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Welcome to the latest edition of Investigative Roundup, highlighting some of the best investigative reporting on healthcare each week.

'Gaping Holes' in Maine Shooting Victims

Richard King, MD, the medical director for trauma at Central Maine Healthcare, told and the damage to patients shot in yet another mass shooting was like nothing he had ever seen before.

"This was the first time that I'd actually taken care of someone with high-velocity gunshot wounds," King told CBS News. "I'd read about them ... but to actually see them in person and see the destructive ability of those rounds was really quite sobering."

Unlike other gunshot wounds, King described the exit wounds from the high-powered rifle to CBS as "gaping holes," and injuries with "complete destruction of the surrounding tissue." When these rounds hit bone, for example, it can shatter and form a missile or projectile that causes more damage outside the bullet track.

King told Reuters that about 30 surgeons were on site within minutes of the first ambulance arriving. They rushed to stop the bleeding and treat about a dozen patients. They were concerned about running out of blood, but the hospital's program manager was able to quickly secure more units from nearby hospitals.

In total, 18 people were killed -- almost the average number of homicides in Maine for an entire year, according to Reuters.

The Rise of a Risky Hernia Repair

Surgeons may be endangering patients by performing a complex hernia repair surgery without the appropriate experience, or worse -- when a simpler procedure could have solved the problem, a investigation found.

The number of times doctors have billed Medicare for component separations rose 10-fold, to about 8,000, from 2006 to 2021, according to the Times. The procedure is difficult to master, but some doctors are teaching each other incorrect techniques, or teaching themselves from online videos, the investigation found.

Sometimes, surgeons go on to perform the surgery incorrectly -- for example, by cutting the wrong part of the muscle -- with steep consequences for patients, including muscle damage and additional hernias.

Michael Rosen, MD, of the Cleveland Clinic, was a pioneer of component separation -- but now he "counts that work among his biggest regrets because it encouraged surgeons to try the procedure when it wasn't appropriate," according to the investigation.

Another incentive for doing component separations is that they're reimbursed at a higher rate than the simpler hernia repair, the Times found. Medicare pays at least $2,450 for the procedure compared with $345 for regular hernia repair. Private insurers usually pay 2 to 3 times what Medicare does, the Times noted.

Research Publishing Shakeup Continues

The group cOAlition S, which has pushed forward a vision of scholarly publishing where authors have more control over their work and readers have open access to articles, has a new proposal that broadens its mission, according to .

The new plan would have all versions of an article, plus all of its peer review reports, to be published openly from the start -- and authors wouldn't pay any fees to do so, according to the report.

Known primarily for its first initiative called Plan S, cOAlition S has accelerated the open-access publishing movement. In 2018, it announced that all researchers it funded would have to make their papers open-access immediately upon publication. The group includes research funders such as Wellcome, the Bill & Melinda Gates Foundation, Howard Hughes Medical Institute, the WHO, and many European research councils.

The plan shook up the scholarly publishing world -- and many publishers, who stood to lose out on both research and publishing fees, added open-access options, Nature reported. The U.S. White House Office of Science and Technology Policy even announced that by the end of 2025, results from federally funded research must be available immediately.

But article-processing charges (APCs), which open-access journals still charge, and "transformative agreements" where universities and libraries pay a "fixed sum to enable affiliated researchers to publish work openly and read paywalled content," still pose a barrier to scholars with fewer resources, especially in low- or middle-income countries, the article stated.

The group's new proposal details new ways around APCs, long wait times during peer review, a lack of transparency around peer review, and pressure to publish in prestigious journals. In one model, researchers would post preprints openly while they submit their paper for review by academics, publishing revisions along the way. Only then would publishers or journals curate finished articles. In theory, the open lead-up process would allow readers to form their own judgement based on the work itself -- not just the journal name. Organizations, libraries, governments, and universities could together cover the costs, the article stated.

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