title: Isotretinoin

text: A possible biological basis for the case reports of depression involves decreased metabolism in the orbitofrontal cortex (OFC) of the frontal lobe. It has also been found that decreased OFC metabolism was correlated with headaches. People reporting headache as a side effect often report comorbid neuropsychiatric symptoms, especially depression; a statistically significant relationship between headache and depression has been established. It is suggested that people sensitive to isotretinoin-induced CNS effects may also be susceptible to other psychiatric side effects such as depression.


title: Isotretinoin

text: Studies in mice and rats have found that retinoids, including isotretinoin, bind to dopaminergic receptors in the central nervous system. Isotretinoin may affect dopaminergic neurotransmission by disrupting the structure of dopamine receptors and decreasing dopaminergic activity. The dopaminergic system is implicated in numerous psychological disorders, including depression. Isotretinoin is also thought to affect the serotonergic system – it increases expression of 5-HT receptors in the pre-synaptic neuron, which inhibit serotonin secretion. Isotretinoin also directly and indirectly increases the translation of the serotonin transporter protein (SERT), leading to increased reuptake and consequently reduced synaptic availability of serotonin.


title: Isotretinoin

text: Inhibition of hippocampal neurogenesis may also play a role in the development of isotretinoin-induced depression. A further effect of isotretinoin on the brain involves retinoic acid function in the hypothalamus, the hormone regulatory centre of the brain and part of the hypothalamus-pituitary-adrenal axis, a key part of the body's stress response. Other brain regions regulated by retinoic acid and potentially disrupted by isotretinoin include the frontal cortex and the striatum.


title: Isotretinoin

text: Oral isotretinoin is best absorbed when taken with a high-fat meal, because it has a high level of lipophilicity. The efficacy of isotretinoin doubles when taken after a high-fat meal compared to when taken without food. Due to isotretinoin's molecular relationship to vitamin A, it should not be taken with vitamin A supplements due to the danger of toxicity through cumulative overdosing. Accutane also negatively interacts with tetracycline, another class of acne drug, and with micro-dosed ('mini-pill') progesterone preparations, norethisterone/ethinylestradiol ('OrthoNovum 7/7/7'), St. John's Wort, phenytoin, and systemic corticosteroids.


title: Isotretinoin

text: Isotretinoin is primarily (99.9%) bound to plasma proteins, mostly albumin. Three metabolites of isotretinoin are detectable in human plasma after oral administration: 4-"oxo"-isotretinoin, retinoid acid (tretinoin), and 4-"oxo"-retinoic acid (4-"oxo"-tretinoin). Isotretinoin also oxidizes, irreversibly, to 4-"oxo"-isotretinoin—which forms its geometric isomer 4-"oxo"-tretinoin. After an orally-administered, 80 mg dose of liquid suspension C-isotretinoin, C-activity in blood declines with a half-life of 90 hours. The metabolites of isotretinoin and its conjugates are then excreted in the subject's urine and faeces in relatively equal amounts. After a single, 80 mg oral dose of Isotretinoin to 74 healthy adult subjects under fed conditions, the mean ±SD elimination half-life (t) of isotretinoin and 4-"oxo"-isotretinoin were 21.0 ± 8.2 hours and 24.0 ± 5.3 hours, respectively. After both single and multiple doses, the observed accumulation ratios of isotretinoin ranged from 0.90 to 5.43 in people with cystic acne.


title: Isotretinoin

text: The compound 13-cis retinoic acid was first studied in the 1960s at Roche Laboratories in Switzerland by Werner Bollag as a treatment for skin cancer. Experiments completed in 1971 showed that the compound was likely to be ineffective for cancer but, surprisingly, that it could be useful to treat acne. However, they also showed that the compound was likely to cause birth defects, so in light of the events around thalidomide, Roche abandoned the product. In 1979, an article was published reporting the drug's effectiveness as a treatment of cystic and conglobate acne on fourteen patients, thirteen of which experienced complete clearing of their disease. In clinical trials, subjects were carefully screened to avoid including women who were or might become pregnant. Roche's New Drug Application for isotretinoin for the treatment of acne included data showing that the drug caused birth defects in rabbits. The FDA approved the application in 1982.


title: Isotretinoin

text: Scientists involved in the clinical trials published articles warning of birth defects at the same time the drug was launched in the US, but nonetheless, isotretinoin was taken up quickly and widely, both among dermatologists and general practitioners. Cases of birth defects showed up in the first year, leading the FDA to begin publishing case reports and to Roche sending warning letters to doctors and placing warning stickers on drug bottles, and including stronger warnings on the label. Lawsuits against Roche started to be filed. In 1983 the FDA's advisory committee was convened and recommended stronger measures, which the FDA took and were that time unprecedented: warning blood banks not to accept blood from people taking the drug and adding a warning to the label advising women to start taking contraceptives a month before starting the drug. However, the use of the drug continued to grow, as did the number of babies born with birth defects. In 1985 the label was updated to include a boxed warning. In early 1988 the FDA called for another advisory committee, and FDA employees prepared an internal memo estimating that around 1,000 babies had been born with birth defects due to isotretinoin, that up to around 1,000 miscarriages had been caused, and that between 5,000 and 7,000 women had had abortions due to isotretinoin. The memo was leaked to "The New York Times" a few days before the meeting, leading to a storm of media attention. In the committee meeting, dermatologists and Roche each argued to keep the drug on the market but to increase education efforts; pediatricians and the Centers for Disease Control and Prevention (CDC) argued to withdraw the drug from the market. The committee recommended restricting physicians who could prescribe the drug and requiring a second opinion before it could be prescribed. The FDA, believing it did not have authority under the law to restrict who had the right to prescribe the drug, kept the drug on the market but took further unprecedented measures: it required Roche to make warnings yet more visible and graphic, provide doctors with informed consent forms to be used when prescribing the drug, and to conduct follow up studies to test whether the measures were reducing exposure of pregnant women to the drug. Roche implemented those measures, and offered to pay for contraception counseling and pregnancy testing for women prescribed the drug; the program was called the "Pregnancy Prevention Program".


title: Isotretinoin

text: A CDC report published in 2000, showed problems with the Pregnancy Prevention Program and showed that the increase in prescriptions was from off-label use, and prompted Roche to revamp its program, renaming it the "Targeted Pregnancy Prevention Program" and adding label changes like requirements for two pregnancy tests, two kinds of contraception, and for doctors to provide pharmacists with prescriptions directly; providing additional educational materials, and providing free pregnancy tests. The FDA had another advisory meeting in late 2000 that again debated how to prevent pregnant women from being exposed to the drug; dermatologists testified about the remarkable efficacy of the drug, the psychological impact of acne, and demanded autonomy to prescribe the drug; others argued that the drug be withdrawn or much stricter measures be taken. In 2001 the FDA announced a new regulatory scheme called SMART (the System to Manage Accutane Related Teratogenicity) that required Roche to provide defined training materials to doctors, and for doctors to sign and return a letter to Roche acknowledging that they had reviewed the training materials, for Roche to then send stickers to doctors, which doctors would have to place on prescriptions they give people after they have confirmed a negative pregnancy test; prescriptions could only be written for 30 days and could not be renewed, thus requiring a new pregnancy test for each prescription.


title: Isotretinoin

text: In February 2002, Roche's patents for isotretinoin expired, and there are now many other companies selling cheaper generic versions of the drug. On 29 June 2009, Roche Pharmaceuticals, the original creator and distributor of isotretinoin, officially discontinued both the manufacture and distribution of their Accutane brand in the United States due to what the company described as business reasons related to low market share (below 5%), coupled with the high cost of defending personal injury lawsuits brought by some people who took the drug. Roche USA continues to defend Accutane and claims to have treated over 13million people since its introduction in 1982. F. Hoffmann-La Roche Ltd. apparently will continue to manufacture and distribute Roaccutane outside of the United States.


title: Isotretinoin

text: Among others, actor James Marshall sued Roche over allegedly Accutane-related disease that resulted in removal of his colon. The jury, however, decided that James Marshall had a pre-existing bowel disease.


title: Isotretinoin

text: Several trials over inflammatory bowel disease claims have been held in the United States, with many of them resulting in multimillion-dollar judgments against the makers of isotretinoin.


title: Isotretinoin

text: As of 2017, isotretinoin was marketed under many brand names worldwide: A-Cnotren, Absorica, Accuran, Accutane, Accutin, Acne Free, Acnecutan, Acnegen, Acnemin, Acneone, Acneral, Acnestar, Acnetane, Acnetin A, Acnetrait, Acnetrex, Acnogen, Acnotin, Acnotren, Acretin, Actaven, Acugen, Acutret, Acutrex, Ai Si Jie, Aisoskin, Aknal, Aknefug Iso, Aknenormin, Aknesil, Aknetrent, Amnesteem, Atlacne, Atretin, Axotret, Casius, Ciscutan, Claravis, Contracné, Curacne, Curacné, Curakne, Curatane, Cuticilin, Decutan, Dercutane, Effederm, Epuris, Eudyna, Farmacne, Flexresan, Flitrion, I-Ret, Inerta, Inflader, Inotrin, Isac, Isdiben, Isoacne, Isobest, Isocural, Isoderm, Isoface, IsoGalen, Isogeril, Isolve, Isoprotil, Isoriac, Isosupra, Isosupra Lidose, Isotane, Isotina, Isotinon, Isotren, Isotret, Isotretinoin, Isotretinoina, Isotretinoína, Isotretinoine, Isotretinoïne, Isotrétinoïne, Isotretinoinum, Isotrex, Isotrin, Isotroin, Izotek, Izotziaja, Lisacne, Locatret, Mayesta, Myorisan, Neotrex, Netlook, Nimegen, Noitron, Noroseptan, Novacne, Oralne, Oraret, Oratane, Piplex, Policano, Procuta, Reducar, Retacnyl, Retin A, Roaccutan, Roaccutane, Roacnetan, Roacta, Roacutan, Rocne, Rocta, Sotret, Stiefotrex, Tai Er Si, Teweisi, Tretin, Tretinac, Tretinex, Tretiva, Tufacne, Zenatane, Zerocutan, Zonatian ME, and Zoretanin.


title: Isotretinoin

text: As of 2017, it was marketed as a topical combination drug with erythromycin under the brand names Isotrex Eritromicina, Isotrexin, and Munderm.


title: Isotretinoin

text: While excessive bone growth has been raised as a possible side effect, a 2006 review found little evidence for this.


title: Richter magnitude scale

text: The Richter scale —also called the Richter magnitude scale, Richter's magnitude scale, and the Gutenberg–Richter scale—is a measure of the strength of earthquakes, developed by Charles Francis Richter and presented in his landmark 1935 paper, where he called it the "magnitude scale". This was later revised and renamed the local magnitude scale, denoted as ML or .


title: Richter magnitude scale

text: Because of various shortcomings of the original scale, most seismological authorities now use other similar scales, such as the moment magnitude scale (), to report earthquake magnitudes, but much of the news media still refers to these as "Richter" magnitudes. All magnitude scales retain the logarithmic character of the original and are scaled to have roughly comparable numeric values (typically in the middle of the scale). Due to the variance in earthquakes, it is essential to understand the Richter scale uses logarithms simply to make the measurements manageable (i.e., a magnitude 3 quake factors 10³ while a magnitude 5 quake is 100 times stronger than that).


title: Richter magnitude scale

text: Prior to the development of the magnitude scale, the only measure of an earthquake's strength or "size" was a subjective assessment of the intensity of shaking observed near the epicenter of the earthquake, categorized by various seismic intensity scales such as the Rossi-Forel scale. ("Size" is used in the sense of the quantity of energy released, not the size of the area affected by shaking, though higher-energy earthquakes do tend to affect a wider area, depending on the local geology.) In 1883 John Milne surmised that the shaking of large earthquakes might generate waves detectable around the globe, and in 1899 E. Von Rehbur Paschvitz observed in Germany seismic waves attributable to an earthquake in Tokyo. In the 1920s Harry O. Wood and John A. Anderson developed the "Wood–Anderson Seismograph", one of the first practical instruments for recording seismic waves. Wood then built, under the auspices of the California Institute of Technology and the Carnegie Institute, a network of seismographs stretching across Southern California. He also recruited the young and unknown Charles Richter to measure the seismograms and locate the earthquakes generating the seismic waves.


title: Richter magnitude scale

text: In 1931 Kiyoo Wadati showed how he had measured, for several strong earthquakes in Japan, the amplitude of the shaking observed at various distances from the epicenter. He then plotted the logarithm of the amplitude against the distance and found a series of curves that showed a rough correlation with the estimated magnitudes of the earthquakes. Richter resolved some difficulties with this method and then, using data collected by his colleague Beno Gutenberg, he produced similar curves, confirming that they could be used to compare the relative magnitudes of different earthquakes.


title: Richter magnitude scale

text: To produce a practical method of assigning an absolute measure of magnitude required additional developments. First, to span the wide range of possible values, Richter adopted Gutenberg's suggestion of a logarithmic scale, where each step represents a tenfold increase of magnitude, similar to the magnitude scale used by astronomers for star brightness. Second, he wanted a magnitude of zero to be around the limit of human perceptibility. Third, he specified the Wood–Anderson seismograph as the standard instrument for producing seismograms. Magnitude was then defined as "the logarithm of the maximum trace amplitude, expressed in microns", measured at a distance of . The scale was calibrated by defining a magnitude 0 shock as one that produces (at a distance of ) a maximum amplitude of 1 micron (1 µm, or 0.001 millimeters) on a seismogram recorded by a . Finally, Richter calculated a table of distance corrections, in that for distances less than 200 kilometers the attenuation is strongly affected by the structure and properties of the regional geology.


title: Richter magnitude scale

text: When Richter presented the resulting scale in 1935, he called it (at the suggestion of Harry Wood) simply a "magnitude" scale. "Richter magnitude" appears to have originated when Perry Byerly told the press that the scale was Richter's and "should be referred to as such." In 1956, Gutenberg and Richter, while still referring to "magnitude scale", labelled it "local magnitude", with the symbol , to distinguish it from two other scales they had developed, the surface wave magnitude (M) and body wave magnitude (M) scales.


title: Richter magnitude scale

text: The Richter scale was defined in 1935 for particular circumstances and instruments; the particular circumstances refer to it being defined for Southern California and "implicitly incorporates the attenuative properties of Southern California crust and mantle." The particular instrument used would become saturated by strong earthquakes and unable to record high values. The scale was replaced in the 1970s by the moment magnitude scale (MMS, symbol ); for earthquakes adequately measured by the Richter scale, numerical values are approximately the same. Although values measured for earthquakes now are , they are frequently reported by the press as Richter values, even for earthquakes of magnitude over 8, when the Richter scale becomes meaningless.


title: Richter magnitude scale

text: The Richter and MMS scales measure the energy released by an earthquake; another scale, the Mercalli intensity scale, classifies earthquakes by their "effects", from detectable by instruments but not noticeable, to catastrophic. The energy and effects are not necessarily strongly correlated; a shallow earthquake in a populated area with soil of certain types can be far more intense in effects than a much more energetic deep earthquake in an isolated area.


title: Richter magnitude scale

text: Several scales have historically been described as the "Richter scale", especially the "local magnitude" and the surface wave scale. In addition, the "body wave magnitude", , and the "moment magnitude", , abbreviated MMS, have been widely used for decades. A couple of new techniques to measure magnitude are in the development stage by seismologists.


title: Richter magnitude scale

text: All magnitude scales have been designed to give numerically similar results. This goal has been achieved well for , , and . The scale gives somewhat different values than the other scales. The reason for so many different ways to measure the same thing is that at different distances, for different hypocentral depths, and for different earthquake sizes, the amplitudes of different types of elastic waves must be measured.


title: Richter magnitude scale

text: The seismic moment, , is proportional to the area of the rupture times the average slip that took place in the earthquake, thus it measures the physical size of the event. is derived from it empirically as a quantity without units, just a number designed to conform to the scale. A spectral analysis is required to obtain , whereas the other magnitudes are derived from a simple measurement of the amplitude of a specifically defined wave.


title: Richter magnitude scale

text: All scales, except , saturate for large earthquakes, meaning they are based on the amplitudes of waves which have a wavelength shorter than the rupture length of the earthquakes. These short waves (high frequency waves) are too short a yardstick to measure the extent of the event. The resulting effective upper limit of measurement for is about 7 and about 8.5 for .


title: Richter magnitude scale

text: New techniques to avoid the saturation problem and to measure magnitudes rapidly for very large earthquakes are being developed. One of these is based on the long-period P-wave; the other is based on a recently discovered channel wave.


title: Richter magnitude scale

text: The energy release of an earthquake, which closely correlates to its destructive power, scales with the power of the shaking amplitude. Thus, a difference in magnitude of 1.0 is equivalent to a factor of 31.6 (formula_1) in the energy released; a difference in magnitude of 2.0 is equivalent to a factor of 1000 (formula_2) in the energy released. The elastic energy radiated is best derived from an integration of the radiated spectrum, but an estimate can be based on because most energy is carried by the high frequency waves.


title: Richter magnitude scale

text: The Richter magnitude of an earthquake is determined from the logarithm of the amplitude of waves recorded by seismographs (adjustments are included to compensate for the variation in the distance between the various seismographs and the epicenter of the earthquake). The original formula is:


title: Richter magnitude scale

text: where is the maximum excursion of the Wood–Anderson seismograph, the empirical function depends only on the epicentral distance of the station, formula_4. In practice, readings from all observing stations are averaged after adjustment with station-specific corrections to obtain the value.


title: Richter magnitude scale

text: Because of the logarithmic basis of the scale, each whole number increase in magnitude represents a tenfold increase in measured amplitude; in terms of energy, each whole number increase corresponds to an increase of about 31.6 times the amount of energy released, and each increase of 0.2 corresponds to approximately a doubling of the energy released.


title: Richter magnitude scale

text: Events with magnitudes greater than 4.5 are strong enough to be recorded by a seismograph anywhere in the world, so long as its sensors are not located in the earthquake's shadow.


title: Richter magnitude scale

text: The following describes the typical effects of earthquakes of various magnitudes near the epicenter. The values are typical only. They should be taken with extreme caution since intensity and thus ground effects depend not only on the magnitude but also on the distance to the epicenter, the depth of the earthquake's focus beneath the epicenter, the location of the epicenter, and geological conditions.


title: Richter magnitude scale

text: The intensity and death toll depend on several factors (earthquake depth, epicenter location, and population density, to name a few) and can vary widely.


title: Richter magnitude scale

text: Millions of minor earthquakes occur every year worldwide, equating to hundreds every hour every day. On the other hand, earthquakes of magnitude 9+ occur about once a year, on average. The largest recorded earthquake was the Great Chilean earthquake of May 22, 1960, which had a magnitude of 9.5 on the moment magnitude scale.


title: Richter magnitude scale

text: Seismologist Susan Hough has suggested that a magnitude 10 quake may represent a very approximate upper limit for what the Earth's tectonic zones are capable of, which would be the result of the largest known continuous belt of faults rupturing together (along the Pacific coast of the Americas). A research at the Tohoku University in Japan found that a magnitude 10 earthquake was theoretically possible if a combined of faults from the Japan Trench to the Kuril–Kamchatka Trench ruptured together and moved by (or if a similar large-scale rupture occurred elsewhere). Such an earthquake would cause ground motions for up to an hour, with tsunamis hitting shores while the ground is still shaking, and if this kind of earthquake occurred, it would probably be a 1-in-10,000 year event.


title: Richter magnitude scale

text: These formulae for Richter magnitude are alternatives to using Richter correlation tables based on Richter standard seismic event (formula_5, formula_6, formula_7). Below, formula_8 is the epicentral distance (in kilometers unless otherwise specified).


title: Richter magnitude scale

text: where formula_10 is the amplitude (maximum ground displacement) of the P-wave, in micrometers, measured at 0.8 Hz.


title: Richter magnitude scale

text: where formula_17 is the duration of the surface wave in seconds, and formula_18 is in degrees. is mainly between 5 and 8.


title: Kaiser Permanente

text: Kaiser Permanente (; KP), commonly known simply as Kaiser, is an American integrated managed care consortium, based in Oakland, California, United States, founded in 1945 by industrialist Henry J. Kaiser and physician Sidney Garfield. Kaiser Permanente is made up of three distinct but interdependent groups of entities: the Kaiser Foundation Health Plan, Inc. (KFHP) and its regional operating subsidiaries; Kaiser Foundation Hospitals; and the regional Permanente Medical Groups. As of 2017, Kaiser Permanente operates in eight states (Hawaii, Washington, Oregon, California, Colorado, Maryland, Virginia, Georgia) and the District of Columbia, and is the largest managed care organization in the United States.


title: Kaiser Permanente

text: Kaiser Permanente is one of the largest nonprofit healthcare plans in the United States, with over 12 million members. It operates 39 hospitals and more than 700 medical offices, with over 300,000 personnel, including more than 87,000 physicians and nurses.


title: Kaiser Permanente

text: Each Permanente Medical Group operates as a separate for-profit partnership or professional corporation in its individual territory, and while none publicly reports its financial results, each is primarily funded by reimbursements from its respective regional Kaiser Foundation Health Plan entity. KFHP is one of the largest not-for-profit organizations in the United States.


title: Kaiser Permanente

text: KP's quality of care has been highly rated and attributed to an emphasis on preventive care, its doctors being salaried rather than paid on a fee-for-service basis, and an attempt to minimize the time patients spend in high-cost hospitals by carefully planning their stay. However, Kaiser has had disputes with its employees' unions; repeatedly faced civil and criminal charges for falsification of records and patient dumping; faced action by regulators over the quality of care it provided, especially to patients with mental health issues; and faced criticism from activists and action from regulators over the size of its cash reserves.


title: Kaiser Permanente

text: Kaiser Permanente provides care throughout eight regions in the United States. Two or three (four, in the case of California) distinct but interdependent legal entities form the Kaiser system within each region. This structure was adopted by Kaiser Permanente physicians and leaders in 1955.


title: Kaiser Permanente

text: Each entity of Kaiser Permanente has its own management and governance structure, although all of the structures are interdependent and cooperative to a great extent. There are multiple affiliated nonprofits registered with the U.S. Internal Revenue Service. According to Form 990 governance questions, Kaiser Foundation Hospitals and Kaiser Foundation Health Plan do not have members with the power to appoint or elect board members, meaning that the board itself nominates and appoints new members.


title: Kaiser Permanente

text: James A. Vohs was appointed CEO in 1978 and chairman in 1980, and he would serve until his retirement in 1992. He was the first chairman to not be a member of the Kaiser family.


title: Kaiser Permanente

text: On November 5, 2012, the board of directors announced that Bernard J. Tyson, Kaiser's president and chief operating officer for the last two years, would replace Halvorson, marking the first time an African American was appointed as chairman. Tyson died in November 2019.


title: Kaiser Permanente

text: As of 2021, Kaiser Permanente had 12.5 million health plan members, 216,776 employees, 23,597 physicians, 63,847 nurses, 39 medical centers, and 724 medical facilities. As of December 31, 2018, the nonprofit Kaiser Foundation Health Plan and Kaiser Foundation Hospitals entities reported a combined $2.5 billion in net income on $79.7 billion in operating revenues.


title: Kaiser Permanente

text: In addition, Kaiser Foundation Hospitals (despite the plural name, a single legal entity) operates medical centers in California, Oregon, and Hawaii, and outpatient facilities in the remaining Kaiser Permanente regions. The hospital foundation entity is not-for-profit and relies on the Kaiser Foundation Health Plans for funding. It also provides infrastructure and facilities that benefit the for-profit medical groups.


title: Kaiser Permanente

text: Kaiser Permanente is administered through eight regions, including one parent and six subordinate health plan entities, one hospital entity, and nine separate, affiliated medical groups:


title: Kaiser Permanente

text: In addition to the regional entities, in 1997, the then-twelve Permanente Medical Groups created The Permanente Federation LLC, a separate entity, which focuses on standardizing patient care and performance under one name and system of policies. Around the same time, The Permanente Company was also chartered as a vehicle to provide investment opportunities for the for-profit Permanente Medical Groups. One of the ventures of the Permanente Company is Kaiser Permanente Ventures, a venture capital firm that invests in emerging medical technologies.


title: Kaiser Permanente

text: A mutual benefit corporation named "Kaiser Foundation for the Advancement of Integrated Health Care" was established on December 27, 2017. The specific purpose of the corporation is "to advocate for and promote the integrated models of health care". The corporation's founder, Maryann Bodayle, has served as the "Governance Administrator" of Kaiser Foundation Health Plan, Inc. since 2013.


title: Kaiser Permanente

text: The history of Kaiser Permanente dates to 1933 and a tiny hospital in the town of Desert Center, California. At that time, Henry J. Kaiser and several other large construction contractors had formed an insurance consortium called Industrial Indemnity to meet their workers' compensation obligations. Sidney Garfield had just finished his residency at Los Angeles County-USC Medical Center at a time when jobs were scarce; he was able to secure a contract with Industrial Indemnity to care for 5,000 construction workers building the Colorado River Aqueduct in the Mojave Desert. Soon enough, Garfield's new hospital was in a precarious financial state (with mounting debt and the staff of three going unpaid), due in part to Garfield's desire to treat all patients regardless of ability to pay, as well as his insistence on equipping the hospital adequately so that critically injured patients could be stabilized for the long journey to full-service hospitals in Los Angeles.


title: Kaiser Permanente

text: However, Garfield won over two Industrial Indemnity executives, Harold Hatch and Alonzo B. Ordway. It was Hatch who proposed to Garfield the specific solution that would lead to the creation of Kaiser Permanente: Industrial Indemnity would prepay 17.5% of premiums, or $1.50 per worker per month, to cover work-related injuries, while the workers would each contribute five cents per day to cover non-work-related injuries. Later, Garfield also credited Ordway with coming up with the general idea of prepayment for industrial health care and explained that he did not know much at the time about other similar health plans except for the Ross-Loos Medical Group.


title: Kaiser Permanente

text: Hatch's solution enabled Garfield to bring his budget back into the positive, and to experiment with providing a broader range of services to the workers besides pure emergency care. By the time work on the aqueduct concluded and the project was wrapped up, Garfield had paid off all of his debts, was supervising ten physicians at three hospitals, and controlled a financial reserve of $150,000.


title: Kaiser Permanente

text: Garfield returned to Los Angeles for further study at County-USC with the intent of entering private practice. However, in March 1938, Consolidated Industries (a consortium led by the Kaiser Company) initiated work on a contract for the upper half of the Grand Coulee Dam in Washington state, and took over responsibility for the thousands of workers who had worked for a different construction consortium on the first half of the dam. Edgar Kaiser, Henry's son, was in charge of the project. To smooth over relations with the workers (who had been treated poorly by their earlier employer), Hatch and Ordway persuaded Edgar to meet with Garfield, and in turn Edgar persuaded Garfield to tour the Grand Coulee site. Garfield subsequently agreed to reproduce at Grand Coulee Dam what he had done on the Colorado River Aqueduct project. He immediately spent $100,000 on renovating the decrepit Mason City Hospital and hired seven physicians.


title: Kaiser Permanente

text: Unlike the workers on Garfield's first project, many workers at Grand Coulee Dam had brought dependents with them. The unions soon forced the Kaiser Company to expand its plan to cover dependents, which resulted in a dramatic shift from industrial medicine into family practice and enabled Garfield to formulate some of the basic principles of Kaiser Permanente. It was also during this time that Henry Kaiser personally became acquainted with Garfield and forged a friendship which lasted until Kaiser's death.


title: Kaiser Permanente

text: In 1939, the Kaiser Company began work on several huge shipbuilding contracts in Oakland, and by the end of 1941 would control four major shipyards on the West Coast. During 1940, the expansion of the American defense-industrial complex in preparation for entrance into World War II resulted in a massive increase in the number of employees at the Richmond shipyard. In January 1941, Henry Kaiser asked Garfield to set up an insurance plan for the Richmond workers (this was merely contract negotiation with insurance companies), and a year later Kaiser asked Garfield to duplicate at Richmond what he had done at Desert Center and Mason City. Unlike the two other projects, the resulting entity lived on after the construction project that gave birth to it, and it is the direct ancestor of today's Kaiser Permanente.


title: Kaiser Permanente

text: On March 1, 1942, Sidney R. Garfield & Associates opened its offices in Oakland to provide care to 20,000 workers, followed by the opening of the Permanente Health Plan on June 1. From the beginning, Kaiser Permanente strongly supported preventive medicine and attempted to educate its members about maintaining their own health.


title: Kaiser Permanente

text: In July, the Permanente Foundation formed to operate Northern California hospitals that would be linked to the outpatient health plans, followed shortly thereafter by the creation of Northern Permanente Foundation for Oregon and Washington and Southern Permanente Foundation for California. The name Permanente came from Permanente Creek, which flowed past Henry Kaiser's Kaiser Permanente Cement Plant on Black Mountain in Cupertino, California. Kaiser's first wife, Bess Fosburgh, liked the name. An abandoned Oakland facility was modernized as the 170-bed Permanente Hospital opened on August 1, 1942 (this facility evolved over the decades into today's flagship Kaiser Oakland Medical Center). Three weeks later, the 71-bed Richmond Field Hospital opened. Six first aid stations were set up in the shipyards to treat industrial accidents and minor illness. Each first aid station had an ambulance ready to rush patients to the surgical field hospital if required. Stabilized patients could be moved to the larger hospital for recuperative care. The Northern Permanente Hospital opened two weeks later to serve workers at the Kaiser shipyard in Vancouver, Washington. Shipyard workers paid seven cents per day for comprehensive health care coverage, and within a year, the shipyard health plan employed sixty physicians with salaries between $450 and $1,000 per month. These physicians established California Physicians Service to offer similar health coverage to the families of shipyard workers. In 1944, Kaiser decided to continue the program after the war and to open it up to the general public.


title: Kaiser Permanente

text: Meanwhile, during the war years, the American Medical Association (AMA) (which opposed managed care organizations from their very beginning) tried to defuse demand for managed care by promoting the rapid expansion of the Blue Cross and Blue Shield preferred provider organization networks.


title: Kaiser Permanente

text: "Courage to Heal", a novel by KP Historical Society President Paul Bernstein, MD, is based on the story of Garfield's life, his struggles with the AMA, and the origins of Kaiser Permanente.


title: Kaiser Permanente

text: In 1943, Henry J. Kaiser and Dr. Sidney R. Garfield opened a 50-bed hospital, housing six physicians for the 3000 employees and their families at the new Kaiser Steel Mill in Fontana, California, offering a pre-paid health care plan for $0.60/week for adults, and $0.30/week for children. In 1945, the Kaiser Permanente health plan was opened to the public.


title: Kaiser Permanente

text: In 1948, Kaiser established the Henry J. Kaiser Family Foundation (also known as Kaiser Family Foundation), a U.S.-based nonprofit, private operating foundation focusing on the major health care issues facing the nation. The Foundation, not associated with Kaiser Permanente or Kaiser Industries, is an independent voice and source of facts and analysis for policymakers, the media, the health care community, and the general public.


title: Kaiser Permanente

text: The end of World War II brought about a huge plunge in Kaiser Permanente membership; for example, 50,000 workers had left the Northern California yards by July 1945. Membership bottomed out at 17,000 for the entire system but then surged back to 26,000 within six months as Garfield aggressively marketed his plan to the public. Sidney Garfield & Associates had been a sole proprietorship, but in 1948, it was reorganized into a partnership, Permanente Medical Group.


title: Kaiser Permanente

text: During this period, a substantial amount of growth came from union members; the unions saw Kaiser Permanente care as more affordable and comprehensive than what was available at the time from private physicians under the fee-for-service system. For example, "Fortune" magazine had reported in 1944 that 90% of the U.S. population could not afford fee-for-service health care. Kaiser Permanente membership soared to 154,000 in 1950, 283,000 in 1952, 470,000 in 1954, 556,000 in 1956, and 618,000 in 1958.


title: Kaiser Permanente

text: From 1944 onward, both Kaiser Permanente and Garfield fought numerous attacks from the AMA and various state and local medical societies. Henry Kaiser came to the defense of both Garfield and the health plans he had created.


title: Kaiser Permanente

text: In 1951, the organization acquired its current name when Henry Kaiser unilaterally directed the trustees of the health plans, hospital foundations, and medical groups to add his name before Permanente. However, the physicians in the Permanente Medical Group deeply resented the implication that they were directly controlled by Kaiser, and successfully forced him to back off with respect to their part of the organization. That same year, Kaiser Permanente also began experiments with large-scale multiphasic screening to identify unknown conditions and to facilitate treatment of known ones. Simultaneously, although no one questioned his medical competence, Garfield's deficiencies as an executive were becoming apparent as the organization expanded far beyond his ability to manage it properly.


title: Kaiser Permanente

text: Henry Kaiser became fascinated with the health care system created for him by Garfield and began to directly manage Kaiser Permanente and Garfield. This resulted in a financial disaster when Kaiser splurged on the new Walnut Creek hospital; his constant intermeddling led to significant friction at every level of the organization. The situation was not helped by Kaiser's marriage to Garfield's head administrative nurse (who had helped care for Kaiser's first wife on her deathbed), convincing Garfield to marry the sister of that nurse, and then having Garfield move in next door to him. Clifford Keene (who would eventually serve as president of Kaiser Permanente) later recalled that this arrangement resulted in a rather dysfunctional and combative family in charge of Kaiser Permanente.


title: Kaiser Permanente

text: Keene was an experienced Permanente physician whom Garfield had personally hired in 1946. During 1953 he had been trying to get a job at U.S. Steel, but on the morning of December 5, 1953, with internal tensions worsening day by day, Garfield met with Keene at the Mark Hopkins Hotel in San Francisco and asked him to turn around the organization. It took Keene 15 years to realize that Kaiser had forced Garfield to ask Keene to become his replacement. Due to the chaos on the board, Keene at first took control with the vague title of Executive Associate, but it soon became clear to everyone that he was actually in charge and Garfield was to become a lobbyist and "ambassador" for the HMO concept.


title: Kaiser Permanente

text: However, even with Garfield relieved of day-to-day management duties, the underlying problem of Henry Kaiser's authoritarian management style continued to persist. After several tense confrontations between Kaiser and Permanente Medical Group physicians, the doctors met with Kaiser's top adviser, Eugene Trefethen, at Kaiser's personal estate near Lake Tahoe on July 12, 1955. Trefethen came up with the idea of a contract between the medical groups and the health plans and hospital foundations that would set out roles, responsibilities, and financial distribution. Trefethen, already a successful attorney, went on to a successful career with Kaiser Permanente and in retirement became a famous vintner.


title: Kaiser Permanente

text: While Keene and Trefethen struggled to fix the damage from Kaiser's micromanagement and Garfield's ineffectual management, Henry Kaiser moved to Oahu in 1956 and insisted on expanding Kaiser Permanente into Hawaii in 1958. He quickly ruined what should have been a simple project, and only a last-minute intervention by Keene and Trefethen in August 1960 prevented the total disintegration of the Hawaii organization. By that year, Kaiser membership had grown to 808,000.


title: Kaiser Permanente

text: Having overseen Kaiser Permanente's successful transformation from Henry Kaiser's health care experiment into a large-scale self-sustaining enterprise, Keene retired in 1975. By 1976, membership reached three million. In 1977, all six of Kaiser Permanente's regions had become federally qualified health maintenance organizations. Historians now believe then President Richard Nixon specifically had Kaiser Permanente in mind when he signed the Health Maintenance Organization Act of 1973 since the organization was mentioned in an Oval Office discussion of the Act, where John Ehrlichman characterized Kaiser's philosophy thus: "All the incentives are toward less medical care, because the less care they give them, the more money they make." In 1980, Kaiser acquired a nonprofit group practice to create its Mid-Atlantic region, encompassing the District of Columbia, Maryland, and Virginia. In 1985, Kaiser Permanente expanded to Georgia.


title: Kaiser Permanente

text: By 1990, Kaiser Permanente provided coverage for about a third of the population of the cities of San Francisco and Oakland; total Northern California membership was over 2.4 million.


title: Kaiser Permanente

text: Elsewhere, Kaiser Permanente did not do as well, and its geographic footprint changed significantly in the 1990s. The organization spun off or closed outposts in Texas, North Carolina, and the Northeast. In 1998, Kaiser Permanente sold its Texas operations, where reported problems had become so severe that the organization directed its lawyers to attempt to block the release of a Texas Department of Insurance report. This prompted the state attorney general to threaten to revoke the organization's license. Kaiser Permanente closed health plans in Charlotte and Raleigh-Durham in North Carolina four years later. The organization also sold its unprofitable Northeast division in 2000. The Ohio division was sold to Catholic Health Partners in 2013.


title: Kaiser Permanente

text: In 1995, Kaiser Permanente celebrated its fiftieth anniversary as a public health plan. Two years later, national membership reached nine million. In 1997, the organization established an agreement with the AFL-CIO to explore a new approach to the relationship between management and labor, known as the Labor Management Partnership. Going into the new millennium, competition in the managed care market increased dramatically, raising new concerns. The Southern California Permanente Medical Group saw declining rates of new members as other managed care groups flourished.


title: Kaiser Permanente

text: In 2002, Kaiser Permanente abandoned its attempt to build its own clinical information system with IBM, writing off some $452 million in software assets. This information technology failure led to major changes in the organization's approach to digital records. Under George Halvorson's direction, Kaiser looked closely at two medical software vendors, Cerner and Epic Systems, ultimately selecting Epic as the primary vendor for a new system, branded KP HealthConnect. Although Kaiser's approach shifted to "buy, not build," the project was unprecedented for a civilian system in size and scope. Deployed across all eight regions over six years and at a cost of more than $6 billion, by 2010, it was the largest civilian electronic medical record system, serving more than 8.6 million Kaiser Permanente members, implemented at a cost exceeding a half million dollars per physician. As of 2020 KP HealthConnect supports 12.2 million members.


title: Kaiser Permanente

text: Early in the 21st century, the NHS and UK Department of Health became impressed with some aspects of the Kaiser operation and initiated a series of studies involving several health care organizations in England. Visits occurred and suggestions of adopting some KP policies are currently active. The management of hospital bed-occupancy by KP, by means of integrated management in and out of hospital and monitoring progress against care pathways has given rise to trials of similar techniques in eight areas of the UK.


title: Kaiser Permanente

text: In 2002, a controversial study by California-based academics published in the British Medical Journal compared Kaiser to the British National Health Service, finding Kaiser to be superior in several respects. Subsequently, a group of health policy academics who were experts on the NHS published a competing analysis claiming that Kaiser's costs were actually substantially higher than the NHS and for a younger and healthier population.


title: Kaiser Permanente

text: In the California Healthcare Quality Report Card 2013 Edition, Kaiser Permanente's Northern California and Southern California regions, KP received four out of four possible stars in Meeting National Standards of Care. KP North and South also received three out of four stars in Members Rate Their HMO. KP's performance has been attributed to three practices: First, KP places a strong emphasis on preventive care, reducing costs later on. Second, its doctors are salaried rather than paid per service, which removes the main incentive for doctors to perform unnecessary procedures. Thirdly, KP attempts to minimize the time patients spend in high-cost hospitals by carefully planning their stay and by shifting care to outpatient clinics. This practice results in lower costs per member, cost savings for KP and greater doctor attention to patients. A comparison to the UK's National Health Service found that patients spend 2–5 times as much time in NHS hospitals as compared to KP hospitals.


title: Kaiser Permanente

text: In June 2013, the California Department of Managed Health Care (DMHC) levied a $4 million fine, the second largest in the agency's history, against Kaiser for not providing adequate mental health care to its patients. Alleged violations of California's timely access laws included failures to accurately track wait times and track doctor availability amid evidence of inconsistent electronic and paper records. It was also found by the DMHC that patients received written materials circulated by Kaiser dissuading them from seeking care, a violation of state and federal laws. DMHC also issued a cease and desist order for Kaiser to end the practices. DMHC conducted a follow up investigation which published in April 2015. The report found Kaiser had put systems in place to better track how patients were being cared for but still had not addressed problems with actually providing mental health care that complied with state and federal laws. Kaiser's challenges on this front were exacerbated by a long, unresolved labor dispute with the union representing therapists.


title: Kaiser Permanente

text: Kaiser appealed the findings, the order, and the fine, and sought to keep the proceedings closed, but in September 2014, in the face of the administrative judge's order to keep the proceedings open, and facing the beginning of public testimony, Kaiser withdrew the appeal and paid the $4 million. It also issued a statement which denied much of the wrongdoing. Kaiser faces ongoing inspections by DMHC and three class-action lawsuits related to the issues identified by the DMHC.


title: Kaiser Permanente

text: In 2006 Kaiser settled five cases for alleged patient dumping—the delivery of homeless hospitalized patients to other agencies or organizations in order to avoid expensive medical care—between 2002 and 2005. Los Angeles city officials had filed civil and criminal legal action against Kaiser Permanente for patient dumping, which was the first action of its kind that the city had taken. The city's decision to charge Kaiser Permanente reportedly was influenced by security camera footage, allegedly showing a 63-year-old patient, dressed in hospital gown and slippers, wandering toward a mission on Skid Row (this footage was prominently featured in the Michael Moore 2007 documentary "Sicko"). At the time that the complaint was filed, city officials said that 10 other hospitals were under investigation for similar issues. Kaiser settled the case, paying $5,000 in civil penalties and agreeing to spend $500,000 on services for the homeless. During that same period, the Department of Health and Human Services' Office of the Inspector General settled 102 cases against U.S. hospitals that resulted in a monetary payment to the agency.


title: Kaiser Permanente

text: In 2004, Northern California Kaiser Permanente initiated an in-house program for kidney transplantation. Prior to opening the transplant center, Northern California Kaiser patients would generally receive transplants at medical centers associated with the University of California (UC San Francisco and UC Davis). Upon opening the transplant center, Kaiser required that members who are transplant candidates in Northern California obtain services exclusively through its internal KP-owned transplant center.


title: Kaiser Permanente

text: While it was in operation, the Kaiser program had a 100% survival rate, which is better than other transplant centers. However, patients who needed a kidney were less likely to be offered one. Northern California Kaiser performed 56 transplants in 2005, and twice that many patients died while waiting for a kidney. At other California transplant centers, more than twice as many people received kidneys than died during the same period. Unlike other centers, the Kaiser program did not perform riskier transplants or use donated organs from elderly or other higher-risk people, which have worse outcomes. Northern California Kaiser closed the kidney transplant program in May 2006. As before, Northern California Kaiser now pays for pre-transplant care and transplants at other hospitals. This change affected approximately 2,000 patients.


title: Kaiser Permanente

text: Kaiser operates a Division of Research, which annually conducts between 200 and 300 studies, and the Center for Health Research, which in 2009 had more than 300 active studies. Kaiser's bias toward prevention is reflected in the areas of interest—vaccine and genetic studies are prominent. The work is funded primarily by federal, state, and other outside (non-Kaiser) institutions.


title: Kaiser Permanente

text: Kaiser has created and operates a voluntary biobank of donated blood samples from members along with their medical record and the responses to a lifestyle and health survey. As of November 2018, the Kaiser Permanente Research Bank had over 300,000 samples, with a goal of 500,000. De-identified data is shared with both Kaiser researchers and researchers from other institutions.


title: Kaiser Permanente

text: Kaiser Permanente announced its plan to start a medical school in December, 2015, and the school welcomed its inaugural class in June, 2020. The vision for the school is to redesign physician education around the pillars of patient-centered care, population health, quality improvement, team-based care, and health equity.


title: Kaiser Permanente

text: Mark Schuster was named the medical school's Founding Dean and CEO in 2017. The Kaiser Permanente Bernard J. Tyson School of Medicine was renamed from the Kaiser Permanente School of Medicine in November 2019 in honor of late Kaiser Permanente Chairman and CEO Bernard J. Tyson. The medical school received preliminary LCME accreditation in February 2019 and is expected to receive full LCME accreditation by 2023. The school will waive all tuition for the full four years of medical school for its first five classes.


title: Kaiser Permanente

text: In order to contain costs, Kaiser requires an agreement by planholders to submit patient malpractice claims to arbitration rather than litigating through the court system. This has triggered some opposition.


title: Kaiser Permanente

text: Wilfredo Engalla is a notable case. In 1991, Engalla died of lung cancer nearly five months after submitting a written demand for arbitration. The California Supreme Court found that Kaiser had a financial incentive to wait until after Engalla died; his spouse could recover $500,000 from Kaiser if the case was arbitrated while he was alive, but only $250,000 after he died. The Foundation for Taxpayer and Consumer Rights contends that Kaiser continues to oppose HMO arbitration reform.


title: Kaiser Permanente

text: Watchdogs have accused Kaiser of abusing the power imbalance inherent in the arbitration system. Kaiser engages in many cases whereas a customer will usually engage in just one and Kaiser can reject any arbitrator unilaterally, thus they can select company-friendly arbitrators over those that rule in favor of customers. As a large organization, Kaiser can also afford to spend much more on lawyers and orators than the customer, giving them more advantages. In response to criticisms, Kaiser established an Office of Independent Administrators (OIA) in 1999 to oversee the arbitration process. The degree to which this office is actually independent has been questioned.


title: Kaiser Permanente

text: Patients and consumer interest groups sporadically attempt to bring lawsuits against Kaiser Permanente. Recent lawsuits include Gary Rushford's 1999 attempt to use proof of a physician lie to overturn an arbitration decision.


title: Kaiser Permanente

text: In one case, Kaiser attempted to significantly expand the scope of its arbitration agreements by arguing it should be able to force "nonsignatories" to its member contracts into arbitration, merely because those third parties had allegedly caused an injury to a Kaiser member which Kaiser had then allegedly exacerbated through its medical malpractice. The California Court of Appeal for the First District did not accept that argument: "Absent a written agreement—or a preexisting relationship or authority to contract for another that might substitute for an arbitration agreement—courts sitting in equity may not compel third party nonsignatories to arbitrate their disputes."


title: Kaiser Permanente

text: While Doctors of Medicine (M.D.) and Doctors of Osteopathic Medicine (D.O.) are partners within the for-profit physician groups, many employees are members of various unions and guilds, depending on their role and service area.


title: Kaiser Permanente

text: KP's California operations were the target of four labor strikes in 2011 and 2012 — two (September 2011, January 2012) involved more than 20,000 nurses, mental health providers, and other professionals. The National Union of Healthcare Workers (NUHW) has accused Kaiser of deliberately stalling negotiations while profiting $2.1 billion in 2011 and paying its CEO George Halvorson $9 million annually. The workers were dissatisfied with proposed changes to pensions and other benefits.


title: Kaiser Permanente

text: On November 11, 2014, up to 18,000 nurses went on strike at KP hospitals in Northern California over Ebola safeguards and patient-care standards during union contract talks. 21 hospitals and 35 clinics in the San Francisco Bay Area were affected.


title: Kaiser Permanente

text: Jamie Court, president of the Foundation for Taxpayer and Consumer Rights has said that Kaiser's retained profits are evidence that Kaiser policies are overpriced and that health insurance regulation is needed.


title: Kaiser Permanente

text: State insurance regulations require that insurers maintain certain minimum amounts of cash reserves to ensure that they are able to meet their obligations; the amount varies by insurer, based on its risk factors, such as its investments, how many people it insures, and other factors; a few states also have caps on how large the reserves can be.


title: Kaiser Permanente

text: Kaiser has been criticized by activists and state regulators for the size of its cash reserves. As of 2015, it had $21.7 billion in cash reserves, which was about 1,600% the amount required by California state regulations. Its reserves had been a target of advertising by Consumer Watchdog supporting Proposition 45 in California's 2014 elections. At the end of 2010 Kaiser held $666 million in reserves, which was about 1,300% of the minimum required under Colorado state law. Those funds were in Kaiser's risk-based capital account, held to pay for disasters or major projects. In 2008, the Colorado regulator required Kaiser to spend down its reserves; after negotiations Kaiser agreed to spend $155 million of its reserves giving credits to its clients and building clinics in underserved parts of the state.


title: Kaiser Permanente

text: Kaiser has been fined nearly $500,000, more than any other health care employer in California, by the California Division of Occupational Safety and Health for its violations regarding patient and staff safety following outbreaks of COVID-19 in its hospitals across the state, particularly in the Bay Area. Kaiser is responsible for more than 10% of all COVID violations in California. A COVID-19 outbreak sickened 92 people at Kaiser San Jose Medical Center on Christmas Day 2020. Kaiser San Leandro received the largest portion of fines, nearly $90k, for delays in reporting COVID infections and for failure to ration medical equipment according to pandemic regulations.


title: Suits (season 9)

text: The ninth and final season of the American legal drama "Suits" was ordered on January 23, 2019. With its renewal, it was announced that it would be the final season of the show with all regulars from the previous season returning. Unlike the second through eighth season, the ninth season consisted of ten episodes instead of sixteen. The final season premiered on USA Network in the United States July 17, 2019, followed by the premiere of spin-off series "Pearson".


title: Suits (season 9)

text: With the renewal, creator Aaron Korsh offered insight on the decision to end the show with a 10-episode ninth season. He stated that he and USA Network decided to extend the cast contracts for two more years beyond season 7 after they wrapped production on season 6. Speaking on the shortened final season, he shared: "Our winter runs consist of 6 episodes, so we all felt like it would be very difficult to just have a truncated finale to a season. We always wanted to have the big 10 in the summer, to go out on a high note so to speak."


title: Suits (season 9)

text: In addition to the ten first-run episodes, USA aired a repeat of the series pilot episode on August 28, with additional commentary from the cast members added.


title: Suits (season 9)

text: Korsh revealed intentions to bring back characters from the past as it has "always been in the lexicon of Suits to bring people back and that's because I think that's how life works," but that the writers were deciding on whom exactly they wanted to bring back as too much returning characters would prevent the story from moving forward. He denied rumors started by British tabloids that they were trying to get Meghan Markle back for a cameo in exchange for a large donation to charity, although he did share that he and Patrick J. Adams were contemplating bringing Mike Ross back for the final season if it worked out with Adams' schedule. At the same time, he stated a cross-over with characters from Pearson had not been ruled out nor planned. On June 3, 2019, it was officially announced that Adams would return as a guest star for the fifth episode of the season. Korsh also hinted that he could re-appear in the series finale, though that was still uncertain. Additionally, Korsh stated that they would always welcome Markle back if she were to reach out, but he did not see it happening.


title: Suits (season 9)

text: Following the eighth-season finale, Korsh stated in an interview that Wendell Pierce's Robert Zane was written out of the show given Pierce's uncertain availability for the ninth season. Nevertheless, Korsh hoped that they would be able to bring him back.


title: Suits (season 9)

text: Additionally, Korsh shared that the ninth season would pick up shortly after where the eighth season left off. After the eighth-season finale, Korsh further shared that the ninth season would explore the newfound relationship between Donna and Harvey and teased that there could be marriage and death in the final season. On Patrick J. Adams' return, Korsh elaborated that Mike's return would see him embroiled in a case against Harvey and Samantha.


title: Suits (season 9)

text: The table read for the fifth episode featuring Mike Ross' return was scheduled for mid-June with filming starting shortly after. Initially, Patrick J. Adams was going to direct the series' penultimate episode, thus the ninth of the season, but his signing on to star in "The Right Stuff" prevented that plan from coming to fruition.


title: Chris Christie

text: Christopher James Christie (born September 6, 1962) is an American politician, lawyer, political commentator, lobbyist, and former federal prosecutor who served as the 55th governor of New Jersey from 2010 to 2018.


title: Chris Christie

text: Christie, who was born in Newark, New Jersey, was raised in Livingston, New Jersey. After graduating in 1984 from the University of Delaware, he earned a J.D. at Seton Hall University School of Law. A Republican, Christie was elected county freeholder (legislator) for Morris County, New Jersey, serving from 1995 to 1998. By 2002, he had campaigned for Presidents George H. W. Bush and George W. Bush; the latter appointed him U.S. Attorney for New Jersey, a position he held from 2002 to 2008.


title: Chris Christie

text: Christie won the 2009 Republican primary for Governor of New Jersey and defeated Democratic incumbent Jon Corzine in the general election. In his first term, he was credited with cutting spending, capping property tax growth and engaging in recovery efforts after Hurricane Sandy. He was re-elected by a wide margin in 2013, defeating State Senate Majority Leader Barbara Buono. During his second term as governor, Christie's standing was damaged by the Fort Lee lane closure scandal. After that time, he ranked among the least popular governors in the United States. He was succeeded by Democrat Phil Murphy.


title: Chris Christie

text: Christie chaired the Republican Governors Association during the 2014 election cycle. On June 30, 2015, he announced his candidacy for the Republican nomination in the 2016 presidential election. He suspended his candidacy on February 10, 2016. Later, he endorsed eventual winner Donald Trump and was named head of Trump's transition planning team. Christie left office in 2018 after his second term as Governor of New Jersey and registered as a lobbyist in June 2020.


title: Chris Christie

text: Christie was born in Newark, New Jersey, to Sondra A. (née Grasso), a telephone receptionist, and Wilbur James "Bill" Christie, a certified public accountant who graduated from Rutgers Business School. His mother was of Italian (Sicilian) ancestry, and his father is of German, Scottish, and Irish descent. Christie's family moved to Livingston, New Jersey, after the 1967 Newark riots, and Christie lived there until he graduated from Livingston High School in 1980. At Livingston, Christie served as class president, played catcher for the baseball team, and was selected as a New Jersey Representative to the United States Senate Youth Program.


title: Chris Christie

text: Christie's father and mother were Republican and Democratic, respectively. He has credited his Democratic-leaning mother for indirectly making him a Republican by encouraging him to volunteer for the gubernatorial candidate who became his role model, Tom Kean. Christie had become interested in Kean after the politician, then a state legislator, spoke to Christie's junior high school class.


title: Chris Christie

text: Christie graduated from the University of Delaware in 1984 with a Bachelor of Arts in political science; while there, he served as president of the student body. He graduated from Seton Hall University School of Law with a J.D. in 1987. He was admitted to the New Jersey State Bar Association and the Bar of the United States District Court, District of New Jersey, in December 1987. He was awarded honorary doctorate degrees by Rutgers University and Monmouth University in 2010.


title: Chris Christie

text: In 1987, Christie joined the law firm of Dughi, Hewit & Palatucci of Cranford, New Jersey. In 1993, he was named a partner in the firm. Christie specialized in securities law, appellate practice, election law, and government affairs. He is a member of the American Bar Association and the New Jersey State Bar Association and was a member of the Election Law Committee of the New Jersey State Bar Association. From 1999 to 2001, Christie was registered statehouse lobbyist for Dughi and Hewit.


title: Chris Christie

text: Christie volunteered for President George H. W. Bush's 1992 re-election campaign in New Jersey and became close to Bush's state director, Bill Palatucci. Following the campaign, Christie decided to run for office and moved to Mendham Township. In 1993, Christie launched a primary challenge against the New Jersey Senate Majority Leader, John H. Dorsey. However, Christie's campaign ended after Dorsey successfully challenged the validity of Christie's petition to appear on the ballot.


title: Chris Christie

text: In 1994, Christie was elected as a Republican to the Board of County Commissioners, or legislators, for Morris County, New Jersey, after he and a running mate defeated incumbents in the party primary. Following the election, the defeated incumbents filed a defamation lawsuit against Christie based on statements made during the primary campaign. Christie had incorrectly stated that the incumbents were under "investigation" for violating certain local laws. The lawsuit was settled out of court, with Christie acknowledging that the prosecutor had convened an "inquiry" instead of an "investigation", and apologizing for the error, which he said was unintentional.


title: Chris Christie

text: As a commissioner, Christie required the county government to obtain three quotes from qualified firms for all contracts. He led a successful effort to bar county officials from accepting gifts from people and firms doing business with the county. He voted to raise the county's open space tax for land preservation; however, county taxes, on the whole, were decreased by 6.6% during his tenure. He successfully pushed for the dismissal of an architect hired to design a new jail, saying that the architect was costing taxpayers too much money. The architect then sued Christie for defamation over remarks he made about the dismissal, eventually dropping the suit without explanation.


title: Chris Christie

text: In 1995, Christie announced a bid for a seat in the New Jersey General Assembly; he and attorney Rick Merkt ran as a ticket against incumbent Assemblyman Anthony Bucco and attorney Michael Patrick Carroll in the Republican primary. Christie ran as a pro-choice candidate and supporter of the ban on assault weapons. Bucco and Carroll, the establishment candidates, defeated the up-and-comers by a wide margin. After this loss, Christie's bid for re-nomination to the freeholder board was unlikely, as unhappy Republicans recruited John J. Murphy to run against Christie in 1997. Murphy defeated Christie in the primary. Murphy, who had falsely accused Christie of having the county pay his legal bills in the architect's lawsuit, was sued by Christie after the election. They settled out of court with the Freeholders admitting wrongdoing and apologizing. Christie's career in Morris County politics was over by 1998.


title: Chris Christie

text: When Christie's part-time position as a Chosen Freeholder lapsed, he returned full attention to his law firm Dughi, Hewit & Palatucci. Alongside fellow partner and later, gubernatorial campaign fundraiser Bill Palatucci, Christie's firm opened an office in the state capital, Trenton, devoted mainly to lobbying. Between 1999 and 2001, Christie and Palatucci lobbied on behalf of, among others, GPU Energy for deregulation of New Jersey's electric and gas industry; the Securities Industry Association to block the inclusion of securities fraud under the state's Consumer Fraud Act; Hackensack University Medical Center for state grants; and the University of Phoenix for a New Jersey higher education license. During the 2000 presidential election, Christie was George W. Bush's campaign lawyer for the state of New Jersey.


title: Chris Christie

text: On December 7, 2001, President George W. Bush appointed Christie the U.S. Attorney for the District of New Jersey. During a Republican presidential debate in August 2015, Christie falsely claimed he had been appointed by President Bush on September 10, 2001, and that the 9/11 attacks occurred in his state the next day. Some members of the New Jersey Bar professed disappointment at Christie's lack of experience. At the time, he had never practiced in a federal courtroom before, and had little experience in criminal law. Christie received the overwhelming support of the Republican Party in New Jersey. A spokesperson for Acting Governor Donald DiFrancesco, who selected nominees for the position, said that he received hundreds of letters of support for Christie "from everyone from the Assembly speaker down to the county level, close to every member of the Legislature and every county chairman." Christie was also a top fundraiser for Bush's 2000 presidential campaign. He helped raise $350,000 for Bush, qualifying him as a "Pioneer", and also donated to DiFrancesco. Democrats seized upon the role played by Bush's political adviser, Karl Rove, after Christie's law partner, William Palatucci, a Republican political consultant and Bush supporter, boasted that he had selected a United States attorney by forwarding Christie's résumé to Rove. According to New Jersey's senior senator, Bob Torricelli, Christie promised to appoint a "professional" with federal courtroom experience as deputy if confirmed. By Senate tradition, if a state's senior Senator opposes the nomination of a U.S. Attorney, the nomination is effectively dead, but Christie's promise was enough for Torricelli to give the nomination his blessing. He was unanimously confirmed by the United States Senate on December 20, 2001, and sworn into office on January 17, 2002.


title: Chris Christie

text: The brother of Christie's uncle (his aunt's second husband), Tino Fiumara, was an organized crime figure; according to Christie, the FBI presumably knew that when they conducted his background check. Later, Christie recused himself from the case and commented about what he had learned growing up with such a relative: "It just told me that you make bad decisions in life and you wind up paying a price."


title: Chris Christie

text: Christie served as U.S. Attorney from January 17, 2002, to December 1, 2008. His office included 137 attorneys, with offices in Newark, Trenton, and Camden. Christie also served on the 17-member Advisory Committee of U.S. Attorneys for Attorneys General John Ashcroft and Alberto Gonzales.


title: Chris Christie

text: Soon after taking office, Christie let it be known that his office would make public corruption a high priority, second only to terrorism. During his six-year tenure, he received praise for his record of convictions in public corruption cases. His office convicted or won guilty pleas from 130 public officials, both Republican and Democratic, at the state, county and local levels. The most notable of these convictions included those of Democratic Hudson County Executive Robert C. Janiszewski in 2002 on bribery charges, Republican Essex County Executive James W. Treffinger in 2003 on corruption charges, former Democratic New Jersey Senate President John A. Lynch Jr., in 2006 on charges of mail fraud and tax evasion, State Senator and former Newark Democratic mayor Sharpe James in 2008 on fraud charges, and Democratic State Senator Wayne R. Bryant in 2008 on charges of bribery, mail fraud, and wire fraud.


title: Chris Christie

text: In 2005, following an investigation, Christie negotiated a plea agreement with Charles Kushner, under which he pleaded guilty to 18 counts of illegal campaign contributions, tax evasion, and witness tampering. Kushner was sentenced to two years in prison.


title: Chris Christie

text: Christie negotiated seven deal deferred prosecution agreements (DPAs) during his tenure, some of which were controversial. Under agreements like these, corporations avoid prosecution if they promise not just to obey the law or pay for bad acts, but also promise to change personnel, or revamp business practices, or adopt new types of corporate governance. They are typically used in lieu of prosecution when there is evidence of particularly egregious corporate misconduct. Since 2002, these types of agreements have been sharply on the rise among federal prosecutors, with 23 between 2002 and 2005, and 66 between 2006 and 2008. Outside monitors are appointed in about half of all DPAs, to make sure that the corporations comply. In one case, Christie recommended the appointment of The Ashcroft Group, a consulting firm owned by his former boss John Ashcroft, as an outside monitor of Zimmer Holdings—a contract worth as much as $52 million from Zimmer, which was an amount in line with fee structures at that time. In another instance, Christie's office deferred criminal prosecution of pharmaceutical company Bristol Myers in a deal that required the company to dedicate $5 million for a business ethics chair at Seton Hall University School of Law, Christie's alma mater.


title: Chris Christie

text: Christie defended the appointment of Ashcroft, citing his prominence and legal acumen. And he defended the Seton Hall donation as happenstance given that there was already a business ethics endowed chair at the only other law school in the state.


title: Chris Christie

text: Still, cases like these led to new rules within the Justice Department, and sparked a congressional hearing on the subject.


title: Chris Christie

text: Besides doubling the size of the anticorruption unit for New Jersey, Christie also prosecuted other federal crimes. For example, he obtained convictions of brothel owners who kept Mexican teenagers in slavery as prostitutes, convicted 42 gang members of the Double II Set of various crimes including more than 25 murders, and convicted British trader Hemant Lakhani of trying to sell missiles. Despite claims of entrapment, Lakhani was convicted by jury in April 2005 of attempting to provide material support to terrorists, unlawful brokering of foreign defense articles, and attempting to import merchandise into the U.S. by means of false statements, plus two counts of money laundering. He was sentenced to 47 years in prison.


title: Chris Christie

text: In 2007, Christie prosecuted the planners of the averted 2007 Fort Dix attack plot, which he has frequently mentioned as a career highlight.


title: Chris Christie

text: During the second term of George W. Bush, a controversy arose about the administration's dismissal of several U.S. attorneys, allegedly for political reasons. When it was revealed that Christie had been on a preliminary version of the hit list, New York Senator Charles Schumer said: "I was shocked when I saw Chris Christie's name on the list last night. It just shows a [Justice] department that has run amok." Pat Meehan, the U.S. attorney in Philadelphia, said: "Among his peers, Chris stands out as one of the most admired. If you were to create a list of the U.S. attorneys who have had the greatest impact, Chris would be one of the top two or three names I'd put on it. This defies explanation."


title: Chris Christie

text: Christie's opponents claimed that he had gotten off the Bush administration's hit list by going after Congressman Robert Menendez; for example, "The New York Times" columnist Paul Krugman wrote, "Menendez's claims of persecution now seem quite plausible." Christie had issued a subpoena regarding Menendez 65 days before the 2006 Senate election, in which Menendez defeated Republican Thomas Kean Jr. to become New Jersey's junior senator. Christie's biographers (journalists Michael Symons and Bob Ingle) concluded that, "The timing of the Menendez-related subpoena doesn't line up right to support the critics' theory." Christie's aides have said that the subpoena was prompted by a newspaper report about Menendez, which prosecutors feared might imminently lead to destruction of documents and other evidence. The investigation of Menendez continued for years after Christie left office as U.S. Attorney, until Menendez was finally cleared on October 5, 2011.


title: Chris Christie

text: Christie filed as a candidate for the office of governor on January 8, 2009. Former Governor Thomas Kean helped Christie campaign and raise money. In the primary on June 2, Christie won the Republican nomination with 55% of the vote, defeating opponents Steve Lonegan and Rick Merkt. He then chose Kimberly Guadagno, Monmouth County sheriff, to complete his campaign ticket as a candidate for lieutenant governor. On November 3, Christie defeated Jon Corzine by a margin of 49% to 45%, with 6% of the vote going to independent candidate Chris Daggett.


title: Chris Christie

text: In November 2012, Christie filed papers to run for a second term in office. Christie was reelected by a large margin on November 5, 2013, defeating Democratic nominee Barbara Buono. Christie advisors said that Christie sought to win by a large margin to position himself for the presidential primaries and develop a model for other Republican candidates. Christie began building a national fundraising network, aided by the fact that only one other state had a gubernatorial contest in 2013, and those financial resources were intended to support a major outreach effort toward blacks, Hispanics and women. He also ordered a $25 million special election to fill the seat of the deceased Senator Frank Lautenberg. The move was believed to be motivated by a desire to keep Newark Mayor Cory Booker from sharing an election day, 20 days afterward, with Christie, thereby depressing otherwise anticipated black voter turnout that tended to vote Democratic.


title: Chris Christie

text: Christie took office as Governor of New Jersey on January 19, 2010. He chose not to move his family into Drumthwacket, the governor's official mansion, and instead resided in a private Mendham Township, New Jersey, residence.


title: Chris Christie

text: While campaigning for governor, Christie promised not to raise taxes. He also vowed to lower the state income and business taxes, with the qualification that this might not occur immediately.


title: Chris Christie

text: As governor, Christie claims his annual budgets did not increase taxes, though he made reductions to tax credits such as the earned income tax credit and property tax relief programs, he would also sign legislation limiting property tax growth to 2% annually. Under Christie, there were no rate increases in the state's top three revenue generators: income tax, sales tax, and corporate tax.


title: Chris Christie

text: In February 2010, Christie signed an executive order declaring a "state of fiscal emergency" due to the projected $2.2 billion budget deficit for that fiscal year. Following the order, Christie proposed a new budget which eliminated the New Jersey Department of the Public Advocate, which had an upkeep of $1.3 million. In late June 2011, Christie utilized New Jersey's line-item veto to eliminate nearly $1 billion from the proposed budget, signing it into law just hours prior to July 1, 2011, the beginning of the state's fiscal year. That same year, Christie signed into law a payroll tax cut authorizing the New Jersey Department of Labor and Workforce Development to reduce payroll deduction for most employees from $148 to $61 per year.


title: Chris Christie

text: On five separate occasions, Christie vetoed legislation pushed by Democrats to implement a millionaire tax. After Democrat Phil Murphy became governor, Democrats backed off the legislation, with New Jersey Senate President Stephen Sweeney stating, "[t]his state is taxed out. If you know anything about New Jersey, they're just weary of the taxes."


title: Chris Christie

text: During Christie's tenure, New Jersey's credit rating was downgraded nine times (across Standard & Poor, Fitch Ratings, and Moody's Investors Service), leaving only Illinois with a lower rating among U.S. states. Christie received a B grade in 2012 and in 2014 from the Cato Institute, a libertarian think tank, in their biennial fiscal policy report on America's governors.


title: Chris Christie

text: On September 18, 2013, Christie signed legislation to overhaul the state's business tax incentive programs. The legislation reduced the number of tax incentive programs from five to two, raised the caps on tax credits, and allowed smaller companies to qualify. It also increased the credits available for businesses in South Jersey.


title: Chris Christie

text: In March 2010, Christie signed into law three state pension reform bills, which had passed with bipartisan support. The laws decreased pension benefits for future hires and required public employees to contribute 1.5 percent of their salaries toward their health care. The laws prompted a lawsuit by the police and firefighters' unions. In his campaign for governor, Christie opposed any change in pension benefits for firefighters and law enforcement officers, including "current officers, future officers or retirees". He described the pension agreement as "a sacred trust".


title: Chris Christie

text: Later that year, he called for further cuts, including the elimination of cost-of-living adjustments for all current and future retirees. In June 2011, Christie announced a deal with the Democratic leadership of the legislature on a reform of public employee pensions and benefits. The deal raised public employees' pension contributions, mandated the state to make annual payments into the system, increased public employee contributions toward health insurance premiums, and ended collective bargaining for health benefits. The reform is projected to save the state $120 billion over 30 years.


title: Chris Christie

text: In June 2013, Christie signed a $33 billion state budget that makes a record $1.7 billion payment to the state's pension fund and also increases school funding by almost $100 million. The budget resulted from negotiations between Christie and Democratic leaders in the state legislature and was the first that Christie has signed as passed, without vetoing any of its provisions.


title: Chris Christie

text: In May 2014, Christie cut the contributions to New Jersey public workers' pension funds for a 14-month period by nearly $2.5 billion to deal with a revenue shortfall in the state budget of $2.75 billion. The state will instead make a $1.3 billion payment during the period. Christie cited the state constitution's requirement to have a balanced budget for his decision to cut payments to pensions for state workers, and follows Christie's changes to the state's pension formula earlier in 2014 to save $900 million through the end of his term.


title: Chris Christie

text: One of Christie's most controversial school policies was to increase the state's control of school districts. The districts contained relatively-high numbers of underachieving students, people of color, poor people, and members of the Democratic Party. In Newark, Christie hired Chris Cerf to replace Cami Anderson as the state-appointed superintendent of its school district. Under Christie, Cerf overruled the district's locally elected school board;, recent research indicated that the reforms advocated by Christie, Anderson, and Cerf did not improve educational outcomes.


title: Chris Christie

text: Christie has been accused of under-funding school districts. Reports indicated that Christie's administration did not adhere to the School Funding Reform Act, and illegally withheld funds from districts throughout the state. His 2017 school-funding proposal was described by education researchers as "one of the least equitable in the country". State commissioner of education Chris Cerf defended policies declared unconstitutional by the Supreme Court of New Jersey, which contradicting basic education research.


title: Chris Christie

text: Christie, whose children attend Catholic school, supports the state giving tax credits to parents who send their children to private and parochial schools. He also supports school vouchers, which parents of students in failing school districts could use for tuition in private schools or for public schools in communities outside their own. Christie supports merit pay for teachers.


title: Chris Christie

text: On August 25, 2010, the U.S. Department of Health and Human Services announced that $400 million in federal Race to the Top education grants to New Jersey would not be issued due to a clerical error in the state's application by an unidentified mid-level state official. Christie said that the Obama administration had overstepped its authority, and the error was in the administration's failure to communicate with the New Jersey government. It was later learned that the issue had been raised with Bret Schundler, Christie's education commissioner. Christie asked for Schundler's resignation; Schundler initially agreed to resign, but asked to be fired the following morning to claim unemployment benefits. According to Schundler, he told Christie the truth and Christie misstated what actually occurred.


title: Chris Christie

text: The Christie administration approved 23 new charter schools in January 2011, including New Jersey's first independent school for children with autism. The approvals increased the state's number of charter schools to 96.


title: Chris Christie

text: On August 6, 2012, Christie signed a law reforming the tenure system for New Jersey public-school teachers. Under the law, teachers would be required to work four years (instead of three) to earn tenure; they would also need to receive positive ratings for two consecutive years. Tenured teachers with poor ratings for two consecutive years would be eligible for dismissal, with the hearing process for appeals related to dismissal of tenured teachers limited to 105 days.


title: Chris Christie

text: On March 6, 2013, the Christie administration released proposed regulations to overhaul the process of evaluating public-school teachers. Under the proposal, a percentage of teacher evaluations would be based on student improvement in state tests or student-achievement goals set by principals.


title: Chris Christie

text: In September 2014, Christie signed a partnership with Mexico on a higher-education project to foster economic cooperation. The program would focus on research ventures, cross-border fellowships, student and teacher exchanges, conferences, and other educational opportunities.


title: Chris Christie

text: Christie has stated that he believes that the New Jersey Department of Environmental Protection is too big and is "killing business" with permit delays and indiscriminate fines. He announced that, if elected, the agency would be his first target for government reduction: he would reduce its workforce and strip it of its fish and wildlife oversight.


title: Chris Christie

text: Christie has stated that he intends to simultaneously spur growth in the state's manufacturing sector and increase New Jersey's capability to produce alternative energy. He has proposed a list of policy measures to achieve this, including giving tax credits to businesses that build new wind energy and manufacturing facilities, changing land use rules to allow solar energy on permanently preserved farmland, installing solar farms on closed landfills, setting up a consolidated energy promotion program, and following a five-to-one production to non-production job ratio in the creation of new energy jobs. In August 2010, legislation to encourage the development of wind power in New Jersey was signed by Christie at the Port of Paulsboro. The "Offshore Wind Economic Development Act" authorized New Jersey Economic Development Authority to provide up to $100 million in tax credits for wind energy facilities. The governor has pledged to ban coal-fired power plants, and to reach 22.5% renewable generation in the state by 2021.


title: Chris Christie

text: On May 26, 2011, Christie announced he would pull the state out of Regional Greenhouse Gas Initiative. This was challenged in court which ruled in March 2014 that Christie had acted illegally in doing so since state regulations do not permit it. His administration sought to repeal the rules.


title: Chris Christie

text: Christie has rejected permanent bans on hydraulic fracturing (fracking) in New Jersey and vetoed measures that would ban the process and disposal of hydraulic fracturing waste in the State. New Jersey has few proven shale reserves and the process is not practiced there. Christie argued that the vetoed Senate Bill (S253) was premature because of an ongoing study to be completed in 2014 and would discriminate against other states, a violation of the Dormant Commerce Clause of the U.S. Constitution. Supporters of legislation have said that hydraulic fracturing waste from Pennsylvania makes its way into New Jersey for treatment, although how much is not clear. They also criticized Christie's legal analysis saying that the Office of Legislative Services has said that the bill is constitutional.


title: Chris Christie

text: Christie's settled a lawsuit with Exxon Mobil by allowing the corporation to pay $225 million in damages for environmental contamination at two sites, less than 3% of the $8.9 billion that the state's lawyers had sought, and extended the compensation to cover other damages not named in the original lawsuit. The settlement was slammed by environmental advocates. David Pringle, state campaign director of Clean Water Action, called it "the biggest corporate subsidy in state history," vowing to overturn it. Jeff Tittel of the Sierra Club called this move "a violation of the public trust." The New Jersey State Senate also condemned the deal, with state Senator Raymond Lesniak and others suggesting the decision was Christie's effort to plug his own budget shortfalls at the expense of taxpayers over the long term. ExxonMobil had donated $500,000 to the Republican Governors Association while Christie was chairman, though they have insisted it was unrelated to the ongoing suit. The previous gubernatorial administration, that of Democrat Jon Corzine, had also attempted to settle with Exxon, for $550 million, though this offer was made before a 2009 ruling that strengthened the state's bargaining position.


title: Chris Christie

text: In June 2013, Christie vetoed S1921, an animal welfare bill introduced by the Humane Society of the United States to prohibit the use of gestation crates on pregnant pigs in the state. The bill had passed in the General Assembly with a vote of 60–5 and the Senate 29–4. A 2013 survey by Mason-Dixon Polling & Research Inc. showed 91% of New Jersey voters supported the legislation. An attempt to override the veto did not come to a vote. In October 2014, a similar bill banning gestation crates, S998, was proposed with a vote in the Senate of 32–1 and in the Assembly of 53–13 (with 9 abstentions). While campaigning in Iowa in November, in a conversation with the former president of the Iowa Pork Producers Association, Christie indicated he would veto the bill. He did so on November 27, 2014. The bill's sponsor, Senator Raymond Lesniak, had vowed to override it.


title: Chris Christie

text: By tradition since the 1947 state constitution, the seven-member New Jersey Supreme Court maintains a political balance and is composed of four members of either the Democratic Party or Republican Party and three of the other. Christie broke with the tradition in May 2010 when he chose not to renominate Justice John E. Wallace Jr. While on the campaign trail, Christie had said the court "inappropriately encroached on both the executive and legislative function, and that if elected governor, [he] would take steps . . . to bring back an appropriate constitutional balance to the court."


title: Chris Christie

text: Over the course of his tenure, Christie had been in a major conflict with the New Jersey Legislature over the court's partisan balance. The stand-off between the governor and the New Jersey Senate resulted in longstanding vacancies, with temporarily assigned appellate judges filling in.


title: Chris Christie

text: In January 2013, Christie vetoed a New Jersey Legislature bill that would have raised the minimum wage from $7.25 to $8.50 per hour. The following November, the issue was placed on the ballot as a constitutional amendment referendum, passing with 61% of the vote.


title: Chris Christie

text: On September 21, 2012, Christie signed Assembly Bill No. 2647 (A-2647) into law that requires employers to post and distribute notice of employees' rights to gender-equal pay, but conditionally vetoed other gender parity bills, requesting revision.


title: Chris Christie

text: Christie emphasizes the need to secure the border, and believes it is premature to discuss legalization of people who came to the United States unlawfully. While serving as U.S. Attorney for the District of New Jersey, Christie stressed that simply "[b]eing in this country without proper documentation is not a crime," but rather a civil wrong; and that undocumented people are not criminals unless they have re-entered the country after being deported. As such, Christie stated, responsibility for dealing with improperly documented foreign nationals lies with U.S. Immigration and Customs Enforcement, not the U.S. Attorney's Office.


title: Chris Christie

text: Christie has been critical about section 287(g) of the Immigration and Nationality Act, enacted in 1996, which can be used to grant local law enforcement officers power to perform immigration law enforcement functions.


title: Chris Christie

text: In December 2013, Christie signed legislation allowing unauthorized immigrants who attend high school for at least three years in New Jersey and graduate to be eligible for the resident rates at state college and universities and community colleges.


title: Chris Christie

text: As governor, Christie opposed same-sex marriage but voiced support for New Jersey's civil union law, which extended to gay couples the same legal benefits of marriage with regards to state law. Christie indicated in 2009 that he would veto any bill legalizing same-sex marriage in the state, saying, "I also believe marriage should be exclusively between one man and one woman... If a bill legalizing same sex marriage came to my desk as Governor, I would veto it." On February 17, 2012, Christie vetoed a bill that would have legalized same-sex marriage in New Jersey. The bill passed by wide but not veto-proof margins in both houses of the legislature. Christie instead proposed that the issue be presented to the voters in a statewide ballot referendum.


title: Chris Christie

text: The issue was rendered moot shortly thereafter by a state court decision, in which the judge stated New Jersey was "... violating the mandate of Lewis and the New Jersey Constitution's equal protection guarantee". The Christie administration responded by asking the state Supreme Court to grant a stay of the decision pending appeal, which was denied on October 18, 2013, in a 7–0 decision of the court which stated that it could "find no public interest in depriving a group of New Jersey residents of their constitutional right to equal protection while the appeals process unfolds". Three days later Christie withdrew the state's appeal.


title: Chris Christie

text: Christie believes that homosexuality is innate, having said, "If someone is born that way, it's very difficult to say then that that's a sin." On August 19, 2013, Christie signed a bill outlawing gay conversion therapy for children, making New Jersey the second state to institute such a law. The law was challenged in the courts, with Christie, in his official capacity as governor, named an appellee.


title: Chris Christie

text: In September 2014, a panel of the 3rd U.S. Circuit Court of Appeals upheld the law, saying it did not violate free speech or religious rights.


title: Chris Christie

text: Early in his political career, Christie stated in an interview that "I would call myself … a kind of a non-thinking pro-choice person, kind of the default position". In 2009, Christie identified himself as anti-abortion, but stated that he would not use the governor's office to "force that down people's throats", while still expressing support for banning "partial-birth abortion", parental notification, and a 24-hour waiting period. He does support legal access to abortion in cases of rape, incest, or if the woman's life is in danger.