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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Supporters of the legislation by Sen. Jerry Hill, D-San Mateo, say the antibiotics are fed to mostly healthy animals such as cows, pigs and chickens to make them grow faster and prevent disease in crowded industrial farms.\u003c/p>\n\u003cp>Widespread use of antibiotics by humans and animals reduce their effectiveness in treating illnesses because the diseases adapt by mutating, creating superbugs. Once-treatable illnesses can become dangerous infections when antibiotics are no longer effective.\u003c/p>\n\u003cp>“The lifesaving potential of antibiotics is quickly diminishing, and people are dying because the drugs are less effective,” Hill said in a statement.\u003c/p>\n\u003cp>Opponents argued that the California legislation does not go far enough to restrict preventive or routine use of antimicrobial drugs. Groups such as the California Cattlemen’s Association remained neutral on the bill.\u003c/p>\n\u003cp>Michael Hansen, a senior scientist at Consumers Union, the policy division of Consumer Reports, said many companies have voluntarily agreed to stop using antibiotics to promote growth after guidance from the Food and Drug Administration.\u003c/p>\n\u003cp>“No state yet has been able to pass a bill that is stronger than the one in California, and the fact that California is an important ag state, that makes this an important action,” Hansen said.\u003c/p>\n\u003cp>The antibiotics are different from the growth hormones used by many food producers that have drawn criticism and that some grocery stores and food chains have phased out. Companies including McDonald’s, Chipotle and Panera also have begun promoting their chicken as raised without antibiotics.\u003c/p>\n\u003cp>Brown, a Democrat, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/10/02/why-advocates-say-browns-veto-of-livestock-antibiotics-bill-is-a-good-thing/\" target=\"_blank\" rel=\"noopener\">vetoed a weaker version\u003c/a> of the bill last year, urging the state Department of Food and Agriculture to work with lawmakers on the issue. \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/09/16/bill-making-california-toughest-in-u-s-on-livestock-antibiotics-now-up-to-governor/\" target=\"_blank\" rel=\"noopener\">His office helped make changes\u003c/a> to this year’s measure to strengthen protections against using antibiotics to prevent disease.\u003c/p>\n\u003cp>The bill allows exemptions when a licensed veterinarian determines antimicrobial drugs are needed to treat a disease or infection, to control the spread of a disease, or in relation to surgery or a medical procedure, according to an analysis prepared for the Legislature.\u003c/p>\n\u003cp>The California Veterinary Medical Association expressed concern that veterinarians might not be able to prescribe the drugs preventively to treat diseases for which there is no test available to determine which animals are carriers.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The law, which takes effect in 2018, also eliminates the availability of livestock antibiotics for over-the-counter sales.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>The state Legislature will reconsider a bill Wednesday that would regulate e-cigarettes the same as tobacco, one day after \u003ca href=\"http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2015.8950\">a new study\u003c/a> was released that shows 14-year-olds who’ve tried e-cigarettes are four times more likely to try other tobacco products.\u003c/p>\n\u003cp>The study, published in the \u003ca href=\"http://Journal%20of%20the%20American%20Medical%20Association\">Journal of the American Medical Association\u003c/a> Tuesday, finds teenagers who have used e-cigarettes are more likely to at least sample tobacco cigarettes, cigars or hookahs, said co-author Adam Leventhal, associate professor and director of the USC Health, Emotion, & Addiction Laboratory at the Keck School of Medicine.\u003c/p>\n\u003cp>[soundcloud url=”https://api.soundcloud.com/tracks/219969068″ params=”color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false” width=”100%” height=”166″ iframe=”true” /]\u003c/p>\n\u003cp>The researchers surveyed 2,530 ninth graders at 10 Los Angeles high schools over the course of a year. Their study builds upon other research that has also found possible links between e-cigarettes and tobacco; the authors cautioned, however, that they did not determine a causal link between trying e-cigarettes and sampling tobacco ones, and called for more research on that question.\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.scpr.org/news/2015/08/18/53830/state-lawmakers-mull-e-cig-rules-as-new-study-sugg//\">Read the full story via KPCC\u003c/a>\u003c/em>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The state Legislature will reconsider a bill Wednesday that would regulate e-cigarettes the same as tobacco, one day after \u003ca href=\"http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2015.8950\">a new study\u003c/a> was released that shows 14-year-olds who’ve tried e-cigarettes are four times more likely to try other tobacco products.\u003c/p>\n\u003cp>The study, published in the \u003ca href=\"http://Journal%20of%20the%20American%20Medical%20Association\">Journal of the American Medical Association\u003c/a> Tuesday, finds teenagers who have used e-cigarettes are more likely to at least sample tobacco cigarettes, cigars or hookahs, said co-author Adam Leventhal, associate professor and director of the USC Health, Emotion, & Addiction Laboratory at the Keck School of Medicine.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='”100%”' height='”166″'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=”https://api.soundcloud.com/tracks/219969068″&visual=true&”color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false”'\n title='”https://api.soundcloud.com/tracks/219969068″'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The researchers surveyed 2,530 ninth graders at 10 Los Angeles high schools over the course of a year. Their study builds upon other research that has also found possible links between e-cigarettes and tobacco; the authors cautioned, however, that they did not determine a causal link between trying e-cigarettes and sampling tobacco ones, and called for more research on that question.\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.scpr.org/news/2015/08/18/53830/state-lawmakers-mull-e-cig-rules-as-new-study-sugg//\">Read the full story via KPCC\u003c/a>\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"title": "Even With Insurance, Medicaid Recipients Still Go to ER for Dental Problems",
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"content": "\u003cp>States that provide Medicaid adult dental care still have high rates of dental patients who show up at hospital emergency departments, particularly in urban underserved areas, according to a \u003ca href=\"https://med.stanford.edu/news/all-news/2015/08/medicaid-dental-coverage-may-not-prevent-tooth-related-er-visits.html\" target=\"_blank\" rel=\"noopener\">study released this week\u003c/a>. The study — by researchers at Stanford University, UC San Francisco, Truven Health Analytics and the federal Agency for Healthcare Research and Quality — was published in \u003cem>\u003ca href=\"http://content.healthaffairs.org/content/34/8/1349.abstract?=right\" target=\"_blank\" rel=\"noopener\">Health Affairs\u003c/a>\u003c/em>.\u003c/p>\n\u003caside class=\"pullquote alignright\">“People say there are plenty of dentists, but there’s a subtler argument we’re trying to make: that there is a low rate of dentists who take Medicaid.”\u003c/aside>\n\u003cp>Researchers said a dearth of dental providers who accept Medicaid patients, particularly in those urban underserved areas, has limited the effectiveness of Medicaid dental coverage in states that provide it.\u003c/p>\n\u003cp>“We found that, in urban counties there were large concentrations of all providers, but not really to serve the poor,” said Maria Raven, senior author of the study and associate professor of emergency medicine at UCSF.\u003c/p>\n\u003cp>“There may be a higher density of dentists [in urban areas], but they’re still not accepting Medi-Cal patients,” Raven said. “Coverage doesn’t equal access.”\u003c/p>\n\u003cp>That has resulted in high ED use even in states with Medicaid dental coverage, she said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Medi-Cal is California’s Medicaid program, and it did not have adult dental coverage in 2010, when the study’s data were collected.\u003c/p>\n\u003cp>Katie Fingar, lead author of the study and research leader in health care at Truven, said the numbers were slightly better in rural areas.\u003c/p>\n\u003cp>“We did see that for those in rural areas, a greater supply [of dental providers] was associated with lower ED use,” Fingar said. But, she said, 90 percent of Medicaid dental visits are in urban areas.\u003c/p>\n\u003cp>[contextly_sidebar id=”sT9KtJ06HSo5xPfgl6TvmZCmlYYDZAHP”]As a result, she said, more than 2 percent of all emergency department visits are related to non-traumatic dental conditions.\u003c/p>\n\u003cp>In April, the American Dental Association released \u003ca href=\"http://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_0415_2.ashx\" target=\"_blank\" rel=\"noopener\">a similar study\u003c/a> that drew similar conclusions.\u003c/p>\n\u003cp>“One of the important things about the study we did is we looked at provider density,” Raven said. “People say there are plenty of dentists, but there’s a subtler argument we’re trying to make, that there is a low rate of dentists who take Medicaid.”\u003c/p>\n\u003cp>Provider rates in California are among the lowest Medicaid rates in the nation, she said, but care can still be worked out in underserved urban areas, such as the use of mid-level dental providers — or getting more dentists to see Medi-Cal patients.\u003c/p>\n\u003cp>“It’s too bad provider rates aren’t higher,” she said, “but everyone needs to pitch in. Coverage is a necessity, but you have to pair it with providers.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>David Gorn is a senior reporter with \u003ca href=\"http://www.californiahealthline.org\" target=\"_blank\" rel=\"noopener\">California Healthline. \u003c/a>\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>States that provide Medicaid adult dental care still have high rates of dental patients who show up at hospital emergency departments, particularly in urban underserved areas, according to a \u003ca href=\"https://med.stanford.edu/news/all-news/2015/08/medicaid-dental-coverage-may-not-prevent-tooth-related-er-visits.html\" target=\"_blank\" rel=\"noopener\">study released this week\u003c/a>. The study — by researchers at Stanford University, UC San Francisco, Truven Health Analytics and the federal Agency for Healthcare Research and Quality — was published in \u003cem>\u003ca href=\"http://content.healthaffairs.org/content/34/8/1349.abstract?=right\" target=\"_blank\" rel=\"noopener\">Health Affairs\u003c/a>\u003c/em>.\u003c/p>\n\u003caside class=\"pullquote alignright\">“People say there are plenty of dentists, but there’s a subtler argument we’re trying to make: that there is a low rate of dentists who take Medicaid.”\u003c/aside>\n\u003cp>Researchers said a dearth of dental providers who accept Medicaid patients, particularly in those urban underserved areas, has limited the effectiveness of Medicaid dental coverage in states that provide it.\u003c/p>\n\u003cp>“We found that, in urban counties there were large concentrations of all providers, but not really to serve the poor,” said Maria Raven, senior author of the study and associate professor of emergency medicine at UCSF.\u003c/p>\n\u003cp>“There may be a higher density of dentists [in urban areas], but they’re still not accepting Medi-Cal patients,” Raven said. “Coverage doesn’t equal access.”\u003c/p>\n\u003cp>That has resulted in high ED use even in states with Medicaid dental coverage, she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Medi-Cal is California’s Medicaid program, and it did not have adult dental coverage in 2010, when the study’s data were collected.\u003c/p>\n\u003cp>Katie Fingar, lead author of the study and research leader in health care at Truven, said the numbers were slightly better in rural areas.\u003c/p>\n\u003cp>“We did see that for those in rural areas, a greater supply [of dental providers] was associated with lower ED use,” Fingar said. But, she said, 90 percent of Medicaid dental visits are in urban areas.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>As a result, she said, more than 2 percent of all emergency department visits are related to non-traumatic dental conditions.\u003c/p>\n\u003cp>In April, the American Dental Association released \u003ca href=\"http://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_0415_2.ashx\" target=\"_blank\" rel=\"noopener\">a similar study\u003c/a> that drew similar conclusions.\u003c/p>\n\u003cp>“One of the important things about the study we did is we looked at provider density,” Raven said. “People say there are plenty of dentists, but there’s a subtler argument we’re trying to make, that there is a low rate of dentists who take Medicaid.”\u003c/p>\n\u003cp>Provider rates in California are among the lowest Medicaid rates in the nation, she said, but care can still be worked out in underserved urban areas, such as the use of mid-level dental providers — or getting more dentists to see Medi-Cal patients.\u003c/p>\n\u003cp>“It’s too bad provider rates aren’t higher,” she said, “but everyone needs to pitch in. Coverage is a necessity, but you have to pair it with providers.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>David Gorn is a senior reporter with \u003ca href=\"http://www.californiahealthline.org\" target=\"_blank\" rel=\"noopener\">California Healthline. \u003c/a>\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Jane Lazarre was pacing the hospital waiting room. Her son Khary, 18, had just come out of surgery, but the nurses weren’t letting her in to see him.\u003c/p>\n\u003cp>“They told us he would be out of anesthesia in a few minutes. He never came out,” she remembers. “The minutes became an hour, the hour became two hours.\"\u003c/p>\n\u003cp>She and her husband became more and more frightened. It was just a routine knee operation. Lazarre asked the nurses what was going on.\u003c/p>\n\u003cp>“They said Khary was having ‘trouble’ coming out of anesthesia,” Lazarre says.\u003c/p>\n\u003cp>[contextly_sidebar id=\"5CcxiB3p3cQnSCBTfP2Io8rKbmuM99t7\"]They called the surgeon in a panic. He went to check on their son and said that Khary had come out of anesthesia violently -- thrashing and flailing about. He told Lazarre that with most young people his age, there wouldn't have been a problem. The doctors and nurses would have gently held him down.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“But with our son, since he was so quote ‘large and powerful’ they were worried he might injure the medical staff. So they had to keep sending him back under the anesthesia,” Lazarre says.\u003c/p>\n\u003cp>Khary was 6 feet tall. But he was slim.\u003c/p>\n\u003cp>“He wasn't the giant they were describing him as,” Lazarre says.\u003c/p>\n\u003cp>\u003cstrong>Baby or 'Militant Black Panther'?\u003c/strong>\u003c/p>\n\u003cp>She pauses. Lazarre is white. Her husband is black. She says she started learning the role race would play in her sons’ lives the day her older son, Adam, was born.\u003c/p>\n\u003cp>“He was a tiny little 6 pound baby. The nurses were white,” she says. “And whenever he cried, they would refer to him as the militant Black Panther.”\u003c/p>\n\u003cp>Lazarre says there’s no doubt in her mind that what happened with Khary and his knee surgery was because of race.\u003c/p>\n\u003cp>[contextly_sidebar id=\"ogqQe7sYg9ub49AojFMaeMDBUcoZMN88\"]\u003c/p>\n\u003cp>“I understood, certainly not for the first time, that my son, and my sons both, were viewed as being dangerous, being potentially frightening to people who were white,” she says, adding that it was likely the surgeon didn’t see it that way. “Like most white people, I don't think he was conscious of it at all.”\u003c/p>\n\u003cp>Lazarre and her husband insisted on seeing Khary.\u003c/p>\n\u003cp>“And he was indeed obviously agitated, and flailing about, covering his head with his arms,” she says. “And we saw right away that he was scared, not angry or violent.”\u003c/p>\n\u003cp>He was scared. Lazarre and her husband leaned over and whispered in Khary’s ear: “’It’s going to be okay, you can calm down.’ And he began coming out of the anesthesia more normally.”\u003c/p>\n\u003cp>Lazarre wrote about this experience in \u003ca href=\"https://www.dukeupress.edu/Beyond-The-Whiteness-of-Whiteness.html\" target=\"_blank\">her book\u003c/a> “Beyond the Whiteness of Whiteness: Memoir of a White Mother of Black Sons.” It will be republished in a new 20th anniversary edition next year with a new preface from Lazarre. She says there's still so much that hasn't changed.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/217606517\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>\u003cb>Disparities Persist\u003c/b>\u003c/p>\n\u003cp>Even as \u003ca href=\"http://www.ncbi.nlm.nih.gov/books/NBK114236/\" target=\"_blank\">health overall\u003c/a> has improved in the U.S., the \u003ca href=\"http://www.nap.edu/openbook.php?record_id=12875&page=R1\" target=\"_blank\">disparities in treatment and outcomes\u003c/a> between white patients, and black and Latino patients, are almost as big as they were 50 years ago. A growing body of research suggests that doctors’ unconscious behaviors play a role in these statistics, and the Institute of Medicine \u003ca href=\"https://iom.nationalacademies.org/~/media/Files/Report%20Files/2003/Unequal-Treatment-Confronting-Racial-and-Ethnic-Disparities-in-Health-Care/Disparitieshcproviders8pgFINAL.pdf\" target=\"_blank\">has called for more studies\u003c/a> looking at discrimination and prejudice.\u003c/p>\n\u003cp>\u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJM199902253400806#t=articleResults\" target=\"_blank\">One study\u003c/a> found that doctors were far less likely to refer black women for advanced cardiac care than white men with identical symptoms. \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448154/#r3\" target=\"_blank\">Other studies\u003c/a> show that African Americans and \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/8445817\" target=\"_blank\">Latino patients\u003c/a> are often prescribed less pain medication than white patients with the same complaints.\u003c/p>\n\u003cp>“We know that doctors spend more time with white patients than with patients of color,” says Howard Ross, founder of management consulting firm Cook Ross.\u003c/p>\n\u003cp>He’s developed a new diversity training curriculum for health care professionals that focuses on the role of unconscious bias in these scenarios.\u003c/p>\n\u003cp>Doctors and nurses don’t mean to treat people differently, Ross says. But, just like police, they harbor stereotypes that they’re not aware they have. Everybody does.\u003c/p>\n\u003cp>“This is normal human behavior,” Ross says. “We can no more stop having bias than we can stop breathing.\"\u003c/p>\n\u003cp>\u003ca href=\"http://spottheblindspot.com/\" target=\"_blank\">Unconscious biases\u003c/a> often surface when we’re multitasking or when we’re stressed. They come up in tense situations where we don’t have time to think. Like police on the street at night who have to decide quickly if a person is reaching for a wallet, or a gun. It’s similar for doctors in the hospital.\u003c/p>\n\u003cp>“You’re dealing with people who are frightened, they’re reactive,” Ross says. “If you’re doing triage in the Emergency Room, for example, you don’t have time to sit back and contemplate, ‘why am I thinking about this,’ You have to instantaneously react.”\u003c/p>\n\u003cp>Doctors are trained to think fast, and to be confident in their decisions.\u003c/p>\n\u003cp>“There’s almost a trained arrogance,” Ross says.\u003c/p>\n\u003cp>This leads to treatments prescribed based on snap judgments, which can reveal internalized stereotypes. A doctor sees one black patient who doesn’t take his medication, perhaps because he can’t afford it. Without realizing it, the doctor starts to assume that all black patients aren’t going to follow instructions.\u003c/p>\n\u003cp>“We’re taught to learn things in a way that involves pattern recognition,” says Rene Salazar, a doctor and professor at UC-San Francisco Medical School. He says he’s fallen prey to his own biases in the exam room.\u003c/p>\n\u003cp>“These preconceived ideas that because someone is from a certain class or a certain background that they’re going to want pain medication for a particular reason that’s not related to your pain,” he says, is one example.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Salazar did a training with Howard Ross’ firm to get a handle on his unconscious biases. Now he teaches a similar course to all new students at the medical school at UCSF, so they can catch their biases early. Learn how they do that tomorrow, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/08/04/ucsf-doctors-students-confront-their-own-unconscious-bias/\" target=\"_blank\">in Part 2 of this story\u003c/a>.\u003c/p>\n\n",
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"excerpt": "A mother found out first-hand when her 18-year-old son had \"trouble\" coming out of anesthesia after knee surgery.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Jane Lazarre was pacing the hospital waiting room. Her son Khary, 18, had just come out of surgery, but the nurses weren’t letting her in to see him.\u003c/p>\n\u003cp>“They told us he would be out of anesthesia in a few minutes. He never came out,” she remembers. “The minutes became an hour, the hour became two hours.\"\u003c/p>\n\u003cp>She and her husband became more and more frightened. It was just a routine knee operation. Lazarre asked the nurses what was going on.\u003c/p>\n\u003cp>“They said Khary was having ‘trouble’ coming out of anesthesia,” Lazarre says.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>They called the surgeon in a panic. He went to check on their son and said that Khary had come out of anesthesia violently -- thrashing and flailing about. He told Lazarre that with most young people his age, there wouldn't have been a problem. The doctors and nurses would have gently held him down.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“But with our son, since he was so quote ‘large and powerful’ they were worried he might injure the medical staff. So they had to keep sending him back under the anesthesia,” Lazarre says.\u003c/p>\n\u003cp>Khary was 6 feet tall. But he was slim.\u003c/p>\n\u003cp>“He wasn't the giant they were describing him as,” Lazarre says.\u003c/p>\n\u003cp>\u003cstrong>Baby or 'Militant Black Panther'?\u003c/strong>\u003c/p>\n\u003cp>She pauses. Lazarre is white. Her husband is black. She says she started learning the role race would play in her sons’ lives the day her older son, Adam, was born.\u003c/p>\n\u003cp>“He was a tiny little 6 pound baby. The nurses were white,” she says. “And whenever he cried, they would refer to him as the militant Black Panther.”\u003c/p>\n\u003cp>Lazarre says there’s no doubt in her mind that what happened with Khary and his knee surgery was because of race.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“I understood, certainly not for the first time, that my son, and my sons both, were viewed as being dangerous, being potentially frightening to people who were white,” she says, adding that it was likely the surgeon didn’t see it that way. “Like most white people, I don't think he was conscious of it at all.”\u003c/p>\n\u003cp>Lazarre and her husband insisted on seeing Khary.\u003c/p>\n\u003cp>“And he was indeed obviously agitated, and flailing about, covering his head with his arms,” she says. “And we saw right away that he was scared, not angry or violent.”\u003c/p>\n\u003cp>He was scared. Lazarre and her husband leaned over and whispered in Khary’s ear: “’It’s going to be okay, you can calm down.’ And he began coming out of the anesthesia more normally.”\u003c/p>\n\u003cp>Lazarre wrote about this experience in \u003ca href=\"https://www.dukeupress.edu/Beyond-The-Whiteness-of-Whiteness.html\" target=\"_blank\">her book\u003c/a> “Beyond the Whiteness of Whiteness: Memoir of a White Mother of Black Sons.” It will be republished in a new 20th anniversary edition next year with a new preface from Lazarre. She says there's still so much that hasn't changed.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/217606517&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/217606517'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003cb>Disparities Persist\u003c/b>\u003c/p>\n\u003cp>Even as \u003ca href=\"http://www.ncbi.nlm.nih.gov/books/NBK114236/\" target=\"_blank\">health overall\u003c/a> has improved in the U.S., the \u003ca href=\"http://www.nap.edu/openbook.php?record_id=12875&page=R1\" target=\"_blank\">disparities in treatment and outcomes\u003c/a> between white patients, and black and Latino patients, are almost as big as they were 50 years ago. A growing body of research suggests that doctors’ unconscious behaviors play a role in these statistics, and the Institute of Medicine \u003ca href=\"https://iom.nationalacademies.org/~/media/Files/Report%20Files/2003/Unequal-Treatment-Confronting-Racial-and-Ethnic-Disparities-in-Health-Care/Disparitieshcproviders8pgFINAL.pdf\" target=\"_blank\">has called for more studies\u003c/a> looking at discrimination and prejudice.\u003c/p>\n\u003cp>\u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJM199902253400806#t=articleResults\" target=\"_blank\">One study\u003c/a> found that doctors were far less likely to refer black women for advanced cardiac care than white men with identical symptoms. \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448154/#r3\" target=\"_blank\">Other studies\u003c/a> show that African Americans and \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/8445817\" target=\"_blank\">Latino patients\u003c/a> are often prescribed less pain medication than white patients with the same complaints.\u003c/p>\n\u003cp>“We know that doctors spend more time with white patients than with patients of color,” says Howard Ross, founder of management consulting firm Cook Ross.\u003c/p>\n\u003cp>He’s developed a new diversity training curriculum for health care professionals that focuses on the role of unconscious bias in these scenarios.\u003c/p>\n\u003cp>Doctors and nurses don’t mean to treat people differently, Ross says. But, just like police, they harbor stereotypes that they’re not aware they have. Everybody does.\u003c/p>\n\u003cp>“This is normal human behavior,” Ross says. “We can no more stop having bias than we can stop breathing.\"\u003c/p>\n\u003cp>\u003ca href=\"http://spottheblindspot.com/\" target=\"_blank\">Unconscious biases\u003c/a> often surface when we’re multitasking or when we’re stressed. They come up in tense situations where we don’t have time to think. Like police on the street at night who have to decide quickly if a person is reaching for a wallet, or a gun. It’s similar for doctors in the hospital.\u003c/p>\n\u003cp>“You’re dealing with people who are frightened, they’re reactive,” Ross says. “If you’re doing triage in the Emergency Room, for example, you don’t have time to sit back and contemplate, ‘why am I thinking about this,’ You have to instantaneously react.”\u003c/p>\n\u003cp>Doctors are trained to think fast, and to be confident in their decisions.\u003c/p>\n\u003cp>“There’s almost a trained arrogance,” Ross says.\u003c/p>\n\u003cp>This leads to treatments prescribed based on snap judgments, which can reveal internalized stereotypes. A doctor sees one black patient who doesn’t take his medication, perhaps because he can’t afford it. Without realizing it, the doctor starts to assume that all black patients aren’t going to follow instructions.\u003c/p>\n\u003cp>“We’re taught to learn things in a way that involves pattern recognition,” says Rene Salazar, a doctor and professor at UC-San Francisco Medical School. He says he’s fallen prey to his own biases in the exam room.\u003c/p>\n\u003cp>“These preconceived ideas that because someone is from a certain class or a certain background that they’re going to want pain medication for a particular reason that’s not related to your pain,” he says, is one example.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Salazar did a training with Howard Ross’ firm to get a handle on his unconscious biases. Now he teaches a similar course to all new students at the medical school at UCSF, so they can catch their biases early. Learn how they do that tomorrow, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/08/04/ucsf-doctors-students-confront-their-own-unconscious-bias/\" target=\"_blank\">in Part 2 of this story\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Millions of Americans Use Medical Devices That May Be Vulnerable to Hacking",
"title": "Millions of Americans Use Medical Devices That May Be Vulnerable to Hacking",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>\u003cstrong>Listen to the story:\u003c/strong>\u003cbr>\nhttp://www.kqed.org/.stream/anon/radio/science/2015/08/20150803ScienceMedicaldeviceshacking.mp3\u003cbr>\nYou have passwords for your smart phone and laptop, but what about your pacemaker or insulin pump?\u003c/p>\n\u003cp>Last Friday, the federal \u003ca href=\"http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm456815.htm\">Food and Drug Administration recommended\u003c/a> that all hospitals in California and across the country stop using a medical device that it says is vulnerable to cyber attacks.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Someone will find a reason to change a counter on an insulin pump or take over a defibrillator just because they can.'\u003ccite>Jamie Court,\u003cbr>\nConsumer Watchdog president\u003c/cite>\u003c/aside>\n\u003cp>The device is an infusion pump that delivers medications or nutrients to patients. A hacker who accessed it could change the drug dosage to give a patient not enough -- or a lethal amount.\u003c/p>\n\u003cp>California security expert Billy Rios says he identified the problem \u003ca href=\"http://xs-sniper.com/blog/\" target=\"_blank\">more than a year ago\u003c/a> and notified the FDA and the Department of Homeland Security.\u003c/p>\n\u003cp>\"Some of these pumps are really dangerous,\" says Rios, who founded digital security company Laconicly. \"If we ever gain access to a hospital network and we know of a vulnerability affecting a particular device, what that really means is we can go from one location and touch one hundred different devices all at once.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>These pumps are not the only medical devices vulnerable to hacking. More than 10 million Americans rely on devices like pacemakers and defibrillators.\u003c/p>\n\u003cp>https://youtu.be/MmQZIRJPfLM\u003c/p>\n\u003cp>\u003cspan style=\"font-size: medium\">(Cyber security expert Billy Rios remotely hacks into Hospira’s Symbiq infusion pump, which the FDA has encouraged all medical centers to stop using .)\u003c/span>\u003c/p>\n\u003cp>If you are a fan of the Showtime television series \u003ca href=\"https://vimeo.com/63176830\">Homeland\u003c/a>, you may remember an episode where assassins killed the vice president by hacking into his pacemaker and disabling it.\u003c/p>\n\u003cp>This episode wasn’t just Hollywood making up stuff. Former Vice President Dick Cheney was so \u003ca href=\"http://abcnews.go.com/US/vice-president-dick-cheney-feared-pacemaker-hacking/story?id=20621434\">afraid of a cyber attack on his own pacemaker\u003c/a> that he had the wireless feature on it disabled.\u003c/p>\n\u003cp>As technology has become more connected, so have medical devices. While some, like pacemakers, can only send information, others, can send and receive data.\u003c/p>\n\u003cp>And that leaves some patients vulnerable to a hacker trying to harm them or use their device as a portal to access medical data.\u003c/p>\n\u003cp>\"All the tools that are required to do software debugging, to get software off of chips and basically to do hardware hacking,\" Rios says, \"it’s become available to just any person.\"\u003c/p>\n\u003caside class=\"pullquote alignleft\">'My biggest fear is that somebody will take out a large number of devices across an institution.'\u003ccite>Kevin McDonald,\u003cbr>\nClinical Information Security Director\u003cbr>\nMayo Clinic\u003c/cite>\u003c/aside>\n\u003cp>As a benign or “white hat” hacker, Rios does research in his Half Moon Bay garage to help the Department of Homeland Security.\u003c/p>\n\u003cp>He proved he could remotely administer a lethal dose of drugs through a patient’s insulin pump. He has also hacked pre-programmed passwords from hundreds of devices. He and his colleague were able to figure out the passwords after acquiring embedded software and technical manuals from several vendors.\u003c/p>\n\u003cp>\"We knew what those 300 passwords were,\" Rios says. \"We could go to any device we wanted to and we had a set of usernames and passwords that would work against all these devices, and so that was pretty alarming.\"\u003c/p>\n\u003cp>The Food and Drug Administration, which regulates the sale of medical devices, has been issuing formal guidelines on the issue.\u003c/p>\n\u003cp>Suzanne Schwartz is the FDA’s Director of Emergency Preparedness. Last year, she helped publish \u003ca href=\"http://www.fda.gov/ucm/groups/fdagov-public/@fdagov-meddev-gen/documents/document/ucm356190.pdf\">new recommendations\u003c/a> for how medical device makers should take cyber-security attacks into account.\u003c/p>\n\u003cfigure id=\"attachment_19957\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/07/Implantable-medical-devices_graphic_WHITE.jpg\">\u003cimg class=\"size-medium wp-image-19957\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/07/Implantable-medical-devices_graphic_WHITE-800x567.jpg\" alt=\"Many there are many implantable medical devices on the market that have vulnerabilities, in fact, the Food and Drug Administration has received approximately 56,000 reports of adverse events associated with the use of infusion pumps, including numerous injuries and deaths. \" width=\"800\" height=\"567\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/07/Implantable-medical-devices_graphic_WHITE-800x567.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/07/Implantable-medical-devices_graphic_WHITE-400x283.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/07/Implantable-medical-devices_graphic_WHITE-1180x836.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/07/Implantable-medical-devices_graphic_WHITE-960x680.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2015/07/Implantable-medical-devices_graphic_WHITE.jpg 1493w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">There are many implantable medical devices on the market that have vulnerabilities, in fact, the Food and Drug Administration has received approximately 56,000 reports of adverse events associated with the use of infusion pumps, including numerous injuries and deaths. \u003ccite>(Massachusetts Institute of Technology)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"That is something, yes, that we continuously monitor and it’s something important that we want to hear about,\" Schwartz says, \"whether it’s directly from the healthcare organizations or from the medical device manufacturers.\"\u003c/p>\n\u003cp>But Consumer Watchdog president Jamie Court says the FDA’s guidelines for medical devices fall short. He says what's needed is a law -- not recommendations -- requiring medical manufacturers and hospitals to upgrade systems to prevent cyber attacks.\u003c/p>\n\u003cp>\"The reality is if they don’t someone is going to die,\" Court says. \"Because it’s not safe. Someone will find a reason to change a counter on an insulin pump or take over a defibrillator just because they can.\"\u003c/p>\n\u003cp>Without legally binding rules, medical device security is left in the hands of hospitals and device makers. And they are required to report device malfunctions only if patients are injured or they die.\u003c/p>\n\u003cp>Medtronic, the nation's largest medical device manufacturer, has not reported any incidents so far.\u003c/p>\n\u003cp>The company declined to be interviewed and sent KQED a statement saying it aims to manufacture products that are as safe and secure as possible.\u003c/p>\n\u003cfigure id=\"attachment_19938\" class=\"wp-caption alignleft\" style=\"max-width: 800px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/07/Kevin-McDonald_Mayo-Clinic_photo.jpg\">\u003cimg class=\"size-medium wp-image-19938\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/07/Kevin-McDonald_Mayo-Clinic_photo-800x600.jpg\" alt=\"Clinical Information Security Director Kevin McDonald (left) at Mayo Clinic in Minnesota leads a team checking medical devices for software vulnerabilities that could cause a device to be infected with malware or exploited by hackers.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/07/Kevin-McDonald_Mayo-Clinic_photo-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/07/Kevin-McDonald_Mayo-Clinic_photo-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/07/Kevin-McDonald_Mayo-Clinic_photo-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/07/Kevin-McDonald_Mayo-Clinic_photo-1920x1440.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2015/07/Kevin-McDonald_Mayo-Clinic_photo-960x720.jpg 960w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Clinical Information Security Director Kevin McDonald (left) at Mayo Clinic in Minnesota leads a team checking medical devices for software vulnerabilities that could cause a device to be infected with malware or exploited by hackers. \u003ccite>(Mayo Clinic)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But Mayo Clinic cyber security expert Kevin McDonald says, while they haven't been catastrophic, some incidents have already occurred.\u003c/p>\n\u003cp>\"Back in 2010,\" he says, \"there was a heart catheterization lab out on the East Coast, that, because of some malware viruses, was put out of business for about three days. So they had to divert their patients to other places.\"\u003c/p>\n\u003cp>McDonald leads a team that’s trying to prevent harmful medical incidents.\u003c/p>\n\u003cp>\"My biggest fear,\" he says, \"is that somebody will take out a large number of devices across an institution.\"\u003c/p>\n\u003cp>To increase patient safety, the Mayo Clinic brought in researchers to analyze some of the devices it uses. It then reported vulnerabilities to the manufacturers.\u003c/p>\n\u003cp>But cyber security expert Rios says no matter what precautions one takes, medical devices are imperfect and will always need monitoring.\u003c/p>\n\u003cp>\"At the end of the day, at the core of it, it's really just a computer,\" he says. \"It's a processor and it's software that someone wrote. And so we can't treat those devices as if they're magical devices; they're not magical devices.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>While last year the FDA issued guidelines for the manufacture of these devices, this year the agency is expected to \u003ca href=\"http://blogs.fda.gov/fdavoice/index.php/2015/02/moving-toward-a-national-medical-device-postmarket-surveillance-system/\">release additional guidelines\u003c/a> for how companies should update the devices’ software after they’re on the market.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>Listen to the story:\u003c/strong>\u003cbr>\nhttp://www.kqed.org/.stream/anon/radio/science/2015/08/20150803ScienceMedicaldeviceshacking.mp3\u003cbr>\nYou have passwords for your smart phone and laptop, but what about your pacemaker or insulin pump?\u003c/p>\n\u003cp>Last Friday, the federal \u003ca href=\"http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm456815.htm\">Food and Drug Administration recommended\u003c/a> that all hospitals in California and across the country stop using a medical device that it says is vulnerable to cyber attacks.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Someone will find a reason to change a counter on an insulin pump or take over a defibrillator just because they can.'\u003ccite>Jamie Court,\u003cbr>\nConsumer Watchdog president\u003c/cite>\u003c/aside>\n\u003cp>The device is an infusion pump that delivers medications or nutrients to patients. A hacker who accessed it could change the drug dosage to give a patient not enough -- or a lethal amount.\u003c/p>\n\u003cp>California security expert Billy Rios says he identified the problem \u003ca href=\"http://xs-sniper.com/blog/\" target=\"_blank\">more than a year ago\u003c/a> and notified the FDA and the Department of Homeland Security.\u003c/p>\n\u003cp>\"Some of these pumps are really dangerous,\" says Rios, who founded digital security company Laconicly. \"If we ever gain access to a hospital network and we know of a vulnerability affecting a particular device, what that really means is we can go from one location and touch one hundred different devices all at once.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>These pumps are not the only medical devices vulnerable to hacking. More than 10 million Americans rely on devices like pacemakers and defibrillators.\u003c/p>\u003c/p>\u003cp>\u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutube'>\n \u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutubeInside'>\n \u003ciframe\n loading='lazy'\n class='utils-parseShortcode-shortcodes-__youtubeShortcode__youtubePlayer'\n type='text/html'\n src='//www.youtube.com/embed/MmQZIRJPfLM'\n title='//www.youtube.com/embed/MmQZIRJPfLM'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>\u003cspan style=\"font-size: medium\">(Cyber security expert Billy Rios remotely hacks into Hospira’s Symbiq infusion pump, which the FDA has encouraged all medical centers to stop using .)\u003c/span>\u003c/p>\n\u003cp>If you are a fan of the Showtime television series \u003ca href=\"https://vimeo.com/63176830\">Homeland\u003c/a>, you may remember an episode where assassins killed the vice president by hacking into his pacemaker and disabling it.\u003c/p>\n\u003cp>This episode wasn’t just Hollywood making up stuff. Former Vice President Dick Cheney was so \u003ca href=\"http://abcnews.go.com/US/vice-president-dick-cheney-feared-pacemaker-hacking/story?id=20621434\">afraid of a cyber attack on his own pacemaker\u003c/a> that he had the wireless feature on it disabled.\u003c/p>\n\u003cp>As technology has become more connected, so have medical devices. While some, like pacemakers, can only send information, others, can send and receive data.\u003c/p>\n\u003cp>And that leaves some patients vulnerable to a hacker trying to harm them or use their device as a portal to access medical data.\u003c/p>\n\u003cp>\"All the tools that are required to do software debugging, to get software off of chips and basically to do hardware hacking,\" Rios says, \"it’s become available to just any person.\"\u003c/p>\n\u003caside class=\"pullquote alignleft\">'My biggest fear is that somebody will take out a large number of devices across an institution.'\u003ccite>Kevin McDonald,\u003cbr>\nClinical Information Security Director\u003cbr>\nMayo Clinic\u003c/cite>\u003c/aside>\n\u003cp>As a benign or “white hat” hacker, Rios does research in his Half Moon Bay garage to help the Department of Homeland Security.\u003c/p>\n\u003cp>He proved he could remotely administer a lethal dose of drugs through a patient’s insulin pump. He has also hacked pre-programmed passwords from hundreds of devices. He and his colleague were able to figure out the passwords after acquiring embedded software and technical manuals from several vendors.\u003c/p>\n\u003cp>\"We knew what those 300 passwords were,\" Rios says. \"We could go to any device we wanted to and we had a set of usernames and passwords that would work against all these devices, and so that was pretty alarming.\"\u003c/p>\n\u003cp>The Food and Drug Administration, which regulates the sale of medical devices, has been issuing formal guidelines on the issue.\u003c/p>\n\u003cp>Suzanne Schwartz is the FDA’s Director of Emergency Preparedness. Last year, she helped publish \u003ca href=\"http://www.fda.gov/ucm/groups/fdagov-public/@fdagov-meddev-gen/documents/document/ucm356190.pdf\">new recommendations\u003c/a> for how medical device makers should take cyber-security attacks into account.\u003c/p>\n\u003cfigure id=\"attachment_19957\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/07/Implantable-medical-devices_graphic_WHITE.jpg\">\u003cimg class=\"size-medium wp-image-19957\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/07/Implantable-medical-devices_graphic_WHITE-800x567.jpg\" alt=\"Many there are many implantable medical devices on the market that have vulnerabilities, in fact, the Food and Drug Administration has received approximately 56,000 reports of adverse events associated with the use of infusion pumps, including numerous injuries and deaths. \" width=\"800\" height=\"567\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/07/Implantable-medical-devices_graphic_WHITE-800x567.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/07/Implantable-medical-devices_graphic_WHITE-400x283.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/07/Implantable-medical-devices_graphic_WHITE-1180x836.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/07/Implantable-medical-devices_graphic_WHITE-960x680.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2015/07/Implantable-medical-devices_graphic_WHITE.jpg 1493w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">There are many implantable medical devices on the market that have vulnerabilities, in fact, the Food and Drug Administration has received approximately 56,000 reports of adverse events associated with the use of infusion pumps, including numerous injuries and deaths. \u003ccite>(Massachusetts Institute of Technology)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"That is something, yes, that we continuously monitor and it’s something important that we want to hear about,\" Schwartz says, \"whether it’s directly from the healthcare organizations or from the medical device manufacturers.\"\u003c/p>\n\u003cp>But Consumer Watchdog president Jamie Court says the FDA’s guidelines for medical devices fall short. He says what's needed is a law -- not recommendations -- requiring medical manufacturers and hospitals to upgrade systems to prevent cyber attacks.\u003c/p>\n\u003cp>\"The reality is if they don’t someone is going to die,\" Court says. \"Because it’s not safe. Someone will find a reason to change a counter on an insulin pump or take over a defibrillator just because they can.\"\u003c/p>\n\u003cp>Without legally binding rules, medical device security is left in the hands of hospitals and device makers. And they are required to report device malfunctions only if patients are injured or they die.\u003c/p>\n\u003cp>Medtronic, the nation's largest medical device manufacturer, has not reported any incidents so far.\u003c/p>\n\u003cp>The company declined to be interviewed and sent KQED a statement saying it aims to manufacture products that are as safe and secure as possible.\u003c/p>\n\u003cfigure id=\"attachment_19938\" class=\"wp-caption alignleft\" style=\"max-width: 800px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/07/Kevin-McDonald_Mayo-Clinic_photo.jpg\">\u003cimg class=\"size-medium wp-image-19938\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/07/Kevin-McDonald_Mayo-Clinic_photo-800x600.jpg\" alt=\"Clinical Information Security Director Kevin McDonald (left) at Mayo Clinic in Minnesota leads a team checking medical devices for software vulnerabilities that could cause a device to be infected with malware or exploited by hackers.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/07/Kevin-McDonald_Mayo-Clinic_photo-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/07/Kevin-McDonald_Mayo-Clinic_photo-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/07/Kevin-McDonald_Mayo-Clinic_photo-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/07/Kevin-McDonald_Mayo-Clinic_photo-1920x1440.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2015/07/Kevin-McDonald_Mayo-Clinic_photo-960x720.jpg 960w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Clinical Information Security Director Kevin McDonald (left) at Mayo Clinic in Minnesota leads a team checking medical devices for software vulnerabilities that could cause a device to be infected with malware or exploited by hackers. \u003ccite>(Mayo Clinic)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But Mayo Clinic cyber security expert Kevin McDonald says, while they haven't been catastrophic, some incidents have already occurred.\u003c/p>\n\u003cp>\"Back in 2010,\" he says, \"there was a heart catheterization lab out on the East Coast, that, because of some malware viruses, was put out of business for about three days. So they had to divert their patients to other places.\"\u003c/p>\n\u003cp>McDonald leads a team that’s trying to prevent harmful medical incidents.\u003c/p>\n\u003cp>\"My biggest fear,\" he says, \"is that somebody will take out a large number of devices across an institution.\"\u003c/p>\n\u003cp>To increase patient safety, the Mayo Clinic brought in researchers to analyze some of the devices it uses. It then reported vulnerabilities to the manufacturers.\u003c/p>\n\u003cp>But cyber security expert Rios says no matter what precautions one takes, medical devices are imperfect and will always need monitoring.\u003c/p>\n\u003cp>\"At the end of the day, at the core of it, it's really just a computer,\" he says. \"It's a processor and it's software that someone wrote. And so we can't treat those devices as if they're magical devices; they're not magical devices.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>While last year the FDA issued guidelines for the manufacture of these devices, this year the agency is expected to \u003ca href=\"http://blogs.fda.gov/fdavoice/index.php/2015/02/moving-toward-a-national-medical-device-postmarket-surveillance-system/\">release additional guidelines\u003c/a> for how companies should update the devices’ software after they’re on the market.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>An urgent care clinic in San Pablo is getting $2 million in state funds to expand service to the community affected by the recent closure of deficit-plagued \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/04/20/san-pablos-doctors-medical-center-to-close-tuesday/\" target=\"_blank\" rel=\"noopener\">Doctors Medical Center\u003c/a>.\u003c/p>\n\u003cp>That grant — secured with the aid of state Sen. Tony Thurmond, a Richmond Democrat — will go to \u003ca href=\"http://www.lifelongmedical.org\" target=\"_blank\" rel=\"noopener\">LifeLong Medical Care, \u003c/a>which in addition to its San Pablo facility runs clinics throughout the East Bay.\u003c/p>\n\u003cp>Marty Lynch, LifeLong’s executive director, says the new funding will go toward expanding the clinic’s hours. The facility is open from noon to 8 p.m. seven days a week; closing time will likely be extended to midnight.\u003c/p>\n\u003cp>The clinic treats about 50 people a day for non-emergency health problems like asthma and minor infections. Lynch says one of the clinic’s major challenges is educating those who depended on the Doctors Medical Center emergency room for such care that LifeLong can take care of them.\u003c/p>\n\u003cp>“If you have some problem that we can deal with — you know, you’re not having a heart attack — much better to come to us than to wait four, five, eight hours in the emergency room,” says Lynch.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Lynch says the clinic hopes to reach at least 80 patients a day — the number of patients estimated to have relied on Doctors’ emergency room for non-emergency care.\u003c/p>\n\u003cp>The new clinic employs some staff from the former hospital, to the delight of Jeffrey Adams, who came to the clinic with his daughter. She’s being examined by her longtime doctor for abdominal pain.\u003c/p>\n\u003cp>“We would have definitely been over to Doctors for [this] because that’s where she was born,” says Adams. “So I like sticking with the same doctor.”\u003c/p>\n\u003cp>Lynch says the new clinic isn’t designed to entirely fill the void left by Doctors, which closed in late April.\u003c/p>\n\u003cp>For instance, patients with true medical emergencies must go to other hospitals in the surrounding area. And he notes a dearth of nearby specialists, such as cardiologists and urologists. He says many either left town when Doctors shut down or retired.\u003c/p>\n\u003cp>Lynch says one of the long-term obstacles to providing care to low-income communities in West Contra Costa County and elsewhere is the meager reimbursement that doctors get from state and federal health insurance programs for the poor and elderly. Those low reimbursement rates mean fewer and fewer doctors will accept patients on Medi-Cal and Medicare.\u003c/p>\n\u003cp>Lynch says he believes the solution to the problem will include a restructuring of both doctor pay — more for primary doctors and less for specialists — and better training.\u003c/p>\n\u003cp>“I think it’s unlikely that Medi-Cal or Medicare will ever pay as much as commercial insurance,” says Lynch. “My own feeling is that we have to train more primary care docs, and we also have to train more specialists who are interested in mission.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Lynch says the key will be finding a way to encourage doctors to pursue careers serving low-income communities.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>An urgent care clinic in San Pablo is getting $2 million in state funds to expand service to the community affected by the recent closure of deficit-plagued \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/04/20/san-pablos-doctors-medical-center-to-close-tuesday/\" target=\"_blank\" rel=\"noopener\">Doctors Medical Center\u003c/a>.\u003c/p>\n\u003cp>That grant — secured with the aid of state Sen. Tony Thurmond, a Richmond Democrat — will go to \u003ca href=\"http://www.lifelongmedical.org\" target=\"_blank\" rel=\"noopener\">LifeLong Medical Care, \u003c/a>which in addition to its San Pablo facility runs clinics throughout the East Bay.\u003c/p>\n\u003cp>Marty Lynch, LifeLong’s executive director, says the new funding will go toward expanding the clinic’s hours. The facility is open from noon to 8 p.m. seven days a week; closing time will likely be extended to midnight.\u003c/p>\n\u003cp>The clinic treats about 50 people a day for non-emergency health problems like asthma and minor infections. Lynch says one of the clinic’s major challenges is educating those who depended on the Doctors Medical Center emergency room for such care that LifeLong can take care of them.\u003c/p>\n\u003cp>“If you have some problem that we can deal with — you know, you’re not having a heart attack — much better to come to us than to wait four, five, eight hours in the emergency room,” says Lynch.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Lynch says the clinic hopes to reach at least 80 patients a day — the number of patients estimated to have relied on Doctors’ emergency room for non-emergency care.\u003c/p>\n\u003cp>The new clinic employs some staff from the former hospital, to the delight of Jeffrey Adams, who came to the clinic with his daughter. She’s being examined by her longtime doctor for abdominal pain.\u003c/p>\n\u003cp>“We would have definitely been over to Doctors for [this] because that’s where she was born,” says Adams. “So I like sticking with the same doctor.”\u003c/p>\n\u003cp>Lynch says the new clinic isn’t designed to entirely fill the void left by Doctors, which closed in late April.\u003c/p>\n\u003cp>For instance, patients with true medical emergencies must go to other hospitals in the surrounding area. And he notes a dearth of nearby specialists, such as cardiologists and urologists. He says many either left town when Doctors shut down or retired.\u003c/p>\n\u003cp>Lynch says one of the long-term obstacles to providing care to low-income communities in West Contra Costa County and elsewhere is the meager reimbursement that doctors get from state and federal health insurance programs for the poor and elderly. Those low reimbursement rates mean fewer and fewer doctors will accept patients on Medi-Cal and Medicare.\u003c/p>\n\u003cp>Lynch says he believes the solution to the problem will include a restructuring of both doctor pay — more for primary doctors and less for specialists — and better training.\u003c/p>\n\u003cp>“I think it’s unlikely that Medi-Cal or Medicare will ever pay as much as commercial insurance,” says Lynch. “My own feeling is that we have to train more primary care docs, and we also have to train more specialists who are interested in mission.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Lynch says the key will be finding a way to encourage doctors to pursue careers serving low-income communities.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Inside the cavernous main building at the Sacramento County Fairgrounds was a beehive of activity. But this was no county fair or concert.\u003c/p>\n\u003cp>Instead, hundreds of long, reclining dental chairs fill the floor, and 2,000 people wait for a turn. The sound of drilling buzzed the air, and the acrid smell of anesthetic permeated it.\u003c/p>\n\u003cp>It was free dental day – a special program run by the California Dental Association Foundation. “CDA Cares” took over the entire fairgrounds for this event in March, and 300 dentists were busy pumping in Novocain and making lame jokes to captive patients.\u003c/p>\n\u003cp>Across the broad hall, there was one station for filling cavities, one for root canals, another for extractions, yet another for dentures.\u003c/p>\n\u003cp>It looked like a sort of Dental Disneyland.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Rhonda Morse of Sacramento was among the patients. She camped out at the fairgrounds the night before the event.\u003c/p>\n\u003cp>“Got here at 7 o’clock last night,” she said. “We slept outside. It gets crowded real fast.”\u003c/p>\n\u003cp>[soundcloud url=”https://api.soundcloud.com/tracks/204359777″ params=”color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false” width=”100%” height=”166″ iframe=”true” /]\u003c/p>\n\u003cp>That’s because the need is so profound. Denti-Cal, the state’s program of dental care for low-income Californians, including 5 million children, is in disarray. At a time when millions more have been added into coverage, it’s becoming harder to find dental care. The CDA Foundation \u003ca title=\"http://www.cdafoundation.org/cda-cares\" href=\"http://www.cdafoundation.org/cda-cares\" target=\"_blank\" rel=\"noopener\">estimates that 10 million Californians\u003c/a> face barriers to dental care.\u003c/p>\n\u003cp>Morse knows this first-hand.\u003c/p>\n\u003cp>“It takes months to get in, then you get an appointment, and it takes months to get in again,” she explained.\u003c/p>\n\u003cp>She said it would have taken her years of appointments to get the dental care she received in a single day at the fair.\u003c/p>\n\u003cp>“Coverage and access are two different things,” said James Stephens, a Palo Alto dentist and former chair of the California Dental Association who volunteered for the Sacramento event.\u003c/p>\n\u003cp>The reason there’s no access, he said, is because so few dentists take Denti-Cal patients — because they lose money on every one of them.\u003c/p>\n\u003cp>“Fees have been cut in the program so much, they’re not enough to create a viable provider network,” Stephens said.\u003c/p>\n\u003cfigure id=\"attachment_25339\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/05/IMG_1429-2-e1430955574138.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-25339\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/05/IMG_1429-2-800x1067.jpg\" alt=\"George Maranon, an oral surgeon from Encino, is extracting a tooth from a young boy who already has diseased gums. \" width=\"800\" height=\"1067\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">George Maranon, an oral surgeon from Encino, is extracting a tooth from a young boy who already has diseased gums. \u003ccite>(David Gorn/California Healthline)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>That network of providers is even thinner now, he said. So there are fewere dentists to serve even more people who have signed up since the state expanded eligibility rules.\u003c/p>\n\u003cp>George Maranon, an oral surgeon from Encino, was working on a tooth extraction at one of the fair stations for a 9-year-old boy with diseased gums. He said he’d rather volunteer his time than take Denti-Cal payments.\u003c/p>\n\u003cp>“There are Denti-Cal patients who I actually see in my practice for free,” Maranon said. “Sometimes dealing with the state in terms of reimbursement can be more expensive than just doing it for free.”\u003c/p>\n\u003cp>Just to get to the national average for provider rates, California would have to spend three times as much as it does now, at least another $100 million a year, according to Elizabeth Mertz, a dental sciences professor at UC San Francisco.\u003c/p>\n\u003cp>Beyond inadequate provider rates, there’s another huge challenge in the Denti-Cal system, Mertz said. Half of the state’s kids are in Denti-Cal, and those kids desperately need preventive care.\u003c/p>\n\u003cp>“So you’re talking about taking care of a large portion of the state’s children,” she said. “If those children grow up with dental disease, they’re going to be adults with dental disease.”\u003c/p>\n\u003cp>She said lawmakers could pass a dental health parity law, and that would put preventive dental health services on the same plane as other essential medical care.\u003c/p>\n\u003cp>“Because nobody’s made it a priority from the top on down,” Mertz said. “When you say something’s essential but you make it optional, that’s not sending the message that it’s a priority.”\u003c/p>\n\u003cp>The new director of the Department of Health Care Services, Jennifer Kent, has acknowledged the deficiencies of Denti-Cal and says fixing it is one of her top two priorities. The department is working on a plan now to restructure the program, but state officials haven’t said whether or not that would include a boost in reimbursement rates.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In the meantime, \u003ca title=\"Fresno Dental Fair\" href=\"http://www.cdafoundation.org/cda-cares/fresno\" target=\"_blank\" rel=\"noopener\">the next free California Dental Association dental fair \u003c/a>will be held in Fresno, in October.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Inside the cavernous main building at the Sacramento County Fairgrounds was a beehive of activity. But this was no county fair or concert.\u003c/p>\n\u003cp>Instead, hundreds of long, reclining dental chairs fill the floor, and 2,000 people wait for a turn. The sound of drilling buzzed the air, and the acrid smell of anesthetic permeated it.\u003c/p>\n\u003cp>It was free dental day – a special program run by the California Dental Association Foundation. “CDA Cares” took over the entire fairgrounds for this event in March, and 300 dentists were busy pumping in Novocain and making lame jokes to captive patients.\u003c/p>\n\u003cp>Across the broad hall, there was one station for filling cavities, one for root canals, another for extractions, yet another for dentures.\u003c/p>\n\u003cp>It looked like a sort of Dental Disneyland.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Rhonda Morse of Sacramento was among the patients. She camped out at the fairgrounds the night before the event.\u003c/p>\n\u003cp>“Got here at 7 o’clock last night,” she said. “We slept outside. It gets crowded real fast.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='”100%”' height='”166″'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=”https://api.soundcloud.com/tracks/204359777″&visual=true&”color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false”'\n title='”https://api.soundcloud.com/tracks/204359777″'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>That’s because the need is so profound. Denti-Cal, the state’s program of dental care for low-income Californians, including 5 million children, is in disarray. At a time when millions more have been added into coverage, it’s becoming harder to find dental care. The CDA Foundation \u003ca title=\"http://www.cdafoundation.org/cda-cares\" href=\"http://www.cdafoundation.org/cda-cares\" target=\"_blank\" rel=\"noopener\">estimates that 10 million Californians\u003c/a> face barriers to dental care.\u003c/p>\n\u003cp>Morse knows this first-hand.\u003c/p>\n\u003cp>“It takes months to get in, then you get an appointment, and it takes months to get in again,” she explained.\u003c/p>\n\u003cp>She said it would have taken her years of appointments to get the dental care she received in a single day at the fair.\u003c/p>\n\u003cp>“Coverage and access are two different things,” said James Stephens, a Palo Alto dentist and former chair of the California Dental Association who volunteered for the Sacramento event.\u003c/p>\n\u003cp>The reason there’s no access, he said, is because so few dentists take Denti-Cal patients — because they lose money on every one of them.\u003c/p>\n\u003cp>“Fees have been cut in the program so much, they’re not enough to create a viable provider network,” Stephens said.\u003c/p>\n\u003cfigure id=\"attachment_25339\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/05/IMG_1429-2-e1430955574138.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-25339\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/05/IMG_1429-2-800x1067.jpg\" alt=\"George Maranon, an oral surgeon from Encino, is extracting a tooth from a young boy who already has diseased gums. \" width=\"800\" height=\"1067\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">George Maranon, an oral surgeon from Encino, is extracting a tooth from a young boy who already has diseased gums. \u003ccite>(David Gorn/California Healthline)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>That network of providers is even thinner now, he said. So there are fewere dentists to serve even more people who have signed up since the state expanded eligibility rules.\u003c/p>\n\u003cp>George Maranon, an oral surgeon from Encino, was working on a tooth extraction at one of the fair stations for a 9-year-old boy with diseased gums. He said he’d rather volunteer his time than take Denti-Cal payments.\u003c/p>\n\u003cp>“There are Denti-Cal patients who I actually see in my practice for free,” Maranon said. “Sometimes dealing with the state in terms of reimbursement can be more expensive than just doing it for free.”\u003c/p>\n\u003cp>Just to get to the national average for provider rates, California would have to spend three times as much as it does now, at least another $100 million a year, according to Elizabeth Mertz, a dental sciences professor at UC San Francisco.\u003c/p>\n\u003cp>Beyond inadequate provider rates, there’s another huge challenge in the Denti-Cal system, Mertz said. Half of the state’s kids are in Denti-Cal, and those kids desperately need preventive care.\u003c/p>\n\u003cp>“So you’re talking about taking care of a large portion of the state’s children,” she said. “If those children grow up with dental disease, they’re going to be adults with dental disease.”\u003c/p>\n\u003cp>She said lawmakers could pass a dental health parity law, and that would put preventive dental health services on the same plane as other essential medical care.\u003c/p>\n\u003cp>“Because nobody’s made it a priority from the top on down,” Mertz said. “When you say something’s essential but you make it optional, that’s not sending the message that it’s a priority.”\u003c/p>\n\u003cp>The new director of the Department of Health Care Services, Jennifer Kent, has acknowledged the deficiencies of Denti-Cal and says fixing it is one of her top two priorities. The department is working on a plan now to restructure the program, but state officials haven’t said whether or not that would include a boost in reimbursement rates.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In the meantime, \u003ca title=\"Fresno Dental Fair\" href=\"http://www.cdafoundation.org/cda-cares/fresno\" target=\"_blank\" rel=\"noopener\">the next free California Dental Association dental fair \u003c/a>will be held in Fresno, in October.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"slug": "plenty-of-responsibility-but-no-required-training-for-in-home-caregivers",
"title": "Plenty of Responsibility, But No Required Training, for In-Home Caregivers",
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"content": "\u003cfigure id=\"attachment_23344\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Messengale-7-e1420584165747.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-large wp-image-23344\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Messengale-7-640x427.jpg\" alt=\"Oliver Massengale took over as his brother’s full-time caregiver six years ago. He says he hasn’t had time for himself in years. (Heidi de Marco/KHN)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Oliver Massengale took over as his brother’s full-time caregiver six years ago. He says he hasn’t had time for himself in years. (Heidi de Marco/KHN)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Anna Gorman,\u003ca title=\"http://kaiserhealthnews.org/news/lots-of-responsibility-for-in-home-care-providers-but-no-training-required/\" href=\"http://kaiserhealthnews.org/news/lots-of-responsibility-for-in-home-care-providers-but-no-training-required/\" target=\"_blank\" rel=\"noopener\"> \u003c/a>\u003c/strong>\u003ca title=\"http://kaiserhealthnews.org/news/lots-of-responsibility-for-in-home-care-providers-but-no-training-required/\" href=\"http://kaiserhealthnews.org/news/lots-of-responsibility-for-in-home-care-providers-but-no-training-required/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>Born just a year apart, Oliver Massengale and his brother Charles grew up together. Now, in a two-story home in Compton, they are growing old together. But Charles Massengale, 71, can do little on his own.\u003c/p>\n\u003cp>The former tree trimmer has severe brain damage from a 30-foot fall, as well as dementia, diabetes and high blood pressure. Six years ago, Oliver took over as his brother’s full-time caregiver. He’s paid about $10.00 an hour by the state.\u003c/p>\n\u003cp>It was not a job he was trained to do.\u003c/p>\n\u003cp>“I didn’t have a clue,” said Oliver, a retired grounds manager at a college. “I was just so afraid of what I was doing.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>He constantly worried –- about giving Charles the wrong medication, about him getting bedsores, about his blood pressure. And he had no idea how easily his brother could fall over. One day, he was cooking and Charles was on a stool at the kitchen counter.\u003c!--more-->\u003c/p>\n\u003cp>“I heard BAM,” he said. “I turned around and he was on the kitchen floor.”\u003c/p>\n\u003cfigure id=\"attachment_23346\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Messengale-5-e1420584871222.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-large wp-image-23346\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Messengale-5-640x427.jpg\" alt=\"Oliver Massengale needs to make sure his brother takes his medicine. He says Charles has a tendency to keep them in his mouth and forget to swallow them (Heidi de Marco/KHN).\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Oliver Massengale needs to make sure his brother takes his medicine. He says Charles has a tendency to keep them in his mouth and forget to swallow them (Heidi de Marco/KHN).\u003c/figcaption>\u003c/figure>\n\u003cp>No overall training is required for the more than 400,000 caregivers in California’s $7.3 billion In-Home Supportive Services Program (IHSS) for low-income elderly and disabled residents. Without instruction even in CPR or first aid, these caregivers can quickly become overwhelmed and their sick or disabled clients can get hurt, according to interviews with caregivers, advocates and elder abuse experts.\u003c/p>\n\u003cp>The lack of training is “of enormous concern,” said Gary Passmore, a vice president of the Congress of California Seniors, an advocacy organization. “We are dealing with a lot of frail, elderly people.”\u003c/p>\n\u003cp>The need for in-home caregivers is rising as the elderly and disabled population grows. The demand for personal aides –- most of whom work in the home — is expected to increase by 37 percent over the next decade, requiring about 1.3 million new positions, according to \u003ca title=\"http://phinational.org/sites/phinational.org/files/phi-factsheet14update-12052014.pdf\" href=\"http://phinational.org/sites/phinational.org/files/phi-factsheet14update-12052014.pdf\" target=\"_blank\" rel=\"noopener\">research published last year\u003c/a> by the New-York based Paraprofessional Healthcare Institute, an advocacy group that also provides training\u003cstrong>. \u003c/strong>\u003c/p>\n\u003cp>The federal government is trying to meet that need by stepping up efforts to expand and train the work force. But for now, there are no federal training requirements for in-home-caregivers. It’s up to states to set them in Medicaid-funded programs like California’s. As a result, training policies vary dramatically.\u003c/p>\n\u003cp>\u003cstrong>Often Providing Medical Care \u003c/strong>\u003c/p>\n\u003cp>In California’s IHSS program, clients are in charge of hiring, managing and training their own caregivers. The program stands out because of its sheer size — it is the nation’s largest publicly-funded home care program –- and because such a high percentage of caregivers are relatives directly employed by the clients rather than agencies, said Abby Marquand, director of policy research for the Paraprofessional Healthcare Institute.\u003c/p>\n\u003cp>“It is a lot easier to ensure a minimum level of training if the person is employed through an agency,” she said.\u003c/p>\n\u003cp>IHSS was never intended to be a medical program. The caregivers are distinct from visiting nurses and the certified home health aides often dispatched after a hospital stay. IHSS caregivers are not certified or licensed and are hired to do personal care and household tasks.\u003c/p>\n\u003cp>But more than a quarter of IHSS clients are 80 or over, and many have chronic health conditions or dementia. In these and other cases, caregivers can end up providing basic medical care -– helping to administer insulin shots, manage other medication or dress wounds, for instance.\u003c/p>\n\u003cfigure id=\"attachment_23348\" class=\"wp-caption alignright\" style=\"max-width: 200px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Messengale-3rev.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-23348\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Messengale-3rev-300x449.jpg\" alt=\"Charles Massengale can eat by himself, but needs help with everything else. The former tree trimmer has severe brain damage from a 30-foot fall, as well as dementia, diabetes and high blood pressure (Heidi de Marco/KHN).\" width=\"200\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Charles Massengale can eat by himself, but needs help with everything else. The former tree trimmer has severe brain damage from a 30-foot fall, as well as dementia, diabetes and high blood pressure (Heidi de Marco/KHN).\u003c/figcaption>\u003c/figure>\n\u003cp>When such “paramedical” services are needed by individual clients, IHSS caregivers are required to get instruction and approval from a health care professional. But the state doesn’t sponsor the training or pay caregivers more for getting it. Only 12 percent of clients have caregivers who have received it.\u003c/p>\n\u003cp>Eileen Carroll, deputy director of the California Department of Social Services, which oversees IHSS, said the program doesn’t have a lot of training requirements because it was set up to give clients the choice of how they want their care delivered.\u003c/p>\n\u003cp>For caregivers who want it, the state offers comprehensive \u003ca title=\"http://www.cdss.ca.gov/agedblinddisabled/PG3366.htm\" href=\"http://www.cdss.ca.gov/agedblinddisabled/PG3366.htm\" target=\"_blank\" rel=\"noopener\">voluntary training information online\u003c/a> on topics such as fall prevention and use of medical equipment, she said.\u003c/p>\n\u003cp>Carroll said many people are fully able to direct their own care and supervise their caregivers, but some aren’t. “Our task is how to work harder to support those who have greater need,” she said.\u003c/p>\n\u003cp>Oliver Massengale, for example, can’t depend on his brother to tell him what he wants or needs — Charles no longer talks much. “Because of the nature of the injuries and his different ailments, he could never train,” Oliver said. “He can’t even take care of himself.”\u003c/p>\n\u003cp>The situation worsened recently because Charles’ health insurance plan changed, and he no longer is being visited by a nurse. So every day Oliver sits inches from Charles, checking his blood pressure and blood sugar and coaching him step-by-step on how to inject insulin into his own arm.\u003c/p>\n\u003cp>“Hold the back of that needle up,” he told Charles on a recent day. “Put it in right there. Now pump the medicine in. Good, good.”\u003c/p>\n\u003cp>When he heard about a training class in Los Angeles, Oliver said he jumped at the chance.\u003c/p>\n\u003cp>“If I’d had this class in advance, it would have made it a lot easier,” he said.\u003c/p>\n\u003cp>[soundcloud url=”https://api.soundcloud.com/tracks/192785628″ params=”color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false” width=”100%” height=”166″ iframe=”true” /]\u003c/p>\n\u003cp>\u003cstrong>A Sensitive Matter\u003c/strong>\u003c/p>\n\u003cp>Whether to require training for those who care for California’s 490,000 low-income elderly and disabled home care clients is a sensitive political — and personal — issue.\u003c/p>\n\u003cp>Carroll said the state is in a tough situation. Training is a positive thing, she said, “but you have a very strong adult disabled community in this program who … oppose any mandatory training.”\u003c/p>\n\u003cp>Many disability rights advocates say a training mandate would make it more difficult for IHSS consumers to find caregivers, chip away at clients’ autonomy and drain resources from the program.\u003c/p>\n\u003cp>“The idea of choice is really paramount,” said Deborah Doctor, legislative advocate at Disability Rights California. “Anything that puts a requirement that erodes that choice is a problem.”\u003c/p>\n\u003cfigure id=\"attachment_23349\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/chuc-2-e1420585465561.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-large wp-image-23349\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/chuc-2-640x427.jpg\" alt=\"Frances Chuc brushes her husband’s hair. Jorge Chuc has been paralyzed for more than 30 years and needs full-time care from his wife. (Heidi de Marco/KHN)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Frances Chuc brushes her husband’s hair. Jorge Chuc has been paralyzed for more than 30 years and needs full-time care from his wife. (Heidi de Marco/KHN)\u003c/figcaption>\u003c/figure>\n\u003cp>Relatives, who make up nearly three-quarters of paid IHSS caregivers, often say they know what is best for their loved ones. And clients are inclined to trust family members and say they can instruct them on what they need\u003cstrong>. \u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>“\u003c/strong>A mother who has been taking care of a child for 20 or 30 or 40 years doesn’t need mandatory training on how to take care of that person,” Doctor said.\u003c/p>\n\u003cp>Training should be made available to those who want it, but should be entirely voluntary, said Nancy Becker Kennedy, who was paralyzed in a diving accident 40 years ago.\u003c/p>\n\u003cp>[contextly_sidebar id=”ZDWZeL7IA0WaNYn7VwnhrQXAGx4kEPFd”]\u003c/p>\n\u003cp>“There is no one size fits all,” said Becker Kennedy, who founded IHSS Consumers Union, a group that advocates for both consumers and workers. “The population is much too diverse to mandate anything across the board.”\u003c/p>\n\u003cp>Many other clients agree. Sheela Gunn-Cushman, who is blind, diabetic and has mild cerebral palsy, lives with roommates in San Lorenzo, Calif., with the help of an IHSS caregiver whom she trained herself.\u003c/p>\n\u003cp>“I don’t feel like anyone is capable of training a [caregiver] about what I need better than I do,” she said. “I am capable of telling them what I need.”\u003c/p>\n\u003cp>A union that represents caregivers, however, sees advantages to a minimum level of training.\u003c/p>\n\u003cp>SEIU-United Healthcare Workers West proposed a \u003ca title=\"http://www.seiu-uhw.org/archives/16457\" href=\"http://www.seiu-uhw.org/archives/16457\" target=\"_blank\" rel=\"noopener\">statewide initiative\u003c/a> last year that would have required 75 hours of training, but the union didn’t get enough signatures to put the measure on the ballot. SEIU plans to try again for the 2016 ballot.\u003c/p>\n\u003cp>Requiring training would “save lives,” said Loretta Jackson, who serves on the union’s executive board and is an IHSS caregiver in Sacramento. It would also reduce the risk of injuries to caregivers, she added.\u003c/p>\n\u003cp>Jackson cares for her sister, who was left partially paralyzed by a stroke 15 years ago. When Jackson first started, she had to call paramedics every few weeks because her sister would fall. Once, Jackson said, her sister took too many pills and started shaking violently.\u003c/p>\n\u003cp>“I didn’t know what to do,” she said. “I started panicking.”\u003c/p>\n\u003cp>Other caregivers tell similar stories.\u003c/p>\n\u003cp>Ariana Ramos, 28, who is taking a training class, said a paralyzed client got a bed sore after sleeping in his wheelchair. Ramos thought it would heal on its own, but it just got worse.\u003c/p>\n\u003cp>“Now I know that we need to keep it covered up,” said Ramos, who lives in South Gate. “Now I know about bacteria and all the things that could get in a bed sore.”\u003c/p>\n\u003cfigure id=\"attachment_23350\" class=\"wp-caption alignleft\" style=\"max-width: 200px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/chuc-4rev.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-23350\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/chuc-4rev-300x449.jpg\" alt=\"Frances Chuc takes a break after a morning of taking care of her paraplegic husband. She says taking care of her husband is daunting, but her previous experience as a caregiver has helped (Heidi de Marco/KHN).\" width=\"200\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Frances Chuc takes a break after a morning of taking care of her paraplegic husband. She says taking care of her husband is daunting, but her previous experience as a caregiver has helped (Heidi de Marco/KHN).\u003c/figcaption>\u003c/figure>\n\u003cp>Caregivers without any medical background or training may not know when to call 911 or how to recognize a heart attack or stroke, said Frances Chuc, who takes care of her paralyzed husband at their home in South Gate and was trained as a nurse aide before she met him. “That person could die in their hands.”\u003c/p>\n\u003cp>A little bit of training can go a long way, said Joanne Spetz, director of UC San Francisco’s newly created Health Workforce Research Center. It can help caregivers recognize when their clients are having bad reactions to medications, for instance, or help them safely lift a person to avoid falls.\u003c/p>\n\u003cp>Training can also reduce turnover in a field that has low job retention, said Marquand of the Paraprofessional Healthcare Institute.\u003c/p>\n\u003cp>Several states are experimenting with different models of training. Washington State, for example,\u003ca title=\"http://www.dshs.wa.gov/altsa/home-and-community-services/individual-providers\" href=\"http://www.dshs.wa.gov/altsa/home-and-community-services/individual-providers\" target=\"_blank\" rel=\"noopener\"> began requiring 75 hours of training\u003c/a> for home caregivers in 2012.\u003c/p>\n\u003cp>It doesn’t make sense that caregivers in the home require less training nationwide than caregivers in nursing homes, said Charissa Raynor, executive director of the SEIU Healthcare NW Training Partnership, which trains 40,000 providers annually. (Certified aides in nursing homes are required by the federal government to have 75 hours of training.)\u003c/p>\n\u003cp>The Washington initiative, Raynor said, will help professionalize the workforce, reduce on-the-job injuries and lead to better care.\u003c/p>\n\u003cp>But not everyone has been happy with the new mandate.\u003c/p>\n\u003cp>“There are a lot of folks who just want to be a caregiver in someone’s home,” said Betty Schwieterman, director of systems advocacy at Disability Rights Washington. “They are not on a career path.”\u003c/p>\n\u003cp>\u003cstrong>Grants From The Government\u003c/strong>\u003c/p>\n\u003cp>The debate over mandatory training is far from resolved. But in the meantime, the federal government is putting money into pilot training efforts in various states.\u003c/p>\n\u003cp>Through the Affordable Care Act, it has awarded about \u003ca title=\"http://bhpr.hrsa.gov/nursing/grants/phcast.html\" href=\"http://bhpr.hrsa.gov/nursing/grants/phcast.html\" target=\"_blank\" rel=\"noopener\">$15 million in grants to California\u003c/a> and five other states to recruit and train qualified caregivers for the elderly and disabled populations\u003cstrong>. \u003c/strong>Classes started in 2011 in cities throughout the state, including San Francisco, Anaheim and Walnut.\u003c/p>\n\u003cp>The class Massengale attended is part of a separate federal grant of nearly $12 million given to the California Long-Term Care Education Center in Los Angeles. The center is training about 6,000 IHSS caregivers in Los Angeles, San Bernardino and Contra Costa counties.\u003c/p>\n\u003cp>An early evaluation of the program, as yet unpublished, by UC San Francisco researchers shows that clients with trained providers are less likely to go to the emergency room or be admitted to a hospital than those with untrained providers.\u003c/p>\n\u003cp>Corinne Eldridge, who runs the program, said trained caregivers can play an important role on a client’s health care team. “They can be the eyes and the ears in the home … and communicate back to the health care provider,” she said.\u003c/p>\n\u003cp>At a recent session in Compton, about two dozen caregivers gathered in a classroom at the public library, their binders of training materials spread out before them. The topic of the day was preventing bed sores and controlling infections.\u003c/p>\n\u003cp>The teacher, nurse Lori Picou, asked the class about the signs and symptoms of infection. The students yelled out answers: Redness. Fever. Fluid or discharge.\u003c/p>\n\u003cp>One offered a story about a bruise that swelled up like a basketball. Another said her paralyzed son was sweating so much that she had to repeatedly change his shirt.\u003c/p>\n\u003cp>Picou reminded the group to wash their hands frequently. “It is one of the most important things an individual can ever do to help control infection,” she said.\u003c/p>\n\u003cp>Oliver Massengale, who is in the class, said he is feeling a little bit more confident about keeping his brother safe. “The more I learn, the better I am to cope with this,” he said.\u003c/p>\n\u003cp>But being a caregiver for someone with so many health conditions is still scary to him.\u003c/p>\n\u003cp>“As I come down those stairs,” he said, “I am saying a prayer and just hoping that everything is all right when I get to the bottom.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>\u003ca title=\"Kaiser Health News\" href=\"www.kaiserhealthnews.org\" target=\"_blank\" rel=\"noopener\">Kaiser Health News \u003c/a>is an editorially independent program of the \u003ca title=\"Kaiser Family Foundation\" href=\"www.kff.org\" target=\"_blank\" rel=\"noopener\">Kaiser Family Foundation.\u003c/a>\u003c/em>\u003c/p>\n\n",
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"title": "Plenty of Responsibility, But No Required Training, for In-Home Caregivers",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_23344\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Messengale-7-e1420584165747.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-large wp-image-23344\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Messengale-7-640x427.jpg\" alt=\"Oliver Massengale took over as his brother’s full-time caregiver six years ago. He says he hasn’t had time for himself in years. (Heidi de Marco/KHN)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Oliver Massengale took over as his brother’s full-time caregiver six years ago. He says he hasn’t had time for himself in years. (Heidi de Marco/KHN)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Anna Gorman,\u003ca title=\"http://kaiserhealthnews.org/news/lots-of-responsibility-for-in-home-care-providers-but-no-training-required/\" href=\"http://kaiserhealthnews.org/news/lots-of-responsibility-for-in-home-care-providers-but-no-training-required/\" target=\"_blank\" rel=\"noopener\"> \u003c/a>\u003c/strong>\u003ca title=\"http://kaiserhealthnews.org/news/lots-of-responsibility-for-in-home-care-providers-but-no-training-required/\" href=\"http://kaiserhealthnews.org/news/lots-of-responsibility-for-in-home-care-providers-but-no-training-required/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>Born just a year apart, Oliver Massengale and his brother Charles grew up together. Now, in a two-story home in Compton, they are growing old together. But Charles Massengale, 71, can do little on his own.\u003c/p>\n\u003cp>The former tree trimmer has severe brain damage from a 30-foot fall, as well as dementia, diabetes and high blood pressure. Six years ago, Oliver took over as his brother’s full-time caregiver. He’s paid about $10.00 an hour by the state.\u003c/p>\n\u003cp>It was not a job he was trained to do.\u003c/p>\n\u003cp>“I didn’t have a clue,” said Oliver, a retired grounds manager at a college. “I was just so afraid of what I was doing.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>He constantly worried –- about giving Charles the wrong medication, about him getting bedsores, about his blood pressure. And he had no idea how easily his brother could fall over. One day, he was cooking and Charles was on a stool at the kitchen counter.\u003c!--more-->\u003c/p>\n\u003cp>“I heard BAM,” he said. “I turned around and he was on the kitchen floor.”\u003c/p>\n\u003cfigure id=\"attachment_23346\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Messengale-5-e1420584871222.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-large wp-image-23346\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Messengale-5-640x427.jpg\" alt=\"Oliver Massengale needs to make sure his brother takes his medicine. He says Charles has a tendency to keep them in his mouth and forget to swallow them (Heidi de Marco/KHN).\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Oliver Massengale needs to make sure his brother takes his medicine. He says Charles has a tendency to keep them in his mouth and forget to swallow them (Heidi de Marco/KHN).\u003c/figcaption>\u003c/figure>\n\u003cp>No overall training is required for the more than 400,000 caregivers in California’s $7.3 billion In-Home Supportive Services Program (IHSS) for low-income elderly and disabled residents. Without instruction even in CPR or first aid, these caregivers can quickly become overwhelmed and their sick or disabled clients can get hurt, according to interviews with caregivers, advocates and elder abuse experts.\u003c/p>\n\u003cp>The lack of training is “of enormous concern,” said Gary Passmore, a vice president of the Congress of California Seniors, an advocacy organization. “We are dealing with a lot of frail, elderly people.”\u003c/p>\n\u003cp>The need for in-home caregivers is rising as the elderly and disabled population grows. The demand for personal aides –- most of whom work in the home — is expected to increase by 37 percent over the next decade, requiring about 1.3 million new positions, according to \u003ca title=\"http://phinational.org/sites/phinational.org/files/phi-factsheet14update-12052014.pdf\" href=\"http://phinational.org/sites/phinational.org/files/phi-factsheet14update-12052014.pdf\" target=\"_blank\" rel=\"noopener\">research published last year\u003c/a> by the New-York based Paraprofessional Healthcare Institute, an advocacy group that also provides training\u003cstrong>. \u003c/strong>\u003c/p>\n\u003cp>The federal government is trying to meet that need by stepping up efforts to expand and train the work force. But for now, there are no federal training requirements for in-home-caregivers. It’s up to states to set them in Medicaid-funded programs like California’s. As a result, training policies vary dramatically.\u003c/p>\n\u003cp>\u003cstrong>Often Providing Medical Care \u003c/strong>\u003c/p>\n\u003cp>In California’s IHSS program, clients are in charge of hiring, managing and training their own caregivers. The program stands out because of its sheer size — it is the nation’s largest publicly-funded home care program –- and because such a high percentage of caregivers are relatives directly employed by the clients rather than agencies, said Abby Marquand, director of policy research for the Paraprofessional Healthcare Institute.\u003c/p>\n\u003cp>“It is a lot easier to ensure a minimum level of training if the person is employed through an agency,” she said.\u003c/p>\n\u003cp>IHSS was never intended to be a medical program. The caregivers are distinct from visiting nurses and the certified home health aides often dispatched after a hospital stay. IHSS caregivers are not certified or licensed and are hired to do personal care and household tasks.\u003c/p>\n\u003cp>But more than a quarter of IHSS clients are 80 or over, and many have chronic health conditions or dementia. In these and other cases, caregivers can end up providing basic medical care -– helping to administer insulin shots, manage other medication or dress wounds, for instance.\u003c/p>\n\u003cfigure id=\"attachment_23348\" class=\"wp-caption alignright\" style=\"max-width: 200px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Messengale-3rev.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-23348\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Messengale-3rev-300x449.jpg\" alt=\"Charles Massengale can eat by himself, but needs help with everything else. The former tree trimmer has severe brain damage from a 30-foot fall, as well as dementia, diabetes and high blood pressure (Heidi de Marco/KHN).\" width=\"200\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Charles Massengale can eat by himself, but needs help with everything else. The former tree trimmer has severe brain damage from a 30-foot fall, as well as dementia, diabetes and high blood pressure (Heidi de Marco/KHN).\u003c/figcaption>\u003c/figure>\n\u003cp>When such “paramedical” services are needed by individual clients, IHSS caregivers are required to get instruction and approval from a health care professional. But the state doesn’t sponsor the training or pay caregivers more for getting it. Only 12 percent of clients have caregivers who have received it.\u003c/p>\n\u003cp>Eileen Carroll, deputy director of the California Department of Social Services, which oversees IHSS, said the program doesn’t have a lot of training requirements because it was set up to give clients the choice of how they want their care delivered.\u003c/p>\n\u003cp>For caregivers who want it, the state offers comprehensive \u003ca title=\"http://www.cdss.ca.gov/agedblinddisabled/PG3366.htm\" href=\"http://www.cdss.ca.gov/agedblinddisabled/PG3366.htm\" target=\"_blank\" rel=\"noopener\">voluntary training information online\u003c/a> on topics such as fall prevention and use of medical equipment, she said.\u003c/p>\n\u003cp>Carroll said many people are fully able to direct their own care and supervise their caregivers, but some aren’t. “Our task is how to work harder to support those who have greater need,” she said.\u003c/p>\n\u003cp>Oliver Massengale, for example, can’t depend on his brother to tell him what he wants or needs — Charles no longer talks much. “Because of the nature of the injuries and his different ailments, he could never train,” Oliver said. “He can’t even take care of himself.”\u003c/p>\n\u003cp>The situation worsened recently because Charles’ health insurance plan changed, and he no longer is being visited by a nurse. So every day Oliver sits inches from Charles, checking his blood pressure and blood sugar and coaching him step-by-step on how to inject insulin into his own arm.\u003c/p>\n\u003cp>“Hold the back of that needle up,” he told Charles on a recent day. “Put it in right there. Now pump the medicine in. Good, good.”\u003c/p>\n\u003cp>When he heard about a training class in Los Angeles, Oliver said he jumped at the chance.\u003c/p>\n\u003cp>“If I’d had this class in advance, it would have made it a lot easier,” he said.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='”100%”' height='”166″'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=”https://api.soundcloud.com/tracks/192785628″&visual=true&”color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false”'\n title='”https://api.soundcloud.com/tracks/192785628″'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003cstrong>A Sensitive Matter\u003c/strong>\u003c/p>\n\u003cp>Whether to require training for those who care for California’s 490,000 low-income elderly and disabled home care clients is a sensitive political — and personal — issue.\u003c/p>\n\u003cp>Carroll said the state is in a tough situation. Training is a positive thing, she said, “but you have a very strong adult disabled community in this program who … oppose any mandatory training.”\u003c/p>\n\u003cp>Many disability rights advocates say a training mandate would make it more difficult for IHSS consumers to find caregivers, chip away at clients’ autonomy and drain resources from the program.\u003c/p>\n\u003cp>“The idea of choice is really paramount,” said Deborah Doctor, legislative advocate at Disability Rights California. “Anything that puts a requirement that erodes that choice is a problem.”\u003c/p>\n\u003cfigure id=\"attachment_23349\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/chuc-2-e1420585465561.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-large wp-image-23349\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/chuc-2-640x427.jpg\" alt=\"Frances Chuc brushes her husband’s hair. Jorge Chuc has been paralyzed for more than 30 years and needs full-time care from his wife. (Heidi de Marco/KHN)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Frances Chuc brushes her husband’s hair. Jorge Chuc has been paralyzed for more than 30 years and needs full-time care from his wife. (Heidi de Marco/KHN)\u003c/figcaption>\u003c/figure>\n\u003cp>Relatives, who make up nearly three-quarters of paid IHSS caregivers, often say they know what is best for their loved ones. And clients are inclined to trust family members and say they can instruct them on what they need\u003cstrong>. \u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>“\u003c/strong>A mother who has been taking care of a child for 20 or 30 or 40 years doesn’t need mandatory training on how to take care of that person,” Doctor said.\u003c/p>\n\u003cp>Training should be made available to those who want it, but should be entirely voluntary, said Nancy Becker Kennedy, who was paralyzed in a diving accident 40 years ago.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“There is no one size fits all,” said Becker Kennedy, who founded IHSS Consumers Union, a group that advocates for both consumers and workers. “The population is much too diverse to mandate anything across the board.”\u003c/p>\n\u003cp>Many other clients agree. Sheela Gunn-Cushman, who is blind, diabetic and has mild cerebral palsy, lives with roommates in San Lorenzo, Calif., with the help of an IHSS caregiver whom she trained herself.\u003c/p>\n\u003cp>“I don’t feel like anyone is capable of training a [caregiver] about what I need better than I do,” she said. “I am capable of telling them what I need.”\u003c/p>\n\u003cp>A union that represents caregivers, however, sees advantages to a minimum level of training.\u003c/p>\n\u003cp>SEIU-United Healthcare Workers West proposed a \u003ca title=\"http://www.seiu-uhw.org/archives/16457\" href=\"http://www.seiu-uhw.org/archives/16457\" target=\"_blank\" rel=\"noopener\">statewide initiative\u003c/a> last year that would have required 75 hours of training, but the union didn’t get enough signatures to put the measure on the ballot. SEIU plans to try again for the 2016 ballot.\u003c/p>\n\u003cp>Requiring training would “save lives,” said Loretta Jackson, who serves on the union’s executive board and is an IHSS caregiver in Sacramento. It would also reduce the risk of injuries to caregivers, she added.\u003c/p>\n\u003cp>Jackson cares for her sister, who was left partially paralyzed by a stroke 15 years ago. When Jackson first started, she had to call paramedics every few weeks because her sister would fall. Once, Jackson said, her sister took too many pills and started shaking violently.\u003c/p>\n\u003cp>“I didn’t know what to do,” she said. “I started panicking.”\u003c/p>\n\u003cp>Other caregivers tell similar stories.\u003c/p>\n\u003cp>Ariana Ramos, 28, who is taking a training class, said a paralyzed client got a bed sore after sleeping in his wheelchair. Ramos thought it would heal on its own, but it just got worse.\u003c/p>\n\u003cp>“Now I know that we need to keep it covered up,” said Ramos, who lives in South Gate. “Now I know about bacteria and all the things that could get in a bed sore.”\u003c/p>\n\u003cfigure id=\"attachment_23350\" class=\"wp-caption alignleft\" style=\"max-width: 200px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/chuc-4rev.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-23350\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/chuc-4rev-300x449.jpg\" alt=\"Frances Chuc takes a break after a morning of taking care of her paraplegic husband. She says taking care of her husband is daunting, but her previous experience as a caregiver has helped (Heidi de Marco/KHN).\" width=\"200\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Frances Chuc takes a break after a morning of taking care of her paraplegic husband. She says taking care of her husband is daunting, but her previous experience as a caregiver has helped (Heidi de Marco/KHN).\u003c/figcaption>\u003c/figure>\n\u003cp>Caregivers without any medical background or training may not know when to call 911 or how to recognize a heart attack or stroke, said Frances Chuc, who takes care of her paralyzed husband at their home in South Gate and was trained as a nurse aide before she met him. “That person could die in their hands.”\u003c/p>\n\u003cp>A little bit of training can go a long way, said Joanne Spetz, director of UC San Francisco’s newly created Health Workforce Research Center. It can help caregivers recognize when their clients are having bad reactions to medications, for instance, or help them safely lift a person to avoid falls.\u003c/p>\n\u003cp>Training can also reduce turnover in a field that has low job retention, said Marquand of the Paraprofessional Healthcare Institute.\u003c/p>\n\u003cp>Several states are experimenting with different models of training. Washington State, for example,\u003ca title=\"http://www.dshs.wa.gov/altsa/home-and-community-services/individual-providers\" href=\"http://www.dshs.wa.gov/altsa/home-and-community-services/individual-providers\" target=\"_blank\" rel=\"noopener\"> began requiring 75 hours of training\u003c/a> for home caregivers in 2012.\u003c/p>\n\u003cp>It doesn’t make sense that caregivers in the home require less training nationwide than caregivers in nursing homes, said Charissa Raynor, executive director of the SEIU Healthcare NW Training Partnership, which trains 40,000 providers annually. (Certified aides in nursing homes are required by the federal government to have 75 hours of training.)\u003c/p>\n\u003cp>The Washington initiative, Raynor said, will help professionalize the workforce, reduce on-the-job injuries and lead to better care.\u003c/p>\n\u003cp>But not everyone has been happy with the new mandate.\u003c/p>\n\u003cp>“There are a lot of folks who just want to be a caregiver in someone’s home,” said Betty Schwieterman, director of systems advocacy at Disability Rights Washington. “They are not on a career path.”\u003c/p>\n\u003cp>\u003cstrong>Grants From The Government\u003c/strong>\u003c/p>\n\u003cp>The debate over mandatory training is far from resolved. But in the meantime, the federal government is putting money into pilot training efforts in various states.\u003c/p>\n\u003cp>Through the Affordable Care Act, it has awarded about \u003ca title=\"http://bhpr.hrsa.gov/nursing/grants/phcast.html\" href=\"http://bhpr.hrsa.gov/nursing/grants/phcast.html\" target=\"_blank\" rel=\"noopener\">$15 million in grants to California\u003c/a> and five other states to recruit and train qualified caregivers for the elderly and disabled populations\u003cstrong>. \u003c/strong>Classes started in 2011 in cities throughout the state, including San Francisco, Anaheim and Walnut.\u003c/p>\n\u003cp>The class Massengale attended is part of a separate federal grant of nearly $12 million given to the California Long-Term Care Education Center in Los Angeles. The center is training about 6,000 IHSS caregivers in Los Angeles, San Bernardino and Contra Costa counties.\u003c/p>\n\u003cp>An early evaluation of the program, as yet unpublished, by UC San Francisco researchers shows that clients with trained providers are less likely to go to the emergency room or be admitted to a hospital than those with untrained providers.\u003c/p>\n\u003cp>Corinne Eldridge, who runs the program, said trained caregivers can play an important role on a client’s health care team. “They can be the eyes and the ears in the home … and communicate back to the health care provider,” she said.\u003c/p>\n\u003cp>At a recent session in Compton, about two dozen caregivers gathered in a classroom at the public library, their binders of training materials spread out before them. The topic of the day was preventing bed sores and controlling infections.\u003c/p>\n\u003cp>The teacher, nurse Lori Picou, asked the class about the signs and symptoms of infection. The students yelled out answers: Redness. Fever. Fluid or discharge.\u003c/p>\n\u003cp>One offered a story about a bruise that swelled up like a basketball. Another said her paralyzed son was sweating so much that she had to repeatedly change his shirt.\u003c/p>\n\u003cp>Picou reminded the group to wash their hands frequently. “It is one of the most important things an individual can ever do to help control infection,” she said.\u003c/p>\n\u003cp>Oliver Massengale, who is in the class, said he is feeling a little bit more confident about keeping his brother safe. “The more I learn, the better I am to cope with this,” he said.\u003c/p>\n\u003cp>But being a caregiver for someone with so many health conditions is still scary to him.\u003c/p>\n\u003cp>“As I come down those stairs,” he said, “I am saying a prayer and just hoping that everything is all right when I get to the bottom.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca title=\"Kaiser Health News\" href=\"www.kaiserhealthnews.org\" target=\"_blank\" rel=\"noopener\">Kaiser Health News \u003c/a>is an editorially independent program of the \u003ca title=\"Kaiser Family Foundation\" href=\"www.kff.org\" target=\"_blank\" rel=\"noopener\">Kaiser Family Foundation.\u003c/a>\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>LOS ANGELES — Contaminated medical instruments are suspected in a “superbug” outbreak at a Los Angeles hospital that has infected at least seven patients, two of whom died. More than 170 others may have been exposed to the antibiotic-resistant bacteria.\u003c/p>\n\u003cp>They were potentially infected with \u003ca href=\"http://www.cdc.gov/HAI/organisms/cre/\" target=\"_blank\" rel=\"noopener\">Carbapenem-resistant Enterobacteriaceae\u003c/a>, or CRE, during endoscopic procedures at Ronald Reagan UCLA Medical Center between October and January, UCLA spokeswoman Dale Tate said. Tests on a patient uncovered the outbreak.\u003c/p>\n\u003cp>Similar outbreaks of potentially lethal CRE have been reported around the nation. They are difficult to treat because some varieties are resistant to most known antibiotics. By one estimate, CRE can contribute to death in up to half of seriously infected patients, according to the U.S. Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>The bacteria may have been a “contributing factor” in the deaths of two patients, UCLA said in a statement. Those who may have been exposed are being sent free home-testing kits that the university will analyze.\u003c/p>\n\u003cp>The bacteria can cause infections of the bladder or lungs. Symptoms can include coughing, fever and chills.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>UCLA said Wednesday that the infections may have been transmitted through two endoscopes used to diagnose and treat pancreatic and bile-duct problems.\u003c/p>\n\u003cp>“We notified all patients who had this type of procedure, and we were using seven different scopes. Only two of them were found to be infected. In an abundance of caution, we notified everybody,” Tate said.\u003c/p>\n\u003cp>The two medical devices carried the bacteria even though they had been sterilized according to the manufacturer’s specifications, UCLA said.\u003c/p>\n\u003cp>“We removed the infected instruments, and we have heightened the sterilization process,” Tate said.\u003c/p>\n\u003cp>On Thursday, the U.S. Food and Drug Administration issued an advisory warning doctors that even when a manufacturer’s cleaning instructions are followed, infectious germs may linger in the devices. Their complex design and tiny parts make complete disinfection extremely difficult, the advisory said.\u003c/p>\n\u003cp>National figures on the bacteria are not kept, but 47 states have seen cases, the CDC said.\u003c/p>\n\u003cp>Since 2012, there have been about a half-dozen outbreaks reaching as many as 150 patients, according to the Los Angeles Times, which first reported the UCLA outbreak.\u003c/p>\n\u003cp>One occurred in Illinois in 2013. Dozens of patients were exposed to CRE, with some cases apparently linked to a tainted endoscope used at a hospital.\u003c/p>\n\u003cp>A Seattle hospital, Virginia Mason Medical Center, reported in January that CRE linked to an endoscope sickened at least 35 patients, and 11 died, though it was unclear whether the infection played a role in those deaths.\u003c/p>\n\u003cp>Experts say the cases represent a disturbing surge.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“This bacteria is emerging in the U.S., and it’s associated with a high mortality rate,” CDC epidemiologist Dr. Alex Kallen told the Times. “We don’t want this circulating anywhere in the community.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>LOS ANGELES — Contaminated medical instruments are suspected in a “superbug” outbreak at a Los Angeles hospital that has infected at least seven patients, two of whom died. More than 170 others may have been exposed to the antibiotic-resistant bacteria.\u003c/p>\n\u003cp>They were potentially infected with \u003ca href=\"http://www.cdc.gov/HAI/organisms/cre/\" target=\"_blank\" rel=\"noopener\">Carbapenem-resistant Enterobacteriaceae\u003c/a>, or CRE, during endoscopic procedures at Ronald Reagan UCLA Medical Center between October and January, UCLA spokeswoman Dale Tate said. Tests on a patient uncovered the outbreak.\u003c/p>\n\u003cp>Similar outbreaks of potentially lethal CRE have been reported around the nation. They are difficult to treat because some varieties are resistant to most known antibiotics. By one estimate, CRE can contribute to death in up to half of seriously infected patients, according to the U.S. Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>The bacteria may have been a “contributing factor” in the deaths of two patients, UCLA said in a statement. Those who may have been exposed are being sent free home-testing kits that the university will analyze.\u003c/p>\n\u003cp>The bacteria can cause infections of the bladder or lungs. Symptoms can include coughing, fever and chills.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>UCLA said Wednesday that the infections may have been transmitted through two endoscopes used to diagnose and treat pancreatic and bile-duct problems.\u003c/p>\n\u003cp>“We notified all patients who had this type of procedure, and we were using seven different scopes. Only two of them were found to be infected. In an abundance of caution, we notified everybody,” Tate said.\u003c/p>\n\u003cp>The two medical devices carried the bacteria even though they had been sterilized according to the manufacturer’s specifications, UCLA said.\u003c/p>\n\u003cp>“We removed the infected instruments, and we have heightened the sterilization process,” Tate said.\u003c/p>\n\u003cp>On Thursday, the U.S. Food and Drug Administration issued an advisory warning doctors that even when a manufacturer’s cleaning instructions are followed, infectious germs may linger in the devices. Their complex design and tiny parts make complete disinfection extremely difficult, the advisory said.\u003c/p>\n\u003cp>National figures on the bacteria are not kept, but 47 states have seen cases, the CDC said.\u003c/p>\n\u003cp>Since 2012, there have been about a half-dozen outbreaks reaching as many as 150 patients, according to the Los Angeles Times, which first reported the UCLA outbreak.\u003c/p>\n\u003cp>One occurred in Illinois in 2013. Dozens of patients were exposed to CRE, with some cases apparently linked to a tainted endoscope used at a hospital.\u003c/p>\n\u003cp>A Seattle hospital, Virginia Mason Medical Center, reported in January that CRE linked to an endoscope sickened at least 35 patients, and 11 died, though it was unclear whether the infection played a role in those deaths.\u003c/p>\n\u003cp>Experts say the cases represent a disturbing surge.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“This bacteria is emerging in the U.S., and it’s associated with a high mortality rate,” CDC epidemiologist Dr. Alex Kallen told the Times. “We don’t want this circulating anywhere in the community.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>As public health officials have been working to curb the measles outbreak that began last month at Disneyland, they have run into an unexpected challenge: Because measles was all but eliminated in the United States about 15 years ago, most younger physicians have never seen it.\u003c/p>\n\u003cp>So now a generation of doctors is getting a crash course via a combination of methods, including informal workshops, emails, fliers and old college textbooks.\u003c/p>\n\u003cp>[soundcloud url=”https://api.soundcloud.com/tracks/188674870″ params=”color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false” width=”100%” height=”166″ iframe=”true” /]\u003c/p>\n\u003cp>On a recent morning, Dr. Greg Moran, interim chief of emergency medicine at Olive View-UCLA Medical Center in Sylmar, gave a quick seminar to a handful of residents, interns and other doctors during their daily huddle in the ER.\u003c/p>\n\u003cp>“Probably most of you young whippersnappers here have never seen a case of measles,” he says, going on to explain when a rash might appear on a person with measles.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In fact, none of the students in the ad hoc workshop had ever seen a case. Before the development of a vaccine in the 1960s, hundreds of thousands of Americans got measles, and about 500 kids died every year, says Moran.\u003c/p>\n\u003cp>\u003cstrong>\u003cem>\u003ca href=\"http://www.scpr.org/news/2015/01/28/49505/younger-doctors-need-a-measles-crash-course/\">Read the full story via KPCC\u003c/a>\u003c/em>\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>As public health officials have been working to curb the measles outbreak that began last month at Disneyland, they have run into an unexpected challenge: Because measles was all but eliminated in the United States about 15 years ago, most younger physicians have never seen it.\u003c/p>\n\u003cp>So now a generation of doctors is getting a crash course via a combination of methods, including informal workshops, emails, fliers and old college textbooks.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='”100%”' height='”166″'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=”https://api.soundcloud.com/tracks/188674870″&visual=true&”color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false”'\n title='”https://api.soundcloud.com/tracks/188674870″'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>On a recent morning, Dr. Greg Moran, interim chief of emergency medicine at Olive View-UCLA Medical Center in Sylmar, gave a quick seminar to a handful of residents, interns and other doctors during their daily huddle in the ER.\u003c/p>\n\u003cp>“Probably most of you young whippersnappers here have never seen a case of measles,” he says, going on to explain when a rash might appear on a person with measles.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In fact, none of the students in the ad hoc workshop had ever seen a case. Before the development of a vaccine in the 1960s, hundreds of thousands of Americans got measles, and about 500 kids died every year, says Moran.\u003c/p>\n\u003cp>\u003cstrong>\u003cem>\u003ca href=\"http://www.scpr.org/news/2015/01/28/49505/younger-doctors-need-a-measles-crash-course/\">Read the full story via KPCC\u003c/a>\u003c/em>\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>In the corner of a gym in a San Francisco jail, there’s something you wouldn’t usually find behind bars: a condom machine.\u003c/p>\n\u003cp>Earlier this year, Gov. Jerry Brown signed a new law that makes condoms available for free in all of California’s prisons. While sex between inmates is illegal, supporters of the “Prisoner Protections for Family and Community Health Act” say making condoms available in prison will help prevent the spread of HIV and other sexually transmitted diseases.\u003c/p>\n\u003cp>The law’s author, Assemblyman Rob Bonta, points to the machines in San Francisco’s jails as a model of how condom distribution could work on the state level.\u003c/p>\n\u003cp>[soundcloud url=”https://api.soundcloud.com/tracks/180179842″ params=”color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false” width=”100%” height=”166″ iframe=”true” /]\u003c/p>\n\u003cp>San Francisco began providing condoms to inmates in the 1980s in response to the AIDS crisis. There are now more than a dozen condom machines in San Francisco’s jails, according to Kate Monico Klein, director of HIV services for Jail Health, a division of the county’s Public Health Department. The dispenser in Jail Number Four was mounted in a corner of the gym “so that people would have a minor amount of privacy,” Monico Klein explains.\u003c/p>\n\u003caside class=\"pullquote alignright\">The CDC estimates that one in seven people living with HIV passes through correctional facilities each year.\u003c/aside>\n\u003cp>Sex in jail is illegal even if it is consensual. Section 286(e) of the California Penal Code outlaws “sodomy with any person of any age while confined in any state prison … or in any local detention facility,” and California’s Code of Regulations prohibits all sexual acts between inmates.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“The law’s the law, but should this behavior occur, there’s a safe, safer way,” says San Francisco Sheriff Ross Mirkarimi. “We want people to be protected.”\u003c/p>\n\u003cp>The Centers for Disease Control and Prevention estimate that one in seven people living with HIV passes through correctional facilities each year.\u003c/p>\n\u003cp>“Condoms are good to have around, I think, because it’s a life-saving device,” says Robert Greve, an inmate who’s serving a short sentence in the jail’s special unit for gay and transgender prisoners. “A lot of people don’t care about their health, I don’t think. Personally, I do. I’d rather not have sex than not use a condom, but some people do.”\u003c/p>\n\u003cfigure id=\"attachment_10367776\" class=\"wp-caption alignleft\" style=\"max-width: 336px\">\u003ca href=\"http://ww2.kqed.org/news/wp-content/uploads/sites/10/2014/12/Mirkarimi.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\" wp-image-10367776\" src=\"http://ww2.kqed.org/news/wp-content/uploads/sites/10/2014/12/Mirkarimi-400x442.jpg\" alt=\"San Francisco Sheriff Ross Mirkarimi\" width=\"336\" height=\"371\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2014/12/Mirkarimi-400x442.jpg 400w, https://cdn.kqed.org/wp-content/uploads/sites/10/2014/12/Mirkarimi-800x884.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2014/12/Mirkarimi.jpg 1440w\" sizes=\"(max-width: 336px) 100vw, 336px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">San Francisco Sheriff Ross Mirkarimi. (Mina Kim/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>Having done time in several states, Greve says this is the first time he’s been locked up in a facility where condoms are provided. With a laugh, he says he likes to make use of the machine, taking “10 of them every time.”\u003c/p>\n\u003cp>Another inmate in the jail, Rene Angel Ramirez, says he’s HIV-positive and uses condoms to keep partners safe — and to protect himself from diseases like gonorrhea, chlamydia or hepatitis C. He says he knows people who have contracted HIV while in custody. “We still have the need of sex,” he explains.\u003c/p>\n\u003cp>As Monico Klein recalls, when condoms were first introduced in San Francisco jails, some deputies were unhappy with the plan. Apart from the illegality of sex between inmates, there were concerns that condoms could be used for smuggling drugs, or filled with urine and thrown at staff, known as “gassing.”\u003c/p>\n\u003cp>She says deputies were also concerned that making condoms available would lead to an increase in both consensual sex and sexual assault. The Sheriff’s Department says that hasn’t happened in the years since condoms have been available. But the condoms have been used in some unexpected ways.\u003c/p>\n\u003cp>“We found that among other things, prisoners take the condoms and they use them as hair ties. They use them as pillows,” says Monico Klein. “One of the deputies told me that they blow them up and use them as balloons. While this initially bothered some people, she says, “we realized that this is another way of destigmatizing HIV.”\u003c/p>\n\u003cp>Even after more than two decades, San Francisco Chief Deputy Sheriff Matthew Freeman says not all deputies are comfortable with condoms being available.\u003c/p>\n\u003cp>“I could not report to you that there still is buy-in from the uniformed staff,” Freeman says, and adds there are reasons sex is prohibited in jail. “We know from experiences running and managing jails that even consensual activity amongst inmates can lead to very real problems.”\u003cstrong>\u003cem> \u003c/em>\u003c/strong>\u003c/p>\n\u003cp>California has five years to come up with its plan for distributing condoms in state prisons, a move that Mirkarimi says is “years overdue.” Other prisons and jails across the U.S. have been slow to follow San Francisco’s lead, something Mirkarimi attributes to the slow pace of reform in the criminal justice system, as well as homophobia.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Inmate Greve says that, based on his own experience in state lockups, the only problem he imagines with providing condoms in California state prisons will be supply, because “people will want as many of them as they can get.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In the corner of a gym in a San Francisco jail, there’s something you wouldn’t usually find behind bars: a condom machine.\u003c/p>\n\u003cp>Earlier this year, Gov. Jerry Brown signed a new law that makes condoms available for free in all of California’s prisons. While sex between inmates is illegal, supporters of the “Prisoner Protections for Family and Community Health Act” say making condoms available in prison will help prevent the spread of HIV and other sexually transmitted diseases.\u003c/p>\n\u003cp>The law’s author, Assemblyman Rob Bonta, points to the machines in San Francisco’s jails as a model of how condom distribution could work on the state level.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='”100%”' height='”166″'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=”https://api.soundcloud.com/tracks/180179842″&visual=true&”color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false”'\n title='”https://api.soundcloud.com/tracks/180179842″'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>San Francisco began providing condoms to inmates in the 1980s in response to the AIDS crisis. There are now more than a dozen condom machines in San Francisco’s jails, according to Kate Monico Klein, director of HIV services for Jail Health, a division of the county’s Public Health Department. The dispenser in Jail Number Four was mounted in a corner of the gym “so that people would have a minor amount of privacy,” Monico Klein explains.\u003c/p>\n\u003caside class=\"pullquote alignright\">The CDC estimates that one in seven people living with HIV passes through correctional facilities each year.\u003c/aside>\n\u003cp>Sex in jail is illegal even if it is consensual. Section 286(e) of the California Penal Code outlaws “sodomy with any person of any age while confined in any state prison … or in any local detention facility,” and California’s Code of Regulations prohibits all sexual acts between inmates.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“The law’s the law, but should this behavior occur, there’s a safe, safer way,” says San Francisco Sheriff Ross Mirkarimi. “We want people to be protected.”\u003c/p>\n\u003cp>The Centers for Disease Control and Prevention estimate that one in seven people living with HIV passes through correctional facilities each year.\u003c/p>\n\u003cp>“Condoms are good to have around, I think, because it’s a life-saving device,” says Robert Greve, an inmate who’s serving a short sentence in the jail’s special unit for gay and transgender prisoners. “A lot of people don’t care about their health, I don’t think. Personally, I do. I’d rather not have sex than not use a condom, but some people do.”\u003c/p>\n\u003cfigure id=\"attachment_10367776\" class=\"wp-caption alignleft\" style=\"max-width: 336px\">\u003ca href=\"http://ww2.kqed.org/news/wp-content/uploads/sites/10/2014/12/Mirkarimi.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\" wp-image-10367776\" src=\"http://ww2.kqed.org/news/wp-content/uploads/sites/10/2014/12/Mirkarimi-400x442.jpg\" alt=\"San Francisco Sheriff Ross Mirkarimi\" width=\"336\" height=\"371\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2014/12/Mirkarimi-400x442.jpg 400w, https://cdn.kqed.org/wp-content/uploads/sites/10/2014/12/Mirkarimi-800x884.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2014/12/Mirkarimi.jpg 1440w\" sizes=\"(max-width: 336px) 100vw, 336px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">San Francisco Sheriff Ross Mirkarimi. (Mina Kim/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>Having done time in several states, Greve says this is the first time he’s been locked up in a facility where condoms are provided. With a laugh, he says he likes to make use of the machine, taking “10 of them every time.”\u003c/p>\n\u003cp>Another inmate in the jail, Rene Angel Ramirez, says he’s HIV-positive and uses condoms to keep partners safe — and to protect himself from diseases like gonorrhea, chlamydia or hepatitis C. He says he knows people who have contracted HIV while in custody. “We still have the need of sex,” he explains.\u003c/p>\n\u003cp>As Monico Klein recalls, when condoms were first introduced in San Francisco jails, some deputies were unhappy with the plan. Apart from the illegality of sex between inmates, there were concerns that condoms could be used for smuggling drugs, or filled with urine and thrown at staff, known as “gassing.”\u003c/p>\n\u003cp>She says deputies were also concerned that making condoms available would lead to an increase in both consensual sex and sexual assault. The Sheriff’s Department says that hasn’t happened in the years since condoms have been available. But the condoms have been used in some unexpected ways.\u003c/p>\n\u003cp>“We found that among other things, prisoners take the condoms and they use them as hair ties. They use them as pillows,” says Monico Klein. “One of the deputies told me that they blow them up and use them as balloons. While this initially bothered some people, she says, “we realized that this is another way of destigmatizing HIV.”\u003c/p>\n\u003cp>Even after more than two decades, San Francisco Chief Deputy Sheriff Matthew Freeman says not all deputies are comfortable with condoms being available.\u003c/p>\n\u003cp>“I could not report to you that there still is buy-in from the uniformed staff,” Freeman says, and adds there are reasons sex is prohibited in jail. “We know from experiences running and managing jails that even consensual activity amongst inmates can lead to very real problems.”\u003cstrong>\u003cem> \u003c/em>\u003c/strong>\u003c/p>\n\u003cp>California has five years to come up with its plan for distributing condoms in state prisons, a move that Mirkarimi says is “years overdue.” Other prisons and jails across the U.S. have been slow to follow San Francisco’s lead, something Mirkarimi attributes to the slow pace of reform in the criminal justice system, as well as homophobia.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Inmate Greve says that, based on his own experience in state lockups, the only problem he imagines with providing condoms in California state prisons will be supply, because “people will want as many of them as they can get.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "How Likely Are You to Have Heart Surgery? A C-Section? Depends Where You Live",
"title": "How Likely Are You to Have Heart Surgery? A C-Section? Depends Where You Live",
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"content": "\u003cfigure id=\"attachment_22581\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/iStock_000018168863_Large-2-e1416359434913.jpg\">\u003cimg class=\"size-large wp-image-22581\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/iStock_000018168863_Large-2-640x426.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\"Location, location, location\" may be a well-known maxim in real estate, but it applies in health care, too. Where you live matters in terms of what treatment you will receive for a given condition.\u003c/p>\n\u003cp>\u003ca title=\"http://www.chcf.org/publications/2014/11/medical-variation-map\" href=\"http://www.chcf.org/publications/2014/11/medical-variation-map\" target=\"_blank\">A new statewide survey\u003c/a> published Tuesday found significant variation in the rate of 13 common elective procedures for several health conditions -- including heart disease, childbirth and arthritis of the hip or knee. Treatments for these conditions are considered \"elective\" because deciding which treatment is best (or deciding on no treatment at all) can depend on someone's preference.\u003c/p>\n\u003cp>It would be ideal if the patient was fully informed of all treatment options and made a decision based on his or her own preferences. But often it's the doctor's preferences that drive the decision.\u003c!--more-->\u003c/p>\n\u003cp>The California Healthcare Foundation has been tracking this variation in its ongoing \"\u003ca title=\"http://www.chcf.org/publications/2014/11/medical-variation-map#\" href=\"http://www.chcf.org/publications/2014/11/medical-variation-map#\" target=\"_blank\">All Over the Map\u003c/a>\" initiative. It previously published data about variation for these elective conditions from 2005 through 2008. This update looks at 2009 through 2012.\u003c/p>\n\u003cp>Some highlights from the survey, which looked at changes in the rates of procedures between the two time periods studied:\u003c/p>\n\u003cul>\n\u003cli>In Deer Park (Napa County), the rate of knee replacement surgery increased by 62 percent. People there are twice as likely to have knee replacement as people in Hawthorne (Los Angeles County).\u003c/li>\n\u003cli>For women having babies in Paramount (L.A. County), the rate of cesarean section increased 25 percent, and women there were more than twice as likely to deliver by C-section as women in Grass Valley, where the C-section rate dropped by 24 percent.\u003c/li>\n\u003cli>In Fresno, people are more than twice as likely to have angiography, compared with the statewide average.\u003c/li>\n\u003c/ul>\n\u003cp>You can use the \u003ca title=\"http://www.chcf.org/publications/2014/11/medical-variation-map\" href=\"http://www.chcf.org/publications/2014/11/medical-variation-map\" target=\"_blank\">interactive map\u003c/a> to look up rates for these procedures where you live. You might find pleasant surprises. Health advocates have been working to reduce rates of C-section. Woodland, Sonoma, Grass Valley and Davis are all Northern California cities with C-section rates well below the statewide average.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003ca href=\"http://www.chcf.org/publications/2014/11/medical-variation-map?utm_source=KQED&utm_medium=Article&utm_campaign=State%20of%20Health\" target=\"_blank\">\u003cimg class=\"alignright\" src=\"http://www.chcf.org/~/media/images/campaigns/variations%20teaser%2020141.jpg\" alt=\"All Over The Map: Surgery Rates in California Vary Widely\" width=\"190\" height=\"258\" border=\"0\">\u003c/a>Maribeth Shannon helps oversee the \"All Over The Map\" project for the foundation. She says that if patients were informed and making decisions about care, rates of procedures would average out over time.\u003c/p>\n\u003cp>It's also important to note that there's no known \"right\" rate, although the statewide average is a reasonable benchmark, she says.\u003c/p>\n\u003cp>\"You wouldn't think that people in Southern California would make a dramatically different decisions as people in Northern California with the same symptoms,\" she said. \"If people are fully informed, there'd be a range of options that people would choose ... but you wouldn't see a decision based on geography.\"\u003c/p>\n\u003cp>In an interview, Shannon elaborated on the spike in knee replacement surgeries in Deer Park. There was a successful knee replacement surgeon in Red Bluff, she told me, and that area had a \"much, much higher knee replacement rate.\" That surgeon moved to St. Helena, in Napa County, and then that area experienced a \"dramatic increase\" in knee replacements. \"The difference seemed to be the presence of a surgeon who was good at doing knee replacement and did a lot, had very high volume.\"\u003c/p>\n\u003cp>\"So to me that's a really great example of what's driving (an increased rate) tends to be the surgeon's preference, rather than the patient's preference,\" she said. There are a range of options for knee pain, she said, everything from no treatment at all, to management with medication to physical therapy.\u003c/p>\n\u003cp>\"You wouldn't want a lot of people, who perhaps would have been happy with physical therapy, opting for knee replacement because that's the only option given to them by their surgeon.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The question becomes a problem for society at large because if patients would have chosen a lesser therapy, if only they had known of it, then health care costs are being driven up unnecessarily.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_22581\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/iStock_000018168863_Large-2-e1416359434913.jpg\">\u003cimg class=\"size-large wp-image-22581\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/iStock_000018168863_Large-2-640x426.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\"Location, location, location\" may be a well-known maxim in real estate, but it applies in health care, too. Where you live matters in terms of what treatment you will receive for a given condition.\u003c/p>\n\u003cp>\u003ca title=\"http://www.chcf.org/publications/2014/11/medical-variation-map\" href=\"http://www.chcf.org/publications/2014/11/medical-variation-map\" target=\"_blank\">A new statewide survey\u003c/a> published Tuesday found significant variation in the rate of 13 common elective procedures for several health conditions -- including heart disease, childbirth and arthritis of the hip or knee. Treatments for these conditions are considered \"elective\" because deciding which treatment is best (or deciding on no treatment at all) can depend on someone's preference.\u003c/p>\n\u003cp>It would be ideal if the patient was fully informed of all treatment options and made a decision based on his or her own preferences. But often it's the doctor's preferences that drive the decision.\u003c!--more-->\u003c/p>\n\u003cp>The California Healthcare Foundation has been tracking this variation in its ongoing \"\u003ca title=\"http://www.chcf.org/publications/2014/11/medical-variation-map#\" href=\"http://www.chcf.org/publications/2014/11/medical-variation-map#\" target=\"_blank\">All Over the Map\u003c/a>\" initiative. It previously published data about variation for these elective conditions from 2005 through 2008. This update looks at 2009 through 2012.\u003c/p>\n\u003cp>Some highlights from the survey, which looked at changes in the rates of procedures between the two time periods studied:\u003c/p>\n\u003cul>\n\u003cli>In Deer Park (Napa County), the rate of knee replacement surgery increased by 62 percent. People there are twice as likely to have knee replacement as people in Hawthorne (Los Angeles County).\u003c/li>\n\u003cli>For women having babies in Paramount (L.A. County), the rate of cesarean section increased 25 percent, and women there were more than twice as likely to deliver by C-section as women in Grass Valley, where the C-section rate dropped by 24 percent.\u003c/li>\n\u003cli>In Fresno, people are more than twice as likely to have angiography, compared with the statewide average.\u003c/li>\n\u003c/ul>\n\u003cp>You can use the \u003ca title=\"http://www.chcf.org/publications/2014/11/medical-variation-map\" href=\"http://www.chcf.org/publications/2014/11/medical-variation-map\" target=\"_blank\">interactive map\u003c/a> to look up rates for these procedures where you live. You might find pleasant surprises. Health advocates have been working to reduce rates of C-section. Woodland, Sonoma, Grass Valley and Davis are all Northern California cities with C-section rates well below the statewide average.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.chcf.org/publications/2014/11/medical-variation-map?utm_source=KQED&utm_medium=Article&utm_campaign=State%20of%20Health\" target=\"_blank\">\u003cimg class=\"alignright\" src=\"http://www.chcf.org/~/media/images/campaigns/variations%20teaser%2020141.jpg\" alt=\"All Over The Map: Surgery Rates in California Vary Widely\" width=\"190\" height=\"258\" border=\"0\">\u003c/a>Maribeth Shannon helps oversee the \"All Over The Map\" project for the foundation. She says that if patients were informed and making decisions about care, rates of procedures would average out over time.\u003c/p>\n\u003cp>It's also important to note that there's no known \"right\" rate, although the statewide average is a reasonable benchmark, she says.\u003c/p>\n\u003cp>\"You wouldn't think that people in Southern California would make a dramatically different decisions as people in Northern California with the same symptoms,\" she said. \"If people are fully informed, there'd be a range of options that people would choose ... but you wouldn't see a decision based on geography.\"\u003c/p>\n\u003cp>In an interview, Shannon elaborated on the spike in knee replacement surgeries in Deer Park. There was a successful knee replacement surgeon in Red Bluff, she told me, and that area had a \"much, much higher knee replacement rate.\" That surgeon moved to St. Helena, in Napa County, and then that area experienced a \"dramatic increase\" in knee replacements. \"The difference seemed to be the presence of a surgeon who was good at doing knee replacement and did a lot, had very high volume.\"\u003c/p>\n\u003cp>\"So to me that's a really great example of what's driving (an increased rate) tends to be the surgeon's preference, rather than the patient's preference,\" she said. There are a range of options for knee pain, she said, everything from no treatment at all, to management with medication to physical therapy.\u003c/p>\n\u003cp>\"You wouldn't want a lot of people, who perhaps would have been happy with physical therapy, opting for knee replacement because that's the only option given to them by their surgeon.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The question becomes a problem for society at large because if patients would have chosen a lesser therapy, if only they had known of it, then health care costs are being driven up unnecessarily.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game and Brown has some lessons he'd like to share. ",
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
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"possible": {
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"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
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"radiolab": {
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},
"rightnowish": {
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"title": "Rightnowish",
"tagline": "Art is where you find it",
"info": "Rightnowish digs into life in the Bay Area right now… ish. Journalist Pendarvis Harshaw takes us to galleries painted on the sides of liquor stores in West Oakland. We'll dance in warehouses in the Bayview, make smoothies with kids in South Berkeley, and listen to classical music in a 1984 Cutlass Supreme in Richmond. Every week, Pen talks to movers and shakers about how the Bay Area shapes what they create, and how they shape the place we call home.",
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"tagline": "Real stories with killer beats",
"info": "The Snap Judgment radio show and podcast mixes real stories with killer beats to produce cinematic, dramatic radio. Snap's musical brand of storytelling dares listeners to see the world through the eyes of another. This is storytelling... with a BEAT!! Snap first aired on public radio stations nationwide in July 2010. Today, Snap Judgment airs on over 450 public radio stations and is brought to the airwaves by KQED & PRX.",
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"soldout": {
"id": "soldout",
"title": "SOLD OUT: Rethinking Housing in America",
"tagline": "A new future for housing",
"info": "Sold Out: Rethinking Housing in America",
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