees ICE, did not respond to a request for information about its policies or Peña’s case.
According to ICE’s guidelines, people in custody should be given access to a telephone, visits from family and friends, and private consultation with legal counsel. The agency can make administrative decisions, including about visitation, when a patient is in the hospital, but should defer to hospital policies on contacting next of kin when a patient is seriously ill, the guidelines state.
Asked in detail about hospital practices related to patients in immigration custody and whether there are best practices that hospitals should follow, Ben Teicher, a spokesperson for the American Hospital Association, declined to comment.
David Simon, a spokesperson for the California Hospital Association, said that “there are times when hospitals will — at the request of law enforcement — maintain confidentiality of patients’ names and other identifying characteristics.”
Although policies vary, members of the public can typically call a hospital and ask for a patient by name to find out whether they’re there, and often be transferred to the patient’s room, said William Weber, an emergency physician in Minneapolis and medical director for the Medical Justice Alliance, which advocates for the medical needs of people in law enforcement custody. Family members and others authorized by the patient can visit. And medical staff routinely call relatives to let them know a loved one is in the hospital, or to ask for information that could help with their care.
But when a patient is in law enforcement custody, hospitals frequently agree to restrict this kind of information sharing and access, Weber said. The rationale is that these measures prevent unauthorized outsiders from threatening the patient or law enforcement personnel, given that hospitals lack the security infrastructure of a prison or detention center. High-profile patients such as celebrities sometimes also request this type of protection.
Several attorneys and healthcare providers questioned the need for such restrictions. Immigration detention is civil, not criminal, detention. The Trump administration says it’s focused on arresting and deporting criminals, yet most of those arrested have no criminal conviction, according to data compiled by the Transactional Records Access Clearinghouse and several news outlets.
Taken outside his home
According to Peña’s wife, Romero, he has no criminal record. Peña came to the United States from Mexico in sixth grade and has an adult son in the U.S. military. The 43-year-old has terminal kidney disease and survived a heart attack in November. He has trouble walking and is partially blind, his wife said. He was detained Dec. 8 while resting outside after coming home from dialysis treatment.
Initially, Romero was able to find her husband through the ICE Online Detainee Locator System. She visited him at a temporary holding facility in downtown Los Angeles, bringing him his medicines and a sweater. She then saw he’d been moved to the Adelanto detention center. But the locator did not show where he was after he was hospitalized.
When she and other relatives drove to the detention facility to find him, they were turned away, she said. Romero received occasional calls from her husband in the hospital but said they were less than 10 minutes long and took place under ICE surveillance. She wanted to know where he was so she could be at the hospital to hold his hand, make sure he was well cared for, and encourage him to stay strong, she said.
Shackling him and preventing him from seeing his family was unfair and unnecessary, she said.
“He’s weak,” Romero said. “It’s not like he’s going to run away.”
ICE guidelines say contact and visits from family and friends should be allowed “within security and operational constraints.” Detainees have a constitutional right to speak confidentially with an attorney. Weber said immigration authorities should tell attorneys where their clients are and allow them to talk in person or use an unmonitored phone line.
Hospitals, though, fall into a gray area on enforcing these rights, since they are primarily focused on treating medical needs, Weber said. Still, he added, hospitals should ensure their policies align with the law.
Family denied access
Numerous immigration attorneys have spent weeks trying to locate clients detained by ICE, with their efforts sometimes thwarted by hospitals.
Nicolas Thompson-Lleras, a Los Angeles attorney who counsels immigrants facing deportation, said two of his clients were registered under aliases at different hospitals in Los Angeles County last year. Initially, the hospitals denied the clients were there and refused to let Thompson-Lleras meet with them, he said. Family members were also denied access, he said.
One of his clients was Bayron Rovidio Marin, a car wash worker injured during a raid in August. Immigration agents surveilled him for over a month at Harbor-UCLA Medical Center, a county-run facility, without charging him.
In November, the Los Angeles County Board of Supervisors voted to curb the use of blackout policies for patients under civil immigration custody at county-run hospitals. In a statement, Arun Patel, the chief patient safety and clinical risk management officer for the Los Angeles County Department of Health Services, said the policies are designed to reduce safety risks for patients, doctors, nurses, and custody officers.
“In some situations, there may be concerns about threats to the patient, attempts to interfere with medical care, unauthorized visitors, or the introduction of contraband,” Patel said. “Our goal is not to restrict care but to allow care to happen safely and without disruption.”
Leaving patients vulnerable
Thompson-Lleras said he’s concerned that hospitals are cooperating with federal immigration authorities at the expense of patients and their families and leaving patients vulnerable to abuse.
“It allows people to be treated suboptimally,” Thompson-Lleras said. “It allows people to be treated on abbreviated timelines, without supervision, without family intervention or advocacy. These people are alone, disoriented, being interrogated, at least in Bayron’s case, under pain and influence of medication.”
Such incidents are alarming to hospital workers. In Los Angeles, two healthcare professionals who asked not to be identified by KFF Health News, out of concern for their livelihoods, said that ICE and hospital administrators, at public and private hospitals, frequently block staff from contacting family members for people in custody, even to find out about their health conditions or what medications they’re on. That violates medical ethics, they said.
Blackout procedures are another concern.
“They help facilitate, whether intentionally or not, the disappearance of patients,” said one worker, a physician for the county’s Department of Health Services and part of a coalition of concerned health workers from across the region.
At Legacy Emanuel Medical Center in Portland, nurses publicly expressed outrage over what they saw as hospital cooperation with ICE and the flouting of patient rights. Legacy Health has sent a cease and desist letter to the nurses’ union, accusing it of making “false or misleading statements.”
“I was really disgusted,” said Blaire Glennon, a nurse who quit her job at the hospital in December. She said numerous patients were brought to the hospital by ICE with serious injuries they sustained while being detained. “I felt like Legacy was doing massive human rights violations.”
Handcuffed while unconscious
Two days before Christmas, Chabolla, Peña’s attorney, received a call from ICE with the answer she and Romero had been waiting for. Peña was at Victor Valley Global Medical Center, about 10 miles from Adelanto, and about to be released.
Excited, Romero and her family made the two-hour-plus drive from Glendale to the hospital to take him home.
When they got there, they found Peña intubated and unconscious, his arm and leg still handcuffed to the hospital bed. He’d had a severe seizure on Dec. 20, but no one had told his family or legal team, his attorney said.
Tim Lineberger, a spokesperson for Victor Valley Global Medical Center’s parent company, KPC Health, said he could not comment on specific patient cases, because of privacy protections. He said the hospital’s policies on patient information disclosure comply with state and federal law.
Peña was finally cleared to go home on Jan. 5. No court date has been set, and his family is filing a petition to adjust his legal status based on his son’s military service. For now, he still faces deportation proceedings.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
As Philadelphia endured another day of historically frigid temperatures, outreach workers on Friday fielded hundreds of calls for shelter as warming centers filled with people seeking respite from the cold.
In the mazelike concourse at Suburban Station, a Project HOME outreach worker hugged clients and encouraged them to head inside.
At the Hub of Hope, the nonprofit’s drop-in center in the concourse for people experiencing homelessness, dozens lined up for hot meals. Later that night, as they had for the last several days, staff would set up cots for up to 80 people with nowhere else to go.
Typically, the Hub closes in the early evening. But amid the ongoing freeze, it’s open 24-7 as city officials and homeless services providers work to keep vulnerable Philadelphians safe.
Last month, the city declared a “Code Blue,” a designation that opens additional shelter beds and other resources. Ever since, the nonprofit’s hotline has fielded more than 6,000 calls, an average of more than 500 a day.
Normally, it receives about 140 a day.
“Many calls are concerned citizens who see someone who is homeless and want a team to go and check on them. Some are people who are literally homeless right now and need a place to go. Some are facing eviction and scared, reaching out for their options,” said Candice Player, the nonprofit’s vice president of advocacy, public policy, and street outreach.
“The extreme cold challenges us and pushes us even harder.”
City officials navigate a lengthy cold snap
When the wind chill makes it feel like it’s 20 degrees outside or lower for more than three days, the city can declare what is called an enhanced Code Blue. The distinction opens up furtherresources, including daytime and nighttime warming centers.
Cheryl Hill, executive director of the Philadelphia Office of Homeless Services, describes these periods as an all-hands-on-deck situation. Hill said that “every city entity can be outreach” during this time, and that work can also be aided by members of the public, who have been quick to call for help.
“We are all basically helping our neighbor, in essence — we see them out on the street, we want to help,” Hill said. “As a result, outreach is getting a lot more calls to go and check on those individuals.”
Philadelphia declared an initial Code Blue on Jan. 18 and an enhanced Code Blue on Jan. 20.
The city has about 3,500 shelter beds, which can become open as people get placed in longer-term housing.
If the beds reach capacity, the city has additional overnight spaces at warming centers, primarily in recreation centers. People who spend the day at warming centers that close overnight can receive transportation to a nighttime center.
People who need a ride to a warming center can ask for transportation at their local police district, city officials said.
On average, the overnight warming centers have provided shelter to about 300 to 400 people across the city per night. Last Monday night, after 9.3 inches of snow had blanketed Philly, warming centers sheltered just shy of 450 people.
Last year, peak usage of warming centers hovered around 150 people, Hill said.
Still, helping the city’s most vulnerable off the streets can be difficult even in the best of circumstances.
On Friday afternoon, a sign posted at the South Philadelphia Library informed people visiting to get out of the cold that they could eat and sleep in a section designated as a warming center. Librarians and community support groups collect and provide snacks, along with hand-warmers and other essentials, for those who need them.
Even so, only a handful of people sat in the area. A woman yelped in pain as she rubbed a blackened toe. Children played with blocks in another corner of the library as others checked out books.
The homeless services office tries to have medical staff at warming sites, but more serious cases get sent to the hospital.
In extreme cold, as a last resort, people with serious mental illnesses who refuse to come inside and are underdressed could be involuntarily committed.
Homeless services providers said they are working around the clock to care for clients exhausted by the struggle of simply staying warm.
“The experience of being homeless in this brutal cold is awful, and the folks who come in are just worn down,” Playersaid.
At shelters run by the Bethesda Project, staff are trying to keep residents’ spirits up and encouraging them to stay inside as much as possible, said director of shelter Kharisma Goldston. “One of our guests was doing haircuts last night,” she said. “We try to do a lot so guys don’t feel like they’re trapped inside.”
Staffers set up additional beds to accommodate more clients, she said.
“We do our best to set up however many beds we can,” she said. “When it’s this cold, it takes a very short amount of time for hypothermia to set in.”
Rachel Beilgard, Project HOME’s senior program manager for outreach, said that outreach teams have encountered several people suffering from frostbite who were involuntarily committed. Some, she said, risked limb amputations if they had stayed outside any longer.
But many people who typically refuse offers for shelter from outreach teams are now accepting help, Beilgard said. “We’ve had a lot of folks this winter who say, ‘Once it starts snowing, come find me,’” she said.
Tim Neumann works with people experiencing housing instability, in Philadelphia.
The count, taken every year at the behest of federal housing officials, happens over one night in January; city workers and volunteers fan out across the city to physically count people sleeping on the street and those in shelters. Federal officials use the count to gauge funding allocations, and city officials look to it to understand the needs on the streets.
The Jan. 22, 2025, count was also taken during a Code Blue, although temperatures were not as frigid as they were last week. It found that homelessness rose by about 9% between 2024 and 2025, after a 38% jump the year before. In Kensington, the number of homeless, unsheltered people dropped by about 17%.
The number of people experiencing chronic homelessness rose by 49%. This is a designation tightly defined by the federal government as a homeless person with a disability who lives in a shelter or in a place that is not meant for habitation, and who has been homeless for a full year, or homeless at least four times in the last three years for a total of 12 months.
The category also includes people who fit these criteria but have entered jail, rehab, or another care facility in the last three months. Most of Philadelphia’s chronically homeless residents were living in emergency shelters.
City officials and providers said a number of factors likely contributed to the increase.
People with substance use disorder and mental health issues are vulnerable to becoming chronically homeless, especially in Philadelphia, where a toxic drug supply causes wounds and intense withdrawal that keep many from seeking shelter. But a lack of affordable housing, low wages, job loss, or a major health issue can also put residents at high risk for homelessness, stressed Crystal Yates-Gale, the city’s deputy managing director for health and human services.
Hill also said that in recent years, Philadelphia has lost bids to receive competitive housing funds from the federal government.
“We’ve been working really intentionally to make sure that our programs will get funded” in the future, Hill said.
Yates-Gale also pointed to Mayor Cherelle L. Parker’s December executive order directing city officials to add 1,000 beds to the shelter system by the end of January. As of last week, the city had added 600 winter shelter beds that are crucial during the enhanced Code Blue and will eventually become available year-round, she said.
Anecdotally, neighborhoods have reported decreases in homelessness since last year, Hill said, although officials will have to wait until February to conduct the count this year.
The count had originally been set for Wednesday, but the city canceled it due to the cold — and because too many outreach staffers were at work getting people inside.
Editor’s note: This article has been updated to reflect that library staff and supporters provide people using daytime warming centers with snacks.
Every day, sometimes several times a day, the 7-year-old girl wants to talk about the mother she lost in the Northeast Philadelphia plane crash.
“She’s missing her all the time and she’ll ask me, `Do you think I look like my mom? Do you think I dress like my mom? Do you see my bag? This is my mom’s bag,’” said 35-year-old Shantell Fletcher, the girl’s godmother.
It has been a year since a medical jet crashed on Cottman Avenue near the Roosevelt Mall, killing all six people onboard. The explosion cast a plume of plane shrapnel and fire over the neighborhood. At least 16 homes were severely damaged and about two dozen people were injured that night.
The girl’s mother, Dominique Goods Burke, and her fiance, Steven Dreuitt Jr., along with Dreuitt’s 10-year-old son, Ramesses Dreuitt Vazquez, were driving on Cottman Avenue on Jan. 31, 2025, just after 6 p.m. when the plane slammed into the ground at more than 278 mph, within feet of their car.
Flames instantly engulfed the vehicle. Dreuitt, 37, trapped in the car with his legs crushed beneath the steering wheel, died at the scene, but Goods Burke and Ramesses escaped with severe burns.
A floral photo of Dominique Goods Burke is carried out after the funeral service as family, friends and community members gather outside at Tindley Temple UM Church in Philadelphia, Pa., on Thursday, May 8, 2025. Dominique passed away at Jefferson hospital on April 27 due to the critical burns from the Roosevelt Mall Learjet crash along Cottman Avenue.
Goods Burke, 34, died of her injuries in April at Thomas Jefferson University Hospital, leaving behind her daughter and her 16-year-old son, Dominick Goods. (The family asked The Inquirer to withhold her daughter’s name to protect her privacy.)
On Saturday evening, Mayor Cherelle L. Parker and other city officials planned to place a wreath at the crash site. About 100 people gathered inside Engine 71 Fire Station on Cottman, the station closest to the crash site.
The plane’s impact had left a bomb-like crater in a driveway apron between a Raising Cane’s restaurant and a Dunkin’ Donuts. The 8-foot-deep hole has since been filled in and paved over, but the loss and devastation are irreparable.
“I don’t know how we made it through a year. It feels fresh, raw. Sometimes it’s hard to breathe,” said Fletcher, who was Goods Burke’s first cousin and best friend. “Losing her, I’ve felt alone and empty. I miss laughing with her. I miss joking with her. I miss celebrating life with her.”
Fletcher is helping to raise Goods Burke’s daughter and her son, Dominick, an 11th grader at Imhotep Institute Charter High School in East Germantown. Dominick’s father was Dreuitt, so he lost both parents.
“My godson doesn’t have his mother or his father. My goddaughter doesn’t have her mamma,” Fletcher said. “Other than them coming back, nothing could ever give us a reprieve from the pain.”
Ramesses Dreuitt Vazquez, 10, spent months in a Boston hospital recovering from burns to more than 90% of his body when the car he was riding in caught fire in the Jan. 31, 2025 plane crash in Northeast Philadelphia.
“I have my moments of still struggling. It’s been really tough,” said Dreuitt’s 61-year-old mother, Alberta “Amira” Brown, whose grandchildren are Ramesses and Dominick. “The life that we once had, we can never get it back.”
An irreplaceable booming voice
Dreuitt worked as a kitchen manager and team leader at the Philadelphia Catering Co. in South Philadelphia for more than seven years. Co-owner Tim Kelly said it was Dreuitt’s job to call staffers to lunch, which the company served to its 45 employees each day at noon.
“Steve would always call lunch, which basically was him just yelling, ‘LUNCH,’ three times loudly,” Kelly said. “His deep booming voice. Many of the guys here have tried to replicate it, but to no avail.”
“Time does help. It softens the blow,” Kelly said. “It was very difficult for a long time for a lot of us, but we’re at the point where we can remember him with a little less sadness and we can smile a bit.”
Goods Burke, whom loved ones affectionately called “Pooda” and colleagues called “Dom,” worked at High Point Cafe as a day bakery manager for years.
Cafe founder Meg Hagele said the staff treats her former work space, dubbed “Dom’s table,” with a shrine-like reverence. Seeing Goods Burke’s handwriting on recipes, scribbles in margins, stirs memories of her vibrancy and creativity.
“She’s very present with us still,” Hagele said. “This accident was just a shock to the entire city, but to be touched so personally by it is just freakish and profound.”
NTSB investigation continues
The National Transportation Safety Board is still investigating the crash’s cause. The plane — a medical transport Learjet 55 owned by Jet Rescue Air Ambulance, headquartered in Mexico City — had taken off at 6:07 p.m. from Northeast Philadelphia Airport. It climbed to 1,640 feet before nosediving just three miles away around 6:08 p.m.
NTSB investigators recovered the cockpit voice recorder at the scene, but after repairing it and playing it back, they found the device “had likely not been recording audio for several years,” according to a preliminary report released in March.
Brown, of Mount Airy, said she got a letter from the NTSB a few weeks ago saying investigators were making progress.
“That’s hope right there,” Brown said in a recent interview. ”It will help to know exactly what happened to make that plane come down. Does it change anything? No.”
Alberta “Amira” Brown remembers her son, Steven Dreuitt Jr., who died in the Jan. 31, 2025, plane crash in Northeast Philadelphia. In November, Brown attended a memorial service at Oxford Presbyterian Church in North Philadelphia.
The cremated remains of the six Mexican nationals who died aboard the plane were returned to loved ones in Mexico City last spring. Among the passengers were 11-year-old Valentina Guzmán Murillo and her 31-year-old mother, Lizeth Murillo Osuna. They were returning home after Valentinahad spent four months undergoing treatment for a spinal condition at Shriners Children’s Philadelphia.
Also killed were the pilot, Alan Montoya Perales, 46; his copilot, Josue de Jesus Juarez Juarez, 43; a Jet Rescue doctor, Raul Meza Arredonda, 41; and paramedic Rodrigo Lopez Padilla, 41.
Philadelphia Fire Commissioner Jeffrey Thompson (from left) Mayor Cherelle L. Parker, and Police Commissioner Kevin J. Bethel ring a ceremonial bell at the one-year anniversary memorial observance of the Northeast Philly plane crash Saturday, Jan. 31, 2026, at Engine 71 Fire Station on Cottman Avenue in Philadelphia.
In the moments after the crash, hundreds of firefighters and rescue workers swarmed the area to put out homes and cars on fire from the jet fuel or burning pieces of aircraft that struck them.
Philadelphia Fire Commissioner Jeffrey Thompson, a 36-year veteran of the city’s fire department, said the plane crash “was without a doubt the biggest thing that I’ve ever responded to.”
In an interview on Thursday, Thompson recalled rushing to the scene from his Fishtown home, filled with dread and adrenaline.
“I remember it was dark. It was cold, and it was raining — it was like something out of a disaster movie,” Thompson said. “As I got closer, I could just see a sea of lights.”
He arrived to find multiple homes and cars on fire. Pools of jet fuel everywhere. And so many pieces of debris that he initially had no idea of the plane’s size. He said he and other first responders will never forget seeing body parts strewn among the wreckage.
“This still affects all of us. Just to see that is so unnatural,” Thompson said. “And the work that they did that night — that’s indelibly etched in their memories.”
More than 150 firefighters scoured “blocks and blocks” of homes, entering each one and every room, to make sure everyone was accounted for. He said he is amazed how multiple agencies worked together to bring “order to chaos.”
“That just gives me goose bumps,” Thompson said. He added, “This is actually therapeutic — me talking to you has been therapeutic because there was a lot there that night and I don’t often talk about this.”
Miracles, luck, and skill
As tragic as that night was, Thompson said, there was some miraculousness, including the fact that the plane struck a patch of empty pavement between two busy restaurants.
“Sometimes in this life, there’s luck,” Thompson said. “It was rush hour. You had a shopping mall and a densely populated neighborhood. It could have been infinitely worse.”
Lashawn ‘Lala’ Hamiel, Andre “Tre” Howard III, and his family cheer on the Eagles during Super Bowl LIX.
Andre Howard Jr. had just picked up his three kids — then ages 4,7, and 10 — from aftercare at Soans Christian Academy. They headed to Dunkin’ for strawberry doughnuts. As they were leaving the parking lot in Howard’s car, the plane exploded a few feet away. A plane part crashed through the car’s window. Howard’s 10-year-old son, Andre “Tre” Howard III, used his body to shield his 4-year-old sister and a piece of metal struck his head.
Tareq Yaseen, a neurosurgeon at Jefferson Torresdale Hospital, was having dinner with his family, including his kids, ages 10 and 6, at Dave & Buster’s at Franklin Mall when he rushed back to the hospital to perform emergency surgery on Tre.
The boy had two gashes in the right side of his head, and his skull had been shattered into more than 20 pieces, Yaseen recalled.
“My son is the exact age as Tre, which made things very personal and emotional to me,” Yaseen said. “He’s gonna die. He was basically losing consciousness and going in a bad direction.”
“I felt for a moment that I would not be able to help him,” Yaseen said. “I was very scared that I’m gonna fail. There’s too much on the line and it’s a little boy.”
Yaseen said he worked fast to relieve the pressure on Tre’s brain and remove bits of broken skull. The surgery was a success. More than 60 relatives and friends in the hospital waiting room hugged and thanked him, Yaseen recalled.
“It’s a moment that would happen in the movies,” Yaseen said. “I was very lucky to take part in saving his life.”
Tre was transferred to the Children’s Hospital of Philadelphia, where he made a near-full recovery. He celebrated his 11th birthday in December.
“With time, he’ll grow up and forget about it. God gave us a gift to forget, which is great,” Yaseen said. “But I will never forget.”
Jefferson neurosurgeon Tareq Yaseen poses for a photo with Andre “Tre” Howard III and his mother, Lashawn “Lala” Hamiel at Jefferson Torresdale Hospital.
A memorial
At the memorial Saturday, Mayor Parker read aloud the names of all eight who perished that night.
“To all the families who continue to carry this grief everyday, that until you’ve walked a mile in their shoes, you can’t begin to understand what it’s like,” Parker said. “It is important for us to affirm that they know that Philadelphia stands with you today and we will always.”
She asked the victims’ family members in attendance to stand and be recognized, including Brown, her grandson, Dominick, and Lisa Goods, the aunt of Goods Burke.
The mayor said she plans to keep close tabs on Dominick.
“Now he knows he belongs to me — don’t try to take him from me,” Parker said as she looked at Dominick seated in the front row.
Parker also recognized first responders for their “extraordinary bravery and selflessness.”
“In a moment of unimaginable tragedy, you all ran towards danger to protect others.”
Alberta “Amira” Brown (center), the grandmother of 10-year-old Ramesses Dreuitt Vazquez, who was severely burned after a plane crashed into his North Philadelphia neighborhood last year at the one year anniversary memorial observance of the Northeast Philly plane crash Saturday, Jan. 31, 2026, at Engine 71 Fire Station on Cottman Ave., in Philadelphia
A 4-week-old baby girl came into the emergency room because she’d been fussy for a full day, and wouldn’t drink from her bottle. On further questioning, the parents said that she had not pooped for 3 days, had been drooling more, had a weaker cry, and seemed very floppy.
In the ER, she was very weak with low muscle tone, droopy eyelids, and a significant amount of drool. The ER physicians could not elicit her normal newborn reflexes. Due to her severe weakness and concern for her ability to keep breathing on her own, the decision was made to insert a breathing tube into her airway to help her breathe.
Low muscle tone and weakness in a newborn baby can have many different causes. Some of these causes include infection, low blood sugar, thyroid problems, neuromuscular diseases, brain bleeds, drug exposure, and genetic or metabolic disorders.
All babies are screened 48 hours after birth for a variety of genetic and metabolic conditions. This baby had a normal newborn screen, so metabolic disorders were unlikely, though. The ER also collected thyroid studies which were normal. This baby had been healthy with normal muscle tone prior to this event, probably eliminating other genetic disorders such as trisomy 21.
Infections, such as sepsis (blood infection), meningitis (brain infection), pneumonia (lung infection), and urinary tract infections can also present with low muscle tone in newborns. In this patient a lumbar puncture, or spinal tap, proved negative for meningitis. Urine and blood cultures were negative for infection. A chest X-ray did not show pneumonia, and a nasal swab was negative for any respiratory viruses.
Drug ingestions or exposures can also present with altered mental status or low muscle tone, but neither turned up in a urine drug screen.
Problems within the brain, such as a tumor or bleed, can also cause low muscle tone. But a head CT scan on our patient was normal.
Finally, low muscle tone can be a feature of some disorders of the neuromuscular system, which is the pathway between the brain and muscles that make muscles work properly. Some examples of these disorders are spinal muscular atrophy, myasthenia gravis, Guillan-Barre syndrome, or infant botulism.
The solution
Given this patient’s age and symptoms, and after eliminating other possibilities, a test for botulism in the baby’s stool was performed. While awaiting the results, this outcome appeared so likely that the baby was treated for presumed botulism.
Botulism is caused by the bacteria Clostridium botulinum, which causes a neuromuscular paralysis that starts with symptoms at the head and descends to the toes. It can occur when infants ingest spores of these bacteria, which sometimes appear in dirt and honey, among other sources. It predominantly affects babies younger than 12 months. Because of the immaturity of a baby’s gut microbiome, the spores can stay in their intestines longer than they would in an older child or adult, and release the botulism toxin.
Pennsylvania has one of the highest rates in the country of these spores, accounting for 17% of all cases in the United States in 2018. It is most commonly reported in infants who live near construction zones. This infant’s father was a construction worker and had a project going on in their backyard.
Fortunately, a treatment exists. It is called botulism immunoglobulin, otherwise known as BabyBig. This treatment provides antibodies to the bacteria, which bind to and neutralize the toxin. Even with this therapy, recovery is a slow process that can take several months. However, patients who are hospitalized and treated quickly should expect a full recovery.
This patient is doing well, and no longer needed the breathing tube after receiving BabyBig. She still has some trouble with feeding and required a feeding tube for some time.
Her treatment was started immediately because test results take so long, and the treatment would not have harmed her if she hadn’t tested positive. In her case, we got the results after she went home from the hospital and it confirmed the botulinum toxin.
Our advice
Do not give honey to any baby under the age of 12 months. If a family member works in construction, especially in high-risk states, make sure to bathe and change into clean clothes before touching a young baby..
BriarRose Edwins is a second-year pediatric resident and Hayley Goldner is a pediatrician in the adolescent medicine department at Nemours Children’s Hospital, Delaware.
Eli Lilly & Co. plans to build a $3.5 billion pharmaceutical plant in the Lehigh Valley to expand manufacturing capacity for next-generation weight-loss medicines, the Indiana company announced Friday in Allentown.
The decision by Lilly to build one of its four new U.S. factories in Lehigh County marks a significant win for Pennsylvania as states compete for the billions Big Pharma, under pressure from Washington, is spending to boost domestic manufacturing.
“The Mid-Atlantic, Northeast in recent years hasn’t seen this type of mega-plant investment. Most of that has gone to the South and the Southwest,” Don Cunningham, CEO of Lehigh Valley Economic Development Corp., said in an interview.
The Lehigh Valley sits in the middle of a pharmaceutical manufacturing belt that stretches from Montgomery County into central New Jersey, but historically has been known for steel, cement, and Mack Trucks. The Lilly plant will put it on the map for life sciences, said Cunningham, whose agency helped recruit Lilly.
Montgomery County, a major drug and vaccine manufacturing hub, secured another significant project during the ongoing pharmaceutical investment push. The British company GSK said in September that it will build a biologics factory in Upper Merion Township, but did not specify how much it would spend there.
Merck, the New Jersey-based drug giant, announced plans for a $1 billion factory and lab near Wilmington, beyond its existing major operations in Montgomery County.
Until now, Lilly has been busy in the South. Last year, Lilly announced plans to spend a total of $17.5 billion on three factories in Alabama, Texas, and Virginia. The Lehigh Valley was in the competition for the Virginia project, which will be built west of Richmond, Cunningham said.
The 150-acre Lehigh Valley site, in Upper Macungie Township, was selected from more than 300 applications for one of the four new Lilly plants. Ohio was among the other finalists, Cunningham said. The property Lilly is acquiring is adjacent to Interstate 78 on the north side just west of the Route 100 interchange.
Pennsylvania boosted its chances of landing the Lilly project by offering up to $50 million in tax credits and $50 million in grants. An additional $5 million will go to a local community college for a job-training program.
Gov. Josh Shapiro played an important part in securing the Lilly commitment, Cunningham said, with “his team bringing to bear every resource the state could.”
When fully operational in 2031, the Lilly complex is expected to employ 850. The average annual pay in a Lilly facility is $100,000, Lilly’s chair and CEO David A. Ricks told a crowd gathered at the Da Vinci Science Center in downtown Allentown.
“Those are high-value jobs that I can say with a lot of confidence change the trajectory of families,” Ricks said.
Among the products Lilly anticipates manufacturing at the plant are Zepbound, which Ricks called the world’s best-selling medicine, and retatrutide, a type of weight-loss medication dubbed “triple G” that acts on three aspects of appetite regulation.
Early results suggest such next-generation medications may lead to more weight loss than seen with the current drugs on the market, such as Novo Nordisk’s Ozempic and Lilly’s Mounjaro, which target one or two metabolic drivers.
When you think of tools for studying substance use and addiction, a social media site like Reddit, TikTok, or YouTube probably isn’t the first thing that comes to mind. Yet the stories shared on social media platforms are offering unprecedented insights into the world of substance use.
In the past, researchers studying peoples’ experiences with addiction relied mostly on clinical observations and self-reported surveys. But only about 5% of people diagnosed with a substance use disorder seek formal treatment. They are only a small sliver of the population who have a substance use disorder — and until recently, there has been no straightforward way to capture the experiences of the other 95%.
Today, millions of people openly discuss their experiences with drugs online, creating a vast collection of raw narratives about drug use. As a doctoral student in information science with a background in public health, I use this material to better understand how people who use drugs describe their lives and make sense of their experiences, especially when it comes to stigma.
These online conversations are reshaping how researchers think about substance use, addiction, and recovery. Advances in artificial intelligence are helping make sense of these conversations at a scale that wasn’t possible before.
The hidden population
The vast majority of people diagnosed with a substance use disorder address the issue informally — seeking support from their community, friends or family, self-medicating, or doing nothing at all. But some choose to post about their drug use in dedicated online communities, such as group forums, often with a level of candor that would be difficult to capture in clinical interviews.
Their social media posts offer a window into real-time, unscripted conversations about substance use. For example, Reddit, which is comprised of topical communities called subreddits, contains over 150 interconnected communities dedicated to various aspects of substance use.
In 2024, my colleagues and I analyzed how participants in drug-related forums on Reddit connect and interact. We found that they focused on the chemistry and pharmacology of substances, support for drug users, recreational experiences such as festivals and book clubs, recovery help, and harm reduction strategies. We then selected a few of the most active communities to develop a system for categorizing different types of personal disclosures by labeling 500 Reddit posts.
Policymakers and public health experts have expressed concerns that social media encourages risky drug use. Our work did not assess that issue, but it did support the notion that platforms such as Reddit and TikTok often serve as a lifeline for people seeking just-in-time support when they need it most.
When we used machine learning to analyze an additional 1,000 posts, we found that most users in the forums we focused on were seeking practical safety information. Posters often posed questions such as how much of a substance is safe to take, what interactions to avoid, and how to recognize signs of trouble.
We observed that these forums function as informal harm reduction spaces. People share not just experiences but warnings, safety protocols, and genuine care for each other’s well-being. When community members are lost to overdose, the responses reveal deep grief and renewed commitments to keeping others safe. This is the everyday reality of how people navigate substance use outside medical settings — with far more nuance and mutual support than critics might expect.
We also explored TikTok, analyzing more than 350 videos from substance-related communities. Recovery advocacy content was the most common, depicted in 33.9% of the videos we analyzed. Just 6.5% of the videos showed active drug use. As on Reddit, we frequently saw people emphasizing safety and care.
Why AI is a game changer
Platforms like Reddit, TikTok, and YouTube host millions of posts, videos, and comments, many filled with slang, sarcasm, regional language, or emotionally charged stories. Analyzing this content manually is time-consuming, inconsistent, and virtually impossible to do at scale.
That’s where AI comes in. Traditional machine learning approaches often rely on fixed word lists or keyword matching, which can miss important contextual cues. In contrast, newer models — especially large language models like OpenAI’s GPT-5 — are capable of understanding nuance, tone, and even the underlying intent of a message. This makes them especially useful for studying complex issues like drug use or stigma, where people often communicate through implication, coded language, or emotional nuance rather than direct statements.
These models can identify patterns across thousands of posts and flag emerging trends. For example, researchers used them to detect shifts in how Canadians on X, the social media site formerly called Twitter, discussed cannabis as legalization approached — capturing shifts in public attitudes that traditional surveys might have missed.
In another study, researchers found that monitoring Reddit discussions can help predict opioid-related overdose rates. Official government data, like that from the Centers for Disease Control and Prevention, typically lags by at least six months. But adding near-real-time Reddit data to forecasting models significantly improved their ability to predict overdose deaths — potentially helping public health officials respond faster to emerging crises.
The role that stigma plays in substance use disorder is difficult to capture in traditional surveys and interviews.
Bringing stigma into focus
One of the most difficult aspects of substance use to study — and to address — is the stigma.
It’s deeply personal, often invisible, and shaped by a person’s identity, relationships, and environment. Researchers have long recognized that stigma, especially when internalized, can erode self-worth, worsen mental health, and prevent people from seeking help. But it’s notoriously hard to capture using traditional research methods.
Most clinical studies rely on surveys or interviews conducted at regular intervals. While useful, these snapshots can miss how stigma unfolds in everyday life. Stigma scholars have emphasized that understanding its full impact requires paying attention to how people talk about themselves and their experiences over time.
On social media platforms, people often discuss stigma organically, in their own words, and in the context of their lived experiences. They might describe being judged by a healthcare provider, express shame about their own substance use, or reflect on how stigma shapes their relationships. Even when posts aren’t directly naming the experience as stigma, they still reveal how stigma is internalized, challenged, or reinforced.
Using large language models, researchers can begin to track these patterns at scale, identifying linguistic signals like shame, guilt, or expressions of hopelessness. In recent work, my colleagues and I showed that stigma expressed on Reddit aligns closely with long-standing stigma theory — suggesting that what people share on social media reflects recognizable stigma processes, not something fundamentally new or separate from what researchers have long studied.
That matters because stigma is one of the most significant barriers to treatment for people with substance use disorder. Understanding how people who use drugs talk about stigma, harm, recovery, and survival, in their own words, can complement surveys and clinical studies and help inform better public health responses.
By taking these everyday expressions seriously, researchers, clinicians, and policymakers can begin to respond to substance use as it is actually lived — messy, evolving, and deeply human.
Layla Bouzoubaa is a doctoral student in information science at Drexel University.
Thomas Jefferson University Hospital was cited by the Pennsylvania Department of Health in the last year for failing to keep a patient from setting fire in their hospital bed, turning away a person who came to the emergency department, and neglecting to monitor a patient’s vital signs.
The incidents were among nearly three dozen times health department inspectors visited Jefferson Health’s flagship hospital in Center City to investigate potential safety violations between November 2024 and October 2025.
Here’s a look at the publicly available details:
Dec. 3, 2024: Inspectors visited for a monitoring survey and found the hospital was in compliance.
Dec. 3: Inspectors followed up on a citation from August 2024 and found the hospital was in compliance. The hospital had been cited for failing to properly document details from cardiac monitoring for a patient with septic shock.
Jan. 24, 2025: The hospital was cited with immediate jeopardy, one of the state’s most serious warnings and a sign of potentially life-threatening safety problems, after a patient suffered first- and second-degree burns in their room. Inspectors found that the patient had attempted to light a cigarette while receiving treatment that involved supplemental oxygen, which can cause materials near it to catch fire. Inspectors found that Jefferson staff had failed to check the patient for smoking paraphernalia and educate them about no-smoking rules, as required by hospital protocol. The hospital posted more “No Smoking” signs, retrained staff, and updated its policies requiring smoking screening for all patients.
Jan. 30: Inspectors came to investigate a complaint but found the hospital was in compliance. Complaint details are not made public when inspectors determine it was unfounded.
Feb. 3: Inspectors came to investigate a complaint but found the hospital was in compliance.
Feb. 6: Inspectors came to investigate a complaint but found the hospital was in compliance.
Feb. 11: Inspectors came to investigate four complaints but found the hospital was in compliance.
Feb. 11: The Joint Commission, a nonprofit hospital accreditation agency, renewed the hospital’s accreditation, effective November 2024, for 36 months.
Feb. 12: Inspectors came to investigate a complaint but found the hospital was in compliance.
Feb. 14: Inspectors came to investigate two complaints but found the hospital was in compliance.
March 11: The hospital was cited for violating rules that require emergency departments to evaluate all patients who arrive seeking care. Inspectors found that a person walked into the emergency department saying they needed to use the restroom, and was asked to leave because the hospital does not have a public restroom. The patient said they were having an emergency and planned to check into the emergency department, but were still told to leave. Inspectors found that the dismissal violated Jefferson’s emergency department policies designed to comply with the federal Emergency Medical Treatment and Labor Act (EMTALA) — anti-patient dumping laws that require hospitals to evaluate and stabilize any patient who seeks emergency treatment. Administrators retrained staff on EMTALA protocol and updated their system for recording security incidents to better document when a provider is called by security to assess a patient who has a non-medical request, such as needing to use the restroom.
April 15: Inspectors followed up on the immediate jeopardy citation from January and found the hospital was in compliance.
April 29: Inspectors came to investigate a complaint but found the hospital was in compliance.
May 5: The hospital was cited for failing to follow protocol designed to prevent patient falls. In December 2024, an 80-year-old patient with impaired vision was admitted to the emergency department and given a drug known to cause patients to need to urinate more often. Inspectors found that the patient was initially evaluated to have a low risk of falling, but was not re-evaluated after being prescribed the medication that could increase how often they needed to get up to use the bathroom and their risk of falling. In response to the complaint, which was reported in December 2024 and finalized in May 2025, hospital administrators retrained staff on fall risk protocols and said they would monitor patient charts.
May 28: Inspectors came to investigate a complaint but found the hospital was in compliance.
May 30: Inspectors came to investigate a complaint but found the hospital was in compliance.
Aug. 14: Inspectors came to investigate a complaint but found the hospital was in compliance.
Aug. 19: Inspectors came to investigate a complaint but found the hospital was in compliance.
Aug. 19: The hospital was cited for failing to properly monitor a patient’s vital signs. Inspectors found that a provider had ordered continuous pulse oximeter monitoring for a patient, and instructions to report when the blood oxygen levels dropped below 90%. A staff member assigned to the patient could not find a pulse oximeter machine for the patient and told inspectors that they reported the issue to another provider, “but she never got back to me.” Hospital administrators acquired more pulse oximeters, retrained staff on medical supplies protocol, and said they would monitor patient hand-offs between nursing shifts.
Oct. 3: Inspectors came to investigate a complaint but found the hospital was in compliance.
The rollout of so-called virtual nurses in hospitals remains a mixed bag, University of Pennsylvania researchers have found in the largest survey to date on nursing care delivered remotely through a screen.
One hospital staffer said virtual nurses are a huge help getting patients checked in.
Another said they worry hospitals are trying to cut corners by keeping floors fully staffed by using virtual nurses.
And sometimes, patients think the virtual nurse is a television advertisement and try to press fast forward, researchers were told.
A new study out of University of Pennsylvania School of Nursing surveyed 880 registered nurses in 10 states, including Pennsylvania, about the virtual nursing programs that have sprung up at health systems across the country.
About half — 57% — of the nurses surveyed said virtual nurse programs did not reduce their workload, with some saying they felt virtual nurses created more work.
But similar numbers also said they thought virtual nurse programs improved the quality of care patients received.
Others said they didn’t think the technology had any impact — positive or negative — on quality of care, according to a study of results published online in December in JAMA Open Network.
“It can be beneficial or a headache,” one nurse interviewed by Penn researchers summed up.
Virtual nursing programs became more widespread during the COVID-19 pandemic, when health systems needed to limit physical interaction to protect patients and medical staff, and have continued to expand in Philadelphia and across the country. Administrators embracing technology and artificial intelligence say they can help streamline administrative responsibilities that can burden staff, provide extra patient oversight, and improve how quickly clinicians can respond to emergencies.
Local examples include Penn Medicine’s use of virtual nurses to monitor patients at risk of falling or pulling out tubes and wires. Jefferson Health assigns a virtual nurse to patients who doctors have decided need to be monitored around the clock.
And virtual nurses handle administrative work, like reviewing medications and giving discharge instructions at Virtua Health hospitals in New Jersey.
The new study from Penn is among the largest to date to evaluate how well the programs are meeting goals, and the mixed results should be a warning to hospital administrators to proceed cautiously, researchers say.
“Virtual nursing programs have been heralded as an innovative silver bullet to hospitals’ nurse staffing challenges, but our findings show that most bedside nurses are not experiencing major benefits,” said lead author K. Jane Muir, an assistant professor of nursing in the university’s Department of Family and Community Health.
Virtual nursing on the rise
Virtual nurses at Virtua Health appear on the television in a patient’s room.
Virtual nursing refers to patient-care responsibilities managed by a team of nurses stationed at a remote hub, where they monitor screens and electronic information feeds.
They are not intended to replace bedside care, but rather to serve as an extra set of eyes to monitor patients.
If a patient who is known to be unsteady on their feet moves as if to get up from bed, a virtual nurse could speak through a screen or sound system asking if they need something and call a nurse on the floor to help them. If the patient falls, a virtual nurse can quickly alert medical staff.
Virtua Health officially launched its program last year.
Virtual nurses make sure patients have the appropriate medications before going home, know their discharge instructions, and have a follow-up appointment scheduled. They work in partnership with the bedside nurse, who focuses on the physical tasks in caring for a patient, while the virtual nurse handles the majority of the discussion.
“It’s something that our patients are requesting and they’ve come to expect,” said Kristin Bloom, a nurse by training who serves as assistant vice president of clinical operations for Virtua’s Hospital at Home program.
Virtua also uses virtual nurses in its intensive care units to help monitor and identify early signs of deterioration. These nurses have access to bedside cameras and can view the patient’s heart rhythms, lab results, and vital signs.
Participants in the Penn survey, conducted in late 2023 and early 2024, did not include nurses working in New Jersey, where Virtua’s hospitals are based.
Virtual nursing challenges
Nurses surveyed by Penn’s researchers said they appreciated the extra set of eyes on patients, but not all were convinced that the virtual monitor was any more effective than bed alerts that can sound when they sense a patient leaving, according to the study.
Karen Lasater, an associate professor of nursing and co-author of the study, urged health systems to include in-hospital nurses when shaping their virtual care programs.
She said including bedside nurses in the conversation about what’s working and not working is “imperative.”
“It’s important that nurses have a seat at the table,” Lasater said.
Nurses surveyed also expressed concern that health systems were using virtual workers to avoid hiring more on-site staff.
Bedside nurses questioned why they were being asked to take on more responsibility because administrators said they couldn’t afford to hire more staff, yet still found funding to build virtual programs.
“They felt like investments in virtual nursing was a workaround,” Lasater said. “Why did they have money to invest in virtual nurses who couldn’t do all the work of the bedside nurses, but couldn’t invest in more bedside nurses?”
At Virtua, administrators have turned to veteran bedside nurses to staff their virtual nursing program.
“It’s an avenue to retain our experienced nursing staff,” Bloom said.
Philadelphia-area hospitals have seen some virtual nursing challenges. In 2024, for instance, Jefferson Abington Hospital was cited by the Pennsylvania Department of Health after inspectors said the power cords attached to the monitors for virtual nursing created a strangulation risk for behavioral health patients.
The hospital treated the incident as a learning experience, adjusting how the mobile monitors are used.
The technology can also be confusing for some patients, who may not grasp the concept of a virtual nurse or may get conflicting instructions from their virtual and bedside nurses, Lasater said.
Penn initially planned to use virtual nurses to help monitor behavioral health patients, who often require one-on-one monitoring around the clock.
But staff found that patients who were experiencing behavioral or mental health challenges were too often confused or unsettled by virtual nurses, and unable to follow their instructions, Bill Hanson, Penn’s chief medical information officer, told The Inquirer in 2024.
“We’re all learning as we go,” he said at the time.
