Health

Portland residents are facing significantly higher water bills and a longer wait for improved water quality as the cost of the Bull Run water filtration plant continues to climb. The project, initially estimated at $500 million in 2017, now carries a price tag exceeding $2.56 billion – a five-fold increase – and its completion has been pushed back by two years, officials announced Thursday. The escalating costs and delays stem from a combination of factors, including a construction pause due to legal challenges and rising material and labor expenses.

The Bull Run filtration plant is intended to address concerns about Cryptosporidium, a parasite that can cause gastrointestinal illness, particularly in individuals with compromised immune systems. While the city, Multnomah County and the Oregon Health Authority maintain that the current water supply from the Bull Run watershed is safe to drink, federal regulations require treatment for the parasite. The project aims to ensure compliance with these standards and provide a more resilient water system for the approximately 1 million residents in the Portland metropolitan area.

Ting Lu, director of Portland’s Bureau of Public Utilities, attributed the ballooning costs to several factors. “This includes additional contracting costs incurred during the pause in construction, permitting and legal costs associated with the land-use approval process, as well as rising costs of labor and materials,” Lu explained. The city has already secured two low-interest federal loans to help mitigate the financial impact, but further funding will likely require a combination of customer rate increases and long-term bonds. The City Council will review the Water Bureau’s budget, including the Bull Run project, in the coming weeks.

Land Use Appeals and Construction Delays

The path to building the filtration plant has been fraught with challenges. Construction began two years ago, but was halted last year after a group of neighbors and environmental organizations appealed Multnomah County’s approval of the project’s land use permits. The appeal centered on concerns about the project’s potential impact on the surrounding rural area’s natural resources. The Oregon Land Use Board of Appeals (LUBA) initially ruled in favor of the appellants, finding that the county had not adequately assessed the potential adverse effects. However, LUBA last week affirmed the project’s permits after the county re-evaluated its findings.

Despite the LUBA decision, opponents could still appeal to the Oregon Court of Appeals. Groups like 1000 Friends of Oregon and the Multnomah County Rural Fire Protection District No. 10, who were involved in the initial appeals, have not yet commented on their next steps. The construction pause, coupled with unforeseen site conditions and potential weather delays, has prompted the city to request a 24-month extension from the Oregon Health Authority for meeting the filtration requirements.

Impact on Water Rates and Public Health

The delays and increased costs will directly impact Portland water customers. Officials estimate the project will account for roughly one-third of planned increases to water bills. Last summer, residents already experienced a water and sewer rate hike of over 6%, the largest in more than a decade, largely due to the filtration plant. Further rate increases are anticipated in the coming years, with the final rates for the coming year to be determined in May. Despite the increases, city officials state that Portland’s water rates remain competitive with those of similar utilities nationwide.

The filtration plant is designed to remove Cryptosporidium, a microscopic parasite that can cause diarrheal illness. According to the U.S. Environmental Protection Agency, surface water sources – like rivers and reservoirs – are particularly vulnerable to contamination. The city began monitoring for Cryptosporidium in 2017 after the EPA and the Oregon Health Authority determined treatment was necessary. While the water is currently considered safe, the filtration system will provide an additional layer of protection, especially during emergencies like wildfires – such as the 2020 Camp Creek fire that threatened the Bull Run watershed – and heavy rainfall events that can compromise water quality, as seen just two months ago.

“These are not hypothetical challenges,” said Priya Dhanapal, deputy city administrator of public works. “Filtration will address these risks directly and it will allow us to deliver safe, reliable drinking water even as conditions change.”

The revised completion date for the Bull Run filtration plant is now 2029, shifting the deadline for full compliance with federal drinking water regulations. In the interim, the Portland Water Bureau will continue to monitor water quality and ensure the safety of the public water supply.

Disclaimer: This article provides informational content about a public health and infrastructure project and should not be considered medical or financial advice. Consult with qualified professionals for personalized guidance.

What do you feel about the rising costs of the Bull Run filtration plant? Share your thoughts in the comments below.

A previously healthy 68-year-ancient woman’s experience with unexplained flank pain led to the discovery of both a new diagnosis of atrial fibrillation (AF) and a concurrent, and often overlooked, condition: renal infarction. This case, recently highlighted in medical literature, underscores the importance of considering renal infarction in patients presenting with flank pain, particularly those with newly detected irregular heart rhythms.

Renal infarction, a rare but serious condition, occurs when blood supply to the kidney is abruptly cut off, leading to tissue damage. Its symptoms can mimic more common ailments like kidney stones or urinary tract infections, making diagnosis challenging. The case emphasizes that early identification is crucial to prevent potentially severe complications, including high blood pressure affecting the kidneys (renovascular hypertension) and chronic kidney disease. Research indicates that the condition is often misdiagnosed due to its non-specific presentation.

The Connection Between Atrial Fibrillation and Renal Infarction

Atrial fibrillation, an irregular and often rapid heart rhythm, is a significant risk factor for renal infarction. The irregular heartbeat can cause blood clots to form in the heart, and these clots can then travel through the bloodstream and lodge in the arteries supplying the kidneys. Medical literature confirms that thromboembolism, often originating from cardiac sources like atrial fibrillation, is a leading cause of renal infarction.

In the reported case, the patient presented with two weeks of worsening left flank pain. Diagnostic imaging, including a CT scan, revealed the renal infarction. Electrocardiogram (ECG) testing simultaneously identified the new onset of atrial fibrillation. The patient responded well to treatment, which included anticoagulation medication to prevent further clot formation, pain management, and a referral for follow-up with a vascular surgeon.

Diagnostic Challenges and the Importance of Timely Imaging

The difficulty in diagnosing renal infarction stems from its vague symptoms. Flank pain, while indicative of a kidney issue, can be caused by a multitude of conditions. This often leads to initial consideration of more common diagnoses like kidney stones (nephrolithiasis) or kidney infections (pyelonephritis). Studies highlight the necessitate for a high index of suspicion, particularly in patients with risk factors like atrial fibrillation.

A thorough medical history, physical examination, and prompt imaging are essential for accurate diagnosis. Contrast-enhanced CT scans are particularly useful in visualizing the kidneys and identifying areas of infarction. The case report stresses that a combination of these factors ensures both diagnostic accuracy and improved patient outcomes.

Atrial Fibrillation and Kidney Disease: A Broader Perspective

The link between atrial fibrillation and kidney health extends beyond the risk of acute renal infarction. Research suggests that atrial fibrillation may also contribute to the progression of chronic kidney disease (CKD) and increase the risk of developing end-stage renal disease (ESRD). A study involving over 3,000 patients with CKD found that those who developed atrial fibrillation had a significantly higher rate of progressing to ESRD compared to those without AF (11.8/100 person-years versus 3.4/100 person-years).

While the exact mechanisms underlying this association are still being investigated, it is believed that atrial fibrillation can disrupt kidney blood flow and contribute to inflammation and fibrosis within the kidneys. This underscores the importance of comprehensive cardiovascular risk management in patients with CKD, including the detection and treatment of atrial fibrillation.

This case serves as a critical reminder for healthcare professionals to consider renal infarction in the differential diagnosis of unexplained flank pain, especially in patients with new-onset atrial fibrillation. Prompt diagnosis and treatment can significantly mitigate the risk of long-term complications and improve patient quality of life.

Further research is needed to fully understand the complex interplay between atrial fibrillation and kidney disease, and to develop targeted strategies for prevention, and management. Continued vigilance and a high degree of clinical suspicion will be essential in identifying and addressing this potentially serious, yet often overlooked, condition.

Have you or someone you know experienced unexplained flank pain? Share your experiences in the comments below. Please also share this article to raise awareness about the importance of recognizing the signs of renal infarction.

Disclaimer: This article is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.

As cyberattacks against the healthcare sector continue to rise in sophistication and frequency, the American Hospital Association (AHA) is urging hospitals and health systems to consider adopting a “zero trust” architecture to bolster their cybersecurity defenses. This shift represents a fundamental rethinking of how healthcare organizations protect sensitive patient data and maintain operational integrity, moving away from traditional perimeter-based security models.

The recommendation comes as the National Security Agency (NSA) recently released implementation guidelines for zero trust, a strategy predicated on the principle of “never trust, always verify.” This means that no user or device – whether inside or outside the network – is automatically trusted and must be continuously authenticated. The AHA highlighted the NSA guidance in a February 19th news release, noting its potential to help healthcare organizations reduce cyber risk through a structured process.

“With cybersecurity threats and attacks continuing to target the healthcare sector, adopting zero trust can help hospitals and health systems further reduce their cyber risk through a structured process,” stated Scott Gee, AHA deputy national advisor for cybersecurity and risk. “The NSA guidance is very detailed, and, even as not tailored to healthcare, the process can be adapted to meet the needs of hospitals and health systems.”

What is Zero Trust?

For decades, healthcare cybersecurity relied on a “castle and moat” approach – strong perimeter defenses like firewalls and intrusion detection systems. The assumption was that anything inside the network was safe. However, today’s attackers routinely bypass these outer walls, exploiting vulnerabilities within the network itself. Zero trust flips this script, operating on the premise that trust is a vulnerability. Every user, device, and application must be continuously verified before being granted access to resources. This includes multi-factor authentication, microsegmentation of networks, and continuous monitoring of activity.

The move towards zero trust isn’t simply about installing latest software; it’s a fundamental shift in mindset and operational procedures. According to a report from Memesita.com, this requires a comprehensive approach to protecting an organization, going beyond just data and perimeter security. It’s a recognition that the traditional security model is no longer sufficient in the face of increasingly sophisticated threats.

The Unique Vulnerabilities of Healthcare

The healthcare industry is particularly vulnerable to cyberattacks for several reasons. Sensitive patient data – including medical records, financial information, and personal identifiers – is a highly valuable target for cybercriminals. The need for uninterrupted operations – particularly in emergency rooms and critical care units – creates immense pressure to quickly resolve attacks, often leading to ransom payments. Outdated infrastructure and limited cybersecurity budgets in many healthcare organizations exacerbate these vulnerabilities. Ransomware attacks, in particular, have become increasingly common, disrupting patient care and causing significant financial losses.

Gee noted that the sophistication of attacks has reached a point where scenarios previously considered “science fiction” are now a reality. This underscores the urgency of adopting more robust security measures like zero trust.

Challenges to Implementation

While the AHA and NSA endorse zero trust as a promising strategy, implementing This proves not without its challenges. The AHA acknowledges that the strategy can be expensive and potentially cost-prohibitive for some organizations. Adapting the NSA’s detailed guidance, which isn’t specifically tailored to healthcare, will also require significant effort and expertise.

The AHA offers resources and services to help hospitals and health systems prepare for, prevent, and mitigate cyberattacks, including incident preparedness and response guidance, and a cybersecurity & risk advisory service. Learn more about AHA’s cybersecurity resources here.

Looking Ahead

The adoption of zero trust architecture is likely to become increasingly prevalent in the healthcare sector as organizations grapple with the escalating threat landscape. The NSA’s recent guidance and the AHA’s endorsement signal a growing consensus that a more proactive and comprehensive approach to cybersecurity is essential. The focus will now shift to overcoming the implementation challenges and ensuring that all healthcare organizations, regardless of size or resources, can effectively protect themselves and their patients.

What are your thoughts on the implementation of zero trust in healthcare? Share your comments below, and please share this article with your network to raise awareness about this critical issue.

Disclaimer: This article provides informational content only and is not intended to be a substitute for professional medical or cybersecurity advice. Always consult with qualified professionals for personalized guidance.