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If there’s a person whose friendship you valued in high school, and you’ve lost touch, reach out and tell them.

Missouri will enter the new fiscal year Saturday in its best financial shape ever. But there are unmistakable signs that the massive surplus, now approaching $8 billion, has likely peaked. Revenues have fallen by double-digit amounts during the last three months, and the state will meet the general revenue projection made in December only because […]

The post Missouri surplus peaking at $8 billion as governor prepares to act on state budget appeared first on Missouri Independent.

Despite voters’ attempts to tighten Missouri’s campaign finance laws, many former state legislators keep control of tens of thousands of campaign dollars without running for public office again. A review of hundreds of former Missouri legislators’ campaign finance reports shows that some of them drew from their candidate committees to spend on campaigns that never […]

The post Former Missouri legislators keep control of leftover campaign funds appeared first on Missouri Independent.

The Vermont Green FC is the first team in the U.S. to make climate action a central tenet of its business plan. It's winning on and off the pitch.

Brazil's political right wants to invalidate Indigenous land claims. A Supreme Court ruling will decide if they can.

by Anjeanette Damon and Byard Duncan

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A California real estate investor continued to be involved with one of the country’s most successful “We Buy Ugly Houses” franchises years after pleading guilty to felony charges for misleading two elderly homeowners who signed below-market sales contracts.

Despite assurances from HomeVestors of America that it had cut ties with Cory Evans “a number of years” ago, the former co-owner of Patriot Holdings LLC was still engaged in the business as recently as March, according to interviews with former business affiliates and text messages and emails obtained by ProPublica.

After ProPublica asked the company in April how it had responded to Evans’ conviction for attempted real estate theft, his involvement in a franchisee group chat appeared to cease. His last message to the group was on March 8.

Dana Pope, who until 2022 ran a Los Angeles-based HomeVestors franchise, said that during her time with the company, “Cory was very much always in the office, always active.” She said, “He was training me. He was in every conference we ever had.”

A HomeVestors corporate spokesperson said this week that the company has documentation showing Evans’ ownership interest in Patriot Holdings was terminated in 2021 and his name removed from the franchise agreement. “Based upon your reporting and questions, we have initiated a review into Cory Evans’ ongoing involvement with Patriot Holdings,” she said.

Neither Evans nor Patriot Holdings’ owners responded to a request for comment. Evans is not listed as a “manager or member” of Patriot Holdings in current California business filings.

Evans caught the attention of law enforcement in 2019, after he misled two elderly Southern California homeowners into signing sales contracts, according to court documents. The deals stemmed from what HomeVestors characterizes in its training and marketing materials as “Ugly Situations”: One homeowner had developed a hoarding problem and feared her house would be seized by the city for code violations; the other faced foreclosure. Both “were desperate for help since they did not want to lose their homes,” and Evans “took advantage of their individual fears for personal gain,” a Ventura County District Attorney’s Office investigator wrote in an arrest warrant declaration.

Evans was charged with four felonies in December 2019. Two charges were dropped in exchange for Evans’ guilty plea to two counts of attempted grand theft of real property in August 2020. When he was sentenced in September 2020, he was given probation and ordered to pay restitution and drop lawsuits he had filed against the two homeowners. He also was prohibited from participating in real estate transactions for about a year.

After the conviction, HomeVestors could have immediately revoked Patriot Holdings’ franchise, which was co-managed by Evans, his brothers and another partner, according to the terms of the agreement. But the parties instead struck a deal, according to HomeVestors’ corporate spokesperson. The franchise could continue operating provided Evans was removed as an owner.

In April, a HomeVestors representative told ProPublica that Evans “has had no affiliation with HomeVestors for a number of years.” And in a May blog post, HomeVestors stated it had “required that Cory Evans be removed from Patriot Holdings.”

Yet texts, emails and interviews indicate otherwise.

From June 2022 to March 2023, Evans was active in a group text chat where Southern California HomeVestors franchisees exchanged advice and updates on events. He sent frequent meeting reminders and added and removed participants from the text group. He orchestrated regular franchisee meetings with a business coach. Ahead of a regional meeting in August 2022, he described a plan to “roll out the most recent products available for Homevestors franchise.” And in January, he announced a training “on the basics of taking calls and running appointments.”

A recent ProPublica investigation found that HomeVestors, which bills itself as the largest cash homebuyer in the country, taught its franchise operators to target people in desperate situations. The reporting found some franchisees used deception and targeted the elderly, the infirm and people close to poverty. In response to the report, two U.S. senators and the head of the Consumer Financial Protection Bureau called for more scrutiny of HomeVestors and companies like it. HomeVestors CEO David Hicks announced this week that he would step down on Aug. 1.

(Our reporters discussed their findings and potential reforms with outside experts in a recent virtual discussion.)

In response to ProPublica’s initial findings, a corporate spokesperson said the company works to weed out bad actors and would ban tactics that can trap homeowners in sales contracts. The spokesperson pointed to Evans’ removal from Patriot Holdings as an example of the company enforcing its ethical standards.

HomeVestors knew as early as January 2020 that Evans had been charged, according to a letter one franchisee wrote to the company’s then-general counsel, Bonnie DePasse. “You took the position that the company is standing behind the Evans and running a counter PR Campaign to minimize the damage,” the franchisee wrote. (A HomeVestors spokesperson said DePasse no longer works for the company and that the lawyer had reiterated “our company values” when communicating with the franchisee.)

Pope said when she joined HomeVestors in May 2020, Evans taught her how to interact with prospective sellers. Emails she received show Evans working with the franchise after the district attorney subpoenaed records from HomeVestors’ corporate offices. Two weeks after Evans pleaded guilty to the charges, he emailed Pope, “We don’t want to lose out on new leads coming in.”

(Highlighted and redacted by ProPublica)

Evans also attended HomeVestors meetings throughout 2021, Pope said. She shared with ProPublica an invitation to a February 2021 meeting that listed Evans and his brother Cody as hosts. She said she was unaware of his legal troubles at the time, even though they were covered by local news outlets. “Had I known all that was going on, I would have probably thought twice about buying that franchise,” she said.

That year, Patriot Holdings was listed among HomeVestors’ “Rising Stars.” Internal HomeVestors records obtained by ProPublica during its investigation also listed Evans alongside his brothers on the company’s 2021 “top sales volume” award. The HomeVestors spokesperson said he was mistakenly included on the award.

In addition to receiving numerous accolades from HomeVestors, Patriot Holdings remains one of its most profitable franchises. Two of Evans’ brothers, Cody and Chris, are development agents who recruit and train new franchisees. Until recently, they were touted on HomeVestors’ website as some of the “Best Real Estate Investors Nationwide.”

Beyond revealing Evans’ continued involvement with HomeVestors, the texts offer an unfiltered view of franchisees’ gripes and challenges. Franchisees celebrated an FTC crackdown on the online homebuying company Opendoor, exchanged tips on evicting tenants who use Section 8 housing assistance and mocked HomeVestors’ advertising agency, Imaginuity, for what they said was a poor return on the monthly marketing fees they paid to the company. (Asked to respond to the criticism, Charlie Calise, the owner of Imaginuity, said: “We won’t speculate on a series of communications that we were not part of.”)

In April, the chat focused on HomeVestors leadership’s all-franchisee webinar, during which the company laid out a plan to “bury” ProPublica’s story. After that meeting, one franchisee called the investigation a “left-wing, lunatic article, stating that Homevestors rips off old people and steals equity.” Another wrote, “I always worry when the company lawyer sends out and invite.”

After Hicks, the CEO, alerted franchise owners to ProPublica’s forthcoming story, text messages show, he and Chief Operating Officer Larry Goodman planned an in-person visit to franchises in Southern California. HomeVestors said the goal of the visit was to “give a company-wide update” that included information about ProPublica’s yet-to-be published story. The spokesperson said Hicks “does not recall seeing Cory Evans at the meeting.”

The month before that meeting — and more than two years after he was convicted — Evans went silent on the group chat. His Homevestors.com email address, which appeared to still be functioning in early April, stopped accepting messages in June.

Mollie Simon contributed research.

While Paul Stanley is best known as the frontman for KISS, music isn’t his only form of expression. In fact, he’s been making art for years and it will be on display at a new exhibition…

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Organizers invited parents, teachers, leaders and neighbors to a public forum at 10 a.m. Saturday at Harris-Stowe State University.

The substance is there. But the sales apparatus isn’t yet.

The chipmaking giant, which expects to receive up to $15 billion in federal tax credits and grants for its Arizona facility, says U.S. workers are not up to the job.

by Annie Waldman

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Millions of Americans have peripheral artery disease, a disorder primarily caused by fatty deposits that can narrow arteries and block blood flow to the legs. Often, the first symptom they feel is leg pain. Experts say that most treatments are safe, but some have expressed a growing sense of alarm that doctors may be doing procedures that patients don’t need, exposing them to unnecessary risks.

ProPublica looked into artery procedures and found that some doctors are making millions of dollars doing a questionable number of treatments. Government insurers pay well for vascular procedures that are done outside of hospitals, and doctors can bill tens of thousands of dollars for treatments done in a single office visit.

One doctor in Maryland made millions of dollars from the federal government for performing thousands of vascular procedures. A state medical board investigation found that his inappropriate treatments put patients at risk of serious harm. One man had to have his leg amputated after invasive treatments for mild pain, according to filings in a settled lawsuit. A grandmother bled out and died shortly after the same doctor cut into her, according to another ongoing lawsuit. The doctor denied the allegations in legal filings, but declined to be interviewed and did not respond to emailed questions.

Some doctors worry about the overuse of procedures and think there should be more oversight. They compare outpatient vascular care to the Wild West and say there are not enough protections to stop patients from getting unnecessary treatments.

We made this guide to help patients ask the right questions and get good health care. This article is not intended as medical advice, so it’s important to speak with your own doctor and use other resources before you make any decisions.

What Is Peripheral Artery Disease?

Peripheral artery disease occurs when plaque or other deposits build up on the walls of blood vessels, often in the legs, and restrict blood flow. Smoking, high cholesterol and diabetes can increase your risk of developing the condition. Around 6.5 million Americans over 40 have peripheral artery disease, which usually affects older people.

What are the symptoms of peripheral artery disease?

People with this chronic disease can live a long time, especially if they exercise, stop smoking and eat healthy food. Up to half of patients don’t have any symptoms, but others feel pain when they walk or exercise, a condition known as claudication. This happens because their leg muscles may not be receiving enough oxygen.

At first, the pain might not be severe, but it can worsen over time and begin to occur even at rest. Some people might also feel coldness or numbness in their legs or feet, see changes in the color of their skin or have a weakened leg pulse. A fraction of patients may eventually develop critical limb ischemia, which can result in an amputation, but this is less likely if the disease is diagnosed early and treated appropriately. Experts told ProPublica that only about 5% of patients who are diagnosed early on in the disease will require an amputation within five years.

“If you go to the doctor and you’re having only walking problems and they tell you that you’re going to lose your leg, they are wrong,” said Dr. Michael Dalsing, a vascular surgeon at Indiana University Health Physicians and a former president of the Society for Vascular Surgery.

How Is Peripheral Artery Disease Diagnosed and Treated?

Doctors can administer noninvasive tests like ultrasounds or blood pressure measurements to see how blocked your blood vessels are. They may also suggest a treadmill exercise test to determine how severe symptoms are.

Peripheral artery disease can’t be cured, but it can be managed with routine monitoring and lifestyle changes.

For mild cases, like patients with just claudication, best practices recommend that doctors start with noninvasive treatments, which can slow or even reverse symptoms. Plans may include regular exercise, changes to your diet and quitting smoking. They might also involve medications to lower your cholesterol, control your blood pressure, prevent the buildup of plaque in your vessels, or reduce leg pain.

If the disease worsens or symptoms are disabling or limb-threatening, doctors may suggest more aggressive treatments that unblock blood vessels. Endovascular procedures are minimally invasive treatments, where a doctor makes a small incision near the hip to access the vessels and threads in flexible catheter tubes to treat blockages. Typical treatments may include balloon angioplasty, the placement of stents or the removal of plaque with a bladed catheter, also known as an atherectomy. These treatments have a relatively short recovery time and can be done in outpatient centers. Alternatively, a doctor may recommend bypass surgery, where blood flow is rerouted around blockages in the vessels.

Angioplasty: A compact balloon is inserted into a blood vessel and inflated to flatten plaque against its walls.

Stent: A metal mesh tube is implanted into a narrowed blood vessel to hold open its walls.

Atherectomy: A catheter, often capped with a blade or laser, is inserted into a blood vessel and removes plaque off its walls.

(Illustrations by Now Medical Studios, special to ProPublica)

All of these more aggressive treatments have risks of complications, like clots, bleeding or even amputation, so your doctor should talk to you about what could happen.

When Should You Ask Questions About a Vascular Treatment?

While most doctors do their best to help their patients, ProPublica’s reporting has found that some doctors suggest invasive treatments that may be too aggressive for mild symptoms. This can increase the risks of complications and may worsen peripheral artery disease.

“You want to start with the lowest-risk thing because claudication rarely leads to an amputation,” said Dr. Peter Lawrence, the former chief of vascular and endovascular surgery at the University of California, Los Angeles.

Patients should feel comfortable asking questions and learning about their treatment plan, especially before signing off on invasive interventions. ProPublica spoke with more than a dozen vascular physicians to understand when patients should seek more information.

When treatment decisions are not explained well.

“The physician should be able to explain the importance and the significance of what they found to justify what they’re planning to order,” said Dr. Gary Lemmon, a vascular surgeon who serves on the appropriateness committee for the Society for Vascular Surgery.

Navigating the health care system to figure out the best treatments can be confusing. Doctors should take time to explain what tests reveal, what disease progression might look like and how it should be treated. Doctors should be aware of what professional practice guidelines and criteria recommend and be able to clearly explain the options to patients. Setting realistic expectations is important. Doctors should be able to clearly describe how any procedure will impact your life and to what extent you can expect your symptoms to improve.

Decisions about your treatment plan should not be made for you, the experts said. They should be made with you.

When treatment decisions are made too quickly.

“A quality marker that someone can sniff right away is if the decision is made quickly and not a lot of time is spent with the patient,” said Dr. Michael Conte, professor and chief of vascular and endovascular surgery at the University of California, San Francisco. “I would be wary of that sort of interaction.”

Patients should be cautious if doctors immediately suggest invasive procedures instead of first trying exercise, diet changes and medicine.

“If a provider recommends that they be treated without a trial of exercise therapy and use of correct medications, and they recommend treatment before six months of conservative management, that should be a red flag,” said Lemmon.

Once patients start receiving invasive interventions, they might need more procedures; with each treatment, there’s a risk of something going wrong.

“One procedure leads to another procedure to another procedure,” said Dr. Nicholas Osborne, an associate professor of vascular surgery at the University of Michigan. “Two years later, they’ve had failed bypasses, they have dead toes, they’re looking at a major amputation or maybe a Hail Mary kind of salvage bypass to get them out of the trouble.”

Peripheral artery disease progresses differently for each person, so doctors need to assess each case carefully before recommending any procedures. “In some patients, that clock ticks really slowly and it takes a long time for them to get from claudication to ever needing anything,” said Dr. Joseph Mills, the current president of the Society for Vascular Surgery and chief of vascular surgery and endovascular therapy at Baylor College of Medicine. “And for others, it’s a more rapidly ticking clock. But when you start to do interventions, whether it’s a bypass or a stent, the clock speeds up.”

When scare tactics are used to push you into a procedure.

Patients with mild vascular disease told ProPublica that they agreed to invasive procedures because doctors told them they would lose their leg without an intervention.

“I see a lot of patients in clinic that come for a second opinion,” said Dr. Caitlin Hicks, an associate professor of surgery at Johns Hopkins University School of Medicine. “And they’ll have been told by some surgeon, ‘You have a narrowing in your blood vessel, you’re going to lose your leg unless we do something.’ And that’s the story that’s fed to many, many patients.”

Without a full picture of the disease, patients may make less informed choices. Doctors should communicate clearly and explain the risks and benefits of any procedure. Otherwise, patients can get scared and seek a procedure they may not need.

How to Find a Doctor You Trust

Finding a doctor you trust can be tricky. Specialists like vascular doctors are often found through primary care physicians, but some also advertise directly to patients in Facebook and Google ads, on billboards and at community events like church or senior center meetings.

“The vast majority of physicians treating vascular disease practice ethically, but [patients] can’t assume that,” said Dr. Kim Hodgson, a former president of the Society for Vascular Surgery. “They can’t just assume that the physician with the flashy advertising and the certificates on the wall is qualified or competent.”

It’s important to make sure that your health is the doctor’s top priority before agreeing to any procedures. Here are some tips on how to find a trustworthy doctor:

• Check for board certification. There are three main types of doctors that treat peripheral artery disease: vascular surgeons and specialists, interventional radiologists, and cardiologists. Look for doctors who have passed a specialty test and are certified by a board. You can check whether your doctor has board certification through state medical board databases.
• Look for membership in medical societies or associations. These organizations are committed to upholding standards of care.
• Research disciplinary records. Check state medical board databases to see whether doctors have gotten into trouble for poor patient care. Some boards also provide information on malpractice lawsuits, but in most states, the best way to access information about those cases is through court records.
• Consider a second opinion. If you have concerns, make an appointment with another doctor.
• Look for involvement in programs committed to transparency and quality patient care. Some medical societies, like the Society for Vascular Surgery, have created initiatives to uphold best practices. The Vascular Quality Initiative collects and analyzes procedure data in a registry. Earlier this year, the society also launched the Vascular Verification Program with the American College of Surgeons to help hospitals improve patient outcomes. “We’re trying to make things more transparent and safe,” said Dalsing, a former president of the society. “As soon as you get things into the light, I think things start to change, and for the better when needed.”

What Questions Should You Ask Your Vascular Doctor?

“Patients have to ask questions, but then the problem is patients don’t even know what questions to ask,” said Dr. Karen Woo, a vascular surgeon and professor at the David Geffen School of Medicine at UCLA. “Most clinicians don’t really go in depth into that risk-benefit conversation and what the consequences are of having an invasive procedure.”

When you receive a new diagnosis from your doctor, it can be overwhelming and hard to know what to ask. But you need to understand your options to make sure you get the best care, so we asked doctors what you should be asking them.

Some recommended questions:

• Could anything else be causing my symptoms?
• What are the different ways to treat my illness?
• Can I make any lifestyle changes before undergoing invasive treatments?
• What are the risks and side effects of the treatment?
• Is there a simpler, safer way to treat my illness?
• What is a good outcome? What is a poor outcome?
• What happens if I don’t receive any treatment?
• If the procedure is not being done in a hospital, can the doctor take me to a hospital if complications arise, and do they have privileges at a nearby hospital?
• Will the procedure require any follow-up procedures?

Do You Have Experience With Peripheral Artery Disease? Have You Had a Procedure on Your Leg? Tell Us About It.

Yusef Salaam campaigned on economic justice and housing reform.

Jason Hawkins of Farmington, MO joined the Real Rock Army today

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The deals mark the Florida company's third acquisition of a St. Louis-area transportation provider since the Hoffmann family embarked on its regional deal spree two years ago.

The Riverboats at the Gateway Arch award guests one of the best views of St. Louis’ working riverfront, the Gateway Arch and the city skyline.   Narrated by the captain

The post St. Louis Riverfront Cruise appeared first on Explore St. Louis.

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https://www.ksdk.com/article/news/local/fire-sk8-liborious-skate-park-north-st-louis/63-0be54560-2211-4b1e-b03d-fe862a845183

A Maryland Heights couple is having a huge problem with their recreational vehicle. A problem they say is caused by the City of Maryland Heights.