INGLEWOOD, Calif. (AP) — A juror who read about the murder trial of multimillionaire Robert Durst during an unprecedented 14-month hiatus tied to the coronavirus pandemic was removed Tuesday as lawyers prepared to present a new round of opening statements.

Judge Mark Windham said he was removing the juror after she violated a court order not to read about the case during the lengthy break. Windham said the juror “took umbrage” that defense attorneys sought a mistrial because they felt the jurors wouldn’t be able to remember what they had heard over six days before the case was halted in March 2020.

Windham acknowledged the hiatus when he welcomed back jurors Monday and joked, “Where did we leave off?”

Whatever jurors may have forgotten about Durst — from the cloud of suspicion that has dogged him for decades to his claims of being trailed by bad luck — they will be reminded in a new round of opening arguments.

Durst, 78, an heir to a New York commercial real estate empire, is charged with first-degree murder in the slaying of his best friend, Susan Berman. She was shot in the back of the head at her Los Angeles home in December 2000.

Durst has pleaded not guilty. His lawyer said Durst didn’t kill her and doesn’t know who did, though he conceded last year that Durst found her body, putting him at the crime scene for the first time.

The unusual move to have a new round of opening statements is just one of several made to get the trial back on track without having to go through the painstaking process of picking a new jury.

The judge moved the case to a larger courtroom in Inglewood to accommodate the distancing needed to resume. Lawyers are spaced out in jury boxes on both sides of the courtroom, Plexiglas separates participants, and the 20 jurors, including eight alternates, are seated several seats and rows apart in the gallery. Only one journalist and one member of the public are allowed in the courtroom.

Durst, who is frail and sickly, returned to court Tuesday after being absent a day earlier. Dressed in a blue jacket, white shirt and tan pants, he was slumped in a wheelchair with a white mask and his gray hair disheveled. Durst, who has hearing aids, was following along with a tablet computer and real-time transcript as the judge reinstructed the jury.

The judge denied a defense request Monday to postpone the case further because Durst has bladder cancer, among other health problems that require hospitalization.

“The question isn’t whether he can endure the rigors of the trial,” defense attorney Dick DeGuerin said. “It’s whether he can survive at all.”

Deputy District Attorney John Lewin scoffed at claims Durst needed to be released to a hospital for treatment, saying he was getting high-quality care in jail.

“It’s a get-out-of-jail-free card,” Lewin said. “The goal here is simply to have this trial go away.”

The sides have often gotten into heated arguments. Tensions exploded Monday into hollering and mutual accusations of lying over an evidence issue.

Durst’s lawyers have repeatedly sought a mistrial without success. They said the unprecedented delay would harm Durst’s ability to get a fair trial because jurors preoccupied with their own health and safety wouldn’t be able to pick up where they left off.

Windham denied each of those motions, saying he would bring the jury back to court when it was safe to do so.

Durst is only on trial in the killing of Berman, the daughter of a Las Vegas mobster whom he became friends with in college, but prosecutors are using the disappearance of his wife and the killing of an elderly neighbor in Texas to bolster their case.

He was arrested in New Orleans in 2015 on the eve of the final episode of “The Jinx: The Life and Deaths of Robert Durst,” an HBO documentary probing the three cases.

Berman served as Durst’s spokeswoman when his wife, Kathie, vanished in New York in 1982 and she helped him cover his tracks, prosecutors said.

Durst has long been suspected of killing his wife, whose body was never found, though he’s denied any role in her disappearance.

Prosecutors in Westchester County, New York, said Monday that they were reviewing the killing of Kathie Durst as one of several unsolved homicides.

When news broke in fall 2000 that the Westchester district attorney had reopened the case, prosecutors allege that Durst went into hiding in Texas and knocked off Berman before she could tell police she helped him cover up the killing.

Nine months later, he fatally shot his neighbor, Morris Black, in the Galveston, Texas, boarding house where they lived. He was acquitted in the case after he testified that he shot the man in self-defense and then in a panic cut up the man’s body and tossed it out to sea.

Los Angeles prosecutors said he killed Black because the older man had discovered his identity.

Durst’s lawyers have said he will testify again in this trial, a rare and risky move. Lewin, the prosecutor, said Monday that he was savoring the chance to cross-examine Durst.

“Get your popcorn and candy and a lounge chair because it’s going to be a while,” Lewin said.

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This year, however, there has been no public outcry about profiteering insurers. Indeed, there’s been little acknowledgement of the fragility of work-sponsored coverage. There have been few questions raised about the Congressional gift of $61.3 billion, which will help lower premiums for people who already buy insurance in the Obamacare exchanges and give new subsidies to help those with high incomes (over $104,800 for a family of four and $51,040 for a single person) buy coverage. These increases ushered in by the pandemic are temporary and end after two years.

People who’ve lost their jobs in the past year and the health insurance that came with them got some help too — up to six months of free COBRA coverage, allowing them to extend their health insurance. After Sept. 30, 2021, laid-off workers must start paying their premiums again to keep their insurance. COBRA requires workers to pay all of the premiums plus a 2% administrative fee, and for most people, coverage lasts 18 months, longer in special circumstances.

So the question is: Did the country get a lot of bang for its buck? Or were there other ways to spend that much money — $34 billion to extend the ACA subsidies for two years, $22.8 billion for COBRA subsidies, and $4.5 billion for the full costs of ACA premiums for people getting unemployment insurance — to improve health care? For example, in late 2019 the Congressional Budget Office estimated that it would cost $30 billion over 10 years to pay for vision care for all people enrolled in the Medicare program. If those kinds of tradeoffs were discussed, they never rose to the level of public discussion.

“I’m not a bit surprised at the numbers,” said former insurance executive Wendell Potter, a sharp critic of private insurers who is spearheading a business initiative to establish a more inclusive health care system. “COBRA is costly, inefficient, and a huge waste of taxpayer dollars. It is just enriching the insurance industry, which doesn’t need enriching. Many companies had their most profitable year ever.” Indeed, some companies have expanded their offerings in the Affordable Care Act marketplaces this year. Cigna, for example, announced late last year it was increasing the number of counties in which it does business to 200 in the 10 states where it sells Obamacare policies. Indeed, a tweet from Business Insider health care reporter Shelby Livingston wrote that “big health insurers are truly bullish on the ACA marketplace these days,” noting that Cigna had announced plans “to double its geographic coverage of the individual market from 20% to 40% by 2025” and that “United Health and Aetna are also getting back into the space.”

Potter believes the new provisions won’t make a huge difference in the uninsured, adding that insurers are betting they will be able to make a significant profit now, especially since the Biden administration was looking to improve the affordability of the ACA. “One way of doing it was to increase the number of people eligible to pay the premiums,” Potter said.

A few in the media have also questioned exactly what the country is getting for its money. Kimberly Leonard, also a senior health reporter for Business Insider, wrote that the $61.3 billion in federal subsidies for ACA premiums and COBRA “would only make a small dent in reducing” the number of Americans without insurance. That figure stood at 29.6 million before the pandemic hit, and an estimated 5.4 million lost coverage between February and May 2020 alone. “Instead,” she wrote, “they’d shift how people get coverage and lower premiums for people who already have insurance.”

In her newsletter The Health 202, The Washington Post’s Paige Winfield Cunningham reported “the cost (of the insurance package) is more per person than the government spends to insure people through its major insurance programs, Medicare and Medicaid — and illustrates just how expensive it is to rely on the nation’s for-profit insurance industry to get Americans covered.” She also reported that the enhanced subsidies wouldn’t last forever, noting that the Congressional Budget Office predicted the uninsured rate would return to current levels by 2023. It’s unlikely the public and even members of Congress who voted on the bill understood the health insurance provisions. Winfield noted, “the cost of the provision is flying under the radar amid the broader debate in Congress over the $1.9 trillion relief package.”

Sarah Kliff at The New York Times also reported how smoothly the insurance provisions moved through Congress “with little opposition” because the health care industry, and Democrats see the plan as a quick and easy way to expand coverage. Kliff noted “private health plans typically pay higher price prices to doctors and hospitals.” So why would they want to look a gift horse in the mouth?

Most Americans probably didn’t focus much on the insurance provisions of the stimulus since most were unaffected by them. (The stimulus package also gave substantial financial inducements to the 12 states, mostly in the South, which have refused to expand their Medicaid programs. I will discuss those provisions in a future post.) However, if people did read a recent story from the Associated Press, they would have gotten a much different view of the relief bill’s health insurance provisions than the nuanced one Leonard, Cunningham, and Kliff gave their readers.

The Associated Press sent out a glowing report about the health care provisions. One headline on the AP story summed up Congressional action: “COVID bill to deliver big health insurance savings for many.” After giving a couple examples of how some people might benefit from the law financially, the story advised readers that “because health insurance is so complicated, consumers are going to have to do their homework to figure out if there’s something in the bill for them.” It also reported that the “biggest winners” were “the more than 11 million people already enrolled in Obamacare as well as those who are now shopping for HealthCare.gov coverage,” noting that generous tax credits would make coverage “more attractive” for some people.

What Americans often fail to understand and the media often fail to report is that the full cost of health insurance is not just the monthly premium. The real cost includes deductibles, copays, and coinsurance. It is not uncommon for an insurer to lure customers into a plan with a low premium and skip over or give short shrift to other costly policy elements — like an $8,000 deductible — that can and have sent sick people to the proverbial poor house.

To see what this cost sharing looks like, I checked out 10 policies now available on HealthCare.gov for a 35-year-old man living in Indiana. The monthly premiums for bronze and silver policies range from $311 to $414, which might be considered reasonable. But the cost-sharing was not. Deductibles ranged from $5,100 to $8,300 and out-of-pocket maximums ranged from $7,000 to $8,550. Appraisals of the stimulus package health care provisions need to be far more nuanced and realistic than the AP reported. After all, the AP has a huge readership still reaching deep into every corner of the country.

But not everyone is so gloomy about the relief act’s health insurance provisions. Katherine Hempstead, a senior policy adviser at the Robert Wood Johnson Foundation who specializes in health insurance, says the insurance provisions in the stimulus package “is a major 2.0 moment for the ACA affordability.” She added, “I think this is a big deal, and you’ll see all these plans participating more and more, and the marketplace will be a more important destination.” Even so, Hempstead agreed cost-sharing is a problem. “Making premiums affordable is not enough. There’s a real risk with cost-sharing. There’s a lot of interest in working on that piece.”

But will these ACA exchanges continue to offer insurance with deductibles and other cost-sharing mechanisms that Hempstead characterizes as “too much financial responsibility on people who have these plans?” Will they clearly reveal all the costs of becoming insured with particular policies?

We know from the last survey taken by The Commonwealth Fund right before the pandemic that 43.4% of Americans ages 19-64 were inadequately insured. Half of all adults who were uninsured or underinsured said they had problems paying medical bills or were paying off medical debt over time. Those numbers hadn’t changed much from the previous survey in 2018. Some of those findings were undoubtedly fueled by insurance plans that came with such high deductibles and coinsurance that people couldn’t pay their medical bills.

It remains to be seen whether the insurance provisions in the stimulus package will change those alarming numbers. There’s no indication they will. The stimulus package sanctioned business as usual for the health care system with yet another Band-Aid fix.

Veteran health care journalist Trudy Lieberman is a contributing editor at the Center for Health Journalism Digital and a regular contributor to the Remaking Health Care column.

Trudy Lieberman

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The headlines have been grim. Seventeen bodies piled up in the morgue at a New Jersey nursing home. Fifty-five residents dead in Brooklyn, N.Y. In one week, 104 residents dead in a facility in western Pennsylvania and 102 dead at a home in San Antonio. In Detroit 26 percent of nursing home residents and staff test positive for the coronavirus.

Residents in nursing homes had been at risk long before I began reporting on them in the 1990s, and care facilities have continued to be the subject of press inquiry all across the country. Staffing shortages, poor care, and downright abuse had been the stuff of media exposes for years long before anyone had heard of the coronavirus.

The usual response? Nursing homes that got in trouble promised to clean up their act, engaging in what came to be called yo-yo compliance with state and federal regulations.

Nursing facilities with numerous deficiencies in care-giving would promise to make recommended changes and improve conditions. But promises were just that. Often, they did not result in permanent or meaningful change. A facility would get in trouble again.

The nursing home story today is different: 100 dead residents at one facility in one week when even 55 or 25 would be highly unusual. Casualties during the coronavirus pandemic raise serious questions about infection control, testing protocols, protective equipment for staff, and the number of personnel to care for residents who are vulnerable to begin with.

Most visitors have been prohibited since the pandemic began, making it more important than ever that the public has access to information about complaints, infection rates, and staffing at their local nursing facilities.

The public needs someone or some agency to be their eyes and ears to help them learn what’s happening on the inside.

Carol Marbin Miller, the deputy investigations editor for the Miami Herald, told me many Florida families wanted to move their relatives who were in Florida facilities when the pandemic hit and residents started dying in large numbers. She said the paper had begun hearing from families wondering how facilities that housed their relatives were adapting, people who needed information to decide whether to leave a family member in what could be a troubled nursing home.

She added that some readers told her they were able to care for their relatives at home for a short time if need be, but they were in the dark about conditions in the nursing facilities where their relatives were living.

Other families, looking for new nursing home placement for relatives coming from a hospital, asked the same question: “Where should I send mom?”

Florida, like a lot of other states, had refused to release numbers of nursing home residents who died from the virus, and it has been something of a national struggle for families and the media to get this information. Marbin Miller’s newspaper, along with other media outlets, threatened legal action, and eventually the state agreed to release the death counts.

At the end of the first week of May, the state reported 665 people had died in the state’s nursing homes and assisted living facilities, an increase of 242 from the previous week. Fourteen facilities reported more than 10 deaths.

A few weeks ago, the Centers for Medicare and Medicaid Services, the federal agency that oversees Medicare and the country’s nursing homes, issued “guidance” requiring the country’s nursing facilities to be more transparent. Beginning May 17, nursing homes will have to report their COVID-19 cases to the federal Centers for Disease Control and Prevention (CDC) and to families and residents already in nursing facilities. Presumably this information will be on the CDC and Centers for Medicare and Medicaid websites and in the states, too.

Earlier this spring, Kaiser Health News offered a glimpse of what nursing home inspectors found when they visited facilities across the country. Infection control was a problem before the days of the coronavirus.

In the past three years, 61 percent of about 9,400 nursing facilities sampled were cited for one or more infection control deficiencies. Sixty-three percent of about 9,700 were cited for infection control deficiencies on their last two standard government surveys.

Even nursing homes with five-star ratings from the government, presumably a designation of high quality, have had problems. It turns out 40 percent of those facilities were cited for infection control lapses.

Results like these suggest families with relatives already in nursing facilities or those about to place a relative in one should look long and hard at the new data available.

“A society’s quality and durability can best be measured by the respect and care given to its elderly citizens,” British historian Arnold Toynbee once warned. Do we measure up?

Have you experienced any problems with nursing homes? Write to Trudy at [trudy.lieberman@gmail.com]trudy.lieberman@gmail.com.

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THINKING ABOUT HEALTH – Column

Two years ago in Dallas I met an 85-year-old woman and her 65-year-old son. Both were very hungry with almost no food in their fridge or in their cupboards. After they had paid their bills, their meager monthly income from Social Security was dwindling. For lunch the mother wanted boiled cabbage with lima beans and collards, but the son reminded her there was no money for that. It was the second week of the month.

They had been on waiting list for food from the Visiting Nurse Association of Texas, the Meals-on-Wheels provider in Dallas. About 800 names were on the list the day I visited.

Indeed, there are waiting lists all over the country, and the statistics are as grim as the prospect of having no food for lunch. The anti-hunger group Feeding America found that nearly 8 percent of Americans 60 and older were food insecure: about 5.5 million seniors.

This year’s congressional budgets are, at least, beginning to address that horrifying statistic.

In the meantime, Feeding America found that almost 10 percent of the Dallas population age 60 and older were “food insecure” meaning they didn’t have consistent access to enough food for good health.

The numbers were even worse in other parts of the South. Nearly 12 percent of the senior population in Mississippi and about 10 percent in Alabama, for example, were food insecure. The problem is hardly confined to the South, though. In Indiana, Feeding America said, nearly 8 percent of seniors were not getting proper food; in South Dakota it was 7.3 percent.

The number of hungry seniors has more than doubled since 2001 and is expected to keep increasing. Meal programs almost everywhere struggle to keep up with the growing demand.

This was the third time in 20 years I found myself reporting on hunger among seniors in America. The numbers of elders on waiting lists has grown since I first visited the topic in 1998 and called attention to the irony of older people coming home from the hospital but finding themselves without the food they needed to heal. When I worked with Kaiser Health News on a third story published just two months ago, focusing on the plight of seniors in Memphis, we found the same thing. Very little had changed except that many more people needed help.

“There are tens of thousands of seniors who are waiting,” said Erika Kelly, chief advocacy officer for Meals on Wheels America. “While they’re waiting, their health deteriorates, and in some cases we know seniors have died.”

Why is this problem so severe in a country so rich? The answer, very simply, is disagreements over funding. In 1965 Congress anticipated an aging population would need social services and passed the Older Americans Act. In 1972 it added the home-delivered meals program as well as congregate meals available in many locations. But federal dollars haven’t kept pace with need, and funds from state and local governments, which often filled in the gaps, have also fallen short.

When that happens, programs must scramble to make up the shortfall, often relying on local philanthropy to help out. But that’s hard to do in places like Pine Bluff, Arkansas, for example, where there are few community resources to tap.

Meals on Wheels America says the nutrition programs are serving 21 million fewer meals a year than in 2005 because of funding shortages. Kelly told me that last year Congress bumped up funding for the program by only $10 million, which means many local programs still experience serious shortfalls.

This year an appropriations bill that has passed the House of Representatives calls for a hefty increase, raising the funding from $906.7 million to one $1 billion. Kelly says, “It would be a record increase.”

The Senate’s appropriations bill, however, is calling for “flat funding,” which means no increase for next year. Advocacy groups are lobbying to change that before the Senate votes on a final bill.

You’d never know from the constant news drumbeat about impeachment and the president that there is other news in Washington. But there is. Whether the Senate decides to increase the budget for home-delivered meals is one story that will tell us whether seniors across America will have enough to eat.

Have you known seniors who have needed food but couldn’t get it? Write to Trudy and trudy.lieberman@gmail.com.

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