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"content": "\n\u003cp class=\"wp-block-paragraph\">After immigration authorities detained a man in Emeryville last week and brought him to an \u003ca href=\"https://www.kqed.org/news/tag/highland-hospital\">Alameda County hospital\u003c/a>, some medical staff said they didn’t receive legally required training that would have helped them respond to enforcement activity. \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">Several staff members at Wilma Chan Highland Hospital Campus in Oakland told administrators in a letter that the Oct. 16 arrival of U.S. Immigration and Customs Enforcement agents and a detainee “highlighted major hazards to the rights and safety of our patients.” \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">Immigration agents brought a man to Highland for treatment after an agent allegedly tackled him and fractured six of his ribs, said Nikolas De Bremaeker, an attorney at Centro Legal De La Raza who represents the man. \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">Since then, De Bremaeker and some employees said agents allegedly tried to obstruct access to counsel, to direct medical treatment and to ask staff for medical information. The agent who tackled the patient, the attorney said, has been “sitting on his bed, grinning at him.” \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">“It’s incredibly scary,” De Bremaeker told KQED. “It’s just unacceptable for ICE agents to be terrorizing folks inside a hospital.” \u003c/p>\n\n\n\n\u003cfigure class=\"wp-block-image size-full\">\u003cimg loading=\"lazy\" decoding=\"async\" width=\"1505\" height=\"1432\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/10/261023-Highland-Hospital-SK-03-5314ee6d.jpg\" alt=\"\" class=\"wp-image-12105985\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/10/261023-Highland-Hospital-SK-03-5314ee6d.jpg 1505w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/10/261023-Highland-Hospital-SK-03-5314ee6d-160x152.jpg 160w\" sizes=\"auto, (max-width: 1505px) 100vw, 1505px\" />\u003cfigcaption class=\"wp-element-caption\">One side of an Alameda Health System employee’s “badge buddy” that outlines how to respond to immigration authorities when they show up to one of the facilities. (Courtesy of Iman Khalil)\u003c/figcaption>\u003c/figure>\n\n\n\n\u003cp class=\"wp-block-paragraph\">About two dozen community members were on the lookout for agents on Thursday morning for hours, being directed by others to make noise if immigration authorities exited or entered the facility. They’d been showing up since Monday, an organizer said. \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">The Alameda Health System, which Highland is a part of, declined to comment on allegations specific to De Bremaeker’s client’s care, citing patient confidentiality. But said, generally, law enforcement does not direct treatment and the system is complying with all laws and requirements concerning immigration enforcement in its facilities. \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">In an earlier statement to KQED about the ICE activity, AHS said that it activated an Incident Command Center and that security personnel are on site monitoring developments. \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">“We are following all immigration response protocols,” AHS said in the statement. \u003c/p>\n\n\n\n\u003ch2 class=\"wp-block-heading\">Alameda Health System’s training falls short, staff says\u003c/h2>\n\n\n\n\u003cp class=\"wp-block-paragraph\">Some staff members told AHS in the letter that they “at all levels, remain confused and consistently express a lack of clarity on policy when patients are brought in civil detention.”\u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">“This is out of step with current best practices in the state of California,” the staff members wrote. \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">\u003ca href=\"https://calmatters.digitaldemocracy.org/bills/ca_202520260sb81\">Senate Bill 81\u003c/a>, which took effect in September 2025, requires medical health care providers to restrict certain immigration information from being shared and, as part of new restrictions to nonpublic areas, facilities must inform staff on how to respond to requests to access sites and establish procedures for receiving visitors.\u003c/p>\n\n\n\n\u003cfigure class=\"wp-block-image size-full\">\u003cimg loading=\"lazy\" decoding=\"async\" width=\"2000\" height=\"1333\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/02/022426_ALAMEDA-COUNTY-HEALTH-CUTS-_GH_010-KQED.jpg\" alt=\"\" class=\"wp-image-12074474\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/02/022426_ALAMEDA-COUNTY-HEALTH-CUTS-_GH_010-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/02/022426_ALAMEDA-COUNTY-HEALTH-CUTS-_GH_010-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/02/022426_ALAMEDA-COUNTY-HEALTH-CUTS-_GH_010-KQED-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\" />\u003cfigcaption class=\"wp-element-caption\">The Wilma Chan Highland Hospital Campus is seen through flowering branches in Oakland on Feb. 24, 2026. The hospital is part of Alameda Health System. (Gustavo Hernandez/KQED)\u003c/figcaption>\u003c/figure>\n\n\n\n\u003cp class=\"wp-block-paragraph\">But staff told administrators the hospital system isn’t in compliance with that law. \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">Ansel Schmidt, a physical therapist at the Highland Hospital, isn’t on the patient’s care team, but helped draft the letter. \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">“I’m not sure that I’ve received anything that I would call training,” Schmidt told KQED. What Schmidt has received is a “badge buddy,” or a reference guide, that he said implies staff can cooperate with ICE. \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">A badge buddy reviewed by KQED shows that staff are instructed to notify an administrator when a patient in ICE custody shows up for care. Providers request agents leave during evaluation, inform patients of their rights and, if they don’t meet admission criteria, can be handed off to the ICE control office. \u003c/p>\n\n\n\n\n\n\u003cp class=\"wp-block-paragraph\">Schmidt said that emails about responding to immigration activity have left him and others feeling “really confused and isolated,” because that “isn’t a training.” \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">In response to staff concerns over training and what training is already in place, AHS said staff are told to “promptly escalate” situations through the appropriate channels where immigration authorities are present at any facility.\u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">“We reinforce these procedures through staff communications, training, scenario-based exercises, desktop training, and quick-reference ‘badge buddies’ that staff can keep with their identification badges,” AHS said. “The protocol has also been reviewed in staff webinar forums, including this week, and recordings are available to staff on our intranet.”\u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">Iman Khalil, a respiratory therapist at San Leandro Hospital, part of the Alameda Health System, said staff members receive minimal training about what to do when immigration authorities show up. Khalil received the same badge and emails Schmidt did.\u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">“Allowing the agents in the hospital … undoes all that training,” Khalil said. “You really don’t think they’ll even allow the agents in the hospital. But here we are.” \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">AHS CEO James Jackson told staff that AHS believed the man in ICE’s custody at the hospital was part of the agency’s civil immigration enforcement authority and called on personnel to review established immigration response protocols, according to an Oct. 19 email obtained and reviewed by KQED. \u003c/p>\n\n\n\n\u003ch2 class=\"wp-block-heading\">ICE-free zone?\u003c/h2>\n\n\n\n\u003cp class=\"wp-block-paragraph\">Highland Hospital, which sits on county property, also falls under Alameda County’s “ICE-free zone” ordinance that limits cooperation with federal immigration authorities. \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">County supervisors and advocates touted the policy, of which similar ones have been adopted across the Bay Area, as a way to push back against violent and sometimes deadly actions by immigration agents during the second Trump administration. In January, agents fatally shot Renee Good and Alex Pretti in Minnesota during a surge of immigration enforcement. \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">But Alameda County Sheriff Yesenia Sanchez and other officials have also noted the limits of just how far the ICE-free zone can go. It doesn’t prevent immigration officials from actually being on county property, Sanchez \u003ca href=\"https://oaklandside.org/2026/01/28/ice-free-zones-are-coming-to-alameda-county/\">said previously\u003c/a>. Officials in other jurisdictions with these “zones” have even referred to them as symbolic — or \u003ca href=\"https://www.mercurynews.com/2026/02/04/ice-free-zones-community-wide-warning-system-weighed-in-richmond-amid-trump-crackdowns/\">a way to create\u003c/a> “false expectations.” \u003c/p>\n\n\n\n\u003cfigure class=\"wp-block-image size-full\">\u003cimg loading=\"lazy\" decoding=\"async\" width=\"1577\" height=\"1560\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/10/261023-Highland-Hospital-SK-02-0b437edd.jpg\" alt=\"\" class=\"wp-image-12105984\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/10/261023-Highland-Hospital-SK-02-0b437edd.jpg 1577w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/10/261023-Highland-Hospital-SK-02-0b437edd-160x158.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/10/261023-Highland-Hospital-SK-02-0b437edd-1536x1519.jpg 1536w\" sizes=\"auto, (max-width: 1577px) 100vw, 1577px\" />\u003cfigcaption class=\"wp-element-caption\">One side of an Alameda Health System employee’s “badge buddy” that outlines how to respond to immigration authorities when they show up to one of the facilities. (Courtesy of Iman Khalil)\u003c/figcaption>\u003c/figure>\n\n\n\n\u003cp class=\"wp-block-paragraph\">De Bremaeker said his client is still in ICE custody as of Thursday afternoon. Another man he represents was detained by ICE in the San Antonio neighborhood in Oakland on the same day, before being taken to another hospital for injuries that De Bremaeker said were sustained because of the officers’ actions. \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">The two cases are part of an “unprecedented escalation” of violence from ICE, De Bremaeker said. \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">The attorney called on federal lawmakers to launch a congressional inquiry into ICE’s actions and, in particular, the agency’s activity in hospitals. \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">“They have been occupying these hospitals for days, creating an incredible threat to community members, terrifying folks who need medical care from going to the hospital,” De Bremaeker said. \u003c/p>\n\n\n\n\n\n\u003cp class=\"wp-block-paragraph\">ICE said that De Bremaeker’s client — who the agency characterized as an “illegal alien” — was arrested as part of a targeted enforcement operation. During which, the agency said the detainee tried to assault officers and refused lawful commands. \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">“Officers relied on their training to control the situation,” an ICE spokesperson said, adding that De Bremaeker’s client disclosed a preexisting injury of falling off a ladder two days prior. \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">The agency said, like other law enforcement agencies, it is standard procedure for ICE to accompany detainees for the safety of staff and public. \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">Renee Coe, with the Party for Socialism and Liberation, is among the community members who came out to keep watch for ICE at the hospital. She said some community members are scared to show up to the hospital because of federal agents’ presence, but urged them not to put off medical care. \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">AHS said its property is not being used as a staging area, operations base or processing location for immigration enforcement activities, and the immigration vehicles currently on Highland property are present “only in connection with a patient who is in immigration enforcement custody.” \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">Several Oakland residents are holding an emergency press conference at 6 p.m. on Friday in front of Highland to demand the release of De Bremaeker’s client and accountability for local authorities, security contracting with the facility and AHS “continuously” assisting ICE operations at the hospital. \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">\u003cem>KQED’s\u003c/em> \u003ca href=\"https://www.kqed.org/author/bkrans\">\u003cem>Brian Krans\u003c/em>\u003c/a> \u003cem>contributed to this report.\u003c/em>\u003c/p>\n",
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"innerHTML": "\n\u003cp>Several staff members at Wilma Chan Highland Hospital Campus in Oakland told administrators in a letter that the Oct. 16 arrival of U.S. Immigration and Customs Enforcement agents and a detainee “highlighted major hazards to the rights and safety of our patients.” \u003c/p>\n",
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"innerHTML": "\n\u003cp>Immigration agents brought a man to Highland for treatment after an agent allegedly tackled him and fractured six of his ribs, said Nikolas De Bremaeker, an attorney at Centro Legal De La Raza who represents the man. \u003c/p>\n",
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"innerHTML": "\n\u003cp>Since then, De Bremaeker and some employees said agents allegedly tried to obstruct access to counsel, to direct medical treatment and to ask staff for medical information. The agent who tackled the patient, the attorney said, has been “sitting on his bed, grinning at him.” \u003c/p>\n",
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"innerHTML": "\n\u003cp>“It’s incredibly scary,” De Bremaeker told KQED. “It’s just unacceptable for ICE agents to be terrorizing folks inside a hospital.” \u003c/p>\n",
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"innerHTML": "\n\u003cfigure class=\"wp-block-image size-full\">\u003cimg src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/10/261023-Highland-Hospital-SK-03-5314ee6d.jpg\" alt=\"\" class=\"wp-image-12105985\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/10/261023-Highland-Hospital-SK-03-5314ee6d.jpg 1505w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/10/261023-Highland-Hospital-SK-03-5314ee6d-160x152.jpg 160w\" sizes=\"(min-width: 992px) min(100vw, 1536px), (min-width: 768px) min(100vw, 1280px), min(100vw, 1020px)\"/>\u003cfigcaption class=\"wp-element-caption\">One side of an Alameda Health System employee’s “badge buddy” that outlines how to respond to immigration authorities when they show up to one of the facilities. \u003ccite class=\"wp-inline-image-credit\"> (Courtesy of Iman Khalil)\u003c/cite>\u003c/figcaption>\u003c/figure>\n",
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"innerHTML": "\n\u003cp>About two dozen community members were on the lookout for agents on Thursday morning for hours, being directed by others to make noise if immigration authorities exited or entered the facility. They’d been showing up since Monday, an organizer said. \u003c/p>\n",
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"innerHTML": "\n\u003cp>The Alameda Health System, which Highland is a part of, declined to comment on allegations specific to De Bremaeker’s client’s care, citing patient confidentiality. But said, generally, law enforcement does not direct treatment and the system is complying with all laws and requirements concerning immigration enforcement in its facilities. \u003c/p>\n",
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"innerHTML": "\n\u003cp>In an earlier statement to KQED about the ICE activity, AHS said that it activated an Incident Command Center and that security personnel are on site monitoring developments. \u003c/p>\n",
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"innerHTML": "\n\u003cp>Some staff members told AHS in the letter that they “at all levels, remain confused and consistently express a lack of clarity on policy when patients are brought in civil detention.”\u003c/p>\n",
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"innerHTML": "\n\u003cp>“This is out of step with current best practices in the state of California,” the staff members wrote. \u003c/p>\n",
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"innerHTML": "\n\u003cp>\u003ca href=\"https://calmatters.digitaldemocracy.org/bills/ca_202520260sb81\">Senate Bill 81\u003c/a>, which took effect in September 2025, requires medical health care providers to restrict certain immigration information from being shared and, as part of new restrictions to nonpublic areas, facilities must inform staff on how to respond to requests to access sites and establish procedures for receiving visitors.\u003c/p>\n",
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"\n\u003cp>\u003ca href=\"https://calmatters.digitaldemocracy.org/bills/ca_202520260sb81\">Senate Bill 81\u003c/a>, which took effect in September 2025, requires medical health care providers to restrict certain immigration information from being shared and, as part of new restrictions to nonpublic areas, facilities must inform staff on how to respond to requests to access sites and establish procedures for receiving visitors.\u003c/p>\n"
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"innerHTML": "\n\u003cfigure class=\"wp-block-image size-full\">\u003cimg src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/02/022426_ALAMEDA-COUNTY-HEALTH-CUTS-_GH_010-KQED.jpg\" alt=\"\" class=\"wp-image-12074474\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/02/022426_ALAMEDA-COUNTY-HEALTH-CUTS-_GH_010-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/02/022426_ALAMEDA-COUNTY-HEALTH-CUTS-_GH_010-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/02/022426_ALAMEDA-COUNTY-HEALTH-CUTS-_GH_010-KQED-1536x1024.jpg 1536w\" sizes=\"(min-width: 992px) min(100vw, 1536px), (min-width: 768px) min(100vw, 1280px), min(100vw, 1020px)\"/>\u003cfigcaption class=\"wp-element-caption\">The Wilma Chan Highland Hospital Campus is seen through flowering branches in Oakland on Feb. 24, 2026. The hospital is part of Alameda Health System.\u003ccite class=\"wp-inline-image-credit\"> (Gustavo Hernandez/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n",
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"innerHTML": "\n\u003cp>But staff told administrators the hospital system isn’t in compliance with that law. \u003c/p>\n",
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"innerHTML": "\n\u003cp>Ansel Schmidt, a physical therapist at the Highland Hospital, isn’t on the patient’s care team, but helped draft the letter. \u003c/p>\n",
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"innerHTML": "\n\u003cp>“I’m not sure that I’ve received anything that I would call training,” Schmidt told KQED. What Schmidt has received is a “badge buddy,” or a reference guide, that he said implies staff can cooperate with ICE. \u003c/p>\n",
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"innerHTML": "\n\u003cp>A badge buddy reviewed by KQED shows that staff are instructed to notify an administrator when a patient in ICE custody shows up for care. Providers request agents leave during evaluation, inform patients of their rights and, if they don’t meet admission criteria, can be handed off to the ICE control office. \u003c/p>\n",
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"\n\u003cp>A badge buddy reviewed by KQED shows that staff are instructed to notify an administrator when a patient in ICE custody shows up for care. Providers request agents leave during evaluation, inform patients of their rights and, if they don’t meet admission criteria, can be handed off to the ICE control office. \u003c/p>\n"
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"innerHTML": "\n\u003cp>Schmidt said that emails about responding to immigration activity have left him and others feeling “really confused and isolated,” because that “isn’t a training.” \u003c/p>\n",
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"innerHTML": "\n\u003cp>In response to staff concerns over training and what training is already in place, AHS said staff are told to “promptly escalate” situations through the appropriate channels where immigration authorities are present at any facility.\u003c/p>\n",
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"innerHTML": "\n\u003cp>“We reinforce these procedures through staff communications, training, scenario-based exercises, desktop training, and quick-reference ‘badge buddies’ that staff can keep with their identification badges,” AHS said. “The protocol has also been reviewed in staff webinar forums, including this week, and recordings are available to staff on our intranet.”\u003c/p>\n",
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"\n\u003cp>“We reinforce these procedures through staff communications, training, scenario-based exercises, desktop training, and quick-reference ‘badge buddies’ that staff can keep with their identification badges,” AHS said. “The protocol has also been reviewed in staff webinar forums, including this week, and recordings are available to staff on our intranet.”\u003c/p>\n"
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"innerHTML": "\n\u003cp>Iman Khalil, a respiratory therapist at San Leandro Hospital, part of the Alameda Health System, said staff members receive minimal training about what to do when immigration authorities show up. Khalil received the same badge and emails Schmidt did.\u003c/p>\n",
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"\n\u003cp>Iman Khalil, a respiratory therapist at San Leandro Hospital, part of the Alameda Health System, said staff members receive minimal training about what to do when immigration authorities show up. Khalil received the same badge and emails Schmidt did.\u003c/p>\n"
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"innerHTML": "\n\u003cp>“Allowing the agents in the hospital … undoes all that training,” Khalil said. “You really don’t think they’ll even allow the agents in the hospital. But here we are.” \u003c/p>\n",
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"\n\u003cp>“Allowing the agents in the hospital … undoes all that training,” Khalil said. “You really don’t think they’ll even allow the agents in the hospital. But here we are.” \u003c/p>\n"
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"innerHTML": "\n\u003cp>AHS CEO James Jackson told staff that AHS believed the man in ICE’s custody at the hospital was part of the agency’s civil immigration enforcement authority and called on personnel to review established immigration response protocols, according to an Oct. 19 email obtained and reviewed by KQED. \u003c/p>\n",
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"\n\u003cp>AHS CEO James Jackson told staff that AHS believed the man in ICE’s custody at the hospital was part of the agency’s civil immigration enforcement authority and called on personnel to review established immigration response protocols, according to an Oct. 19 email obtained and reviewed by KQED. \u003c/p>\n"
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"innerHTML": "\n\u003cp>Highland Hospital, which sits on county property, also falls under Alameda County’s “ICE-free zone” ordinance that limits cooperation with federal immigration authorities. \u003c/p>\n",
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"\n\u003cp>Highland Hospital, which sits on county property, also falls under Alameda County’s “ICE-free zone” ordinance that limits cooperation with federal immigration authorities. \u003c/p>\n"
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"innerHTML": "\n\u003cp>County supervisors and advocates touted the policy, of which similar ones have been adopted across the Bay Area, as a way to push back against violent and sometimes deadly actions by immigration agents during the second Trump administration. In January, agents fatally shot Renee Good and Alex Pretti in Minnesota during a surge of immigration enforcement. \u003c/p>\n",
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"\n\u003cp>County supervisors and advocates touted the policy, of which similar ones have been adopted across the Bay Area, as a way to push back against violent and sometimes deadly actions by immigration agents during the second Trump administration. In January, agents fatally shot Renee Good and Alex Pretti in Minnesota during a surge of immigration enforcement. \u003c/p>\n"
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"innerHTML": "\n\u003cp>But Alameda County Sheriff Yesenia Sanchez and other officials have also noted the limits of just how far the ICE-free zone can go. It doesn’t prevent immigration officials from actually being on county property, Sanchez \u003ca href=\"https://oaklandside.org/2026/01/28/ice-free-zones-are-coming-to-alameda-county/\">said previously\u003c/a>. Officials in other jurisdictions with these “zones” have even referred to them as symbolic — or \u003ca href=\"https://www.mercurynews.com/2026/02/04/ice-free-zones-community-wide-warning-system-weighed-in-richmond-amid-trump-crackdowns/\">a way to create\u003c/a> “false expectations.” \u003c/p>\n",
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"\n\u003cp>But Alameda County Sheriff Yesenia Sanchez and other officials have also noted the limits of just how far the ICE-free zone can go. It doesn’t prevent immigration officials from actually being on county property, Sanchez \u003ca href=\"https://oaklandside.org/2026/01/28/ice-free-zones-are-coming-to-alameda-county/\">said previously\u003c/a>. Officials in other jurisdictions with these “zones” have even referred to them as symbolic — or \u003ca href=\"https://www.mercurynews.com/2026/02/04/ice-free-zones-community-wide-warning-system-weighed-in-richmond-amid-trump-crackdowns/\">a way to create\u003c/a> “false expectations.” \u003c/p>\n"
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"innerHTML": "\n\u003cp>De Bremaeker said his client is still in ICE custody as of Thursday afternoon. Another man he represents was detained by ICE in the San Antonio neighborhood in Oakland on the same day, before being taken to another hospital for injuries that De Bremaeker said were sustained because of the officers’ actions. \u003c/p>\n",
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"\n\u003cp>De Bremaeker said his client is still in ICE custody as of Thursday afternoon. Another man he represents was detained by ICE in the San Antonio neighborhood in Oakland on the same day, before being taken to another hospital for injuries that De Bremaeker said were sustained because of the officers’ actions. \u003c/p>\n"
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"innerHTML": "\n\u003cp>The two cases are part of an “unprecedented escalation” of violence from ICE, De Bremaeker said. \u003c/p>\n",
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"innerHTML": "\n\u003cp>The attorney called on federal lawmakers to launch a congressional inquiry into ICE’s actions and, in particular, the agency’s activity in hospitals. \u003c/p>\n",
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"innerHTML": "\n\u003cp>“They have been occupying these hospitals for days, creating an incredible threat to community members, terrifying folks who need medical care from going to the hospital,” De Bremaeker said. \u003c/p>\n",
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"\n\u003cp>“They have been occupying these hospitals for days, creating an incredible threat to community members, terrifying folks who need medical care from going to the hospital,” De Bremaeker said. \u003c/p>\n"
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"innerHTML": "\n\u003cp>ICE said that De Bremaeker’s client — who the agency characterized as an “illegal alien” — was arrested as part of a targeted enforcement operation. During which, the agency said the detainee tried to assault officers and refused lawful commands. \u003c/p>\n",
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"\n\u003cp>ICE said that De Bremaeker’s client — who the agency characterized as an “illegal alien” — was arrested as part of a targeted enforcement operation. During which, the agency said the detainee tried to assault officers and refused lawful commands. \u003c/p>\n"
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"innerHTML": "\n\u003cp>“Officers relied on their training to control the situation,” an ICE spokesperson said, adding that De Bremaeker’s client disclosed a preexisting injury of falling off a ladder two days prior. \u003c/p>\n",
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"\n\u003cp>“Officers relied on their training to control the situation,” an ICE spokesperson said, adding that De Bremaeker’s client disclosed a preexisting injury of falling off a ladder two days prior. \u003c/p>\n"
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"innerHTML": "\n\u003cp>The agency said, like other law enforcement agencies, it is standard procedure for ICE to accompany detainees for the safety of staff and public. \u003c/p>\n",
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"innerHTML": "\n\u003cp>Renee Coe, with the Party for Socialism and Liberation, is among the community members who came out to keep watch for ICE at the hospital. She said some community members are scared to show up to the hospital because of federal agents’ presence, but urged them not to put off medical care. \u003c/p>\n",
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"\n\u003cp>Renee Coe, with the Party for Socialism and Liberation, is among the community members who came out to keep watch for ICE at the hospital. She said some community members are scared to show up to the hospital because of federal agents’ presence, but urged them not to put off medical care. \u003c/p>\n"
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"innerHTML": "\n\u003cp>AHS said its property is not being used as a staging area, operations base or processing location for immigration enforcement activities, and the immigration vehicles currently on Highland property are present “only in connection with a patient who is in immigration enforcement custody.” \u003c/p>\n",
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"\n\u003cp>AHS said its property is not being used as a staging area, operations base or processing location for immigration enforcement activities, and the immigration vehicles currently on Highland property are present “only in connection with a patient who is in immigration enforcement custody.” \u003c/p>\n"
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"innerHTML": "\n\u003cp>Several Oakland residents are holding an emergency press conference at 6 p.m. on Friday in front of Highland to demand the release of De Bremaeker’s client and accountability for local authorities, security contracting with the facility and AHS “continuously” assisting ICE operations at the hospital. \u003c/p>\n",
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"\n\u003cp>Several Oakland residents are holding an emergency press conference at 6 p.m. on Friday in front of Highland to demand the release of De Bremaeker’s client and accountability for local authorities, security contracting with the facility and AHS “continuously” assisting ICE operations at the hospital. \u003c/p>\n"
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"innerHTML": "\n\u003cp>\u003cem>KQED’s\u003c/em> \u003ca href=\"https://www.kqed.org/author/bkrans\">\u003cem>Brian Krans\u003c/em>\u003c/a> \u003cem>contributed to this report.\u003c/em>\u003c/p>\n",
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"excerpt": "Oakland’s Highland Hospital staff and community members expressed concerns after ICE agents allegedly brought a patient in with six fractured ribs last week. ",
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"title": "East Bay Immigration Arrest Raises Questions About ‘ICE-Free Zones,’ Training at Hospitals | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\n\u003cp class=\"wp-block-paragraph\">After immigration authorities detained a man in Emeryville last week and brought him to an \u003ca href=\"https://www.kqed.org/news/tag/highland-hospital\">Alameda County hospital\u003c/a>, some medical staff said they didn’t receive legally required training that would have helped them respond to enforcement activity. \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">Several staff members at Wilma Chan Highland Hospital Campus in Oakland told administrators in a letter that the Oct. 16 arrival of U.S. Immigration and Customs Enforcement agents and a detainee “highlighted major hazards to the rights and safety of our patients.” \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">Immigration agents brought a man to Highland for treatment after an agent allegedly tackled him and fractured six of his ribs, said Nikolas De Bremaeker, an attorney at Centro Legal De La Raza who represents the man. \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">Since then, De Bremaeker and some employees said agents allegedly tried to obstruct access to counsel, to direct medical treatment and to ask staff for medical information. The agent who tackled the patient, the attorney said, has been “sitting on his bed, grinning at him.” \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">“It’s incredibly scary,” De Bremaeker told KQED. “It’s just unacceptable for ICE agents to be terrorizing folks inside a hospital.” \u003c/p>\n\n\n\n\u003cfigure class=\"wp-block-image size-full\">\u003cimg loading=\"lazy\" decoding=\"async\" width=\"1505\" height=\"1432\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/10/261023-Highland-Hospital-SK-03-5314ee6d.jpg\" alt=\"\" class=\"wp-image-12105985\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/10/261023-Highland-Hospital-SK-03-5314ee6d.jpg 1505w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/10/261023-Highland-Hospital-SK-03-5314ee6d-160x152.jpg 160w\" sizes=\"auto, (max-width: 1505px) 100vw, 1505px\" />\u003cfigcaption class=\"wp-element-caption\">One side of an Alameda Health System employee’s “badge buddy” that outlines how to respond to immigration authorities when they show up to one of the facilities. (Courtesy of Iman Khalil)\u003c/figcaption>\u003c/figure>\n\n\n\n\u003cp class=\"wp-block-paragraph\">About two dozen community members were on the lookout for agents on Thursday morning for hours, being directed by others to make noise if immigration authorities exited or entered the facility. They’d been showing up since Monday, an organizer said. \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">The Alameda Health System, which Highland is a part of, declined to comment on allegations specific to De Bremaeker’s client’s care, citing patient confidentiality. But said, generally, law enforcement does not direct treatment and the system is complying with all laws and requirements concerning immigration enforcement in its facilities. \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">In an earlier statement to KQED about the ICE activity, AHS said that it activated an Incident Command Center and that security personnel are on site monitoring developments. \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">“We are following all immigration response protocols,” AHS said in the statement. \u003c/p>\n\n\n\n\u003ch2 class=\"wp-block-heading\">Alameda Health System’s training falls short, staff says\u003c/h2>\n\n\n\n\u003cp class=\"wp-block-paragraph\">Some staff members told AHS in the letter that they “at all levels, remain confused and consistently express a lack of clarity on policy when patients are brought in civil detention.”\u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">“This is out of step with current best practices in the state of California,” the staff members wrote. \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">\u003ca href=\"https://calmatters.digitaldemocracy.org/bills/ca_202520260sb81\">Senate Bill 81\u003c/a>, which took effect in September 2025, requires medical health care providers to restrict certain immigration information from being shared and, as part of new restrictions to nonpublic areas, facilities must inform staff on how to respond to requests to access sites and establish procedures for receiving visitors.\u003c/p>\n\n\n\n\u003cfigure class=\"wp-block-image size-full\">\u003cimg loading=\"lazy\" decoding=\"async\" width=\"2000\" height=\"1333\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/02/022426_ALAMEDA-COUNTY-HEALTH-CUTS-_GH_010-KQED.jpg\" alt=\"\" class=\"wp-image-12074474\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/02/022426_ALAMEDA-COUNTY-HEALTH-CUTS-_GH_010-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/02/022426_ALAMEDA-COUNTY-HEALTH-CUTS-_GH_010-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/02/022426_ALAMEDA-COUNTY-HEALTH-CUTS-_GH_010-KQED-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\" />\u003cfigcaption class=\"wp-element-caption\">The Wilma Chan Highland Hospital Campus is seen through flowering branches in Oakland on Feb. 24, 2026. The hospital is part of Alameda Health System. (Gustavo Hernandez/KQED)\u003c/figcaption>\u003c/figure>\n\n\n\n\u003cp class=\"wp-block-paragraph\">But staff told administrators the hospital system isn’t in compliance with that law. \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">Ansel Schmidt, a physical therapist at the Highland Hospital, isn’t on the patient’s care team, but helped draft the letter. \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">“I’m not sure that I’ve received anything that I would call training,” Schmidt told KQED. What Schmidt has received is a “badge buddy,” or a reference guide, that he said implies staff can cooperate with ICE. \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">A badge buddy reviewed by KQED shows that staff are instructed to notify an administrator when a patient in ICE custody shows up for care. Providers request agents leave during evaluation, inform patients of their rights and, if they don’t meet admission criteria, can be handed off to the ICE control office. \u003c/p>\n\n\n\n\n\n\u003cp class=\"wp-block-paragraph\">Schmidt said that emails about responding to immigration activity have left him and others feeling “really confused and isolated,” because that “isn’t a training.” \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">In response to staff concerns over training and what training is already in place, AHS said staff are told to “promptly escalate” situations through the appropriate channels where immigration authorities are present at any facility.\u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">“We reinforce these procedures through staff communications, training, scenario-based exercises, desktop training, and quick-reference ‘badge buddies’ that staff can keep with their identification badges,” AHS said. “The protocol has also been reviewed in staff webinar forums, including this week, and recordings are available to staff on our intranet.”\u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">Iman Khalil, a respiratory therapist at San Leandro Hospital, part of the Alameda Health System, said staff members receive minimal training about what to do when immigration authorities show up. Khalil received the same badge and emails Schmidt did.\u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">“Allowing the agents in the hospital … undoes all that training,” Khalil said. “You really don’t think they’ll even allow the agents in the hospital. But here we are.” \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">AHS CEO James Jackson told staff that AHS believed the man in ICE’s custody at the hospital was part of the agency’s civil immigration enforcement authority and called on personnel to review established immigration response protocols, according to an Oct. 19 email obtained and reviewed by KQED. \u003c/p>\n\n\n\n\u003ch2 class=\"wp-block-heading\">ICE-free zone?\u003c/h2>\n\n\n\n\u003cp class=\"wp-block-paragraph\">Highland Hospital, which sits on county property, also falls under Alameda County’s “ICE-free zone” ordinance that limits cooperation with federal immigration authorities. \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">County supervisors and advocates touted the policy, of which similar ones have been adopted across the Bay Area, as a way to push back against violent and sometimes deadly actions by immigration agents during the second Trump administration. In January, agents fatally shot Renee Good and Alex Pretti in Minnesota during a surge of immigration enforcement. \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">But Alameda County Sheriff Yesenia Sanchez and other officials have also noted the limits of just how far the ICE-free zone can go. It doesn’t prevent immigration officials from actually being on county property, Sanchez \u003ca href=\"https://oaklandside.org/2026/01/28/ice-free-zones-are-coming-to-alameda-county/\">said previously\u003c/a>. Officials in other jurisdictions with these “zones” have even referred to them as symbolic — or \u003ca href=\"https://www.mercurynews.com/2026/02/04/ice-free-zones-community-wide-warning-system-weighed-in-richmond-amid-trump-crackdowns/\">a way to create\u003c/a> “false expectations.” \u003c/p>\n\n\n\n\u003cfigure class=\"wp-block-image size-full\">\u003cimg loading=\"lazy\" decoding=\"async\" width=\"1577\" height=\"1560\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/10/261023-Highland-Hospital-SK-02-0b437edd.jpg\" alt=\"\" class=\"wp-image-12105984\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/10/261023-Highland-Hospital-SK-02-0b437edd.jpg 1577w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/10/261023-Highland-Hospital-SK-02-0b437edd-160x158.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/10/261023-Highland-Hospital-SK-02-0b437edd-1536x1519.jpg 1536w\" sizes=\"auto, (max-width: 1577px) 100vw, 1577px\" />\u003cfigcaption class=\"wp-element-caption\">One side of an Alameda Health System employee’s “badge buddy” that outlines how to respond to immigration authorities when they show up to one of the facilities. (Courtesy of Iman Khalil)\u003c/figcaption>\u003c/figure>\n\n\n\n\u003cp class=\"wp-block-paragraph\">De Bremaeker said his client is still in ICE custody as of Thursday afternoon. Another man he represents was detained by ICE in the San Antonio neighborhood in Oakland on the same day, before being taken to another hospital for injuries that De Bremaeker said were sustained because of the officers’ actions. \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">The two cases are part of an “unprecedented escalation” of violence from ICE, De Bremaeker said. \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">The attorney called on federal lawmakers to launch a congressional inquiry into ICE’s actions and, in particular, the agency’s activity in hospitals. \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">“They have been occupying these hospitals for days, creating an incredible threat to community members, terrifying folks who need medical care from going to the hospital,” De Bremaeker said. \u003c/p>\n\n\n\n\n\n\u003cp class=\"wp-block-paragraph\">ICE said that De Bremaeker’s client — who the agency characterized as an “illegal alien” — was arrested as part of a targeted enforcement operation. During which, the agency said the detainee tried to assault officers and refused lawful commands. \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">“Officers relied on their training to control the situation,” an ICE spokesperson said, adding that De Bremaeker’s client disclosed a preexisting injury of falling off a ladder two days prior. \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">The agency said, like other law enforcement agencies, it is standard procedure for ICE to accompany detainees for the safety of staff and public. \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">Renee Coe, with the Party for Socialism and Liberation, is among the community members who came out to keep watch for ICE at the hospital. She said some community members are scared to show up to the hospital because of federal agents’ presence, but urged them not to put off medical care. \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">AHS said its property is not being used as a staging area, operations base or processing location for immigration enforcement activities, and the immigration vehicles currently on Highland property are present “only in connection with a patient who is in immigration enforcement custody.” \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">Several Oakland residents are holding an emergency press conference at 6 p.m. on Friday in front of Highland to demand the release of De Bremaeker’s client and accountability for local authorities, security contracting with the facility and AHS “continuously” assisting ICE operations at the hospital. \u003c/p>\n\n\n\n\u003cp class=\"wp-block-paragraph\">\u003cem>KQED’s\u003c/em> \u003ca href=\"https://www.kqed.org/author/bkrans\">\u003cem>Brian Krans\u003c/em>\u003c/a> \u003cem>contributed to this report.\u003c/em>\u003c/p>\n\u003c/div>\u003c/p>",
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"slug": "maternity-group-care-for-and-by-black-people-is-improving-outcomes-in-oakland",
"title": "Maternity Group Care for and by Black People Is Improving Outcomes in Oakland",
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"headTitle": "Maternity Group Care for and by Black People Is Improving Outcomes in Oakland | KQED",
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"content": "\u003cp>Things didn’t go as planned when DeAnna Jones, 31, delivered her first child in Oakland three years ago.\u003c/p>\n\u003cp>She wanted to have a natural birth, but early contractions led doctors to medically induce her labor a week earlier than her due date. Her daughter’s birth turned out well, but she wished she had known more going into the experience.\u003c/p>\n\u003cp>“I did have a birth plan, and getting induced was not part of that,” Jones said. “So when it came at 39 weeks to be induced, I was like, okay … but I didn’t necessarily say why or can I wait until I’m actually 40 weeks or things that I probably should have asked.”\u003c/p>\n\u003cfigure id=\"attachment_11968844\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11968844\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-023-JY-qut.jpg\" alt=\"Two African American women smiles as they go over a chart.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-023-JY-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-023-JY-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-023-JY-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-023-JY-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-023-JY-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">BElovedBIRTH Black Centering midwife Chantal Davis (left) holds up an infographic on decision making alongside program director Jyesha Wren (right) during a group care session for expectant Black mothers at the Alameda Wellness Center in Oakland on Wednesday, Nov. 8, 2023. \u003ccite>(Juliana Yamada/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Jones didn’t feel mistreated during her experience at the Wilma Chan Highland Hospital Campus, but it gave her pause when she became pregnant again.\u003c/p>\n\u003cp>So Jones was excited when, around eight weeks into her second pregnancy, she was invited to participate in a group perinatal care program that’s trying to improve the patient experience for Black women like her who live in Alameda County. The program, called BElovedBIRTH Black Centering, is resulting in healthier births and prompting state officials to look into expanding it to other public hospitals in California.\u003c/p>\n\u003cp>The program groups up to a dozen Black women in similar stages of pregnancy and offers them care from a team of Black doctors, midwives, doulas, nutritionists, breastfeeding experts and other wellness professionals. Participants receive a range of services before, during and after giving birth — from childbirth education to mental health support and social services.\u003c/p>\n\u003cfigure id=\"attachment_11968845\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11968845\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-014-JY-qut.jpg\" alt=\"African American women smile as they sit in a circle and listen to one of them speak.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-014-JY-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-014-JY-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-014-JY-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-014-JY-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-014-JY-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Latasha Dixon (center) acts out a decision-making scenario during a BElovedBIRTH Black Centering group care session for expectant Black mothers at the Alameda Wellness Center. \u003ccite>(Juliana Yamada/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The program also harnesses donations from the community to give away fresh produce, baby supplies, postpartum meal deliveries and pregnancy portraits with a professional photographer.\u003c/p>\n\u003cp>“We have really adopted the ‘it takes a village’ mindset and the commitment to say, okay, if we know better, we have to do better,” said Jyesha Wren, a midwife and director of the program.\u003c/p>\n\u003cp>[pullquote align=\"right\" size=\"medium\" citation=\"Jyesha Wren, director, BElovedBIRTH Black Centering\"]‘We have really adopted the ‘it takes a village’ mindset and the commitment to say, okay, if we know better, we have to do better.’[/pullquote]Wren, along with the Alameda Health System, which operates Highland Hospital and other community health centers, and the Alameda County Public Health Department, launched the program in 2020 to address the alarming rate of pregnancy-related deaths and complications affecting Black women. So far, the $3.5 million public-private initiative has served more than 200 patients who qualify for Medi-Cal because of their low income.\u003c/p>\n\u003cp>American women are dying during pregnancy or in the year after \u003ca href=\"https://www.commonwealthfund.org/blog/2022/us-maternal-mortality-crisis-continues-worsen-international-comparison\">at a far higher rate than in other wealthy nations\u003c/a>, and \u003ca href=\"https://www.cdc.gov/healthequity/features/maternal-mortality/index.html\">Black women are three times as likely to die\u003c/a> from giving birth as white mothers.\u003c/p>\n\u003cp>While California’s maternal mortality rate has been \u003ca href=\"https://www.cmqcc.org/research/maternal-mortality-review-ca-pamr/ca-pamr-recent-data\">lower than the rest of the \u003c/a>country in the last decade, \u003ca href=\"https://www.nber.org/system/files/working_papers/w30693/w30693.pdf\">a landmark study of babies born in the state (PDF)\u003c/a> between 2007 and 2016 found that childbirth is riskier for Black women, regardless of their socioeconomic status. The study, which examines birth, death and hospitalization records with income tax and demographic data, found that high-income Black mothers have the same risk of dying in the first year after giving birth as the poorest white mothers.\u003c/p>\n\u003cp>“There are many factors that may be driving this, but the primary factor behind all of that is racism in all of its forms, whether that’s structural or institutional or interpersonal racism,” said Kim Harley, a researcher at UC Berkeley’s School of Public Health. “We see that impacting the whole life course of Black birthing people, and it’s shown in the outcomes that they have during pregnancy.”\u003c/p>\n\u003cfigure id=\"attachment_11968851\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11968851\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-019-JY-qut.jpg\" alt=\"A pregnant African American woman looks on as someone handles a catheter in a room with chairs.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-019-JY-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-019-JY-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-019-JY-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-019-JY-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-019-JY-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">DeAnna Jones watches as BElovedBIRTH Black Centering team members demonstrate a balloon catheter procedure during birth at a group care session for expectant Black mothers at the Alameda Wellness Center. \u003ccite>(Juliana Yamada/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>More recently, a survey of 2,400 mothers by the U.S. Centers for Disease Control and Prevention found that \u003ca href=\"https://www.cdc.gov/vitalsigns/respectful-maternity-care/index.html\">one in five women said they had been mistreated \u003c/a>while receiving maternity care. Mistreatment was reported most often by Black, Hispanic and multiracial moms and those with public or no insurance. What’s more, almost half of the women surveyed said they held back in asking questions or sharing concerns with their providers because they didn’t want to “make a big deal” or not feeling confident that they knew what they were talking about.\u003c/p>\n\u003ch2>A unique model of care\u003c/h2>\n\u003cp>BElovedBIRTH combines several strategies, such as having a doula provide nonmedical support during a birth, that \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10292163/\">has been shown to improve outcomes\u003c/a> for Black mothers and their babies.\u003c/p>\n\u003cp>While typical prenatal checkups last about 15 minutes and can leave parents feeling rushed and overwhelmed, BElovedBIRTH takes a different approach. Participants partake in group prenatal care, also known as centering, where they get two hours to learn about what’s happening to their bodies and ask questions.\u003c/p>\n\u003cfigure id=\"attachment_11968848\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11968848\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-028-JY-qut.jpg\" alt=\"A pregnant woman is laying down and receiving prenatal care from another woman.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-028-JY-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-028-JY-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-028-JY-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-028-JY-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-028-JY-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Midwife Chantal Davis finishes checking Taj’ae Harris’ baby’s heartbeat during a checkup at BElovedBIRTH Black Centering’s group care session for expectant Black mothers at the Alameda Wellness Center. \u003ccite>(Juliana Yamada/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>BElovedBIRTH participants meet twice a month at a clinic located in a former shopping mall in East Oakland, but the setting feels nothing like a medical office. Portraits of pregnant Black people hang on the wall and mellow Afrobeat music plays in the background. There’s a lounge filled with books where women sip tea and chat with each other.\u003c/p>\n\u003cp>[aside label=\"Related Stories\" postID=\"news_11965919,news_11943821,news_11958841\"]During a recent visit, six women, including DeAnna Jones, took turns going behind a room divider where a nurse measured their blood pressure and their baby’s heartbeat.\u003c/p>\n\u003cp>Then, they formed a circle to learn from a team of Black midwives and doulas about different methods for speeding up labor and the pros and cons of each one. They also role-played what it might be like if their deliveries don’t go as planned.\u003c/p>\n\u003cp>Dressed in a T-shirt that exposed her full belly, Jones went over a scenario where she was admitted to the hospital with high blood pressure. A midwife suggested speeding up contractions with medication or a balloon-like device to widen her cervix.\u003c/p>\n\u003cp>Jones weighed the risks and benefits of using either method or doing nothing at all and asked: “Is there a possibility that I can wait a little bit?” A doula stepped in and asked if she needed more time to discuss the options.\u003c/p>\n\u003cp>Jones said, “Yes,” seemingly relieved to have that choice.\u003c/p>\n\u003cfigure id=\"attachment_11968849\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11968849\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-016-JY-qut.jpg\" alt=\"An African American woman holds a natal chart in front of a class.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-016-JY-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-016-JY-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-016-JY-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-016-JY-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-016-JY-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Doula Mysti Dyse holds up a chart displaying cervix dilation during a BElovedBIRTH Black Centering group care session for expectant Black mothers at the Alameda Wellness Center. \u003ccite>(Juliana Yamada/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The purpose of the exercise was to empower patients to make informed decisions.\u003c/p>\n\u003cp>“These things may seem kind of simple and basic, but the sad reality is that in most medicalized health care, they’re not happening,” Wren said.\u003c/p>\n\u003cp>“There’s no time for them to get information. There’s no time for them to be actually taking charge of their health care in that way and knowing what’s going on with their bodies and making their decisions and having them respected.”\u003c/p>\n\u003cfigure id=\"attachment_11968850\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11968850\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-007-JY-qut.jpg\" alt=\"An African American woman smiles as she sits in front of a whiteboard with writing on it.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-007-JY-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-007-JY-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-007-JY-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-007-JY-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-007-JY-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">BElovedBIRTH Black Centering Program Director Jyesha Wren holds a group care session for expectant Black mothers at the Alameda Wellness Center. \u003ccite>(Juliana Yamada/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In an independent survey of Black moms who participated in the program, the majority said they felt less stressed during pregnancy and more prepared to advocate for themselves.\u003c/p>\n\u003cp>Taj’ae Harris, 20, said before coming here, much of what she knew about childbirth came from TikTok and YouTube.\u003c/p>\n\u003cp>[pullquote align=\"right\" size=\"medium\" citation=\"Taj’ae Harris, program participant\"]‘I’ve been learning a lot of things, like the steps, like coping during labor, different tools being used, different things to ask the doctors, different things to make you feel safe.’[/pullquote]“But then actually coming in here and learning even more stuff, it all, like, pieced together,” she said. “So I’ve been learning a lot of things, like the steps, like coping during labor, different tools being used, different things to ask the doctors, different things to make you feel safe.”\u003c/p>\n\u003cp>Meanwhile, Jones said she feels more confident as she prepares for her second delivery.\u003c/p>\n\u003cp>“I wish I had this program then, but now that I’m in it, I’m excited and ready to go,” she said.\u003c/p>\n\u003cp>An ongoing study led by Harley, the reproductive epidemiologist at UC Berkeley, found that the BElovedBIRTH participants’ babies had a higher rate of being born at full term and with a healthy birth weight than other Black babies born at Highland, which is Alameda County’s main public hospital.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The California Department of Health Care Services, which administers Medi-Cal, is exploring ways to make a program like BElovedBIRTH financially sustainable so it can be implemented in other public health systems.\u003c/p>\n\u003cp>The program would expand the state’s recent efforts to\u003ca href=\"https://www.cdph.ca.gov/Programs/CFH/DMCAH/PEI/Pages/default.aspx\"> improve health equity for new parents and babies\u003c/a>. The state already expanded postpartum care and access to doulas for Medi-Cal patients. It’s starting to offer unconditional cash, ranging from $600 to $1000 per month, to pregnant people in certain communities who are at high risk for preterm birth or postpartum complications. The state’s pilot project is an expansion of \u003ca href=\"https://pretermbirthca.ucsf.edu/expecting-justice\">a San Francisco experiment that provides extra cash and doula care for Black and Pacific Islander pregnant people\u003c/a> — two groups that have the highest preterm birth rate in the city.\u003c/p>\n\u003cp>The state is also putting pressure on perinatal care providers to comply with a law requiring that their workers undergo unconscious bias training.\u003c/p>\n\u003cfigure id=\"attachment_11968854\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11968854\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-025-JY-qut.jpg\" alt=\"Five African American women sit in a room, smiling and conversing.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-025-JY-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-025-JY-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-025-JY-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-025-JY-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-025-JY-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">From left to right: Monique Gomez, Taj’ae Harris, and Latasha Dixon attend a BElovedBIRTH Black Centering group care session for expectant Black mothers alongside midwife Chantal Davis and doula Mystic Dyse at the Alameda Wellness Center. \u003ccite>(Juliana Yamada/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But two years after that law took effect, \u003ca href=\"https://www.kqed.org/news/11965919/california-hospitals-ignored-bias-training-despite-high-black-maternal-death-rate\">an investigation by the state Department of Justice\u003c/a> found only 17% of those providers began training their employees.\u003c/p>\n\u003cp>Wren said mandating unconscious bias training is a step in the right direction, but she thinks advancing health equity will also require empowering pregnant Black people so that they can demand a higher standard of care and holding health care providers accountable.\u003c/p>\n\u003cp>“It really is a matter of life and death for our health system to do things differently because we know that if we continue to deliver health care in the way that we have, we’ll continue to have preventable morbidity and mortality,” she said.\u003c/p>\n\u003ch2>A legacy of fighting for health equity\u003c/h2>\n\u003cp>Wren says the BElovedBIRTH Black Centering is thriving because of grassroots support in a community with a tradition of activism. It draws inspiration from the Black Panthers Party, which operated more than a dozen free medical clinics for Black communities in Oakland and elsewhere in the 1960s and 70s.\u003c/p>\n\u003cp>[pullquote align=\"right\" size=\"medium\" citation=\"Jyesha Wren, director, BElovedBIRTH Black Centering\"]‘It really is a matter of life and death for our health system to do things differently because we know that if we continue to deliver health care in the way that we have, we’ll continue to have preventable morbidity and mortality.’[/pullquote]They “really recognized the health impacts of racism in all of its forms and the need to do community-centered health care work that was by and for us,” she said.\u003c/p>\n\u003cp>The Oakland area also benefits from having a larger than usual pool of Black midwives, doulas and maternity care providers.\u003c/p>\n\u003cp>Wren credits the former head of Highland Hospital’s Maternal and Child Health department for taking the unusual step in the 1980s of including midwives in the labor and delivery room. That wasn’t common practice then but has since been shown to lower birth complications. The move created a robust midwife department, and some of its staff members are now supporting BElovedBIRTH participants.\u003c/p>\n\u003cfigure id=\"attachment_11968855\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11968855\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-003-JY-qut.jpg\" alt=\"A wall full of photos, cards, messages.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-003-JY-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-003-JY-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-003-JY-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-003-JY-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-003-JY-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Pregnancy portraits fill the walls of BElovedBIRTH Black Centering at the Alameda Wellness Center. \u003ccite>(Juliana Yamada/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The doctor who advocated for midwives was James Jackson. His son, James E.T. Jackson, is now CEO of Alameda Health System.\u003c/p>\n\u003cp>“He understood their value, and what the Beloved program has shown is that the cohort model and working with midwives and doulas create a safe space for these mothers that they did not have before,” he said.\u003c/p>\n\u003cp>Alameda Health System is encouraged by the outcomes, the younger Jackson said and is looking to expand the program to other ethnic groups experiencing disproportionate rates of maternal and infant mortality.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"excerpt": "A new group prenatal care program called BElovedBIRTH Black Centering is resulting in healthier births and prompting state officials to look into expanding it to other public hospitals in California.",
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"title": "Maternity Group Care for and by Black People Is Improving Outcomes in Oakland | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Things didn’t go as planned when DeAnna Jones, 31, delivered her first child in Oakland three years ago.\u003c/p>\n\u003cp>She wanted to have a natural birth, but early contractions led doctors to medically induce her labor a week earlier than her due date. Her daughter’s birth turned out well, but she wished she had known more going into the experience.\u003c/p>\n\u003cp>“I did have a birth plan, and getting induced was not part of that,” Jones said. “So when it came at 39 weeks to be induced, I was like, okay … but I didn’t necessarily say why or can I wait until I’m actually 40 weeks or things that I probably should have asked.”\u003c/p>\n\u003cfigure id=\"attachment_11968844\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11968844\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-023-JY-qut.jpg\" alt=\"Two African American women smiles as they go over a chart.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-023-JY-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-023-JY-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-023-JY-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-023-JY-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-023-JY-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">BElovedBIRTH Black Centering midwife Chantal Davis (left) holds up an infographic on decision making alongside program director Jyesha Wren (right) during a group care session for expectant Black mothers at the Alameda Wellness Center in Oakland on Wednesday, Nov. 8, 2023. \u003ccite>(Juliana Yamada/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Jones didn’t feel mistreated during her experience at the Wilma Chan Highland Hospital Campus, but it gave her pause when she became pregnant again.\u003c/p>\n\u003cp>So Jones was excited when, around eight weeks into her second pregnancy, she was invited to participate in a group perinatal care program that’s trying to improve the patient experience for Black women like her who live in Alameda County. The program, called BElovedBIRTH Black Centering, is resulting in healthier births and prompting state officials to look into expanding it to other public hospitals in California.\u003c/p>\n\u003cp>The program groups up to a dozen Black women in similar stages of pregnancy and offers them care from a team of Black doctors, midwives, doulas, nutritionists, breastfeeding experts and other wellness professionals. Participants receive a range of services before, during and after giving birth — from childbirth education to mental health support and social services.\u003c/p>\n\u003cfigure id=\"attachment_11968845\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11968845\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-014-JY-qut.jpg\" alt=\"African American women smile as they sit in a circle and listen to one of them speak.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-014-JY-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-014-JY-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-014-JY-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-014-JY-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-014-JY-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Latasha Dixon (center) acts out a decision-making scenario during a BElovedBIRTH Black Centering group care session for expectant Black mothers at the Alameda Wellness Center. \u003ccite>(Juliana Yamada/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The program also harnesses donations from the community to give away fresh produce, baby supplies, postpartum meal deliveries and pregnancy portraits with a professional photographer.\u003c/p>\n\u003cp>“We have really adopted the ‘it takes a village’ mindset and the commitment to say, okay, if we know better, we have to do better,” said Jyesha Wren, a midwife and director of the program.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "‘We have really adopted the ‘it takes a village’ mindset and the commitment to say, okay, if we know better, we have to do better.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Wren, along with the Alameda Health System, which operates Highland Hospital and other community health centers, and the Alameda County Public Health Department, launched the program in 2020 to address the alarming rate of pregnancy-related deaths and complications affecting Black women. So far, the $3.5 million public-private initiative has served more than 200 patients who qualify for Medi-Cal because of their low income.\u003c/p>\n\u003cp>American women are dying during pregnancy or in the year after \u003ca href=\"https://www.commonwealthfund.org/blog/2022/us-maternal-mortality-crisis-continues-worsen-international-comparison\">at a far higher rate than in other wealthy nations\u003c/a>, and \u003ca href=\"https://www.cdc.gov/healthequity/features/maternal-mortality/index.html\">Black women are three times as likely to die\u003c/a> from giving birth as white mothers.\u003c/p>\n\u003cp>While California’s maternal mortality rate has been \u003ca href=\"https://www.cmqcc.org/research/maternal-mortality-review-ca-pamr/ca-pamr-recent-data\">lower than the rest of the \u003c/a>country in the last decade, \u003ca href=\"https://www.nber.org/system/files/working_papers/w30693/w30693.pdf\">a landmark study of babies born in the state (PDF)\u003c/a> between 2007 and 2016 found that childbirth is riskier for Black women, regardless of their socioeconomic status. The study, which examines birth, death and hospitalization records with income tax and demographic data, found that high-income Black mothers have the same risk of dying in the first year after giving birth as the poorest white mothers.\u003c/p>\n\u003cp>“There are many factors that may be driving this, but the primary factor behind all of that is racism in all of its forms, whether that’s structural or institutional or interpersonal racism,” said Kim Harley, a researcher at UC Berkeley’s School of Public Health. “We see that impacting the whole life course of Black birthing people, and it’s shown in the outcomes that they have during pregnancy.”\u003c/p>\n\u003cfigure id=\"attachment_11968851\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11968851\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-019-JY-qut.jpg\" alt=\"A pregnant African American woman looks on as someone handles a catheter in a room with chairs.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-019-JY-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-019-JY-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-019-JY-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-019-JY-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-019-JY-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">DeAnna Jones watches as BElovedBIRTH Black Centering team members demonstrate a balloon catheter procedure during birth at a group care session for expectant Black mothers at the Alameda Wellness Center. \u003ccite>(Juliana Yamada/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>More recently, a survey of 2,400 mothers by the U.S. Centers for Disease Control and Prevention found that \u003ca href=\"https://www.cdc.gov/vitalsigns/respectful-maternity-care/index.html\">one in five women said they had been mistreated \u003c/a>while receiving maternity care. Mistreatment was reported most often by Black, Hispanic and multiracial moms and those with public or no insurance. What’s more, almost half of the women surveyed said they held back in asking questions or sharing concerns with their providers because they didn’t want to “make a big deal” or not feeling confident that they knew what they were talking about.\u003c/p>\n\u003ch2>A unique model of care\u003c/h2>\n\u003cp>BElovedBIRTH combines several strategies, such as having a doula provide nonmedical support during a birth, that \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10292163/\">has been shown to improve outcomes\u003c/a> for Black mothers and their babies.\u003c/p>\n\u003cp>While typical prenatal checkups last about 15 minutes and can leave parents feeling rushed and overwhelmed, BElovedBIRTH takes a different approach. Participants partake in group prenatal care, also known as centering, where they get two hours to learn about what’s happening to their bodies and ask questions.\u003c/p>\n\u003cfigure id=\"attachment_11968848\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11968848\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-028-JY-qut.jpg\" alt=\"A pregnant woman is laying down and receiving prenatal care from another woman.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-028-JY-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-028-JY-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-028-JY-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-028-JY-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-028-JY-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Midwife Chantal Davis finishes checking Taj’ae Harris’ baby’s heartbeat during a checkup at BElovedBIRTH Black Centering’s group care session for expectant Black mothers at the Alameda Wellness Center. \u003ccite>(Juliana Yamada/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>BElovedBIRTH participants meet twice a month at a clinic located in a former shopping mall in East Oakland, but the setting feels nothing like a medical office. Portraits of pregnant Black people hang on the wall and mellow Afrobeat music plays in the background. There’s a lounge filled with books where women sip tea and chat with each other.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>During a recent visit, six women, including DeAnna Jones, took turns going behind a room divider where a nurse measured their blood pressure and their baby’s heartbeat.\u003c/p>\n\u003cp>Then, they formed a circle to learn from a team of Black midwives and doulas about different methods for speeding up labor and the pros and cons of each one. They also role-played what it might be like if their deliveries don’t go as planned.\u003c/p>\n\u003cp>Dressed in a T-shirt that exposed her full belly, Jones went over a scenario where she was admitted to the hospital with high blood pressure. A midwife suggested speeding up contractions with medication or a balloon-like device to widen her cervix.\u003c/p>\n\u003cp>Jones weighed the risks and benefits of using either method or doing nothing at all and asked: “Is there a possibility that I can wait a little bit?” A doula stepped in and asked if she needed more time to discuss the options.\u003c/p>\n\u003cp>Jones said, “Yes,” seemingly relieved to have that choice.\u003c/p>\n\u003cfigure id=\"attachment_11968849\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11968849\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-016-JY-qut.jpg\" alt=\"An African American woman holds a natal chart in front of a class.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-016-JY-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-016-JY-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-016-JY-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-016-JY-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-016-JY-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Doula Mysti Dyse holds up a chart displaying cervix dilation during a BElovedBIRTH Black Centering group care session for expectant Black mothers at the Alameda Wellness Center. \u003ccite>(Juliana Yamada/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The purpose of the exercise was to empower patients to make informed decisions.\u003c/p>\n\u003cp>“These things may seem kind of simple and basic, but the sad reality is that in most medicalized health care, they’re not happening,” Wren said.\u003c/p>\n\u003cp>“There’s no time for them to get information. There’s no time for them to be actually taking charge of their health care in that way and knowing what’s going on with their bodies and making their decisions and having them respected.”\u003c/p>\n\u003cfigure id=\"attachment_11968850\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11968850\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-007-JY-qut.jpg\" alt=\"An African American woman smiles as she sits in front of a whiteboard with writing on it.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-007-JY-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-007-JY-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-007-JY-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-007-JY-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-007-JY-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">BElovedBIRTH Black Centering Program Director Jyesha Wren holds a group care session for expectant Black mothers at the Alameda Wellness Center. \u003ccite>(Juliana Yamada/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In an independent survey of Black moms who participated in the program, the majority said they felt less stressed during pregnancy and more prepared to advocate for themselves.\u003c/p>\n\u003cp>Taj’ae Harris, 20, said before coming here, much of what she knew about childbirth came from TikTok and YouTube.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“But then actually coming in here and learning even more stuff, it all, like, pieced together,” she said. “So I’ve been learning a lot of things, like the steps, like coping during labor, different tools being used, different things to ask the doctors, different things to make you feel safe.”\u003c/p>\n\u003cp>Meanwhile, Jones said she feels more confident as she prepares for her second delivery.\u003c/p>\n\u003cp>“I wish I had this program then, but now that I’m in it, I’m excited and ready to go,” she said.\u003c/p>\n\u003cp>An ongoing study led by Harley, the reproductive epidemiologist at UC Berkeley, found that the BElovedBIRTH participants’ babies had a higher rate of being born at full term and with a healthy birth weight than other Black babies born at Highland, which is Alameda County’s main public hospital.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The California Department of Health Care Services, which administers Medi-Cal, is exploring ways to make a program like BElovedBIRTH financially sustainable so it can be implemented in other public health systems.\u003c/p>\n\u003cp>The program would expand the state’s recent efforts to\u003ca href=\"https://www.cdph.ca.gov/Programs/CFH/DMCAH/PEI/Pages/default.aspx\"> improve health equity for new parents and babies\u003c/a>. The state already expanded postpartum care and access to doulas for Medi-Cal patients. It’s starting to offer unconditional cash, ranging from $600 to $1000 per month, to pregnant people in certain communities who are at high risk for preterm birth or postpartum complications. The state’s pilot project is an expansion of \u003ca href=\"https://pretermbirthca.ucsf.edu/expecting-justice\">a San Francisco experiment that provides extra cash and doula care for Black and Pacific Islander pregnant people\u003c/a> — two groups that have the highest preterm birth rate in the city.\u003c/p>\n\u003cp>The state is also putting pressure on perinatal care providers to comply with a law requiring that their workers undergo unconscious bias training.\u003c/p>\n\u003cfigure id=\"attachment_11968854\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11968854\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-025-JY-qut.jpg\" alt=\"Five African American women sit in a room, smiling and conversing.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-025-JY-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-025-JY-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-025-JY-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-025-JY-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-025-JY-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">From left to right: Monique Gomez, Taj’ae Harris, and Latasha Dixon attend a BElovedBIRTH Black Centering group care session for expectant Black mothers alongside midwife Chantal Davis and doula Mystic Dyse at the Alameda Wellness Center. \u003ccite>(Juliana Yamada/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But two years after that law took effect, \u003ca href=\"https://www.kqed.org/news/11965919/california-hospitals-ignored-bias-training-despite-high-black-maternal-death-rate\">an investigation by the state Department of Justice\u003c/a> found only 17% of those providers began training their employees.\u003c/p>\n\u003cp>Wren said mandating unconscious bias training is a step in the right direction, but she thinks advancing health equity will also require empowering pregnant Black people so that they can demand a higher standard of care and holding health care providers accountable.\u003c/p>\n\u003cp>“It really is a matter of life and death for our health system to do things differently because we know that if we continue to deliver health care in the way that we have, we’ll continue to have preventable morbidity and mortality,” she said.\u003c/p>\n\u003ch2>A legacy of fighting for health equity\u003c/h2>\n\u003cp>Wren says the BElovedBIRTH Black Centering is thriving because of grassroots support in a community with a tradition of activism. It draws inspiration from the Black Panthers Party, which operated more than a dozen free medical clinics for Black communities in Oakland and elsewhere in the 1960s and 70s.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "‘It really is a matter of life and death for our health system to do things differently because we know that if we continue to deliver health care in the way that we have, we’ll continue to have preventable morbidity and mortality.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>They “really recognized the health impacts of racism in all of its forms and the need to do community-centered health care work that was by and for us,” she said.\u003c/p>\n\u003cp>The Oakland area also benefits from having a larger than usual pool of Black midwives, doulas and maternity care providers.\u003c/p>\n\u003cp>Wren credits the former head of Highland Hospital’s Maternal and Child Health department for taking the unusual step in the 1980s of including midwives in the labor and delivery room. That wasn’t common practice then but has since been shown to lower birth complications. The move created a robust midwife department, and some of its staff members are now supporting BElovedBIRTH participants.\u003c/p>\n\u003cfigure id=\"attachment_11968855\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11968855\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-003-JY-qut.jpg\" alt=\"A wall full of photos, cards, messages.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-003-JY-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-003-JY-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-003-JY-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-003-JY-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-003-JY-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Pregnancy portraits fill the walls of BElovedBIRTH Black Centering at the Alameda Wellness Center. \u003ccite>(Juliana Yamada/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The doctor who advocated for midwives was James Jackson. His son, James E.T. Jackson, is now CEO of Alameda Health System.\u003c/p>\n\u003cp>“He understood their value, and what the Beloved program has shown is that the cohort model and working with midwives and doulas create a safe space for these mothers that they did not have before,” he said.\u003c/p>\n\u003cp>Alameda Health System is encouraged by the outcomes, the younger Jackson said and is looking to expand the program to other ethnic groups experiencing disproportionate rates of maternal and infant mortality.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"slug": "the-difference-between-life-and-death-how-some-california-emergency-rooms-are-working-to-stem-the-overdose-crisis",
"title": "'The Difference Between Life and Death': How Some California Emergency Rooms Are Working to Stem the Overdose Crisis",
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"headTitle": "‘The Difference Between Life and Death’: How Some California Emergency Rooms Are Working to Stem the Overdose Crisis | KQED",
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"content": "\u003cp>Inside Saint Francis Memorial Hospital’s frenetic emergency room, near San Francisco’s Tenderloin neighborhood, Dr. Joanne Sun quickly scans the medical record of her fourth overdose patient of the day.\u003c/p>\n\u003cp>“It seems to me that people are mainly overdosing on fentanyl,” said Sun, the hospital’s emergency department director. “A lot of times they don’t even realize that what they bought off the street was fentanyl. Their intent was actually to do crystal or cocaine.”[pullquote align=\"right\" size=\"medium\" citation=\"Dr. Joanne Sun, St. Francis Memorial Hospital Emergency Department\"]‘I definitely see us as a stabilizer. That’s first and foremost. We make sure you’re stable. But then I also think of us as a bridge towards social services.’[/pullquote]Fentanyl is a synthetic opioid that’s up to 100 times stronger than morphine, and is now commonly mixed in street drugs.\u003c/p>\n\u003cp>“I think the pandemic has made everything worse in terms of mental health,” Sun said. “And unfortunately, drugs are going to be a crutch.”\u003c/p>\n\u003cp>Almost on cue, an older Black man with bloodshot eyes is wheeled through the ambulance bay. He says he intended to smoke crack, but overdosed after unknowingly inhaling fentanyl.\u003c/p>\n\u003cp>\u003ca href=\"https://www.sfchronicle.com/sf/article/San-Francisco-s-overdose-epidemic-16434757.php\">Black people who use drugs in San Francisco are nearly six times more likely than people of other races there to die of accidental overdoses\u003c/a>, according to data recently compiled by The San Francisco Chronicle.\u003c/p>\n\u003cp>That discrepancy can be directly attributed to structural racism, according to the city’s Department of Public Health. “Among the effects of structural racism are years of unjust drug policies that punish rather than offer care, unaffordable housing, poverty, inequitable access to effective treatments for opioid use disorder, and discriminatory practices in the healthcare system,” a department spokesperson said in an email.\u003c/p>\n\u003cp>San Francisco has one of the nation’s highest overdose rates, with a related death rate more than triple those in Los Angeles and New York. To put that in context, \u003ca href=\"https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm,\">nearly three times as many people in this city died from drug overdoses\u003c/a> than from COVID-19 last year.\u003c/p>\n\u003cfigure id=\"attachment_11896391\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11896391 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/11/RS51214_010_SanFrancisco_StFrancisER_08262021-qut.jpg\" alt=\"A woman with a white lab coat and face mask standing at a computer.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/RS51214_010_SanFrancisco_StFrancisER_08262021-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/RS51214_010_SanFrancisco_StFrancisER_08262021-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/RS51214_010_SanFrancisco_StFrancisER_08262021-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/RS51214_010_SanFrancisco_StFrancisER_08262021-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/RS51214_010_SanFrancisco_StFrancisER_08262021-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Joanne Sun, who heads Saint Francis Memorial Hospital’s Emergency Department in San Francisco, on Aug. 26, 2021. \u003ccite>(Beth LaBerge/ KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch3>Shifting treatment from jails to hospitals\u003c/h3>\n\u003cp>For decades, authorities have punished people who do drugs, even as the statistics have overwhelmingly demonstrated that such an approach is simply not effective in stemming drug use.\u003c/p>\n\u003cp>More than \u003ca href=\"https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm\">93,000 people in the United States died from drug overdoses \u003c/a>last year — an average of about \u003ca href=\"https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm\">250 people a day\u003c/a> — the highest one-year death toll on record. That includes the most deaths to date from overdoses of synthetic opioids, like fentanyl, as well as stimulants, like cocaine.[aside label=\"related coverage\" tag=\"drug-overdose\"]The dire situation is pushing policymakers to switch gears and increasingly recognize addiction as a disease requiring medical attention that should be treated in hospitals rather than jails.\u003c/p>\n\u003cp>“I see us as a bridge,” said Sun. “I definitely see us as a stabilizer. That’s first and foremost. We make sure you’re stable. But then I also think of us as a bridge towards social services.”\u003c/p>\n\u003cp>Treating addiction in hospitals, however, is actually still rare and relatively new. Historically, \u003ca href=\"https://www.fda.gov/drugs/information-drug-class/information-about-medication-assisted-treatment-mat\">ER docs have not dispensed evidence-based treatment\u003c/a> designed to relieve opioid withdrawal symptoms. Until a few years ago, standard practice was to offer patients something to settle their nerves or relieve diarrhea. And then once stabilized, patients were often sent on their way.\u003c/p>\n\u003cp>“Essentially you would get handed a piece of paper, and that was your referral to your treatment and good luck,” said Christian Hailozian, a substance use navigator at Highland Hospital in Oakland. “That was essentially it: ‘Please don’t come back to the emergency department.’ That was kind of the way that patients were treated.”\u003c/p>\n\u003cp>It was an approach that yielded overburdened ERs with revolving doors.\u003c/p>\n\u003cfigure id=\"attachment_11896383\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11896383 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/11/RS51227_023_SanFrancisco_StFrancisER_08262021-qut.jpg\" alt=\"An EMT pushing a gurney through a hospital hallway.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/RS51227_023_SanFrancisco_StFrancisER_08262021-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/RS51227_023_SanFrancisco_StFrancisER_08262021-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/RS51227_023_SanFrancisco_StFrancisER_08262021-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/RS51227_023_SanFrancisco_StFrancisER_08262021-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/RS51227_023_SanFrancisco_StFrancisER_08262021-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">An EMT brings a patient into the Saint Francis Memorial Hospital ER in San Francisco on Aug. 26, 2021. \u003ccite>(Beth LaBerge/ KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003ca href=\"https://cabridge.org/\">California Bridge\u003c/a>, a statewide program developed in 2018, is designed to break this cycle by medically treating opioid withdrawal symptoms inside the ER rather than sending patients elsewhere for treatment, and losing that rare opportunity for face-to-face contact.\u003c/p>\n\u003cp>“The program creates a seamless continuum of care from the acute ER crisis to outpatient treatment,” said Dr. Andrew Herring, the medical director of Highland’s substance use disorder treatment program. “When you’re dealing with something as tenuous as treatment for opioid use disorder, it’s really the difference between life and death.”\u003c/p>\n\u003cp>The program, which started as a pilot at eight hospitals across the state, performed so well that the state invested another $20 million last fall to expand the model.\u003c/p>\n\u003cp>“Patients with addiction come into the ED,” said Skye Christensen, a spokesperson for the program. “They are going to show up there. But how\u003ci> \u003c/i>they’re treated and whether or not they’re provided with ongoing care is central to whether they come back requiring more in-depth hospital resources.”\u003c/p>\n\u003ch3>Breaking the cycle\u003c/h3>\n\u003cp>On a recent morning, a woman named Sonia arrived at Highland’s ER, her nose running and clothes drenched with sweat. (Her last name is not being used because of the stigma of addiction.)\u003c/p>\n\u003cp>“I’ve been sick, throwing up from both ends,” Sonia said, her voice shaky. “Last night I blacked out playing bingo.”\u003c/p>\n\u003cp>An ER doctor quickly determined she was in opioid withdrawal and dispensed a low dose of buprenorphine, also known by the brand name Suboxone. Almost immediately, Sonia brightened up.\u003c/p>\n\u003cp>The small white pills, one of three medications approved in the U.S. to treat opioid addiction, work by easing withdrawal symptoms and cravings for 24 to 48 hours, a crucial window meant to demonstrate to patients that kicking their habit is possible.\u003c/p>\n\u003cfigure id=\"attachment_11896386\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11896386 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/11/RS51809_051_Oakland_HighlandHospitalBridgeProgram_10062021-qut.jpg\" alt=\"A man with a hat lies on a hospital bed, looking at a doctor in blue scrubs.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/RS51809_051_Oakland_HighlandHospitalBridgeProgram_10062021-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/RS51809_051_Oakland_HighlandHospitalBridgeProgram_10062021-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/RS51809_051_Oakland_HighlandHospitalBridgeProgram_10062021-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/RS51809_051_Oakland_HighlandHospitalBridgeProgram_10062021-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/RS51809_051_Oakland_HighlandHospitalBridgeProgram_10062021-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Monish Ullal administers buprenorphine to patient Jay Flohr at the Bridge substance use clinic at Highland Hospital in Oakland on Oct. 6, 2021. \u003ccite>(Beth LaBerge/ KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“[Buprenorphine] lowers mortality risk by about 50%,” said Dr. Monish Ullal, an internal medicine and substance use expert at Highland. “There’s very little in medicine that has that big of an impact on a person’s chances of dying.”\u003cbr>\n\u003cb>\u003c/b>\u003cbr>\nStudies show that patients who receive opioid medications, like buprenorphine, in the ER are twice as likely to remain in treatment a month later than those who only receive treatment referrals. Despite that rate of efficacy, \u003ca href=\"https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2765704\">only 3% of ER doctors in the U.S. are trained to dispense the drug\u003c/a>, according to a 2020 Yale School of Medicine survey.[pullquote align=\"right\" size=\"medium\" citation=\"Christian Hailozian, substance use navigator at Highland Hospital\"]‘Just letting them know it’s OK. We got you. That extra kind of hand-holding that these patients need to really start that journey of recovery.’[/pullquote]One reason for the slow adoption: Many patients and doctors are skeptical of an opioid alternative that may have to be taken on a daily basis.\u003c/p>\n\u003cp>“Patients will ask, ‘How long am I going to stay on this medication?’” said Ullal. “‘How soon can I get off?’ And then doctors are asking, too, ‘Aren’t you just replacing one drug for another? They’re stuck on the buprenorphine, too.’”\u003c/p>\n\u003cp>But that’s the case for treating many diseases, Ullal counters, like high cholesterol or high blood pressure.\u003c/p>\n\u003cp>“People will start taking those medicines and not bat an eye when they take it for the rest of their lives because there’s benefit from the medicines and the benefits outweigh the risks,” he said. “And I would say it’s the same thing with this medication.”\u003c/p>\n\u003ch3>Treating a substance use disorder for what it is\u003c/h3>\n\u003cp>Ullal says adopting this approach is treating a substance use disorder for what it is: a brain disease that requires specific medication. And now, California Bridge is training ER doctors across the state to dispense buprenorphine on demand.\u003c/p>\n\u003cp>A man named Drew, one of Highland’s more regular overdose patients, credits opioid alternatives like buprenorphine and methadone for saving his life. The 36-year-old, with a shaved head and a long scar across his nose, has injected heroin and ingested methamphetamine for 18 years. He says he lives on the streets and has long been estranged from his family — his mom intermittently calls jails and hospitals in Alameda County to make sure he’s still alive.\u003c/p>\n\u003cp>“I’m not going to lie. I would have definitely stayed using drugs. I wouldn’t see the point or put myself through the withdrawals,” said Drew, who recently enrolled in an in-patient substance use program. “The option of buprenorphine is helping a lot of people like me get off drugs. Because it’s pure hell for me. I experience withdrawals for like forever.”\u003c/p>\n\u003cfigure id=\"attachment_11896380\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11896380 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/11/RS51210_006_SanFrancisco_StFrancisER_08262021-qut.jpg\" alt=\"A woman wearing a face mask and holding a clipboard speaks with a doctor dressed in blue scrubs.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/RS51210_006_SanFrancisco_StFrancisER_08262021-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/RS51210_006_SanFrancisco_StFrancisER_08262021-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/RS51210_006_SanFrancisco_StFrancisER_08262021-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/RS51210_006_SanFrancisco_StFrancisER_08262021-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/RS51210_006_SanFrancisco_StFrancisER_08262021-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Substance use navigator Monique Randolph confers with an ER doctor at Saint Francis Memorial Hospital in San Francisco on Aug. 26, 2021. \u003ccite>(Beth LaBerge/ KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The road to recovery is long and fraught, and it often takes a very dedicated person to help those who use drugs break their addiction — the reason why each patient in the California Bridge program is assigned a substance use navigator to help ensure a transfer to long-term treatment after they leave the ER.\u003c/p>\n\u003cp>\u003ca href=\"https://www.recoverynowlc.com/recovery-assistance.html\">Nearly 40% of hospitals across the state are now staffed with a navigator\u003c/a>, and the program has a goal of staffing every acute-care hospital with one by 2025.\u003c/p>\n\u003cp>“Just letting them know it’s OK,” said Hailozian, the substance use navigator from Highland. “We got you. That extra kind of hand-holding that these patients need to really start that journey of recovery. You have a disease, we’re here to help you.”\u003c/p>\n\u003cp>Hailozian offers various forms of assistance, from helping a patient get signed up for health insurance to filling a prescription or connecting them to a treatment facility.\u003c/p>\n\u003cp>Monique Randolph, a substance use navigator at St. Francis Hospital, notes that the personal connection is key.\u003c/p>\n\u003cp>“I want somebody to be able to walk in that door and not feel alone,” she said. “And not feel judged and kind of know, ‘Hey, I can relate.’”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"excerpt": "With overdose deaths skyrocketing in California and beyond, policymakers are increasingly prioritizing drug treatment programs in hospitals over traditional, more punitive approaches like incarceration. ",
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"title": "'The Difference Between Life and Death': How Some California Emergency Rooms Are Working to Stem the Overdose Crisis | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Inside Saint Francis Memorial Hospital’s frenetic emergency room, near San Francisco’s Tenderloin neighborhood, Dr. Joanne Sun quickly scans the medical record of her fourth overdose patient of the day.\u003c/p>\n\u003cp>“It seems to me that people are mainly overdosing on fentanyl,” said Sun, the hospital’s emergency department director. “A lot of times they don’t even realize that what they bought off the street was fentanyl. Their intent was actually to do crystal or cocaine.”\u003c/p>\u003c/div>",
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"content": "‘I definitely see us as a stabilizer. That’s first and foremost. We make sure you’re stable. But then I also think of us as a bridge towards social services.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Fentanyl is a synthetic opioid that’s up to 100 times stronger than morphine, and is now commonly mixed in street drugs.\u003c/p>\n\u003cp>“I think the pandemic has made everything worse in terms of mental health,” Sun said. “And unfortunately, drugs are going to be a crutch.”\u003c/p>\n\u003cp>Almost on cue, an older Black man with bloodshot eyes is wheeled through the ambulance bay. He says he intended to smoke crack, but overdosed after unknowingly inhaling fentanyl.\u003c/p>\n\u003cp>\u003ca href=\"https://www.sfchronicle.com/sf/article/San-Francisco-s-overdose-epidemic-16434757.php\">Black people who use drugs in San Francisco are nearly six times more likely than people of other races there to die of accidental overdoses\u003c/a>, according to data recently compiled by The San Francisco Chronicle.\u003c/p>\n\u003cp>That discrepancy can be directly attributed to structural racism, according to the city’s Department of Public Health. “Among the effects of structural racism are years of unjust drug policies that punish rather than offer care, unaffordable housing, poverty, inequitable access to effective treatments for opioid use disorder, and discriminatory practices in the healthcare system,” a department spokesperson said in an email.\u003c/p>\n\u003cp>San Francisco has one of the nation’s highest overdose rates, with a related death rate more than triple those in Los Angeles and New York. To put that in context, \u003ca href=\"https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm,\">nearly three times as many people in this city died from drug overdoses\u003c/a> than from COVID-19 last year.\u003c/p>\n\u003cfigure id=\"attachment_11896391\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11896391 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/11/RS51214_010_SanFrancisco_StFrancisER_08262021-qut.jpg\" alt=\"A woman with a white lab coat and face mask standing at a computer.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/RS51214_010_SanFrancisco_StFrancisER_08262021-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/RS51214_010_SanFrancisco_StFrancisER_08262021-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/RS51214_010_SanFrancisco_StFrancisER_08262021-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/RS51214_010_SanFrancisco_StFrancisER_08262021-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/RS51214_010_SanFrancisco_StFrancisER_08262021-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Joanne Sun, who heads Saint Francis Memorial Hospital’s Emergency Department in San Francisco, on Aug. 26, 2021. \u003ccite>(Beth LaBerge/ KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch3>Shifting treatment from jails to hospitals\u003c/h3>\n\u003cp>For decades, authorities have punished people who do drugs, even as the statistics have overwhelmingly demonstrated that such an approach is simply not effective in stemming drug use.\u003c/p>\n\u003cp>More than \u003ca href=\"https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm\">93,000 people in the United States died from drug overdoses \u003c/a>last year — an average of about \u003ca href=\"https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm\">250 people a day\u003c/a> — the highest one-year death toll on record. That includes the most deaths to date from overdoses of synthetic opioids, like fentanyl, as well as stimulants, like cocaine.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>The dire situation is pushing policymakers to switch gears and increasingly recognize addiction as a disease requiring medical attention that should be treated in hospitals rather than jails.\u003c/p>\n\u003cp>“I see us as a bridge,” said Sun. “I definitely see us as a stabilizer. That’s first and foremost. We make sure you’re stable. But then I also think of us as a bridge towards social services.”\u003c/p>\n\u003cp>Treating addiction in hospitals, however, is actually still rare and relatively new. Historically, \u003ca href=\"https://www.fda.gov/drugs/information-drug-class/information-about-medication-assisted-treatment-mat\">ER docs have not dispensed evidence-based treatment\u003c/a> designed to relieve opioid withdrawal symptoms. Until a few years ago, standard practice was to offer patients something to settle their nerves or relieve diarrhea. And then once stabilized, patients were often sent on their way.\u003c/p>\n\u003cp>“Essentially you would get handed a piece of paper, and that was your referral to your treatment and good luck,” said Christian Hailozian, a substance use navigator at Highland Hospital in Oakland. “That was essentially it: ‘Please don’t come back to the emergency department.’ That was kind of the way that patients were treated.”\u003c/p>\n\u003cp>It was an approach that yielded overburdened ERs with revolving doors.\u003c/p>\n\u003cfigure id=\"attachment_11896383\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11896383 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/11/RS51227_023_SanFrancisco_StFrancisER_08262021-qut.jpg\" alt=\"An EMT pushing a gurney through a hospital hallway.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/RS51227_023_SanFrancisco_StFrancisER_08262021-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/RS51227_023_SanFrancisco_StFrancisER_08262021-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/RS51227_023_SanFrancisco_StFrancisER_08262021-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/RS51227_023_SanFrancisco_StFrancisER_08262021-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/RS51227_023_SanFrancisco_StFrancisER_08262021-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">An EMT brings a patient into the Saint Francis Memorial Hospital ER in San Francisco on Aug. 26, 2021. \u003ccite>(Beth LaBerge/ KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003ca href=\"https://cabridge.org/\">California Bridge\u003c/a>, a statewide program developed in 2018, is designed to break this cycle by medically treating opioid withdrawal symptoms inside the ER rather than sending patients elsewhere for treatment, and losing that rare opportunity for face-to-face contact.\u003c/p>\n\u003cp>“The program creates a seamless continuum of care from the acute ER crisis to outpatient treatment,” said Dr. Andrew Herring, the medical director of Highland’s substance use disorder treatment program. “When you’re dealing with something as tenuous as treatment for opioid use disorder, it’s really the difference between life and death.”\u003c/p>\n\u003cp>The program, which started as a pilot at eight hospitals across the state, performed so well that the state invested another $20 million last fall to expand the model.\u003c/p>\n\u003cp>“Patients with addiction come into the ED,” said Skye Christensen, a spokesperson for the program. “They are going to show up there. But how\u003ci> \u003c/i>they’re treated and whether or not they’re provided with ongoing care is central to whether they come back requiring more in-depth hospital resources.”\u003c/p>\n\u003ch3>Breaking the cycle\u003c/h3>\n\u003cp>On a recent morning, a woman named Sonia arrived at Highland’s ER, her nose running and clothes drenched with sweat. (Her last name is not being used because of the stigma of addiction.)\u003c/p>\n\u003cp>“I’ve been sick, throwing up from both ends,” Sonia said, her voice shaky. “Last night I blacked out playing bingo.”\u003c/p>\n\u003cp>An ER doctor quickly determined she was in opioid withdrawal and dispensed a low dose of buprenorphine, also known by the brand name Suboxone. Almost immediately, Sonia brightened up.\u003c/p>\n\u003cp>The small white pills, one of three medications approved in the U.S. to treat opioid addiction, work by easing withdrawal symptoms and cravings for 24 to 48 hours, a crucial window meant to demonstrate to patients that kicking their habit is possible.\u003c/p>\n\u003cfigure id=\"attachment_11896386\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11896386 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/11/RS51809_051_Oakland_HighlandHospitalBridgeProgram_10062021-qut.jpg\" alt=\"A man with a hat lies on a hospital bed, looking at a doctor in blue scrubs.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/RS51809_051_Oakland_HighlandHospitalBridgeProgram_10062021-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/RS51809_051_Oakland_HighlandHospitalBridgeProgram_10062021-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/RS51809_051_Oakland_HighlandHospitalBridgeProgram_10062021-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/RS51809_051_Oakland_HighlandHospitalBridgeProgram_10062021-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/RS51809_051_Oakland_HighlandHospitalBridgeProgram_10062021-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Monish Ullal administers buprenorphine to patient Jay Flohr at the Bridge substance use clinic at Highland Hospital in Oakland on Oct. 6, 2021. \u003ccite>(Beth LaBerge/ KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“[Buprenorphine] lowers mortality risk by about 50%,” said Dr. Monish Ullal, an internal medicine and substance use expert at Highland. “There’s very little in medicine that has that big of an impact on a person’s chances of dying.”\u003cbr>\n\u003cb>\u003c/b>\u003cbr>\nStudies show that patients who receive opioid medications, like buprenorphine, in the ER are twice as likely to remain in treatment a month later than those who only receive treatment referrals. Despite that rate of efficacy, \u003ca href=\"https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2765704\">only 3% of ER doctors in the U.S. are trained to dispense the drug\u003c/a>, according to a 2020 Yale School of Medicine survey.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>One reason for the slow adoption: Many patients and doctors are skeptical of an opioid alternative that may have to be taken on a daily basis.\u003c/p>\n\u003cp>“Patients will ask, ‘How long am I going to stay on this medication?’” said Ullal. “‘How soon can I get off?’ And then doctors are asking, too, ‘Aren’t you just replacing one drug for another? They’re stuck on the buprenorphine, too.’”\u003c/p>\n\u003cp>But that’s the case for treating many diseases, Ullal counters, like high cholesterol or high blood pressure.\u003c/p>\n\u003cp>“People will start taking those medicines and not bat an eye when they take it for the rest of their lives because there’s benefit from the medicines and the benefits outweigh the risks,” he said. “And I would say it’s the same thing with this medication.”\u003c/p>\n\u003ch3>Treating a substance use disorder for what it is\u003c/h3>\n\u003cp>Ullal says adopting this approach is treating a substance use disorder for what it is: a brain disease that requires specific medication. And now, California Bridge is training ER doctors across the state to dispense buprenorphine on demand.\u003c/p>\n\u003cp>A man named Drew, one of Highland’s more regular overdose patients, credits opioid alternatives like buprenorphine and methadone for saving his life. The 36-year-old, with a shaved head and a long scar across his nose, has injected heroin and ingested methamphetamine for 18 years. He says he lives on the streets and has long been estranged from his family — his mom intermittently calls jails and hospitals in Alameda County to make sure he’s still alive.\u003c/p>\n\u003cp>“I’m not going to lie. I would have definitely stayed using drugs. I wouldn’t see the point or put myself through the withdrawals,” said Drew, who recently enrolled in an in-patient substance use program. “The option of buprenorphine is helping a lot of people like me get off drugs. Because it’s pure hell for me. I experience withdrawals for like forever.”\u003c/p>\n\u003cfigure id=\"attachment_11896380\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11896380 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/11/RS51210_006_SanFrancisco_StFrancisER_08262021-qut.jpg\" alt=\"A woman wearing a face mask and holding a clipboard speaks with a doctor dressed in blue scrubs.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/RS51210_006_SanFrancisco_StFrancisER_08262021-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/RS51210_006_SanFrancisco_StFrancisER_08262021-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/RS51210_006_SanFrancisco_StFrancisER_08262021-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/RS51210_006_SanFrancisco_StFrancisER_08262021-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/RS51210_006_SanFrancisco_StFrancisER_08262021-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Substance use navigator Monique Randolph confers with an ER doctor at Saint Francis Memorial Hospital in San Francisco on Aug. 26, 2021. \u003ccite>(Beth LaBerge/ KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The road to recovery is long and fraught, and it often takes a very dedicated person to help those who use drugs break their addiction — the reason why each patient in the California Bridge program is assigned a substance use navigator to help ensure a transfer to long-term treatment after they leave the ER.\u003c/p>\n\u003cp>\u003ca href=\"https://www.recoverynowlc.com/recovery-assistance.html\">Nearly 40% of hospitals across the state are now staffed with a navigator\u003c/a>, and the program has a goal of staffing every acute-care hospital with one by 2025.\u003c/p>\n\u003cp>“Just letting them know it’s OK,” said Hailozian, the substance use navigator from Highland. “We got you. That extra kind of hand-holding that these patients need to really start that journey of recovery. You have a disease, we’re here to help you.”\u003c/p>\n\u003cp>Hailozian offers various forms of assistance, from helping a patient get signed up for health insurance to filling a prescription or connecting them to a treatment facility.\u003c/p>\n\u003cp>Monique Randolph, a substance use navigator at St. Francis Hospital, notes that the personal connection is key.\u003c/p>\n\u003cp>“I want somebody to be able to walk in that door and not feel alone,” she said. “And not feel judged and kind of know, ‘Hey, I can relate.’”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>\u003cem>Jump to resources:\u003c/em>\u003c/p>\n\u003cul>\n\u003cli>\u003ca href=\"#support\">\u003cstrong>Where to find support for substance abuse disorder\u003c/strong>\u003c/a>\u003c/li>\n\u003c/ul>\n\u003cp>\u003cem>In this episode of The California Report Magazine, health reporters Lesley McClurg and April Dembosky take us inside hospitals and clinics to meet people dealing with substance addiction who are getting help in new ways. For the first time, doctors and caregivers are asking: What do you need from us?\u003c/em>\u003c/p>\n\u003cp>Last year more than 93,000 people died of drug overdoses nationwide, more than 10,000 of them in California. The public health crisis, which has spiked during COVID, is taking a horrific toll on communities and cities across the state.\u003c/p>\n\u003cp>For decades the state’s approach has been to punish people who do drugs. But it hasn’t worked.\u003c/p>\n\u003cp>“It’s more than a failure, it has been incredibly harmful,” said Dr. Monish Ullal, internal medicine physician and associate medical director of the Bridge clinic at Highland Hospital. “I think the war on drugs is one of the most disappointing things that our country has done in the last 30 years.”\u003c/p>\n\u003cp>Now policymakers are switching gears by recognizing addiction as a disease needing medical attention. California is investing large amounts of money in new models of treatment for those dealing with substance addiction. Two new programs are showing promise, and becoming models for the rest of the country.\u003c/p>\n\u003cfigure id=\"attachment_11891410\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11891410\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/10/RS51782_024_Oakland_HighlandHospitalBridgeProgram_10062021-qut-1-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51782_024_Oakland_HighlandHospitalBridgeProgram_10062021-qut-1-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51782_024_Oakland_HighlandHospitalBridgeProgram_10062021-qut-1-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51782_024_Oakland_HighlandHospitalBridgeProgram_10062021-qut-1-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51782_024_Oakland_HighlandHospitalBridgeProgram_10062021-qut-1-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51782_024_Oakland_HighlandHospitalBridgeProgram_10062021-qut-1.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">California Bridge Founding Member and Director of Harm Reduction Services Joshua Luftig speaks with a patient about Narcan at the Bridge substance use program at Highland Hospital in Oakland on Oct. 6, 2021 . \u003ccite>(Beth LeBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch3>\u003cb>Emergency rooms anchor recovery efforts\u003c/b>\u003c/h3>\n\u003cp>The first initiative is called \u003ca href=\"https://cabridge.org/\">CA Bridge\u003c/a>, and its goal is to initiate treatment for patients with a substance use disorder in the emergency department. It may be hard to believe, but treating substance addiction within a hospital is fairly recent strategy.\u003c/p>\n\u003cp>The program has a two-pronged approach. First, emergency medical physicians are trained to dispense medication to treat opioid use. Once a patient is stable, they are assigned a counselor or “substance use navigator” to ensure a strong hand-off to long-term treatment once they leave the ER.\u003c/p>\n\u003cfigure id=\"attachment_11891415\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11891415 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/10/RS51209_005_SanFrancisco_StFrancisER_08262021-qut-800x533.jpg\" alt=\"A woman with long hair, glasses, a mask, and a floral shirt points at a clipboard, which a doctor in blue scrubs and a mask looks at.\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51209_005_SanFrancisco_StFrancisER_08262021-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51209_005_SanFrancisco_StFrancisER_08262021-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51209_005_SanFrancisco_StFrancisER_08262021-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51209_005_SanFrancisco_StFrancisER_08262021-qut-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51209_005_SanFrancisco_StFrancisER_08262021-qut.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Substance Use Manager Monique Randolph speaks with a doctor at the Saint Francis Emergency Department in San Francisco on Aug. 26, 2021. \u003ccite>(Beth LeBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“Just letting them know it’s OK. We got you,” explained Christian Hailozian, a substance use navigator at Highland Hospital. “That extra kind of hand-holding that these patients need to really start that journey of recovery.”\u003c/p>\n\u003cp>[aside postID=\"news_11854373\" hero=\"https://ww2.kqed.org/app/uploads/sites/10/2019/02/Rick-Andrews-at-SF-AIDS-Foundation-1020x678.jpg\"]The pilot program, which started at eight California hospitals, worked so well that the state invested another $20 million last fall to expand the California Bridge model. Now 144, or about 40% of hospitals across the state, have staffed a substance use navigator. The goal is to enroll all remaining hospitals by 2025.\u003c/p>\n\u003cp>The other big initiative is a new treatment for addiction to methamphetamine or cocaine. While there are three FDA-approved medications available to treat opioid use disorder — the cornerstone of the Bridge program — there are none for stimulants.\u003c/p>\n\u003cp>“There’s a lot of hopelessness in the community using stimulants, a lot less belief that treatment will help them,” said Dr. Kelly Pfeifer, deputy director of behavioral health at the California Department of Health Care Services.\u003c/p>\n\u003cfigure id=\"attachment_11890594\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11890594\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/01/rs46611_009_sanfrancisco_billylemon_01142021-qut-1536x1024-2-93d1d0b27c5ab9ae1460333fecf87ea21095e212-s1200-800x600.jpg\" alt=\"A man in sunglasses and a hat stands beneath a Pride flag outside a Victorian with a sign that says Castro Country Club.\" width=\"800\" height=\"600\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/01/rs46611_009_sanfrancisco_billylemon_01142021-qut-1536x1024-2-93d1d0b27c5ab9ae1460333fecf87ea21095e212-s1200-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/01/rs46611_009_sanfrancisco_billylemon_01142021-qut-1536x1024-2-93d1d0b27c5ab9ae1460333fecf87ea21095e212-s1200-1020x765.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/01/rs46611_009_sanfrancisco_billylemon_01142021-qut-1536x1024-2-93d1d0b27c5ab9ae1460333fecf87ea21095e212-s1200-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/01/rs46611_009_sanfrancisco_billylemon_01142021-qut-1536x1024-2-93d1d0b27c5ab9ae1460333fecf87ea21095e212-s1200.jpg 1200w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Billy Lemon, 50, kicked his meth habit more than nine years ago after taking part in a ‘contingency management’ program for meth and cocaine users at the San Francisco AIDS Foundation. For every negative drug test, he earned a small amount of money. Lemon now runs the Castro Country Club, a recovery center in San Francisco. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003ca href=\"https://www.drugabuse.gov/news-events/news-releases/2021/09/methamphetamine-involved-overdose-deaths-nearly-tripled-between-2015-to-2019-nih-study-finds\">Meth-related overdoses have tripled nationwide\u003c/a> in recent years, and treatment providers are desperate to find something that works.\u003c/p>\n\u003cp>Providers have landed on a behavioral treatment that studies show is highly effective, but has been only narrowly deployed: \u003ca href=\"https://www.kqed.org/news/11854373/state-lawmakers-move-to-expand-effective-but-controversial-treatment-for-meth-addiction\">contingency management\u003c/a>, an incentive therapy that uses money or prizes to encourage people who use drugs not to use them.\u003c/p>\n\u003cp>California is betting big on contingency management. Lawmakers passed a bill that would authorize the state’s Medi-Cal program to offer the treatment. It’s awaiting Gov. Gavin Newsom’s signature, and state health officials also have requested permission from the federal government to provide the therapy to hundreds of thousands of Californians in lower-income households.\u003c/p>\n\u003cfigure id=\"attachment_11891417\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11891417 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/10/RS51766_007_Oakland_HighlandHospitalBridgeProgram_10062021-qut.jpg\" alt='A person wearing scrubs and a face mask moves through a door, next to a letterboard sign saying \"Welcome to the Bridge.\"' width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51766_007_Oakland_HighlandHospitalBridgeProgram_10062021-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51766_007_Oakland_HighlandHospitalBridgeProgram_10062021-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51766_007_Oakland_HighlandHospitalBridgeProgram_10062021-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51766_007_Oakland_HighlandHospitalBridgeProgram_10062021-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51766_007_Oakland_HighlandHospitalBridgeProgram_10062021-qut-1536x1024.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Christian Hailozian, substance use navigator and program coordinator, walks out of the Bridge substance use program office at Highland Hospital in Oakland on Oct. 6, 2021. \u003ccite>(Beth LeBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch3>\u003ca id=\"support\">\u003c/a>Where to find support for substance abuse disorder\u003c/h3>\n\u003cul>\n\u003cli>If you are insured through Medi-Cal, you can access your county’s \u003cstrong>substance abuse disorder county access line\u003c/strong>. The resources offered vary by county. \u003ca href=\"https://www.dhcs.ca.gov/individuals/Pages/SUD_County_Access_Lines.aspx\">Find the list of phone numbers here.\u003c/a>\u003c/li>\n\u003cli>Most California counties participate in the \u003cstrong>Drug Medi-Cal Organized Delivery System\u003c/strong>, a 2015 expansion that provides more alcohol and drug use services to people in need. \u003ca href=\"https://choosechangeca.org/?campaign=print\">Get more information on how to access treatment for an opioid addiction here.\u003c/a>\u003c/li>\n\u003cli>The \u003ca href=\"https://www.sfaf.org/services/substance-use-treatment/\">\u003cstrong>San Francisco AIDS Foundation\u003c/strong>\u003c/a> offers a variety of initiatives that center harm reduction to support those dealing with substance addiction. This includes support for \u003ca href=\"https://www.sfaf.org/services/substance-use-treatment/cocaine-crack-use-support/\">cocaine and crack use\u003c/a>, \u003ca href=\"https://www.sfaf.org/services/substance-use-treatment/meth-use-support/\">meth use\u003c/a> and \u003ca href=\"https://www.sfaf.org/services/syringe-access-disposal/\">safe syringe disposal sites\u003c/a>.\u003c/li>\n\u003cli>Finding support for mental illness can sometimes be part of dealing with substance abuse. NAMI is the \u003cstrong>National Alliance on Mental Illness\u003c/strong>, and several counties have their own chapter. \u003ca href=\"https://namica.org/find-your-local-nami\">Find the closest one to you here.\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"https://cabridge.org/tools/resources/\">Providers wanting to learn how to make \u003cstrong>CA Bridge\u003c/strong> part of your work can learn more here.\u003c/a>\u003c/li>\n\u003c/ul>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Jump to resources:\u003c/em>\u003c/p>\n\u003cul>\n\u003cli>\u003ca href=\"#support\">\u003cstrong>Where to find support for substance abuse disorder\u003c/strong>\u003c/a>\u003c/li>\n\u003c/ul>\n\u003cp>\u003cem>In this episode of The California Report Magazine, health reporters Lesley McClurg and April Dembosky take us inside hospitals and clinics to meet people dealing with substance addiction who are getting help in new ways. For the first time, doctors and caregivers are asking: What do you need from us?\u003c/em>\u003c/p>\n\u003cp>Last year more than 93,000 people died of drug overdoses nationwide, more than 10,000 of them in California. The public health crisis, which has spiked during COVID, is taking a horrific toll on communities and cities across the state.\u003c/p>\n\u003cp>For decades the state’s approach has been to punish people who do drugs. But it hasn’t worked.\u003c/p>\n\u003cp>“It’s more than a failure, it has been incredibly harmful,” said Dr. Monish Ullal, internal medicine physician and associate medical director of the Bridge clinic at Highland Hospital. “I think the war on drugs is one of the most disappointing things that our country has done in the last 30 years.”\u003c/p>\n\u003cp>Now policymakers are switching gears by recognizing addiction as a disease needing medical attention. California is investing large amounts of money in new models of treatment for those dealing with substance addiction. Two new programs are showing promise, and becoming models for the rest of the country.\u003c/p>\n\u003cfigure id=\"attachment_11891410\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11891410\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/10/RS51782_024_Oakland_HighlandHospitalBridgeProgram_10062021-qut-1-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51782_024_Oakland_HighlandHospitalBridgeProgram_10062021-qut-1-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51782_024_Oakland_HighlandHospitalBridgeProgram_10062021-qut-1-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51782_024_Oakland_HighlandHospitalBridgeProgram_10062021-qut-1-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51782_024_Oakland_HighlandHospitalBridgeProgram_10062021-qut-1-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51782_024_Oakland_HighlandHospitalBridgeProgram_10062021-qut-1.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">California Bridge Founding Member and Director of Harm Reduction Services Joshua Luftig speaks with a patient about Narcan at the Bridge substance use program at Highland Hospital in Oakland on Oct. 6, 2021 . \u003ccite>(Beth LeBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch3>\u003cb>Emergency rooms anchor recovery efforts\u003c/b>\u003c/h3>\n\u003cp>The first initiative is called \u003ca href=\"https://cabridge.org/\">CA Bridge\u003c/a>, and its goal is to initiate treatment for patients with a substance use disorder in the emergency department. It may be hard to believe, but treating substance addiction within a hospital is fairly recent strategy.\u003c/p>\n\u003cp>The program has a two-pronged approach. First, emergency medical physicians are trained to dispense medication to treat opioid use. Once a patient is stable, they are assigned a counselor or “substance use navigator” to ensure a strong hand-off to long-term treatment once they leave the ER.\u003c/p>\n\u003cfigure id=\"attachment_11891415\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11891415 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/10/RS51209_005_SanFrancisco_StFrancisER_08262021-qut-800x533.jpg\" alt=\"A woman with long hair, glasses, a mask, and a floral shirt points at a clipboard, which a doctor in blue scrubs and a mask looks at.\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51209_005_SanFrancisco_StFrancisER_08262021-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51209_005_SanFrancisco_StFrancisER_08262021-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51209_005_SanFrancisco_StFrancisER_08262021-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51209_005_SanFrancisco_StFrancisER_08262021-qut-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51209_005_SanFrancisco_StFrancisER_08262021-qut.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Substance Use Manager Monique Randolph speaks with a doctor at the Saint Francis Emergency Department in San Francisco on Aug. 26, 2021. \u003ccite>(Beth LeBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“Just letting them know it’s OK. We got you,” explained Christian Hailozian, a substance use navigator at Highland Hospital. “That extra kind of hand-holding that these patients need to really start that journey of recovery.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>The pilot program, which started at eight California hospitals, worked so well that the state invested another $20 million last fall to expand the California Bridge model. Now 144, or about 40% of hospitals across the state, have staffed a substance use navigator. The goal is to enroll all remaining hospitals by 2025.\u003c/p>\n\u003cp>The other big initiative is a new treatment for addiction to methamphetamine or cocaine. While there are three FDA-approved medications available to treat opioid use disorder — the cornerstone of the Bridge program — there are none for stimulants.\u003c/p>\n\u003cp>“There’s a lot of hopelessness in the community using stimulants, a lot less belief that treatment will help them,” said Dr. Kelly Pfeifer, deputy director of behavioral health at the California Department of Health Care Services.\u003c/p>\n\u003cfigure id=\"attachment_11890594\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11890594\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/01/rs46611_009_sanfrancisco_billylemon_01142021-qut-1536x1024-2-93d1d0b27c5ab9ae1460333fecf87ea21095e212-s1200-800x600.jpg\" alt=\"A man in sunglasses and a hat stands beneath a Pride flag outside a Victorian with a sign that says Castro Country Club.\" width=\"800\" height=\"600\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/01/rs46611_009_sanfrancisco_billylemon_01142021-qut-1536x1024-2-93d1d0b27c5ab9ae1460333fecf87ea21095e212-s1200-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/01/rs46611_009_sanfrancisco_billylemon_01142021-qut-1536x1024-2-93d1d0b27c5ab9ae1460333fecf87ea21095e212-s1200-1020x765.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/01/rs46611_009_sanfrancisco_billylemon_01142021-qut-1536x1024-2-93d1d0b27c5ab9ae1460333fecf87ea21095e212-s1200-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/01/rs46611_009_sanfrancisco_billylemon_01142021-qut-1536x1024-2-93d1d0b27c5ab9ae1460333fecf87ea21095e212-s1200.jpg 1200w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Billy Lemon, 50, kicked his meth habit more than nine years ago after taking part in a ‘contingency management’ program for meth and cocaine users at the San Francisco AIDS Foundation. For every negative drug test, he earned a small amount of money. Lemon now runs the Castro Country Club, a recovery center in San Francisco. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003ca href=\"https://www.drugabuse.gov/news-events/news-releases/2021/09/methamphetamine-involved-overdose-deaths-nearly-tripled-between-2015-to-2019-nih-study-finds\">Meth-related overdoses have tripled nationwide\u003c/a> in recent years, and treatment providers are desperate to find something that works.\u003c/p>\n\u003cp>Providers have landed on a behavioral treatment that studies show is highly effective, but has been only narrowly deployed: \u003ca href=\"https://www.kqed.org/news/11854373/state-lawmakers-move-to-expand-effective-but-controversial-treatment-for-meth-addiction\">contingency management\u003c/a>, an incentive therapy that uses money or prizes to encourage people who use drugs not to use them.\u003c/p>\n\u003cp>California is betting big on contingency management. Lawmakers passed a bill that would authorize the state’s Medi-Cal program to offer the treatment. It’s awaiting Gov. Gavin Newsom’s signature, and state health officials also have requested permission from the federal government to provide the therapy to hundreds of thousands of Californians in lower-income households.\u003c/p>\n\u003cfigure id=\"attachment_11891417\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11891417 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/10/RS51766_007_Oakland_HighlandHospitalBridgeProgram_10062021-qut.jpg\" alt='A person wearing scrubs and a face mask moves through a door, next to a letterboard sign saying \"Welcome to the Bridge.\"' width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51766_007_Oakland_HighlandHospitalBridgeProgram_10062021-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51766_007_Oakland_HighlandHospitalBridgeProgram_10062021-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51766_007_Oakland_HighlandHospitalBridgeProgram_10062021-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51766_007_Oakland_HighlandHospitalBridgeProgram_10062021-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51766_007_Oakland_HighlandHospitalBridgeProgram_10062021-qut-1536x1024.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Christian Hailozian, substance use navigator and program coordinator, walks out of the Bridge substance use program office at Highland Hospital in Oakland on Oct. 6, 2021. \u003ccite>(Beth LeBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch3>\u003ca id=\"support\">\u003c/a>Where to find support for substance abuse disorder\u003c/h3>\n\u003cul>\n\u003cli>If you are insured through Medi-Cal, you can access your county’s \u003cstrong>substance abuse disorder county access line\u003c/strong>. The resources offered vary by county. \u003ca href=\"https://www.dhcs.ca.gov/individuals/Pages/SUD_County_Access_Lines.aspx\">Find the list of phone numbers here.\u003c/a>\u003c/li>\n\u003cli>Most California counties participate in the \u003cstrong>Drug Medi-Cal Organized Delivery System\u003c/strong>, a 2015 expansion that provides more alcohol and drug use services to people in need. \u003ca href=\"https://choosechangeca.org/?campaign=print\">Get more information on how to access treatment for an opioid addiction here.\u003c/a>\u003c/li>\n\u003cli>The \u003ca href=\"https://www.sfaf.org/services/substance-use-treatment/\">\u003cstrong>San Francisco AIDS Foundation\u003c/strong>\u003c/a> offers a variety of initiatives that center harm reduction to support those dealing with substance addiction. This includes support for \u003ca href=\"https://www.sfaf.org/services/substance-use-treatment/cocaine-crack-use-support/\">cocaine and crack use\u003c/a>, \u003ca href=\"https://www.sfaf.org/services/substance-use-treatment/meth-use-support/\">meth use\u003c/a> and \u003ca href=\"https://www.sfaf.org/services/syringe-access-disposal/\">safe syringe disposal sites\u003c/a>.\u003c/li>\n\u003cli>Finding support for mental illness can sometimes be part of dealing with substance abuse. NAMI is the \u003cstrong>National Alliance on Mental Illness\u003c/strong>, and several counties have their own chapter. \u003ca href=\"https://namica.org/find-your-local-nami\">Find the closest one to you here.\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"https://cabridge.org/tools/resources/\">Providers wanting to learn how to make \u003cstrong>CA Bridge\u003c/strong> part of your work can learn more here.\u003c/a>\u003c/li>\n\u003c/ul>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Hundreds of nurses walked off their jobs Wednesday at three hospitals in Alameda County as part of a five-day strike to call attention to stalled contract negotiations and their concerns about workplace and patient safety.\u003c/p>\n\u003cp>“[Personal protective equipment] is probably the biggest thing that we want. And safe staffing levels. We definitely don’t want to be laid off,” said Adrian Jackson, a respiratory care nurse at Highland Hospital in Oakland. “We just want to keep what we do have and make sure that we’re safely staffed.”\u003c/p>\n\u003cp>Wages are at stake, too, said Pete Castelli, public sector director for the California Nurses Association (CNA), which represents some of the nurses on strike.\u003c/p>\n\u003cp>“We’re at an impasse because management refuses to offer any substantive gains for nurses or even a market price so they can retain nurses and keep them working here,” Castelli said.\u003c/p>\n\u003cfigure id=\"attachment_11841461\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11841461\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2020/10/RS45249_011_KQED_Alameda_AlamedaHospitalStrike_10072020-qut-800x533.jpg\" alt=\"Alameda Health System employees and supporters march outside of Alameda Hospital on Oct. 7, 2020, during a planned five-day strike over COVID-19 safety concerns and stalled contract negotiations.\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2020/10/RS45249_011_KQED_Alameda_AlamedaHospitalStrike_10072020-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/10/RS45249_011_KQED_Alameda_AlamedaHospitalStrike_10072020-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/10/RS45249_011_KQED_Alameda_AlamedaHospitalStrike_10072020-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/10/RS45249_011_KQED_Alameda_AlamedaHospitalStrike_10072020-qut-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/10/RS45249_011_KQED_Alameda_AlamedaHospitalStrike_10072020-qut.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Alameda Health System employees and supporters march outside of Alameda Hospital on Oct. 7, 2020, during a planned five-day strike over COVID-19 safety concerns and stalled contract negotiations. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>About 150 nurses at San Leandro Hospital and 175 at Alameda Hospital are represented by the CNA, while about 900 nurses at Highland Hospital are represented by the Service Employees International Union (SEIU) Local 1021, according to union representatives.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In addition to nurses, other SEIU members at Highland Hospital who work as technicians, clerks, housekeepers and social workers are joining the strike, bringing the total number of striking employees there to about 3,200, according to John Pearson, an SEIU chapter president.\u003c/p>\n\u003cp>The unions said they worked together to coordinate strikes at the same time.\u003c/p>\n\u003cp>[aside tag=\"nurses-strike\" label=\"related coverage\"]\u003c/p>\n\u003cp>The organization that manages all three hospitals, Alameda Health System (AHS), said it has brought in hundreds of replacement workers but has had to adjust service levels by canceling elective procedures and rescheduling appointments.\u003c/p>\n\u003cp>“We apologize to our patients and community health partners for any inconvenience they may experience due to postponement or reduction of some services during the strike,” wrote Terry Lightfoot, director of public affairs and community engagement for AHS, in a statement.\u003c/p>\n\u003cp>“While we are disappointed that the unions called this strike at a time when there are already extraordinary strains on health care providers, we encourage them to return to the bargaining table, where we can resolve our differences and reach agreement on a fair, mutually beneficial contract.”\u003c/p>\n\u003cp>In a memo to the Alameda County Board of Supervisors, the hospital system’s CEO, Delvecchio Finley, shared details of the management’s offers, which include a 2.5% raise in wages every year for the next three years and an additional 12 weeks of paid leave for anyone needing to care for a family member because of the COVID-19 pandemic.\u003c/p>\n\u003cp>“I implore the unions to please call off these strikes and let’s get back to trying to work together,” Finley wrote.\u003c/p>\n\u003cfigure id=\"attachment_11841465\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11841465\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2020/10/RS45244_006_KQED_Alameda_AlamedaHospitalStrike_10072020-qut-800x533.jpg\" alt=\"Alameda Health System employees and supporters march outside of Alameda Hospital on Oct. 7, 2020. About 175 nurses at Alameda Hospital and 150 at San Leandro Hospital are represented by the California Nurses Association, while about 900 nurses at Highland Hospital are represented by the Service Employees International Union Local 1021, according to union representatives. \" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2020/10/RS45244_006_KQED_Alameda_AlamedaHospitalStrike_10072020-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/10/RS45244_006_KQED_Alameda_AlamedaHospitalStrike_10072020-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/10/RS45244_006_KQED_Alameda_AlamedaHospitalStrike_10072020-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/10/RS45244_006_KQED_Alameda_AlamedaHospitalStrike_10072020-qut-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/10/RS45244_006_KQED_Alameda_AlamedaHospitalStrike_10072020-qut.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Alameda Health System employees and supporters march outside of Alameda Hospital on Oct. 7, 2020. About 175 nurses at Alameda Hospital and 150 at San Leandro Hospital are represented by the California Nurses Association, while about 900 nurses at Highland Hospital are represented by the Service Employees International Union Local 1021, according to union representatives. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But union representatives said there are additional provisions they want to see, including guarantees of higher staffing levels, better access to PPE, more space for treating COVID-19 patients and better maintenance of hospital equipment.\u003c/p>\n\u003cp>“They have to respect the fact that we know what we need in order to take care of our patients,” said Karen Rothblatt, an operating room nurse at Alameda Hospital and a nurse’s representative for the CNA.\u003c/p>\n\u003cp>Representatives for both the CNA and SEIU are calling for the county Board of Supervisors to intervene in contract negotiations.\u003c/p>\n\u003cp>“We want to get back to work. We want to get back to taking care of our patients,” Rothblatt said. “The last thing nurses want to do is be on strike.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>KQED’s Shannon Lin contributed additional reporting to this story.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Hundreds of nurses walked off their jobs Wednesday at three hospitals in Alameda County as part of a five-day strike to call attention to stalled contract negotiations and their concerns about workplace and patient safety.\u003c/p>\n\u003cp>“[Personal protective equipment] is probably the biggest thing that we want. And safe staffing levels. We definitely don’t want to be laid off,” said Adrian Jackson, a respiratory care nurse at Highland Hospital in Oakland. “We just want to keep what we do have and make sure that we’re safely staffed.”\u003c/p>\n\u003cp>Wages are at stake, too, said Pete Castelli, public sector director for the California Nurses Association (CNA), which represents some of the nurses on strike.\u003c/p>\n\u003cp>“We’re at an impasse because management refuses to offer any substantive gains for nurses or even a market price so they can retain nurses and keep them working here,” Castelli said.\u003c/p>\n\u003cfigure id=\"attachment_11841461\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11841461\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2020/10/RS45249_011_KQED_Alameda_AlamedaHospitalStrike_10072020-qut-800x533.jpg\" alt=\"Alameda Health System employees and supporters march outside of Alameda Hospital on Oct. 7, 2020, during a planned five-day strike over COVID-19 safety concerns and stalled contract negotiations.\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2020/10/RS45249_011_KQED_Alameda_AlamedaHospitalStrike_10072020-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/10/RS45249_011_KQED_Alameda_AlamedaHospitalStrike_10072020-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/10/RS45249_011_KQED_Alameda_AlamedaHospitalStrike_10072020-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/10/RS45249_011_KQED_Alameda_AlamedaHospitalStrike_10072020-qut-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/10/RS45249_011_KQED_Alameda_AlamedaHospitalStrike_10072020-qut.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Alameda Health System employees and supporters march outside of Alameda Hospital on Oct. 7, 2020, during a planned five-day strike over COVID-19 safety concerns and stalled contract negotiations. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>About 150 nurses at San Leandro Hospital and 175 at Alameda Hospital are represented by the CNA, while about 900 nurses at Highland Hospital are represented by the Service Employees International Union (SEIU) Local 1021, according to union representatives.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In addition to nurses, other SEIU members at Highland Hospital who work as technicians, clerks, housekeepers and social workers are joining the strike, bringing the total number of striking employees there to about 3,200, according to John Pearson, an SEIU chapter president.\u003c/p>\n\u003cp>The unions said they worked together to coordinate strikes at the same time.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The organization that manages all three hospitals, Alameda Health System (AHS), said it has brought in hundreds of replacement workers but has had to adjust service levels by canceling elective procedures and rescheduling appointments.\u003c/p>\n\u003cp>“We apologize to our patients and community health partners for any inconvenience they may experience due to postponement or reduction of some services during the strike,” wrote Terry Lightfoot, director of public affairs and community engagement for AHS, in a statement.\u003c/p>\n\u003cp>“While we are disappointed that the unions called this strike at a time when there are already extraordinary strains on health care providers, we encourage them to return to the bargaining table, where we can resolve our differences and reach agreement on a fair, mutually beneficial contract.”\u003c/p>\n\u003cp>In a memo to the Alameda County Board of Supervisors, the hospital system’s CEO, Delvecchio Finley, shared details of the management’s offers, which include a 2.5% raise in wages every year for the next three years and an additional 12 weeks of paid leave for anyone needing to care for a family member because of the COVID-19 pandemic.\u003c/p>\n\u003cp>“I implore the unions to please call off these strikes and let’s get back to trying to work together,” Finley wrote.\u003c/p>\n\u003cfigure id=\"attachment_11841465\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11841465\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2020/10/RS45244_006_KQED_Alameda_AlamedaHospitalStrike_10072020-qut-800x533.jpg\" alt=\"Alameda Health System employees and supporters march outside of Alameda Hospital on Oct. 7, 2020. About 175 nurses at Alameda Hospital and 150 at San Leandro Hospital are represented by the California Nurses Association, while about 900 nurses at Highland Hospital are represented by the Service Employees International Union Local 1021, according to union representatives. \" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2020/10/RS45244_006_KQED_Alameda_AlamedaHospitalStrike_10072020-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/10/RS45244_006_KQED_Alameda_AlamedaHospitalStrike_10072020-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/10/RS45244_006_KQED_Alameda_AlamedaHospitalStrike_10072020-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/10/RS45244_006_KQED_Alameda_AlamedaHospitalStrike_10072020-qut-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/10/RS45244_006_KQED_Alameda_AlamedaHospitalStrike_10072020-qut.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Alameda Health System employees and supporters march outside of Alameda Hospital on Oct. 7, 2020. About 175 nurses at Alameda Hospital and 150 at San Leandro Hospital are represented by the California Nurses Association, while about 900 nurses at Highland Hospital are represented by the Service Employees International Union Local 1021, according to union representatives. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But union representatives said there are additional provisions they want to see, including guarantees of higher staffing levels, better access to PPE, more space for treating COVID-19 patients and better maintenance of hospital equipment.\u003c/p>\n\u003cp>“They have to respect the fact that we know what we need in order to take care of our patients,” said Karen Rothblatt, an operating room nurse at Alameda Hospital and a nurse’s representative for the CNA.\u003c/p>\n\u003cp>Representatives for both the CNA and SEIU are calling for the county Board of Supervisors to intervene in contract negotiations.\u003c/p>\n\u003cp>“We want to get back to work. We want to get back to taking care of our patients,” Rothblatt said. “The last thing nurses want to do is be on strike.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>KQED’s Shannon Lin contributed additional reporting to this story.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Dr. Jessica Zitter specializes in critical and palliative care medicine and practices at Highland Hospital in Oakland, where she helps people with serious illness talk about how they want to live, all the way to the end.\u003c/p>\n\u003cp>Zitter says those are conversations we all should be having with our loved ones — even if we’re healthy and young. She is the author of \u003ca href=\"https://protect-us.mimecast.com/s/GEp6CyPmRxsNByzzfZXprl?domain=jessicazitter.com\" target=\"_blank\" rel=\"noopener noreferrer\">Extreme Measures: Finding a Better Path to the End of Life,\u003c/a> and her work has been featured in the documentary \u003ca href=\"https://www.netflix.com/title/80106307\">“Extremis”\u003c/a> on Netflix, as well as the forthcoming film \u003ca href=\"https://protect-us.mimecast.com/s/YsLqCzpn0ysRjmppUXnBtw?domain=caregiveralovestory.com\">“Caregiver: A Love Story.” \u003c/a>\u003c/p>\n\u003cp>Here are three stories about her patients, followed by some concrete tools you can use for planning and talking about the end of your life with loved ones.\u003c/p>\n\u003ch3>Michael Thomas: ‘Enjoying Every Moment’\u003c/h3>\n\u003cp>Michael Thomas is 64 and has COPD, a lung disease that makes it hard to breathe. He has already been in and out of the hospital several times this year and is particularly vulnerable if he were to get sick with COVID-19.\u003c/p>\n\u003cp>When Zitter talked with him over Zoom this spring, she asked him what he wanted most. His answer? To be with his children and grandchildren in Ohio. But he also said he didn’t feel a sense of urgency to visit them, because he believed he had plenty of time left.\u003c/p>\n\u003cfigure id=\"attachment_11838731\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11838731\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2020/09/RS44913_Michael-Thomas-with-family_cropped-800x450.jpg\" alt=\"Michael Thomas' family visits him in an Ohio hospital.\" width=\"800\" height=\"450\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44913_Michael-Thomas-with-family_cropped-800x450.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44913_Michael-Thomas-with-family_cropped-1020x574.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44913_Michael-Thomas-with-family_cropped-160x90.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44913_Michael-Thomas-with-family_cropped-1536x864.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44913_Michael-Thomas-with-family_cropped.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Michael Thomas’ family visits him in an Ohio hospital. \u003ccite>(Courtesy of Michael Thomas)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“You are a more confident person than I am about myself!” Zitter told him. “I want to be totally frank with you, because I think you deserve that. I’m concerned you may not have as much time to live as you think you do. If someone told me, ‘Michael is going to die within the next six months,’ I would not be surprised.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Zitter said she has to steel herself to deliver this kind of news. But she believes her patients deserve to know the truth.\u003c/p>\n\u003cp>“I know you have some serious goals, and they include being with family,” she told Thomas. “I would hate for you to miss that opportunity.”\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"Dr. Jessica Zitter, critical and palliative care specialist\"]‘This is really what palliative care is all about. It’s about how people want to live their lives. That informs how people want to die. But it really starts with how they want to live.’[/pullquote]\u003c/p>\n\u003cp>Thomas has since moved to Ohio to be close to his family — a decision sparked by his conversation with Zitter and Highland Hospital’s chaplain, Pastor Betty Clark.\u003c/p>\n\u003cp>“I didn’t want to come home. I didn’t want my family to see me in the condition that I’m in,” Thomas told Zitter over zoom after his move to Ohio. “That’s why I was hesitant to come. But then I know they love me so much. And here I am today, enjoying every moment.”\u003c/p>\n\u003cp>“It just shows that if we can just bring ourselves to just face our mortality and plan for it, we can get what Michael got,” Zitter said. “We can get this precious time with the people that he loved the most or whatever it is that’s most important to you.”\u003c/p>\n\u003cfigure id=\"attachment_11838351\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11838351\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2020/09/RS44911_Jessica-Zitter-Evan-Rusoja-with-patient-qut-800x533.jpg\" alt=\"Dr. Jessica Zitter with a patient at Highland Hospital in Oakland. \" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44911_Jessica-Zitter-Evan-Rusoja-with-patient-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44911_Jessica-Zitter-Evan-Rusoja-with-patient-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44911_Jessica-Zitter-Evan-Rusoja-with-patient-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44911_Jessica-Zitter-Evan-Rusoja-with-patient-qut-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44911_Jessica-Zitter-Evan-Rusoja-with-patient-qut.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Jessica Zitter with a patient at Highland Hospital in Oakland. \u003ccite>(Courtesy of Jessica Zitter)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch3>Evelyn Jarillo: ‘It Makes You Think About Others’\u003c/h3>\n\u003cp>Evelyn Jarillo is a grocery store worker in Los Angeles who got sick with COVID-19 in March. She recovered, but her husband, who has diabetes, also tested positive and is still suffering from health complications. She’s also worried about her 22-year-old son.\u003c/p>\n\u003cp>“When you’re sick and you’re feeling the way you feel, it makes you think about others,” Jarillo told Zitter when they spoke by Zoom recently. “It made you think about what happens if my son gets sick, what happens if he doesn’t make it? No mother will be able to deal with [talking to] their kids about, ‘Son, if you die tomorrow, what do you want me to do?’ ”\u003c/p>\n\u003cp>“Wait, let me make sure I understand,” Zitter said. “Are you saying you can’t ask your son, ‘What you want me to do if you got COVID and you were in the hospital on a ventilator?’ You don’t feel like you could talk to him about that?”\u003c/p>\n\u003cp>“I can’t,” Jarillo told her.\u003c/p>\n\u003cp>“Evelyn saw something that most of us don’t get a chance to see,” said Zitter. “She saw the potential for death.”\u003c/p>\n\u003cp>Like many of us, when Jarillo thought about members of her family dying, she faced a mental block, Zitter said. It seemed easier for Jarillo to share her thoughts about flower arrangements for her own funeral than to think about tough topics like a do-not-resuscitate order or discussing it with her children.\u003c/p>\n\u003cp>[aside tag=\"end-of-life\" label=\"related coverage\"]\u003c/p>\n\u003cp>Zitter had a similar conversation with her own son on his 18th birthday by playing a game called \u003ca href=\"http://www.gowish.org/\">Go Wish\u003c/a>. The game helps families talk about their preferences around death and the important things they want to hold on to throughout the course of their life.\u003c/p>\n\u003cp>“Like Evelyn, the last thing I want to do is think about my children dying,” said Zitter. “It’s just grim. It’s horrifying. It feels in some ways like not what a mother does, right? A mother is supposed to focus on the positives, the weddings. We’re not supposed to focus on the deathbed moments of a child. But asking open-ended questions is something you can and should do with your family. Just leaving space for more.”\u003c/p>\n\u003cp>Zitter has conducted workshops on death and dying with teenagers. Just like sex education, she says, there should be a place for death education in high schools.\u003c/p>\n\u003ch3>Andrew Rich: ‘This Is Where I Want to Die’\u003c/h3>\n\u003cfigure id=\"attachment_11838192\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11838192\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2020/09/RS44908_Andrew-Neville-smiling-qut-800x803.jpg\" alt=\"\" width=\"800\" height=\"803\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44908_Andrew-Neville-smiling-qut-800x803.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44908_Andrew-Neville-smiling-qut-1020x1024.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44908_Andrew-Neville-smiling-qut-160x161.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44908_Andrew-Neville-smiling-qut-1530x1536.jpg 1530w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44908_Andrew-Neville-smiling-qut.jpg 1904w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Andrew Rich with his dad, Neville Rich. \u003ccite>(Courtesy of Andrew Rich.)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Andrew Rich traveled to Sonoma early in the pandemic to celebrate his dad’s 92nd birthday. During the visit, his father got sick. They didn’t realize it was COVID-19, and when his father had great difficulty breathing, the family decided to bring him to an emergency room. He spent two weeks on a ventilator and then died alone in the hospital, because COVID-19 rules meant no one could visit him.\u003c/p>\n\u003cp>Rich said that was not what his dad had planned when he imagined his death.\u003c/p>\n\u003cp>“If we could rewind the clock two weeks to that Sunday morning when he collapsed, if we could have put him back in bed and said, ‘Dad, there’s the high likelihood that you have COVID and you’re 92, what do you want to do?’ He absolutely would have said, ‘Leave me here. This is where I want to be. I want to be in this bedroom looking out in the valley. And if I die, this is where I want to die,’ ” Rich said.\u003c/p>\n\u003cp>“The best-laid plans can get completely upended in the face of fear and illness and symptoms and your family not being there with you,” said Zitter, who recommends that families talk proactively about their wishes. “These conversations have to happen early and frequently. We have to get over the fear of talking about it and make it part of our family’s conversations around the dinner table.”\u003c/p>\n\u003cp>Zitter said that she is “very much committed” to critical care medicine and said that it is “in some ways miraculous.” But Zitter says the medicine that keeps us alive should not distract us from the truth of our mortality.\u003c/p>\n\u003cp>“We’ve watched the rise of the hospital and the intensive care unit to the point that we’ve become enamored of the many interventions and treatments that we consider to be the offerings of our modern medical system,” she said. “We’ve really lost the discriminating power and allowed ourselves to get completely distracted from making the preparations we need to face death, from thinking about our deaths and how we want to live, right to the end.”\u003c/p>\n\u003cp>“This is really what palliative care is all about. It’s about how people want to live their lives,” Zitter said. “That informs how people want to die. But it really starts with how they want to live.”\u003c/p>\n\u003ch3>\u003cstrong>Resources\u003c/strong>\u003c/h3>\n\u003cp>Here are things you can do to prepare, no matter your age or health.\u003c/p>\n\u003cul>\n\u003cli>Play “\u003ca href=\"http://gowish.org/\">Go Wish\u003c/a>” with your loved ones. The game helps people start talking about what is most important to them in terms of health and life.\u003c/li>\n\u003cli>Have a conversation about death at the dinner table. The interactive website \u003ca href=\"https://deathoverdinner.org/\">Death Over Dinner\u003c/a> can help you plan your conversation.\u003c/li>\n\u003cli>Write up an \u003ca href=\"https://www.nhpco.org/patients-and-caregivers/advance-care-planning/advance-directives/downloading-your-states-advance-directive/\">Advance Directive\u003c/a> and give it to your doctors and your loved ones. This document should be reviewed whenever your medical condition changes or you learn new information about an illness or condition.\u003c/li>\n\u003cli>People with advanced illness who are considered to be at risk for a life-threatening clinical event should talk to their doctor about completing a \u003ca href=\"https://polst.org/form-patients\">POLST\u003c/a> form. A POLST form is a medical order that documents a person’s preferences for receiving or not receiving certain types of medical interventions (for example, chest compressions, a feeding tube or a breathing tube).\u003c/li>\n\u003cli>If needed, execute a \u003ca href=\"https://www.nolo.com/legal-encyclopedia/california-financial-power-of-attorney-31871.html\">Durable Financial Power of Attorney\u003c/a>, a simple way to arrange for someone to handle your finances, such a bills or insurance matters, if you are unable to do so yourself.\u003c/li>\n\u003cli>Write your \u003ca href=\"https://money.usnews.com/money/personal-finance/family-finance/articles/steps-to-writing-a-will\">last will and testament\u003c/a> and/or a \u003ca href=\"https://www.nextavenue.org/do-you-need-a-trust-for-your-estate-plan/\">revocable trust \u003c/a>to clarify and determine how your assets are distributed after death.\u003c/li>\n\u003cli>Consider what your preferences are for a memorial ceremony, and discuss it with your loved ones.\u003c/li>\n\u003c/ul>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>https://www.youtube.com/watch?v=TJiY8duVgz0\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Dr. Jessica Zitter specializes in critical and palliative care medicine and practices at Highland Hospital in Oakland, where she helps people with serious illness talk about how they want to live, all the way to the end.\u003c/p>\n\u003cp>Zitter says those are conversations we all should be having with our loved ones — even if we’re healthy and young. She is the author of \u003ca href=\"https://protect-us.mimecast.com/s/GEp6CyPmRxsNByzzfZXprl?domain=jessicazitter.com\" target=\"_blank\" rel=\"noopener noreferrer\">Extreme Measures: Finding a Better Path to the End of Life,\u003c/a> and her work has been featured in the documentary \u003ca href=\"https://www.netflix.com/title/80106307\">“Extremis”\u003c/a> on Netflix, as well as the forthcoming film \u003ca href=\"https://protect-us.mimecast.com/s/YsLqCzpn0ysRjmppUXnBtw?domain=caregiveralovestory.com\">“Caregiver: A Love Story.” \u003c/a>\u003c/p>\n\u003cp>Here are three stories about her patients, followed by some concrete tools you can use for planning and talking about the end of your life with loved ones.\u003c/p>\n\u003ch3>Michael Thomas: ‘Enjoying Every Moment’\u003c/h3>\n\u003cp>Michael Thomas is 64 and has COPD, a lung disease that makes it hard to breathe. He has already been in and out of the hospital several times this year and is particularly vulnerable if he were to get sick with COVID-19.\u003c/p>\n\u003cp>When Zitter talked with him over Zoom this spring, she asked him what he wanted most. His answer? To be with his children and grandchildren in Ohio. But he also said he didn’t feel a sense of urgency to visit them, because he believed he had plenty of time left.\u003c/p>\n\u003cfigure id=\"attachment_11838731\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11838731\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2020/09/RS44913_Michael-Thomas-with-family_cropped-800x450.jpg\" alt=\"Michael Thomas' family visits him in an Ohio hospital.\" width=\"800\" height=\"450\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44913_Michael-Thomas-with-family_cropped-800x450.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44913_Michael-Thomas-with-family_cropped-1020x574.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44913_Michael-Thomas-with-family_cropped-160x90.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44913_Michael-Thomas-with-family_cropped-1536x864.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44913_Michael-Thomas-with-family_cropped.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Michael Thomas’ family visits him in an Ohio hospital. \u003ccite>(Courtesy of Michael Thomas)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“You are a more confident person than I am about myself!” Zitter told him. “I want to be totally frank with you, because I think you deserve that. I’m concerned you may not have as much time to live as you think you do. If someone told me, ‘Michael is going to die within the next six months,’ I would not be surprised.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Zitter said she has to steel herself to deliver this kind of news. But she believes her patients deserve to know the truth.\u003c/p>\n\u003cp>“I know you have some serious goals, and they include being with family,” she told Thomas. “I would hate for you to miss that opportunity.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "‘This is really what palliative care is all about. It’s about how people want to live their lives. That informs how people want to die. But it really starts with how they want to live.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Thomas has since moved to Ohio to be close to his family — a decision sparked by his conversation with Zitter and Highland Hospital’s chaplain, Pastor Betty Clark.\u003c/p>\n\u003cp>“I didn’t want to come home. I didn’t want my family to see me in the condition that I’m in,” Thomas told Zitter over zoom after his move to Ohio. “That’s why I was hesitant to come. But then I know they love me so much. And here I am today, enjoying every moment.”\u003c/p>\n\u003cp>“It just shows that if we can just bring ourselves to just face our mortality and plan for it, we can get what Michael got,” Zitter said. “We can get this precious time with the people that he loved the most or whatever it is that’s most important to you.”\u003c/p>\n\u003cfigure id=\"attachment_11838351\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11838351\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2020/09/RS44911_Jessica-Zitter-Evan-Rusoja-with-patient-qut-800x533.jpg\" alt=\"Dr. Jessica Zitter with a patient at Highland Hospital in Oakland. \" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44911_Jessica-Zitter-Evan-Rusoja-with-patient-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44911_Jessica-Zitter-Evan-Rusoja-with-patient-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44911_Jessica-Zitter-Evan-Rusoja-with-patient-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44911_Jessica-Zitter-Evan-Rusoja-with-patient-qut-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44911_Jessica-Zitter-Evan-Rusoja-with-patient-qut.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Jessica Zitter with a patient at Highland Hospital in Oakland. \u003ccite>(Courtesy of Jessica Zitter)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch3>Evelyn Jarillo: ‘It Makes You Think About Others’\u003c/h3>\n\u003cp>Evelyn Jarillo is a grocery store worker in Los Angeles who got sick with COVID-19 in March. She recovered, but her husband, who has diabetes, also tested positive and is still suffering from health complications. She’s also worried about her 22-year-old son.\u003c/p>\n\u003cp>“When you’re sick and you’re feeling the way you feel, it makes you think about others,” Jarillo told Zitter when they spoke by Zoom recently. “It made you think about what happens if my son gets sick, what happens if he doesn’t make it? No mother will be able to deal with [talking to] their kids about, ‘Son, if you die tomorrow, what do you want me to do?’ ”\u003c/p>\n\u003cp>“Wait, let me make sure I understand,” Zitter said. “Are you saying you can’t ask your son, ‘What you want me to do if you got COVID and you were in the hospital on a ventilator?’ You don’t feel like you could talk to him about that?”\u003c/p>\n\u003cp>“I can’t,” Jarillo told her.\u003c/p>\n\u003cp>“Evelyn saw something that most of us don’t get a chance to see,” said Zitter. “She saw the potential for death.”\u003c/p>\n\u003cp>Like many of us, when Jarillo thought about members of her family dying, she faced a mental block, Zitter said. It seemed easier for Jarillo to share her thoughts about flower arrangements for her own funeral than to think about tough topics like a do-not-resuscitate order or discussing it with her children.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Zitter had a similar conversation with her own son on his 18th birthday by playing a game called \u003ca href=\"http://www.gowish.org/\">Go Wish\u003c/a>. The game helps families talk about their preferences around death and the important things they want to hold on to throughout the course of their life.\u003c/p>\n\u003cp>“Like Evelyn, the last thing I want to do is think about my children dying,” said Zitter. “It’s just grim. It’s horrifying. It feels in some ways like not what a mother does, right? A mother is supposed to focus on the positives, the weddings. We’re not supposed to focus on the deathbed moments of a child. But asking open-ended questions is something you can and should do with your family. Just leaving space for more.”\u003c/p>\n\u003cp>Zitter has conducted workshops on death and dying with teenagers. Just like sex education, she says, there should be a place for death education in high schools.\u003c/p>\n\u003ch3>Andrew Rich: ‘This Is Where I Want to Die’\u003c/h3>\n\u003cfigure id=\"attachment_11838192\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11838192\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2020/09/RS44908_Andrew-Neville-smiling-qut-800x803.jpg\" alt=\"\" width=\"800\" height=\"803\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44908_Andrew-Neville-smiling-qut-800x803.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44908_Andrew-Neville-smiling-qut-1020x1024.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44908_Andrew-Neville-smiling-qut-160x161.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44908_Andrew-Neville-smiling-qut-1530x1536.jpg 1530w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44908_Andrew-Neville-smiling-qut.jpg 1904w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Andrew Rich with his dad, Neville Rich. \u003ccite>(Courtesy of Andrew Rich.)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Andrew Rich traveled to Sonoma early in the pandemic to celebrate his dad’s 92nd birthday. During the visit, his father got sick. They didn’t realize it was COVID-19, and when his father had great difficulty breathing, the family decided to bring him to an emergency room. He spent two weeks on a ventilator and then died alone in the hospital, because COVID-19 rules meant no one could visit him.\u003c/p>\n\u003cp>Rich said that was not what his dad had planned when he imagined his death.\u003c/p>\n\u003cp>“If we could rewind the clock two weeks to that Sunday morning when he collapsed, if we could have put him back in bed and said, ‘Dad, there’s the high likelihood that you have COVID and you’re 92, what do you want to do?’ He absolutely would have said, ‘Leave me here. This is where I want to be. I want to be in this bedroom looking out in the valley. And if I die, this is where I want to die,’ ” Rich said.\u003c/p>\n\u003cp>“The best-laid plans can get completely upended in the face of fear and illness and symptoms and your family not being there with you,” said Zitter, who recommends that families talk proactively about their wishes. “These conversations have to happen early and frequently. We have to get over the fear of talking about it and make it part of our family’s conversations around the dinner table.”\u003c/p>\n\u003cp>Zitter said that she is “very much committed” to critical care medicine and said that it is “in some ways miraculous.” But Zitter says the medicine that keeps us alive should not distract us from the truth of our mortality.\u003c/p>\n\u003cp>“We’ve watched the rise of the hospital and the intensive care unit to the point that we’ve become enamored of the many interventions and treatments that we consider to be the offerings of our modern medical system,” she said. “We’ve really lost the discriminating power and allowed ourselves to get completely distracted from making the preparations we need to face death, from thinking about our deaths and how we want to live, right to the end.”\u003c/p>\n\u003cp>“This is really what palliative care is all about. It’s about how people want to live their lives,” Zitter said. “That informs how people want to die. But it really starts with how they want to live.”\u003c/p>\n\u003ch3>\u003cstrong>Resources\u003c/strong>\u003c/h3>\n\u003cp>Here are things you can do to prepare, no matter your age or health.\u003c/p>\n\u003cul>\n\u003cli>Play “\u003ca href=\"http://gowish.org/\">Go Wish\u003c/a>” with your loved ones. The game helps people start talking about what is most important to them in terms of health and life.\u003c/li>\n\u003cli>Have a conversation about death at the dinner table. The interactive website \u003ca href=\"https://deathoverdinner.org/\">Death Over Dinner\u003c/a> can help you plan your conversation.\u003c/li>\n\u003cli>Write up an \u003ca href=\"https://www.nhpco.org/patients-and-caregivers/advance-care-planning/advance-directives/downloading-your-states-advance-directive/\">Advance Directive\u003c/a> and give it to your doctors and your loved ones. This document should be reviewed whenever your medical condition changes or you learn new information about an illness or condition.\u003c/li>\n\u003cli>People with advanced illness who are considered to be at risk for a life-threatening clinical event should talk to their doctor about completing a \u003ca href=\"https://polst.org/form-patients\">POLST\u003c/a> form. A POLST form is a medical order that documents a person’s preferences for receiving or not receiving certain types of medical interventions (for example, chest compressions, a feeding tube or a breathing tube).\u003c/li>\n\u003cli>If needed, execute a \u003ca href=\"https://www.nolo.com/legal-encyclopedia/california-financial-power-of-attorney-31871.html\">Durable Financial Power of Attorney\u003c/a>, a simple way to arrange for someone to handle your finances, such a bills or insurance matters, if you are unable to do so yourself.\u003c/li>\n\u003cli>Write your \u003ca href=\"https://money.usnews.com/money/personal-finance/family-finance/articles/steps-to-writing-a-will\">last will and testament\u003c/a> and/or a \u003ca href=\"https://www.nextavenue.org/do-you-need-a-trust-for-your-estate-plan/\">revocable trust \u003c/a>to clarify and determine how your assets are distributed after death.\u003c/li>\n\u003cli>Consider what your preferences are for a memorial ceremony, and discuss it with your loved ones.\u003c/li>\n\u003c/ul>\n\u003cp>\u003c/p>\u003c/div>",
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"slug": "east-bay-restaurants-and-health-care-workers-are-hurting-this-grassroots-campaign-helps-them-both",
"title": "East Bay Restaurants and Health Care Workers Are Hurting. This Grassroots Campaign Helps Them Both",
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"content": "\u003cp>Bay Area novelist Ayelet Waldman began with a simple desire: to help the helpers.\u003c/p>\n\u003cp>On March 19, she set out to deliver some meals to local hospitals from nearby restaurants that were struggling to find business after\u003ca href=\"https://www.kqed.org/science/1959566/california-gov-gavin-newsom-orders-state-to-shelter-in-place\" target=\"_blank\" rel=\"noopener noreferrer\"> a statewide shelter-in-place order\u003c/a> was announced in response to the coronavirus pandemic.\u003c/p>\n\u003cp>Two weeks later, the project has turned into a full-blown campaign called \u003ca href=\"https://www.eastbayfeeder.org/\">East Bay FeedER\u003c/a> with 40 volunteers and more than $200,000 raised. The group is currently providing meals twice a day to five East Bay hospitals.\u003c/p>\n\u003cp>Waldman said she’s thinking about what television personality Fred Rogers’ mother said to him \u003ca href=\"https://www.youtube.com/watch?v=-LGHtc_D328\" target=\"_blank\" rel=\"noopener noreferrer\">about looking for the people who are assisting others during times of distress\u003c/a>.\u003c/p>\n\u003cp>“That’s what makes me feel better,” Waldman said. “To be able to help the helpers. That is what sustains me through this.”\u003c/p>\n\u003cfigure id=\"attachment_11810735\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11810735\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2020/04/Kaiser-Oak-4.3-800x450.jpg\" alt=\"\" width=\"800\" height=\"450\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2020/04/Kaiser-Oak-4.3-800x450.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/04/Kaiser-Oak-4.3-160x90.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/04/Kaiser-Oak-4.3-1020x574.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/04/Kaiser-Oak-4.3.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">A delivery from Best Coast Burritos arrived to Kaiser Permanente Hospital in Oakland on April 3. \u003ccite>(Courtesy of Beth Chan and Colleen Paz)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Shortly after the shelter-in-place order, Waldman received an email from her friend Tanya Holland, owner of \u003ca href=\"http://www.brownsugarkitchen.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Brown Sugar Kitchen\u003c/a> in Oakland. Holland was asking customers to do takeout to support the restaurant. Waldman immediately ordered. At the same time, a friend and ER doctor called Waldman to tell her someone had dropped off a meal for him.\u003c/p>\n\u003cp>“It was the first time that he’d eaten not out of a [vending] machine in ages,” Waldman said. She realized she could do something — so she called Brown Sugar Kitchen back and asked for 25 meals and then delivered them to Highland Hospital in Oakland.\u003c/p>\n\u003cp>“The nurse I first spoke to got all teary, and I got all teary, and I dropped off the food,” Waldman said about her first delivery. She thought she could afford to do this once a week, so she went on Twitter — tagging her husband, author Michael Chabon — to see which restaurants would want to help.\u003c/p>\n\u003cp>https://twitter.com/ayeletw/status/1241473527900823563?s=20\u003c/p>\n\u003cp>“I got inundated with hundreds and hundreds of restaurants,” Waldman said. She then started to scale up. On March 25, the team had a delivery every day of the week, with Jenny Schwartz from \u003ca href=\"https://www.hopscotchoakland.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Hopscotch\u003c/a> restaurant in Oakland organizing the restaurants. Jeremy Crandell, who has served on nonprofit boards for arts organizations for the past 15 years, volunteered as the operations lead to coordinate drivers and logistics.\u003c/p>\n\u003cp>Schwartz said the efforts are two-fold, “It allows us to support our local restaurants, which would otherwise be really strapped. And because we pay full price and we give a nice tip, they can pay their servers.”\u003c/p>\n\u003cp>At the same time, she said, it “provides some nurturing food in return to front-line medical staff.”\u003c/p>\n\u003cp>Though it may seem minor, a weekly order can make a difference for an independent restaurant, according to Schwartz.\u003c/p>\n\u003cp>“[An] order of 40 to 50 meals brings in enough revenue to help keep two staff on payroll and can be the difference between keeping the lights on or shuttering entirely,” Schwartz said. “[Our] efforts are just as much for the restaurants as they are for the first responders.”\u003c/p>\n\u003cfigure id=\"attachment_11810736\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11810736 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2020/04/Brown_Sugar_Highland-800x450.jpg\" alt=\"\" width=\"800\" height=\"450\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2020/04/Brown_Sugar_Highland-800x450.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/04/Brown_Sugar_Highland-160x90.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/04/Brown_Sugar_Highland-1020x574.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/04/Brown_Sugar_Highland.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Tanya Holland of Brown Sugar Kitchen making a delivery to Highland Hospital. \u003ccite>(Courtesy of Jeremy Crandell)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Waldman did not initially plan in-depth safety protocols for her first delivery, but the team has now established protocols to both coordinate timing and maximize cleanliness.\u003c/p>\n\u003cp>“We’ve liaised with the hospitals so we know when it’s best and when they most appreciate the meals,” Waldman said. “The restaurants that have signed on to provide the meals are following best practices on cleanliness.” [aside tag=\"coronavirus, covid-19\" label=\"More Coronavirus Coverage\"]\u003c/p>\n\u003cp>Waldman’s organization has partnered with world-renowned chef José Andrés of \u003ca href=\"https://wck.org/\" target=\"_blank\" rel=\"noopener noreferrer\">World Central Kitchen\u003c/a>, a Washington, D.C.-based nonprofit that helps provide meals during natural disasters. CEO Nate Mook said in a statement that they are “thrilled to work with the dedicated community that launched East Bay FeedER as a way to respond to this unprecedented crisis by nourishing first responders and sustaining their local restaurants.”\u003c/p>\n\u003cp>Waldman described her group as “scrappy” and “grassroots.” She said, “We’re going to be doing our own thing, raising our own money, serving our own food, until the end of this pandemic crisis.”\u003c/p>\n\u003cp>As of Saturday, East Bay FeedER had already served over 1,600 meals.\u003c/p>\n\u003cp>Schwartz, from Hopscotch restaurant, said, “The sense of community is unlike anything I have ever experienced and it keeps me going every day.”\u003c/p>\n\u003cp>To donate to East Bay FeedER, click \u003ca href=\"https://donate.wck.org/give/279709/#!/donation/checkout\" target=\"_blank\" rel=\"noopener noreferrer\">here\u003c/a>.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Bay Area novelist Ayelet Waldman began with a simple desire: to help the helpers.\u003c/p>\n\u003cp>On March 19, she set out to deliver some meals to local hospitals from nearby restaurants that were struggling to find business after\u003ca href=\"https://www.kqed.org/science/1959566/california-gov-gavin-newsom-orders-state-to-shelter-in-place\" target=\"_blank\" rel=\"noopener noreferrer\"> a statewide shelter-in-place order\u003c/a> was announced in response to the coronavirus pandemic.\u003c/p>\n\u003cp>Two weeks later, the project has turned into a full-blown campaign called \u003ca href=\"https://www.eastbayfeeder.org/\">East Bay FeedER\u003c/a> with 40 volunteers and more than $200,000 raised. The group is currently providing meals twice a day to five East Bay hospitals.\u003c/p>\n\u003cp>Waldman said she’s thinking about what television personality Fred Rogers’ mother said to him \u003ca href=\"https://www.youtube.com/watch?v=-LGHtc_D328\" target=\"_blank\" rel=\"noopener noreferrer\">about looking for the people who are assisting others during times of distress\u003c/a>.\u003c/p>\n\u003cp>“That’s what makes me feel better,” Waldman said. “To be able to help the helpers. That is what sustains me through this.”\u003c/p>\n\u003cfigure id=\"attachment_11810735\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11810735\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2020/04/Kaiser-Oak-4.3-800x450.jpg\" alt=\"\" width=\"800\" height=\"450\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2020/04/Kaiser-Oak-4.3-800x450.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/04/Kaiser-Oak-4.3-160x90.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/04/Kaiser-Oak-4.3-1020x574.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/04/Kaiser-Oak-4.3.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">A delivery from Best Coast Burritos arrived to Kaiser Permanente Hospital in Oakland on April 3. \u003ccite>(Courtesy of Beth Chan and Colleen Paz)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Shortly after the shelter-in-place order, Waldman received an email from her friend Tanya Holland, owner of \u003ca href=\"http://www.brownsugarkitchen.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Brown Sugar Kitchen\u003c/a> in Oakland. Holland was asking customers to do takeout to support the restaurant. Waldman immediately ordered. At the same time, a friend and ER doctor called Waldman to tell her someone had dropped off a meal for him.\u003c/p>\n\u003cp>“It was the first time that he’d eaten not out of a [vending] machine in ages,” Waldman said. She realized she could do something — so she called Brown Sugar Kitchen back and asked for 25 meals and then delivered them to Highland Hospital in Oakland.\u003c/p>\n\u003cp>“The nurse I first spoke to got all teary, and I got all teary, and I dropped off the food,” Waldman said about her first delivery. She thought she could afford to do this once a week, so she went on Twitter — tagging her husband, author Michael Chabon — to see which restaurants would want to help.\u003c/p>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\n\u003cp>“I got inundated with hundreds and hundreds of restaurants,” Waldman said. She then started to scale up. On March 25, the team had a delivery every day of the week, with Jenny Schwartz from \u003ca href=\"https://www.hopscotchoakland.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Hopscotch\u003c/a> restaurant in Oakland organizing the restaurants. Jeremy Crandell, who has served on nonprofit boards for arts organizations for the past 15 years, volunteered as the operations lead to coordinate drivers and logistics.\u003c/p>\n\u003cp>Schwartz said the efforts are two-fold, “It allows us to support our local restaurants, which would otherwise be really strapped. And because we pay full price and we give a nice tip, they can pay their servers.”\u003c/p>\n\u003cp>At the same time, she said, it “provides some nurturing food in return to front-line medical staff.”\u003c/p>\n\u003cp>Though it may seem minor, a weekly order can make a difference for an independent restaurant, according to Schwartz.\u003c/p>\n\u003cp>“[An] order of 40 to 50 meals brings in enough revenue to help keep two staff on payroll and can be the difference between keeping the lights on or shuttering entirely,” Schwartz said. “[Our] efforts are just as much for the restaurants as they are for the first responders.”\u003c/p>\n\u003cfigure id=\"attachment_11810736\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11810736 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2020/04/Brown_Sugar_Highland-800x450.jpg\" alt=\"\" width=\"800\" height=\"450\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2020/04/Brown_Sugar_Highland-800x450.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/04/Brown_Sugar_Highland-160x90.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/04/Brown_Sugar_Highland-1020x574.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/04/Brown_Sugar_Highland.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Tanya Holland of Brown Sugar Kitchen making a delivery to Highland Hospital. \u003ccite>(Courtesy of Jeremy Crandell)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Waldman did not initially plan in-depth safety protocols for her first delivery, but the team has now established protocols to both coordinate timing and maximize cleanliness.\u003c/p>\n\u003cp>“We’ve liaised with the hospitals so we know when it’s best and when they most appreciate the meals,” Waldman said. “The restaurants that have signed on to provide the meals are following best practices on cleanliness.” \u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Waldman’s organization has partnered with world-renowned chef José Andrés of \u003ca href=\"https://wck.org/\" target=\"_blank\" rel=\"noopener noreferrer\">World Central Kitchen\u003c/a>, a Washington, D.C.-based nonprofit that helps provide meals during natural disasters. CEO Nate Mook said in a statement that they are “thrilled to work with the dedicated community that launched East Bay FeedER as a way to respond to this unprecedented crisis by nourishing first responders and sustaining their local restaurants.”\u003c/p>\n\u003cp>Waldman described her group as “scrappy” and “grassroots.” She said, “We’re going to be doing our own thing, raising our own money, serving our own food, until the end of this pandemic crisis.”\u003c/p>\n\u003cp>As of Saturday, East Bay FeedER had already served over 1,600 meals.\u003c/p>\n\u003cp>Schwartz, from Hopscotch restaurant, said, “The sense of community is unlike anything I have ever experienced and it keeps me going every day.”\u003c/p>\n\u003cp>To donate to East Bay FeedER, click \u003ca href=\"https://donate.wck.org/give/279709/#!/donation/checkout\" target=\"_blank\" rel=\"noopener noreferrer\">here\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Oakland Clinic Screens Asylum-Seekers for Honesty",
"title": "Oakland Clinic Screens Asylum-Seekers for Honesty",
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"content": "\u003cp>Dr. Nick Nelson walks through busy Highland Hospital in Oakland to a sixth‐floor exam room, where he sees patients from around the world who say they have fled torture and violence.\u003c/p>\n\u003cp>Nelson, who practices internal medicine, is the medical director of the Highland Human Rights Clinic, part of the Alameda County health system. A few times each week, he and his team conduct medical evaluations of people who are seeking asylum in the United States. The doctors listen to the patients' stories. They search for signs of trauma. They scrutinize injuries, including electrocution scars, bullet wounds and unset broken bones.\u003c/p>\n\u003cp>As the Trump administration looks to reduce the number of asylum applicants, citing loopholes and fraudulent claims, this clinic — and others like it in San Diego, Los Angeles, New York and Chicago — seeks evidence that can help determine whether someone should gain asylum in the U.S.\u003c/p>\n\u003cp>The Highland clinic opened in 2001 as a place for asylum-seekers and refugees to get care. Five years later, the staff started offering forensic exams that aim to discern whether there is evidence of torture or abuse. Nelson, who took over as director in 2012, says his team does between 80 and 120 evaluations each year.\u003c/p>\n\u003cp>Nelson and his colleagues essentially diagnose — and in many cases, substantiate — the truth of what these patients say occurred. Sometimes the asylum-seekers have health coverage that pays for the exams, but the county covers the cost for those who don't.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Our job is to make sure that the asylum office understands all the medical and psychological facts about a person's case so that they can make a decision,\" Nelson said.\u003c/p>\n\u003cp>Nelson bases his findings on an internationally recognized protocol for torture documentation.\u003c/p>\n\u003cp>For example, he may be called on to judge whether a scar or injury could have occurred as the patient describes. Sometimes, Nelson said, attorneys ask him to answer specific questions, such as, \"Is this burn scar consistent with a cigarette burn?\" or \"Are these marks on his back consistent with being beaten with PVC pipe?\"\u003c/p>\n\u003cp>Nelson has had some medical training on what to expect to see in cases of torture. He also applies his general expertise as a doctor in knowing how to interview and examine patients, and has learned something about the countries these asylum-seekers are fleeing and the injuries they may have endured.\u003c/p>\n\u003cfigure id=\"attachment_11679647\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-11679647\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/07/asylum-seekers-3-e1531157981677.jpg\" alt=\"\" width=\"1920\" height=\"1281\">\u003cfigcaption class=\"wp-caption-text\">Dr. Nick Nelson, director of the Highland Human Rights Clinic, examines Gebremeskl Tefamicael, an asylum-seeker from Eritrea, on June 11, 2018. Nelson searches for signs of trauma and examines injuries and wounds. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>For example, when someone is hit with a long, stiff object, it produces a pair of parallel bruises like railroad tracks, he said.\u003c/p>\n\u003cp>\"That's a specific thing that I didn't learn in medical school or residency,\" he said, \"but that I have learned through taking care of a lot of people who have been tortured.\"\u003c/p>\n\u003cp>In most cases, Nelson said, he finds evidence to support the stories his patients tell him. But there are also exams that don't yield definitive evidence.\u003c/p>\n\u003cp>Nelson also addresses the asylum-seekers' health needs, sometimes diagnosing cases of tuberculosis or HIV that were previously undiagnosed. Nearly all of the patients he sees need mental health referrals, he said, because of years of torture or abuse in their native countries.\u003c/p>\n\u003cp>One of the patients Nelson recently treated is 60‐year‐old Juan Lopez Aguilar, an indigenous Mayan who fled Guatemala three years ago. He said he was beaten and threatened off and on for nearly four decades because of his ethnicity and feared for his life back home.\u003c/p>\n\u003cp>Lopez Aguilar's son also was murdered in 2005 and his daughter fled because of threats, his attorney said.\u003c/p>\n\u003cp>\"I'm worried,\" Lopez Aguilar told the doctor through a translator, as he sat in the exam room. \"There are a lot of gangs. They want to kill people in my community.\"\u003c/p>\n\u003cfigure id=\"attachment_11679648\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-11679648\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/07/asylum-seekers-7-e1531158138309.jpg\" alt=\"\" width=\"1920\" height=\"1281\">\u003cfigcaption class=\"wp-caption-text\">Juan Lopez Aguilar, who fled Guatemala three years ago, meets with Dr. Nick Nelson at the Highland Hospital in Oakland on June 11, 2018. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Nelson first examined and interviewed Lopez Aguilar earlier this spring and wrote a report corroborating the man's account for his asylum case, formally filed last year.\u003c/p>\n\u003cp>Lopez Aguilar, who grew up in a family of peasant farmers, told Nelson that his community was attacked by soldiers when he was in his 20s and that his father was killed during that attack. Lopez Aguilar moved to another part of Guatemala, where he continued to be the victim of \"race‐based harassment, extortion and threats,\" Nelson said.\u003c/p>\n\u003cp>The man's story echoes those of other clinic patients. Nelson said violence and discrimination against indigenous Mayan‐speaking Guatemalans is common.\u003c/p>\n\u003cp>Lopez Aguilar, who has worked as a dishwasher, has now returned to the clinic for a regular medical visit. He tells the doctor in his native language that he has been having severe headaches and dizziness since soon after he arrived in the U.S.\u003c/p>\n\u003cp>His wife and some of his children are back in Guatemala, he explained, and he can't petition to bring his wife to the States unless and until he is granted asylum. That won't be before 2020, when his court date is scheduled.\u003c/p>\n\u003cp>Men like Lopez Aguilar have faced increasingly tough odds since early June, when U.S. Attorney General Jeff Sessions announced that gang violence and domestic abuse would no longer be considered grounds for granting asylum.\u003c/p>\n\u003cp>To be eligible for asylum, applicants must prove they face physical violence, or fear it, based on factors such as race, ethnicity or religion.\u003c/p>\n\u003cp>Even before the Trump administration's recent crackdown, getting asylum was a difficult and time‐consuming proposition. In 2017, only about 38 percent of asylum-seekers in the U.S. were granted that status by the immigration court, according to data from the nonpartisan Transactional Records Access Clearinghouse at Syracuse University.\u003c/p>\n\u003cp>The harsher federal policies, including detentions at the border, have generated anxiety and uncertainty among those seeking asylum and their advocates and immigration lawyers.\u003c/p>\n\u003cp>\"Every day is a roller coaster,\" said Oakland attorney Haregu Gaime, who frequently refers her clients to the Highland clinic.\u003c/p>\n\u003cp>Niloufar Khonsari, executive director of Pangea Legal Services, a Bay Area legal advocacy group, said the obstacles won't deter people from seeking a safe place to live or from seeking judicial help to stay in the U.S.\u003c/p>\n\u003cp>When applicants are examined at the Highland clinic, Khonsari said, it \"definitely makes a difference for judges.\"\u003c/p>\n\u003cp>Gaime said the clinic's reports frequently help corroborate her clients' experiences in a way that their testimony alone cannot.\u003c/p>\n\u003cp>\"Sometimes a traumatized person is not able to relay what happened to them in a way that tells the full story,\" she said.\u003c/p>\n\u003cp>Ira Mehlman, spokesman for the Federation for American Immigration Reform, which favors stricter controls on immigration, noted that there are limits to a doctor's ability to interpret these cases. Doctors may be able to determine if somebody suffered an injury, he said, but not necessarily the circumstances that led to it. \"And they can't determine if it was because of political persecution,\" he said.\u003c/p>\n\u003cp>Mehlman said there is no question that there is violence in Central America and that gangs are rampant, but the U.S. can't accept everyone who is danger.\u003c/p>\n\u003cfigure id=\"attachment_11679650\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-11679650\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/07/asylum-seekers-10-e1531158348464.jpg\" alt=\"\" width=\"1920\" height=\"1281\">\u003cfigcaption class=\"wp-caption-text\">Dr. Nick Nelson examines patient Juan Lopez Aguilar at Highland Hospital in Oakland on June 11, 2018. Aguilar had spent decades being persecuted as an indigenous Mayan in Guatemala. “I’m worried,” he says through a translator while sitting in the exam room. “There are a lot of gangs. They want to kill people in my community.” \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>On the same morning that Nelson saw Lopez Aguilar at Highland clinic, he also examined Gebremeskl Tefamicael, an asylum-seeker from Eritrea. Nelson took notes as he listened to Tefamicael's story of being conscripted into the military, then imprisoned and tortured.\u003c/p>\n\u003cp>Nelson asked Tefamicael exactly what his tormentors used to tie him up.\u003c/p>\n\u003cp>It was a rope made from tree bark, the patient responded, as Nelson wrote in his notebook a description of the scars on Tefamicael's wrists.\u003c/p>\n\u003cp>Afterward, Nelson's report for the court stated that Tefamicael's physical scars and psychological state are consistent with the man's description of what happened to him.\u003c/p>\n\u003cp>Nelson said he got involved with the clinic because he wanted to treat people who were underserved. People fleeing their countries and seeking asylum here are \"definitely one of the more ... underserved and generally marginalized\" communities, he said.\u003c/p>\n\u003cp>Often, Nelson doesn't hear until months or years later whether his patients have been granted asylum. But when the request is approved, he said, he sees a tremendous change in them.\u003c/p>\n\u003cp>Getting asylum doesn't take away the trauma, but it relieves these people of the fear of returning to a country where they are not safe, Nelson said.\u003c/p>\n\u003cp>\"When someone who has got a real basis for an asylum claim gets granted, and you were part of demonstrating why that should be the case,\" he said, \"that feels really good.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"https://khn.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a> (KHN) is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\n",
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"excerpt": "As new federal policies make it harder to gain asylum in the U.S., foreign applicants try to improve their chances by having doctors evaluate their conditions — perhaps bolstering their stories of torture and violent persecution back home.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Dr. Nick Nelson walks through busy Highland Hospital in Oakland to a sixth‐floor exam room, where he sees patients from around the world who say they have fled torture and violence.\u003c/p>\n\u003cp>Nelson, who practices internal medicine, is the medical director of the Highland Human Rights Clinic, part of the Alameda County health system. A few times each week, he and his team conduct medical evaluations of people who are seeking asylum in the United States. The doctors listen to the patients' stories. They search for signs of trauma. They scrutinize injuries, including electrocution scars, bullet wounds and unset broken bones.\u003c/p>\n\u003cp>As the Trump administration looks to reduce the number of asylum applicants, citing loopholes and fraudulent claims, this clinic — and others like it in San Diego, Los Angeles, New York and Chicago — seeks evidence that can help determine whether someone should gain asylum in the U.S.\u003c/p>\n\u003cp>The Highland clinic opened in 2001 as a place for asylum-seekers and refugees to get care. Five years later, the staff started offering forensic exams that aim to discern whether there is evidence of torture or abuse. Nelson, who took over as director in 2012, says his team does between 80 and 120 evaluations each year.\u003c/p>\n\u003cp>Nelson and his colleagues essentially diagnose — and in many cases, substantiate — the truth of what these patients say occurred. Sometimes the asylum-seekers have health coverage that pays for the exams, but the county covers the cost for those who don't.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Our job is to make sure that the asylum office understands all the medical and psychological facts about a person's case so that they can make a decision,\" Nelson said.\u003c/p>\n\u003cp>Nelson bases his findings on an internationally recognized protocol for torture documentation.\u003c/p>\n\u003cp>For example, he may be called on to judge whether a scar or injury could have occurred as the patient describes. Sometimes, Nelson said, attorneys ask him to answer specific questions, such as, \"Is this burn scar consistent with a cigarette burn?\" or \"Are these marks on his back consistent with being beaten with PVC pipe?\"\u003c/p>\n\u003cp>Nelson has had some medical training on what to expect to see in cases of torture. He also applies his general expertise as a doctor in knowing how to interview and examine patients, and has learned something about the countries these asylum-seekers are fleeing and the injuries they may have endured.\u003c/p>\n\u003cfigure id=\"attachment_11679647\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-11679647\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/07/asylum-seekers-3-e1531157981677.jpg\" alt=\"\" width=\"1920\" height=\"1281\">\u003cfigcaption class=\"wp-caption-text\">Dr. Nick Nelson, director of the Highland Human Rights Clinic, examines Gebremeskl Tefamicael, an asylum-seeker from Eritrea, on June 11, 2018. Nelson searches for signs of trauma and examines injuries and wounds. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>For example, when someone is hit with a long, stiff object, it produces a pair of parallel bruises like railroad tracks, he said.\u003c/p>\n\u003cp>\"That's a specific thing that I didn't learn in medical school or residency,\" he said, \"but that I have learned through taking care of a lot of people who have been tortured.\"\u003c/p>\n\u003cp>In most cases, Nelson said, he finds evidence to support the stories his patients tell him. But there are also exams that don't yield definitive evidence.\u003c/p>\n\u003cp>Nelson also addresses the asylum-seekers' health needs, sometimes diagnosing cases of tuberculosis or HIV that were previously undiagnosed. Nearly all of the patients he sees need mental health referrals, he said, because of years of torture or abuse in their native countries.\u003c/p>\n\u003cp>One of the patients Nelson recently treated is 60‐year‐old Juan Lopez Aguilar, an indigenous Mayan who fled Guatemala three years ago. He said he was beaten and threatened off and on for nearly four decades because of his ethnicity and feared for his life back home.\u003c/p>\n\u003cp>Lopez Aguilar's son also was murdered in 2005 and his daughter fled because of threats, his attorney said.\u003c/p>\n\u003cp>\"I'm worried,\" Lopez Aguilar told the doctor through a translator, as he sat in the exam room. \"There are a lot of gangs. They want to kill people in my community.\"\u003c/p>\n\u003cfigure id=\"attachment_11679648\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-11679648\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/07/asylum-seekers-7-e1531158138309.jpg\" alt=\"\" width=\"1920\" height=\"1281\">\u003cfigcaption class=\"wp-caption-text\">Juan Lopez Aguilar, who fled Guatemala three years ago, meets with Dr. Nick Nelson at the Highland Hospital in Oakland on June 11, 2018. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Nelson first examined and interviewed Lopez Aguilar earlier this spring and wrote a report corroborating the man's account for his asylum case, formally filed last year.\u003c/p>\n\u003cp>Lopez Aguilar, who grew up in a family of peasant farmers, told Nelson that his community was attacked by soldiers when he was in his 20s and that his father was killed during that attack. Lopez Aguilar moved to another part of Guatemala, where he continued to be the victim of \"race‐based harassment, extortion and threats,\" Nelson said.\u003c/p>\n\u003cp>The man's story echoes those of other clinic patients. Nelson said violence and discrimination against indigenous Mayan‐speaking Guatemalans is common.\u003c/p>\n\u003cp>Lopez Aguilar, who has worked as a dishwasher, has now returned to the clinic for a regular medical visit. He tells the doctor in his native language that he has been having severe headaches and dizziness since soon after he arrived in the U.S.\u003c/p>\n\u003cp>His wife and some of his children are back in Guatemala, he explained, and he can't petition to bring his wife to the States unless and until he is granted asylum. That won't be before 2020, when his court date is scheduled.\u003c/p>\n\u003cp>Men like Lopez Aguilar have faced increasingly tough odds since early June, when U.S. Attorney General Jeff Sessions announced that gang violence and domestic abuse would no longer be considered grounds for granting asylum.\u003c/p>\n\u003cp>To be eligible for asylum, applicants must prove they face physical violence, or fear it, based on factors such as race, ethnicity or religion.\u003c/p>\n\u003cp>Even before the Trump administration's recent crackdown, getting asylum was a difficult and time‐consuming proposition. In 2017, only about 38 percent of asylum-seekers in the U.S. were granted that status by the immigration court, according to data from the nonpartisan Transactional Records Access Clearinghouse at Syracuse University.\u003c/p>\n\u003cp>The harsher federal policies, including detentions at the border, have generated anxiety and uncertainty among those seeking asylum and their advocates and immigration lawyers.\u003c/p>\n\u003cp>\"Every day is a roller coaster,\" said Oakland attorney Haregu Gaime, who frequently refers her clients to the Highland clinic.\u003c/p>\n\u003cp>Niloufar Khonsari, executive director of Pangea Legal Services, a Bay Area legal advocacy group, said the obstacles won't deter people from seeking a safe place to live or from seeking judicial help to stay in the U.S.\u003c/p>\n\u003cp>When applicants are examined at the Highland clinic, Khonsari said, it \"definitely makes a difference for judges.\"\u003c/p>\n\u003cp>Gaime said the clinic's reports frequently help corroborate her clients' experiences in a way that their testimony alone cannot.\u003c/p>\n\u003cp>\"Sometimes a traumatized person is not able to relay what happened to them in a way that tells the full story,\" she said.\u003c/p>\n\u003cp>Ira Mehlman, spokesman for the Federation for American Immigration Reform, which favors stricter controls on immigration, noted that there are limits to a doctor's ability to interpret these cases. Doctors may be able to determine if somebody suffered an injury, he said, but not necessarily the circumstances that led to it. \"And they can't determine if it was because of political persecution,\" he said.\u003c/p>\n\u003cp>Mehlman said there is no question that there is violence in Central America and that gangs are rampant, but the U.S. can't accept everyone who is danger.\u003c/p>\n\u003cfigure id=\"attachment_11679650\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-11679650\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/07/asylum-seekers-10-e1531158348464.jpg\" alt=\"\" width=\"1920\" height=\"1281\">\u003cfigcaption class=\"wp-caption-text\">Dr. Nick Nelson examines patient Juan Lopez Aguilar at Highland Hospital in Oakland on June 11, 2018. Aguilar had spent decades being persecuted as an indigenous Mayan in Guatemala. “I’m worried,” he says through a translator while sitting in the exam room. “There are a lot of gangs. They want to kill people in my community.” \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>On the same morning that Nelson saw Lopez Aguilar at Highland clinic, he also examined Gebremeskl Tefamicael, an asylum-seeker from Eritrea. Nelson took notes as he listened to Tefamicael's story of being conscripted into the military, then imprisoned and tortured.\u003c/p>\n\u003cp>Nelson asked Tefamicael exactly what his tormentors used to tie him up.\u003c/p>\n\u003cp>It was a rope made from tree bark, the patient responded, as Nelson wrote in his notebook a description of the scars on Tefamicael's wrists.\u003c/p>\n\u003cp>Afterward, Nelson's report for the court stated that Tefamicael's physical scars and psychological state are consistent with the man's description of what happened to him.\u003c/p>\n\u003cp>Nelson said he got involved with the clinic because he wanted to treat people who were underserved. People fleeing their countries and seeking asylum here are \"definitely one of the more ... underserved and generally marginalized\" communities, he said.\u003c/p>\n\u003cp>Often, Nelson doesn't hear until months or years later whether his patients have been granted asylum. But when the request is approved, he said, he sees a tremendous change in them.\u003c/p>\n\u003cp>Getting asylum doesn't take away the trauma, but it relieves these people of the fear of returning to a country where they are not safe, Nelson said.\u003c/p>\n\u003cp>\"When someone who has got a real basis for an asylum claim gets granted, and you were part of demonstrating why that should be the case,\" he said, \"that feels really good.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
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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": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
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"tagline": "Politics from a personal perspective",
"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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"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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"info": "A two-time Peabody Award-winner, Radiolab is an investigation told through sounds and stories, and centered around one big idea. In the Radiolab world, information sounds like music and science and culture collide. Hosted by Jad Abumrad and Robert Krulwich, the show is designed for listeners who demand skepticism, but appreciate wonder. WNYC Studios is the producer of other leading podcasts including Freakonomics Radio, Death, Sex & Money, On the Media and many more.",
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"reveal": {
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"officialWebsiteLink": "https://www.revealnews.org/episodes/",
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},
"rightnowish": {
"id": "rightnowish",
"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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"science-friday": {
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