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"content": "\u003cp>[dropcap]W[/dropcap]hen Miriam McDonald decided she wanted to have another baby at age 44, her doctor told her she had a better chance of winning the lottery. So when she got pregnant, she and her husband were thrilled. But within three days of giving birth to their son, everything turned.\u003c/p>\n\u003cp>“I was thinking, ‘Oh my God, what did I do?’ I just brought this baby into this world and I can barely take care of myself right now,” she said. “I feel exhausted. I haven’t slept in three days. I haven’t really eaten in three days.”\u003c/p>\n\u003cp>As the weeks went by, her depression got worse. She felt sad, but also indifferent. She didn’t want to hold her baby, she didn’t want to change him. She said she felt no connection with him at all.\u003c/p>\n\u003cp>This confused her – she never felt anything like this after her first two kids – and she worried her mood might hurt her son. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4113321/#R2\">Untreated postpartum depression can affect babies’ cognitive and social development\u003c/a>. For the mother, it can be life or death. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4113321/\">Suicide accounts for 20% of maternal deaths\u003c/a>.\u003c/p>\n\u003cp>“Every day, I was crying. Every day, I felt like I just wanted to die. Every day, I thought about ending my life,” said McDonald, who is Latina and works at UC Davis as an IT professional.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She went to Kaiser Permanente, her health care provider, for help. She said they put her on a merry-go-round of medication trial and error. The first drug her doctor prescribed made her anxious. The second drug gave her horrific nightmares. A third drug gave her auditory and visual hallucinations that took seven weeks to go away. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Then, her doctor retired. And when McDonald complained to her new doctor that she was still depressed four months after giving birth, the physician suggested more medications.\u003c/span>\u003c/p>\n\u003cp>“I was desperate,” McDonald said. “I was like, ‘I’m trying to help myself, but things are just getting worse.’ So what am I left with?”\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She started doing her own research and learned about a new treatment called brexanolone. It’s \u003ca href=\"https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-post-partum-depression\">the \u003c/a>\u003c/span>\u003cspan style=\"font-weight: 400\">first and only drug\u003c/span>\u003cspan style=\"font-weight: 400\"> approved by the U.S. Food and Drug Administration to treat postpartum depression, which \u003ca href=\"https://www.americashealthrankings.org/explore/health-of-women-and-children/measure/postpartum_depression/state/CA\">affects \u003c/a>\u003c/span>\u003cspan style=\"font-weight: 400\">1 out of 8 new mothers\u003c/span>\u003cspan style=\"font-weight: 400\"> in California. Instead of targeting the serotonin system in the brain, like most antidepressants, brexanolone works by rebalancing the stress hormones that can get out of kilter after having a baby. It’s delivered through an IV infusion over 2 1/2 days in the hospital. \u003c/span>\u003c/p>\n\u003cp>In \u003cspan style=\"font-weight: 400\">clinical trials\u003c/span>\u003cspan style=\"font-weight: 400\">, \u003ca href=\"https://www.fda.gov/media/121348/download\">75% of women who got brexanolone started to feel better\u003c/a> immediately after the three-day treatment. Half the women went into complete remission.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">McDonald wanted to try it. \u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_11879318\" class=\"wp-caption aligncenter\" style=\"max-width: 2560px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11879318\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/06/trying-to-smile-1-scaled.jpg\" alt=\"\" width=\"2560\" height=\"1920\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/trying-to-smile-1-scaled.jpg 2560w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/trying-to-smile-1-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/trying-to-smile-1-1020x765.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/trying-to-smile-1-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/trying-to-smile-1-1536x1152.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/trying-to-smile-1-2048x1536.jpg 2048w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/trying-to-smile-1-1920x1440.jpg 1920w\" sizes=\"auto, (max-width: 2560px) 100vw, 2560px\">\u003cfigcaption class=\"wp-caption-text\">For the first year of her son’s life, Miriam McDonald says all her smiles were fake or strained. \u003ccite>(Courtesy Miriam McDonald)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">“People walk out of the hospital, wanting to be with their child, wanting to return home,” said \u003c/span>\u003ca href=\"https://www.med.unc.edu/psych/directory/riah-patterson/\">\u003cspan style=\"font-weight: 400\">Dr. Riah Patterson\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, who has been treating women with brexanolone at the University of North Carolina at Chapel Hill since it became available in summer 2019. “There is a hopefulness, a brightness. You can really see that transformation in the hospital room over those 60 hours. It’s pretty miraculous.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">When McDonald asked her doctor for brexanolone, she said no. \u003c/span>\u003c/p>\n\u003cp>In an email, she said the existing studies were “not very impressive.” She told McDonald that she didn’t meet Kaiser’s criteria for the drug: She would have had to try and fail four medications and electroconvulsive therapy before she could try brexanolone. And all this had to happen within six months of having her baby, or she couldn’t try it at all.\u003c/p>\n\u003cp>How could anyone qualify, McDonald wondered?\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“This is crazy. By the time you even try one drug, that’s like four weeks out,” she said. “Another drug is four weeks out, another drug is four weeks out. There’s just no way.”\u003c/span>\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"State Sen. Scott Wiener, D-San Francisco\"]‘If Kaiser is making it effectively impossible to get a particular, important mental health treatment, that could definitely be a violation of our parity law.’[/pullquote]\u003cspan style=\"font-weight: 400\">Kaiser’s guidance is an outlier. KQED analyzed guidelines from a dozen health plans operating in California. Three of them require women to fail one medication before trying brexanolone. One plan – the state’s Medi-Cal program for low-income women – requires two fails. But Kaiser is the only system KQED found that recommends women first fail four drugs.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“That’s absurd,” said UNC’s Patterson, one of several experts in postpartum depression who, in turn, called Kaiser’s guidance “ridiculous,” “harsh,” “abusive” and “insane.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">It may also be illegal. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Under a \u003c/span>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200SB855\">\u003cspan style=\"font-weight: 400\">new state law that took effect in January\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> , health plans must conform to “generally accepted standards of care,” including nonprofit guidelines, scientific literature and expert consensus, when making decisions about mental health treatment.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“If Kaiser is making it effectively impossible to get a particular, important mental health treatment, that could definitely be a violation of our parity law,” said state Sen. Scott Wiener, D-San Francisco, the bill’s author. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Kaiser says it always follows the law. It says its integrated structure makes it different from traditional insurers. At Kaiser, a patient’s doctor determines whether a medication is necessary, not the health plan, and the criteria doctors use are recommendations, not requirements or prerequisites that patients need to “exhaust,” said Dr. Maria Koshy, Kaiser’s chair of psychiatry for Northern California. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“At the end of the day, this is an individual clinical decision by both the provider – the physician – and the patient,” she said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But former Kaiser clinicians and legislative experts familiar with Kaiser’s model say the culture around these recommendations is to follow them. Doctors get questioned or can face consequences if they don’t, said Wiener.\u003c/span>\u003c/p>\n\u003ch3>‘It Saved My Life’\u003c/h3>\n\u003cp>\u003cspan style=\"font-weight: 400\">McDonald’s physician followed the criteria as if they were prerequisites when she declined to prescribe brexanolone. Kaiser’s grievance department sent a letter to another woman, Yesenia Muñoz, denying brexanolone because she had not failed enough medications.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“When I talked to the caseworker at Kaiser that had denied the medication, he said that Zulresso was very expensive,” said Muñoz, referring to brexanolone’s brand name.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Brexanolone treatment costs $34,000 for the medication, plus the cost of the three-day hospital stay, which can tack on another $30,000, at least. Kaiser is not yet certified to administer the treatment in-house, so it must pay outside hospitals to provide it. It says it has plans to eventually open three of its own certified centers.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Muñoz was devastated by the denial. She was overwhelmed by postpartum depression and anxiety shortly after her daughter was born and, as a Latina, she said she was hesitant to seek help at first. When she did, none of the medications or therapies Kaiser offered her worked. She still felt suicidal.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“I could get out the door sometimes and take the stroller and go walk, and my mind kept on saying, ‘If you just step in front of the car, it’s all going to go away,’ ” she remembers.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Muñoz got help from family and co-workers to appeal Kaiser’s decision to the state, and after reviewing her medical records, regulators ordered Kaiser to pay for the brexanolone treatment.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Muñoz went to UC Davis Medical Center to get it, and she started feeling better within the first day.\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_11879428\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11879428\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/06/MunozAndBaby.jpg\" alt=\"Yesenia smiling holding baby\" width=\"1920\" height=\"1760\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/MunozAndBaby.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/MunozAndBaby-800x733.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/MunozAndBaby-1020x935.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/MunozAndBaby-160x147.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/MunozAndBaby-1536x1408.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">After Yesenia Muñoz received brexanolone to treat her postpartum depression, she felt blessed, connected with her daughter and ‘happy enough to want to live.’ \u003ccite>(Courtesy Yesenia Munoz)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">“The nurse came in and she said something funny and I laughed,” Muñoz said. “It was the first time I had laughed in so long.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She started looking through photos and videos of her daughter on her phone and she says it was like she was experiencing those moments for the first time. She started making plans for the future. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“It was like a switch flicked and it made me happy enough to want to live,” she said. “It saved my life.”\u003c/span>\u003c/p>\n\u003ch3>‘There Is No Place Where We Say Kaiser Is Exempt’\u003c/h3>\n\u003cp>\u003cspan style=\"font-weight: 400\">In 2008, Congress passed a landmark federal law aimed at correcting imbalances in how insurers covered mental health treatments compared to physical health, later reinforced by the Affordable Care Act in 2010. \u003c/span>\u003cspan style=\"font-weight: 400\">But \u003c/span>\u003ca href=\"https://www.kqed.org/stateofhealth/series/state-of-mind\">\u003cspan style=\"font-weight: 400\">insurers found loopholes\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, creating overly restrictive or self-serving criteria that made it easy to deny services, and as a result, save money.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">California’s new law, \u003c/span>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200SB855\">\u003cspan style=\"font-weight: 400\">Senate Bill 855\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, is aimed at tightening those loopholes, and has been \u003c/span>\u003ca href=\"https://www.statnews.com/2020/10/14/new-california-law-should-serve-as-a-national-model-for-mental-health-care-reform/\">\u003cspan style=\"font-weight: 400\">hailed by advocates as a national model\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> for mental health reform. It requires health plans to use clinically based, expert-recognized criteria and guidelines in making medical decisions, with the goal of limiting arbitrary or cost-driven denials. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Kaiser raises questions about how precisely the new law applies to them, given its unique integrated structure, where doctors make determinations about what is medically necessary rather than the health plan side of the organization. Kaiser’s Dr. Koshy said SB 855’s requirement to comply with generally accepted standards of care “does not apply” to its brexanolone recommendations because they were developed and are used by doctors, not plan administrators. (When KQED asked Kaiser to provide the brexanolone policy its health plan uses, it said it didn’t have one.)\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“We 100% intended this law to apply to the care people get at Kaiser,” said Julie Snyder, government affairs director at \u003ca href=\"https://steinberginstitute.org/\" target=\"_blank\" rel=\"noopener noreferrer\">the Steinberg Institute\u003c/a>, which co-sponsored the law. “There is no place where we say Kaiser is exempt.” \u003c/span>\u003c/p>\n\u003cp>[aside postID=stateofhealth_185796,stateofhealth_193386,stateofhealth_191734 label='Related Coverage']\u003cspan style=\"font-weight: 400\">Doctors at Kaiser have historically been “gatekeepers” for services in the system, said \u003ca href=\"https://psych-appeal.com/meiram-bendat-attorney-founder/\" target=\"_blank\" rel=\"noopener noreferrer\">Meiram Bendat\u003c/a>, an attorney and licensed psychotherapist who also advised on the law. It doesn’t matter if practice recommendations for brexanolone were written by doctors or administrators, or whether the recommendations are mandatory or optional – Bendat says they must be compliant with the law. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“If it’s inconsistent with generally accepted standards of care, then it has no place in California,” he said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Some of Kaiser’s recommended criteria for brexanolone are aligned with generally accepted standards of care; for example, reserving the drug for women who are six months or less postpartum, which was a criterion used in the \u003c/span>\u003ca href=\"https://www.fda.gov/media/121348/download\">\u003cspan style=\"font-weight: 400\">clinical trials the FDA relied on when it approved the drug\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But the recommendation to try four or five alternative treatments before considering brexanolone conflicts with the judgment of half a dozen women’s health experts interviewed for this story. They say there just isn’t enough time in the postpartum period. And there’s too much at stake. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Not only are babies at risk of developmental and emotional problems if their mother is depressed, \u003c/span>\u003ca href=\"https://neurosciencenews.com/paternal-anxiety-18177/#:~:text=Summary%3A%20A%20new%20study%20reports,this%20period%20was%20under%204%25.\">\u003cspan style=\"font-weight: 400\">husbands and partners are also at higher risk for depression and anxiety\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. And because new moms are learning to breastfeed, and figuring out what’s part of the new normal and what’s not, it can take months just to recognize there’s a problem, said UNC’s Riah Patterson.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“It takes so long for this illness to come to recognition and for someone to actually get into an appointment and actually be seen by a provider,” she said.\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_11879416\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11879416\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/06/Riah-Patterson.jpg\" alt=\"\" width=\"1920\" height=\"1436\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Riah-Patterson.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Riah-Patterson-800x598.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Riah-Patterson-1020x763.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Riah-Patterson-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Riah-Patterson-1536x1149.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Riah Patterson discusses patients and treatment plans with her trainee, a third-year psychiatry resident at the Center for Women’s Mood Disorders at UNC-Chapel Hill. \u003ccite>(Courtesy Riah Patterson)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">Indeed, the FDA fast-tracked the approval of brexanolone in part because of how quickly it worked, allowing women to feel better and get back to their families in three days.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“It’s new, it’s promising,” said Kaiser’s Koshy, but, she added, “it’s not a benign medication.” \u003c/span>\u003ca href=\"https://www.fda.gov/media/121348/download\">\u003cspan style=\"font-weight: 400\">Six women in the clinical trials experienced loss or near loss of consciousness,\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> which is why the FDA requires women to be continuously monitored in certified health centers when getting the infusion. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Also, the safety and efficacy data is limited, Koshy said. The clinical trials only compared brexanolone to placebo, not to alternative treatments. So while the data show brexanolone works better than nothing, there’s no data on whether it works better than Zoloft or electroconvulsive therapy. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Koshy says Kaiser is always reviewing practice recommendations as new evidence becomes available, but also acknowledged that Kaiser’s recommendations for brexanolone have not been updated since they were first developed two years ago, in July 2019. \u003c/span>\u003c/p>\n\u003cp>It is unclear what role the \u003ca href=\"https://dmhc.ca.gov/\">Department of Managed Health Care\u003c/a>, the state agency that regulates Kaiser, will play in resolving these questions. In a statement, the department said it will review any criteria or guidelines the Kaiser health plan uses for brexanolone, but said it does not have jurisdiction over physician decisions.\u003c/p>\n\u003cp>The DMHC also monitors patient complaints around new medications and treatments in order to identify problems with access to care. So far, \u003ca href=\"https://wpso.dmhc.ca.gov/imr/\">the DMHC has published two complaints about brexanolone in its public database\u003c/a> – both were filed by Kaiser patients.\u003c/p>\n\u003cp>\u003ca href=\"https://www.benefitscafe.com/insurance-companies/kaiserpermanente/\"> \u003cspan style=\"font-weight: 400\">Kaiser is the \u003c/span>\u003cspan style=\"font-weight: 400\">largest insurer in California\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. It holds a 40% share of the market, covering 6.1 million patients. But at UC Davis, where Kaiser says it sends all patients who need brexanolone in Northern California, Kaiser patients are only 15% of those who got the drug, according to \u003c/span>\u003ca href=\"https://health.ucdavis.edu/team/search/1499/shannon-clark---obstetrics-and-gynecology-sacramento\">\u003cspan style=\"font-weight: 400\">Dr. Shannon Clark\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, a psychiatrist and OB-GYN overseeing the treatments. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She says of the 13 women who’ve been treated at UC Davis in the last two years, only two were from Kaiser. One was Muñoz, who was approved only after the state intervened. The other was Whitney Worthington. Both women canceled their coverage with Kaiser over the postpartum mental health care they received.\u003c/span>\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"Marcus Worthington, husband of Whitney Worthington\"]‘The only thing that changed was that we were able to stir up enough dirt and I was able to pitch a big enough fit … It finally got on somebody’s radar who wasn’t going to ignore it.’[/pullquote]\u003cspan style=\"font-weight: 400\">Worthington struggled with depression for most of her adult life, but when she decided to get pregnant, she got help from her psychiatrist and therapist to wean off her antidepressant. It was a grueling withdrawal process. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“That was the worst two months of my life,” she said. “Feeling suicidal at times. It was just miserable.” \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She knew then that if she got depressed after her baby was born, she did not want to take medication because she wanted to have more children and didn’t want to go through withdrawal again. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">When she ended up in the Kaiser ER with suicidal thoughts a few weeks after giving birth, she had to repeatedly decline offers — even threats — of medication. She saw a series of providers at two Kaiser hospitals and several told her she needed brexanolone. One said “it was her only hope.” \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But Worthington was also told by other Kaiser providers that it wasn’t necessary, that Kaiser didn’t offer it at all, and that cost was an issue. The official denial that came from Kaiser’s billing department offered no reason, said Marcus Worthington, Whitney’s husband. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">He spent weeks on the phone with multiple Kaiser representatives, fighting, negotiating and pleading, until a high-level administrator stepped in and personally approved it. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“The only thing that changed was that we were able to stir up enough dirt and I was able to pitch a big enough fit,” said Marcus, who is Latino and Native American. “I have a relatively Anglo-Saxon name and Whitney is a young white woman. Frankly, I think it all plays in that it finally got on somebody’s radar who wasn’t going to ignore it.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">After getting the treatment at UC Davis, Whitney says she could think clearly again and truly enjoy the last two months of maternity leave she had with her daughter. She called brexanolone “a total miracle.”\u003c/span>\u003c/p>\n\u003ch3>‘This Is How You Treat Postpartum Mental Health?’\u003c/h3>\n\u003cp>\u003cspan style=\"font-weight: 400\">Kaiser said it cannot comment on any individual cases because of privacy laws, but said generally, “We feel deep compassion for any patient experiencing the difficult and serious effects of postpartum depression, and our goal is always to support every patient’s safe return to a healthy mental state.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">When Miriam McDonald called Kaiser’s grievance department to complain about her treatment, Kaiser sent the cops to her house for a welfare check.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The officers were calm and nice, McDonald said, but when she closed the door, she cried her eyes out.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\"> \u003c/span>\u003cspan style=\"font-weight: 400\">“It just brought me to a whole new low,” she said. “Why didn’t my doctor call me and talk to me first? I mean, this is how you treat postpartum mental health? How dare\u003c/span> \u003cspan style=\"font-weight: 400\">you.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">McDonald also appealed Kaiser’s denial of brexanolone to state regulators, \u003ca href=\"https://www.2020mom.org/\" target=\"_blank\" rel=\"noopener noreferrer\">with help from advocates at 2020 Mom\u003c/a>, but by the time she got there, the clock had already run out. She was past the six-month postpartum cutoff. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She never got brexanolone.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Still, she continued to fight for relief and eventually got Kaiser to cover a different treatment called \u003c/span>\u003ca href=\"https://www.mayoclinic.org/tests-procedures/transcranial-magnetic-stimulation/about/pac-20384625\">\u003cspan style=\"font-weight: 400\">transcranial magnetic stimulation\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, which uses an electromagnetic coil to stimulate nerve cells in the brain that control mood.\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_11879420\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11879420\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/06/Out-of-the-fog.jpg\" alt=\"\" width=\"1920\" height=\"1440\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Out-of-the-fog.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Out-of-the-fog-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Out-of-the-fog-1020x765.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Out-of-the-fog-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Out-of-the-fog-1536x1152.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Miriam McDonald said she is finally feeling like herself again, a year and a half after her son’s birth. \u003ccite>(Courtesy Miriam McDonald)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>McDonald had to go five days a week for three months. Now, more than a year and a half after having her baby, she is finally feeling like herself again.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“I can remember I woke up one day and I was excited. I had actual joy,” she remembers. “I got up and I walked into his room and I was like, ‘Hey, Nico! Hi! Hey, baby!’ And he jumped up from his crib and giggled and put his arms out. And I just swooped him up in my arms and cried. Because I was like, ‘I am so proud to be your mom.’ ”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Now when her son smiles at her, she genuinely smiles back. But she can’t help but grieve all the smiles she didn’t return. How she felt like she was barely there when her son took his first steps.\u003c/span>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“I felt like I’ve been robbed really of all those moments,” she said, “of those little milestones, that I’m never going to get back.” \u003c/span>\u003c/p>\n\n",
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"excerpt": "Kaiser's practices around the new drug, brexanolone, may run afoul of a new California law designed to limit unfair denials of mental health treatment.",
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"title": "There's Only 1 Drug for Postpartum Depression. Why Does Kaiser Permanente Make It So Hard to Get? | KQED",
"description": "Kaiser's practices around the new drug, brexanolone, may run afoul of a new California law designed to limit unfair denials of mental health treatment.",
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"headline": "There's Only 1 Drug for Postpartum Depression. Why Does Kaiser Permanente Make It So Hard to Get?",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003c/p>\u003cp>\u003cspan class=\"utils-parseShortcode-shortcodes-__dropcapShortcode__dropcap\">W\u003c/span>\u003c/p>\u003cp>hen Miriam McDonald decided she wanted to have another baby at age 44, her doctor told her she had a better chance of winning the lottery. So when she got pregnant, she and her husband were thrilled. But within three days of giving birth to their son, everything turned.\u003c/p>\n\u003cp>“I was thinking, ‘Oh my God, what did I do?’ I just brought this baby into this world and I can barely take care of myself right now,” she said. “I feel exhausted. I haven’t slept in three days. I haven’t really eaten in three days.”\u003c/p>\n\u003cp>As the weeks went by, her depression got worse. She felt sad, but also indifferent. She didn’t want to hold her baby, she didn’t want to change him. She said she felt no connection with him at all.\u003c/p>\n\u003cp>This confused her – she never felt anything like this after her first two kids – and she worried her mood might hurt her son. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4113321/#R2\">Untreated postpartum depression can affect babies’ cognitive and social development\u003c/a>. For the mother, it can be life or death. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4113321/\">Suicide accounts for 20% of maternal deaths\u003c/a>.\u003c/p>\n\u003cp>“Every day, I was crying. Every day, I felt like I just wanted to die. Every day, I thought about ending my life,” said McDonald, who is Latina and works at UC Davis as an IT professional.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She went to Kaiser Permanente, her health care provider, for help. She said they put her on a merry-go-round of medication trial and error. The first drug her doctor prescribed made her anxious. The second drug gave her horrific nightmares. A third drug gave her auditory and visual hallucinations that took seven weeks to go away. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Then, her doctor retired. And when McDonald complained to her new doctor that she was still depressed four months after giving birth, the physician suggested more medications.\u003c/span>\u003c/p>\n\u003cp>“I was desperate,” McDonald said. “I was like, ‘I’m trying to help myself, but things are just getting worse.’ So what am I left with?”\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She started doing her own research and learned about a new treatment called brexanolone. It’s \u003ca href=\"https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-post-partum-depression\">the \u003c/a>\u003c/span>\u003cspan style=\"font-weight: 400\">first and only drug\u003c/span>\u003cspan style=\"font-weight: 400\"> approved by the U.S. Food and Drug Administration to treat postpartum depression, which \u003ca href=\"https://www.americashealthrankings.org/explore/health-of-women-and-children/measure/postpartum_depression/state/CA\">affects \u003c/a>\u003c/span>\u003cspan style=\"font-weight: 400\">1 out of 8 new mothers\u003c/span>\u003cspan style=\"font-weight: 400\"> in California. Instead of targeting the serotonin system in the brain, like most antidepressants, brexanolone works by rebalancing the stress hormones that can get out of kilter after having a baby. It’s delivered through an IV infusion over 2 1/2 days in the hospital. \u003c/span>\u003c/p>\n\u003cp>In \u003cspan style=\"font-weight: 400\">clinical trials\u003c/span>\u003cspan style=\"font-weight: 400\">, \u003ca href=\"https://www.fda.gov/media/121348/download\">75% of women who got brexanolone started to feel better\u003c/a> immediately after the three-day treatment. Half the women went into complete remission.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">McDonald wanted to try it. \u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_11879318\" class=\"wp-caption aligncenter\" style=\"max-width: 2560px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11879318\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/06/trying-to-smile-1-scaled.jpg\" alt=\"\" width=\"2560\" height=\"1920\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/trying-to-smile-1-scaled.jpg 2560w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/trying-to-smile-1-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/trying-to-smile-1-1020x765.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/trying-to-smile-1-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/trying-to-smile-1-1536x1152.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/trying-to-smile-1-2048x1536.jpg 2048w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/trying-to-smile-1-1920x1440.jpg 1920w\" sizes=\"auto, (max-width: 2560px) 100vw, 2560px\">\u003cfigcaption class=\"wp-caption-text\">For the first year of her son’s life, Miriam McDonald says all her smiles were fake or strained. \u003ccite>(Courtesy Miriam McDonald)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">“People walk out of the hospital, wanting to be with their child, wanting to return home,” said \u003c/span>\u003ca href=\"https://www.med.unc.edu/psych/directory/riah-patterson/\">\u003cspan style=\"font-weight: 400\">Dr. Riah Patterson\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, who has been treating women with brexanolone at the University of North Carolina at Chapel Hill since it became available in summer 2019. “There is a hopefulness, a brightness. You can really see that transformation in the hospital room over those 60 hours. It’s pretty miraculous.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">When McDonald asked her doctor for brexanolone, she said no. \u003c/span>\u003c/p>\n\u003cp>In an email, she said the existing studies were “not very impressive.” She told McDonald that she didn’t meet Kaiser’s criteria for the drug: She would have had to try and fail four medications and electroconvulsive therapy before she could try brexanolone. And all this had to happen within six months of having her baby, or she couldn’t try it at all.\u003c/p>\n\u003cp>How could anyone qualify, McDonald wondered?\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“This is crazy. By the time you even try one drug, that’s like four weeks out,” she said. “Another drug is four weeks out, another drug is four weeks out. There’s just no way.”\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "‘If Kaiser is making it effectively impossible to get a particular, important mental health treatment, that could definitely be a violation of our parity law.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cspan style=\"font-weight: 400\">Kaiser’s guidance is an outlier. KQED analyzed guidelines from a dozen health plans operating in California. Three of them require women to fail one medication before trying brexanolone. One plan – the state’s Medi-Cal program for low-income women – requires two fails. But Kaiser is the only system KQED found that recommends women first fail four drugs.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“That’s absurd,” said UNC’s Patterson, one of several experts in postpartum depression who, in turn, called Kaiser’s guidance “ridiculous,” “harsh,” “abusive” and “insane.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">It may also be illegal. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Under a \u003c/span>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200SB855\">\u003cspan style=\"font-weight: 400\">new state law that took effect in January\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> , health plans must conform to “generally accepted standards of care,” including nonprofit guidelines, scientific literature and expert consensus, when making decisions about mental health treatment.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“If Kaiser is making it effectively impossible to get a particular, important mental health treatment, that could definitely be a violation of our parity law,” said state Sen. Scott Wiener, D-San Francisco, the bill’s author. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Kaiser says it always follows the law. It says its integrated structure makes it different from traditional insurers. At Kaiser, a patient’s doctor determines whether a medication is necessary, not the health plan, and the criteria doctors use are recommendations, not requirements or prerequisites that patients need to “exhaust,” said Dr. Maria Koshy, Kaiser’s chair of psychiatry for Northern California. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“At the end of the day, this is an individual clinical decision by both the provider – the physician – and the patient,” she said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But former Kaiser clinicians and legislative experts familiar with Kaiser’s model say the culture around these recommendations is to follow them. Doctors get questioned or can face consequences if they don’t, said Wiener.\u003c/span>\u003c/p>\n\u003ch3>‘It Saved My Life’\u003c/h3>\n\u003cp>\u003cspan style=\"font-weight: 400\">McDonald’s physician followed the criteria as if they were prerequisites when she declined to prescribe brexanolone. Kaiser’s grievance department sent a letter to another woman, Yesenia Muñoz, denying brexanolone because she had not failed enough medications.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“When I talked to the caseworker at Kaiser that had denied the medication, he said that Zulresso was very expensive,” said Muñoz, referring to brexanolone’s brand name.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Brexanolone treatment costs $34,000 for the medication, plus the cost of the three-day hospital stay, which can tack on another $30,000, at least. Kaiser is not yet certified to administer the treatment in-house, so it must pay outside hospitals to provide it. It says it has plans to eventually open three of its own certified centers.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Muñoz was devastated by the denial. She was overwhelmed by postpartum depression and anxiety shortly after her daughter was born and, as a Latina, she said she was hesitant to seek help at first. When she did, none of the medications or therapies Kaiser offered her worked. She still felt suicidal.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“I could get out the door sometimes and take the stroller and go walk, and my mind kept on saying, ‘If you just step in front of the car, it’s all going to go away,’ ” she remembers.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Muñoz got help from family and co-workers to appeal Kaiser’s decision to the state, and after reviewing her medical records, regulators ordered Kaiser to pay for the brexanolone treatment.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Muñoz went to UC Davis Medical Center to get it, and she started feeling better within the first day.\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_11879428\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11879428\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/06/MunozAndBaby.jpg\" alt=\"Yesenia smiling holding baby\" width=\"1920\" height=\"1760\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/MunozAndBaby.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/MunozAndBaby-800x733.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/MunozAndBaby-1020x935.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/MunozAndBaby-160x147.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/MunozAndBaby-1536x1408.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">After Yesenia Muñoz received brexanolone to treat her postpartum depression, she felt blessed, connected with her daughter and ‘happy enough to want to live.’ \u003ccite>(Courtesy Yesenia Munoz)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">“The nurse came in and she said something funny and I laughed,” Muñoz said. “It was the first time I had laughed in so long.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She started looking through photos and videos of her daughter on her phone and she says it was like she was experiencing those moments for the first time. She started making plans for the future. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“It was like a switch flicked and it made me happy enough to want to live,” she said. “It saved my life.”\u003c/span>\u003c/p>\n\u003ch3>‘There Is No Place Where We Say Kaiser Is Exempt’\u003c/h3>\n\u003cp>\u003cspan style=\"font-weight: 400\">In 2008, Congress passed a landmark federal law aimed at correcting imbalances in how insurers covered mental health treatments compared to physical health, later reinforced by the Affordable Care Act in 2010. \u003c/span>\u003cspan style=\"font-weight: 400\">But \u003c/span>\u003ca href=\"https://www.kqed.org/stateofhealth/series/state-of-mind\">\u003cspan style=\"font-weight: 400\">insurers found loopholes\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, creating overly restrictive or self-serving criteria that made it easy to deny services, and as a result, save money.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">California’s new law, \u003c/span>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200SB855\">\u003cspan style=\"font-weight: 400\">Senate Bill 855\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, is aimed at tightening those loopholes, and has been \u003c/span>\u003ca href=\"https://www.statnews.com/2020/10/14/new-california-law-should-serve-as-a-national-model-for-mental-health-care-reform/\">\u003cspan style=\"font-weight: 400\">hailed by advocates as a national model\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> for mental health reform. It requires health plans to use clinically based, expert-recognized criteria and guidelines in making medical decisions, with the goal of limiting arbitrary or cost-driven denials. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Kaiser raises questions about how precisely the new law applies to them, given its unique integrated structure, where doctors make determinations about what is medically necessary rather than the health plan side of the organization. Kaiser’s Dr. Koshy said SB 855’s requirement to comply with generally accepted standards of care “does not apply” to its brexanolone recommendations because they were developed and are used by doctors, not plan administrators. (When KQED asked Kaiser to provide the brexanolone policy its health plan uses, it said it didn’t have one.)\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“We 100% intended this law to apply to the care people get at Kaiser,” said Julie Snyder, government affairs director at \u003ca href=\"https://steinberginstitute.org/\" target=\"_blank\" rel=\"noopener noreferrer\">the Steinberg Institute\u003c/a>, which co-sponsored the law. “There is no place where we say Kaiser is exempt.” \u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cspan style=\"font-weight: 400\">Doctors at Kaiser have historically been “gatekeepers” for services in the system, said \u003ca href=\"https://psych-appeal.com/meiram-bendat-attorney-founder/\" target=\"_blank\" rel=\"noopener noreferrer\">Meiram Bendat\u003c/a>, an attorney and licensed psychotherapist who also advised on the law. It doesn’t matter if practice recommendations for brexanolone were written by doctors or administrators, or whether the recommendations are mandatory or optional – Bendat says they must be compliant with the law. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“If it’s inconsistent with generally accepted standards of care, then it has no place in California,” he said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Some of Kaiser’s recommended criteria for brexanolone are aligned with generally accepted standards of care; for example, reserving the drug for women who are six months or less postpartum, which was a criterion used in the \u003c/span>\u003ca href=\"https://www.fda.gov/media/121348/download\">\u003cspan style=\"font-weight: 400\">clinical trials the FDA relied on when it approved the drug\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But the recommendation to try four or five alternative treatments before considering brexanolone conflicts with the judgment of half a dozen women’s health experts interviewed for this story. They say there just isn’t enough time in the postpartum period. And there’s too much at stake. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Not only are babies at risk of developmental and emotional problems if their mother is depressed, \u003c/span>\u003ca href=\"https://neurosciencenews.com/paternal-anxiety-18177/#:~:text=Summary%3A%20A%20new%20study%20reports,this%20period%20was%20under%204%25.\">\u003cspan style=\"font-weight: 400\">husbands and partners are also at higher risk for depression and anxiety\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. And because new moms are learning to breastfeed, and figuring out what’s part of the new normal and what’s not, it can take months just to recognize there’s a problem, said UNC’s Riah Patterson.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“It takes so long for this illness to come to recognition and for someone to actually get into an appointment and actually be seen by a provider,” she said.\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_11879416\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11879416\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/06/Riah-Patterson.jpg\" alt=\"\" width=\"1920\" height=\"1436\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Riah-Patterson.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Riah-Patterson-800x598.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Riah-Patterson-1020x763.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Riah-Patterson-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Riah-Patterson-1536x1149.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Riah Patterson discusses patients and treatment plans with her trainee, a third-year psychiatry resident at the Center for Women’s Mood Disorders at UNC-Chapel Hill. \u003ccite>(Courtesy Riah Patterson)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">Indeed, the FDA fast-tracked the approval of brexanolone in part because of how quickly it worked, allowing women to feel better and get back to their families in three days.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“It’s new, it’s promising,” said Kaiser’s Koshy, but, she added, “it’s not a benign medication.” \u003c/span>\u003ca href=\"https://www.fda.gov/media/121348/download\">\u003cspan style=\"font-weight: 400\">Six women in the clinical trials experienced loss or near loss of consciousness,\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> which is why the FDA requires women to be continuously monitored in certified health centers when getting the infusion. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Also, the safety and efficacy data is limited, Koshy said. The clinical trials only compared brexanolone to placebo, not to alternative treatments. So while the data show brexanolone works better than nothing, there’s no data on whether it works better than Zoloft or electroconvulsive therapy. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Koshy says Kaiser is always reviewing practice recommendations as new evidence becomes available, but also acknowledged that Kaiser’s recommendations for brexanolone have not been updated since they were first developed two years ago, in July 2019. \u003c/span>\u003c/p>\n\u003cp>It is unclear what role the \u003ca href=\"https://dmhc.ca.gov/\">Department of Managed Health Care\u003c/a>, the state agency that regulates Kaiser, will play in resolving these questions. In a statement, the department said it will review any criteria or guidelines the Kaiser health plan uses for brexanolone, but said it does not have jurisdiction over physician decisions.\u003c/p>\n\u003cp>The DMHC also monitors patient complaints around new medications and treatments in order to identify problems with access to care. So far, \u003ca href=\"https://wpso.dmhc.ca.gov/imr/\">the DMHC has published two complaints about brexanolone in its public database\u003c/a> – both were filed by Kaiser patients.\u003c/p>\n\u003cp>\u003ca href=\"https://www.benefitscafe.com/insurance-companies/kaiserpermanente/\"> \u003cspan style=\"font-weight: 400\">Kaiser is the \u003c/span>\u003cspan style=\"font-weight: 400\">largest insurer in California\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. It holds a 40% share of the market, covering 6.1 million patients. But at UC Davis, where Kaiser says it sends all patients who need brexanolone in Northern California, Kaiser patients are only 15% of those who got the drug, according to \u003c/span>\u003ca href=\"https://health.ucdavis.edu/team/search/1499/shannon-clark---obstetrics-and-gynecology-sacramento\">\u003cspan style=\"font-weight: 400\">Dr. Shannon Clark\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, a psychiatrist and OB-GYN overseeing the treatments. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She says of the 13 women who’ve been treated at UC Davis in the last two years, only two were from Kaiser. One was Muñoz, who was approved only after the state intervened. The other was Whitney Worthington. Both women canceled their coverage with Kaiser over the postpartum mental health care they received.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "‘The only thing that changed was that we were able to stir up enough dirt and I was able to pitch a big enough fit … It finally got on somebody’s radar who wasn’t going to ignore it.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cspan style=\"font-weight: 400\">Worthington struggled with depression for most of her adult life, but when she decided to get pregnant, she got help from her psychiatrist and therapist to wean off her antidepressant. It was a grueling withdrawal process. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“That was the worst two months of my life,” she said. “Feeling suicidal at times. It was just miserable.” \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She knew then that if she got depressed after her baby was born, she did not want to take medication because she wanted to have more children and didn’t want to go through withdrawal again. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">When she ended up in the Kaiser ER with suicidal thoughts a few weeks after giving birth, she had to repeatedly decline offers — even threats — of medication. She saw a series of providers at two Kaiser hospitals and several told her she needed brexanolone. One said “it was her only hope.” \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But Worthington was also told by other Kaiser providers that it wasn’t necessary, that Kaiser didn’t offer it at all, and that cost was an issue. The official denial that came from Kaiser’s billing department offered no reason, said Marcus Worthington, Whitney’s husband. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">He spent weeks on the phone with multiple Kaiser representatives, fighting, negotiating and pleading, until a high-level administrator stepped in and personally approved it. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“The only thing that changed was that we were able to stir up enough dirt and I was able to pitch a big enough fit,” said Marcus, who is Latino and Native American. “I have a relatively Anglo-Saxon name and Whitney is a young white woman. Frankly, I think it all plays in that it finally got on somebody’s radar who wasn’t going to ignore it.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">After getting the treatment at UC Davis, Whitney says she could think clearly again and truly enjoy the last two months of maternity leave she had with her daughter. She called brexanolone “a total miracle.”\u003c/span>\u003c/p>\n\u003ch3>‘This Is How You Treat Postpartum Mental Health?’\u003c/h3>\n\u003cp>\u003cspan style=\"font-weight: 400\">Kaiser said it cannot comment on any individual cases because of privacy laws, but said generally, “We feel deep compassion for any patient experiencing the difficult and serious effects of postpartum depression, and our goal is always to support every patient’s safe return to a healthy mental state.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">When Miriam McDonald called Kaiser’s grievance department to complain about her treatment, Kaiser sent the cops to her house for a welfare check.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The officers were calm and nice, McDonald said, but when she closed the door, she cried her eyes out.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\"> \u003c/span>\u003cspan style=\"font-weight: 400\">“It just brought me to a whole new low,” she said. “Why didn’t my doctor call me and talk to me first? I mean, this is how you treat postpartum mental health? How dare\u003c/span> \u003cspan style=\"font-weight: 400\">you.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">McDonald also appealed Kaiser’s denial of brexanolone to state regulators, \u003ca href=\"https://www.2020mom.org/\" target=\"_blank\" rel=\"noopener noreferrer\">with help from advocates at 2020 Mom\u003c/a>, but by the time she got there, the clock had already run out. She was past the six-month postpartum cutoff. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">She never got brexanolone.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Still, she continued to fight for relief and eventually got Kaiser to cover a different treatment called \u003c/span>\u003ca href=\"https://www.mayoclinic.org/tests-procedures/transcranial-magnetic-stimulation/about/pac-20384625\">\u003cspan style=\"font-weight: 400\">transcranial magnetic stimulation\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, which uses an electromagnetic coil to stimulate nerve cells in the brain that control mood.\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_11879420\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11879420\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/06/Out-of-the-fog.jpg\" alt=\"\" width=\"1920\" height=\"1440\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Out-of-the-fog.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Out-of-the-fog-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Out-of-the-fog-1020x765.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Out-of-the-fog-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/06/Out-of-the-fog-1536x1152.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Miriam McDonald said she is finally feeling like herself again, a year and a half after her son’s birth. \u003ccite>(Courtesy Miriam McDonald)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>McDonald had to go five days a week for three months. Now, more than a year and a half after having her baby, she is finally feeling like herself again.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“I can remember I woke up one day and I was excited. I had actual joy,” she remembers. “I got up and I walked into his room and I was like, ‘Hey, Nico! Hi! Hey, baby!’ And he jumped up from his crib and giggled and put his arms out. And I just swooped him up in my arms and cried. Because I was like, ‘I am so proud to be your mom.’ ”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Now when her son smiles at her, she genuinely smiles back. But she can’t help but grieve all the smiles she didn’t return. How she felt like she was barely there when her son took his first steps.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“I felt like I’ve been robbed really of all those moments,” she said, “of those little milestones, that I’m never going to get back.” \u003c/span>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Hospital care at home is nothing new for patients with low-level health needs. But since the pandemic began, a growing number of health care providers – including Adventist Health, the Mayo Clinic and California health care giant Kaiser Permanente – are offering people with more serious health conditions hospital-level treatment in the comfort of their homes.\u003c/p>\n\u003cp>It’s something Janet Yetenekian, who lives in Glendale with her family, experienced this year after she came down with a severe case of COVID-19.\u003c/p>\n\u003cp>Back in December, with pandemic isolation finally getting to Yetenekian, her husband and two teenage kids, the family accepted an invitation to join an afternoon barbecue.\u003c/p>\n\u003cp>“We just go, ‘OK, we’ve been home all this time,’ you know, ‘Let’s just go a few hours and come back,’ ” Yetenekian said.\u003c/p>\n\u003cp>But the day after the gathering, the host came down with fever. A test confirmed it was COVID-19. Within two weeks, Yetenekian’s husband and kids got mild cases of the disease while her blood oxygen plummeted to dangerously low levels.\u003c/p>\n\u003cp>“And a few days later, I had to go to the hospital,” she said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Treatment included an IV drip of the antiviral drug Remdesivir and constant monitoring — things normally done in a hospital. So it surprised Yetenekian when her doctor at Adventist Health offered to move all her care home to be monitored virtually.\u003c/p>\n\u003cp>“It was even better than the hospital,” she said. “They were constantly reaching out, ‘It’s time for you to do your vitals,’ or ‘It’s time for you to take your medications.’ ”\u003c/p>\n\u003cp>Doctors and nurses at a command center nearly 200 miles away managed Yetenekian’s care as part of \u003ca href=\"https://protect-us.mimecast.com/s/hh9CC5yWjXSMyAoBty71EA?domain=geekdoctor.blogspot.com\">a new federal effort aimed at freeing up hospital beds\u003c/a> during public health emergencies. Under the model, about 60 illnesses, including COVID-19, qualify for home treatment.\u003c/p>\n\u003cp>“Heart failure, pneumonia, skin infections — those are all patient populations we can safely care for in the home,” said Dr. Margaret Paulson, who leads the Mayo Clinic’s new home-based care program in rural Wisconsin.\u003c/p>\n\u003cfigure id=\"attachment_11873625\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11873625\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/05/Dr.-Maniaci-and-Dr-Paulson-at-the-Command-Center-in-Jacksonville3-1.jpg\" alt=\"\" width=\"1920\" height=\"1279\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/05/Dr.-Maniaci-and-Dr-Paulson-at-the-Command-Center-in-Jacksonville3-1.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/05/Dr.-Maniaci-and-Dr-Paulson-at-the-Command-Center-in-Jacksonville3-1-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/05/Dr.-Maniaci-and-Dr-Paulson-at-the-Command-Center-in-Jacksonville3-1-1020x679.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/05/Dr.-Maniaci-and-Dr-Paulson-at-the-Command-Center-in-Jacksonville3-1-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/05/Dr.-Maniaci-and-Dr-Paulson-at-the-Command-Center-in-Jacksonville3-1-1536x1023.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">The Mayo Clinic’s Dr. Margaret Paulson at a a health care command center in Jacksonville, Wisconsin. \u003ccite>(Photo courtesy the Mayo Clinic)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Paulson said once her patients understand that home care does not mean less care, they eagerly embrace it.\u003c/p>\n\u003cp>“Especially for patients who have been in the hospital a lot, to know that they can actually go home and sleep in their own bed and be with their family and have their pets by their side, it’s just really reassuring,” she said.\u003c/p>\n\u003cp>And \u003ca href=\"https://bmjopen.bmj.com/content/11/1/e043285\">studies suggest\u003c/a> at-home care provides better outcomes for patients and costs less to provide than traditional inpatient care.\u003c/p>\n\u003cp>“This is actually a higher level of touch from physicians and advanced practitioners,” said Dr. Kavita Patel, a physician and health policy fellow at the Brookings Institution.\u003c/p>\n\u003cp>Regularly scheduled video conferencing and 24/7 monitoring is augmented by twice-daily, in-person visits by nurses and other health workers who provide basic care like antibiotics.\u003c/p>\n\u003cp>“This isn’t just sending mom or dad to the bedroom,” she said.\u003c/p>\n\u003cp>[aside label='Coronavirus Coverage' tag='coronavirus']Patel said it’s the technology infrastructure that’s key: Wi-Fi phones that ring directly into a hospital’s command center, iPads that allow video conferencing with health professionals and wearable devices with emergency call buttons.\u003c/p>\n\u003cp>Raphael Rakowski is co-founder of Medically Home, the tech company that supports at-home programs for Adventist Health, Mayo Clinic and Kaiser Permanente. On Thursday, those latter two health care entities announced a combined $100 million investment in Medically Home to help expand the service to other health systems.\u003c/p>\n\u003cp>Rakowski said there’s another selling point of the at-home care model — patients don’t have to transfer to a different facility while they heal.\u003c/p>\n\u003cp>“We stay with the patient until they’re fully recovered and that averages anywhere from 20 to 30 days, sometimes longer,” Rakowski said. “So we substitute not just for the hospital, but for all the care that follows.”\u003c/p>\n\u003cp>Still, not every patient is a fit. To be eligible for care at home, they must live within 30 minutes of emergency care. They also need high-speed internet and, said Patel, they can’t be too sick.\u003c/p>\n\u003cp>“This can’t be something where it’s so complicated that you are monitoring a patient, worried that they could crash and need to be in the ICU within minutes,” she said.\u003c/p>\n\u003cp>But for moderate COVID-19 and dozens of other conditions, at-home hospital care programs now offered in 30 states are likely to become a more common option as more health systems adopt the program and even more diseases are added to those now eligible for at-home care.\u003c/p>\n\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Hospital care at home is nothing new for patients with low-level health needs. But since the pandemic began, a growing number of health care providers – including Adventist Health, the Mayo Clinic and California health care giant Kaiser Permanente – are offering people with more serious health conditions hospital-level treatment in the comfort of their homes.\u003c/p>\n\u003cp>It’s something Janet Yetenekian, who lives in Glendale with her family, experienced this year after she came down with a severe case of COVID-19.\u003c/p>\n\u003cp>Back in December, with pandemic isolation finally getting to Yetenekian, her husband and two teenage kids, the family accepted an invitation to join an afternoon barbecue.\u003c/p>\n\u003cp>“We just go, ‘OK, we’ve been home all this time,’ you know, ‘Let’s just go a few hours and come back,’ ” Yetenekian said.\u003c/p>\n\u003cp>But the day after the gathering, the host came down with fever. A test confirmed it was COVID-19. Within two weeks, Yetenekian’s husband and kids got mild cases of the disease while her blood oxygen plummeted to dangerously low levels.\u003c/p>\n\u003cp>“And a few days later, I had to go to the hospital,” she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Treatment included an IV drip of the antiviral drug Remdesivir and constant monitoring — things normally done in a hospital. So it surprised Yetenekian when her doctor at Adventist Health offered to move all her care home to be monitored virtually.\u003c/p>\n\u003cp>“It was even better than the hospital,” she said. “They were constantly reaching out, ‘It’s time for you to do your vitals,’ or ‘It’s time for you to take your medications.’ ”\u003c/p>\n\u003cp>Doctors and nurses at a command center nearly 200 miles away managed Yetenekian’s care as part of \u003ca href=\"https://protect-us.mimecast.com/s/hh9CC5yWjXSMyAoBty71EA?domain=geekdoctor.blogspot.com\">a new federal effort aimed at freeing up hospital beds\u003c/a> during public health emergencies. Under the model, about 60 illnesses, including COVID-19, qualify for home treatment.\u003c/p>\n\u003cp>“Heart failure, pneumonia, skin infections — those are all patient populations we can safely care for in the home,” said Dr. Margaret Paulson, who leads the Mayo Clinic’s new home-based care program in rural Wisconsin.\u003c/p>\n\u003cfigure id=\"attachment_11873625\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11873625\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/05/Dr.-Maniaci-and-Dr-Paulson-at-the-Command-Center-in-Jacksonville3-1.jpg\" alt=\"\" width=\"1920\" height=\"1279\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/05/Dr.-Maniaci-and-Dr-Paulson-at-the-Command-Center-in-Jacksonville3-1.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/05/Dr.-Maniaci-and-Dr-Paulson-at-the-Command-Center-in-Jacksonville3-1-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/05/Dr.-Maniaci-and-Dr-Paulson-at-the-Command-Center-in-Jacksonville3-1-1020x679.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/05/Dr.-Maniaci-and-Dr-Paulson-at-the-Command-Center-in-Jacksonville3-1-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/05/Dr.-Maniaci-and-Dr-Paulson-at-the-Command-Center-in-Jacksonville3-1-1536x1023.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">The Mayo Clinic’s Dr. Margaret Paulson at a a health care command center in Jacksonville, Wisconsin. \u003ccite>(Photo courtesy the Mayo Clinic)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Paulson said once her patients understand that home care does not mean less care, they eagerly embrace it.\u003c/p>\n\u003cp>“Especially for patients who have been in the hospital a lot, to know that they can actually go home and sleep in their own bed and be with their family and have their pets by their side, it’s just really reassuring,” she said.\u003c/p>\n\u003cp>And \u003ca href=\"https://bmjopen.bmj.com/content/11/1/e043285\">studies suggest\u003c/a> at-home care provides better outcomes for patients and costs less to provide than traditional inpatient care.\u003c/p>\n\u003cp>“This is actually a higher level of touch from physicians and advanced practitioners,” said Dr. Kavita Patel, a physician and health policy fellow at the Brookings Institution.\u003c/p>\n\u003cp>Regularly scheduled video conferencing and 24/7 monitoring is augmented by twice-daily, in-person visits by nurses and other health workers who provide basic care like antibiotics.\u003c/p>\n\u003cp>“This isn’t just sending mom or dad to the bedroom,” she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Patel said it’s the technology infrastructure that’s key: Wi-Fi phones that ring directly into a hospital’s command center, iPads that allow video conferencing with health professionals and wearable devices with emergency call buttons.\u003c/p>\n\u003cp>Raphael Rakowski is co-founder of Medically Home, the tech company that supports at-home programs for Adventist Health, Mayo Clinic and Kaiser Permanente. On Thursday, those latter two health care entities announced a combined $100 million investment in Medically Home to help expand the service to other health systems.\u003c/p>\n\u003cp>Rakowski said there’s another selling point of the at-home care model — patients don’t have to transfer to a different facility while they heal.\u003c/p>\n\u003cp>“We stay with the patient until they’re fully recovered and that averages anywhere from 20 to 30 days, sometimes longer,” Rakowski said. “So we substitute not just for the hospital, but for all the care that follows.”\u003c/p>\n\u003cp>Still, not every patient is a fit. To be eligible for care at home, they must live within 30 minutes of emergency care. They also need high-speed internet and, said Patel, they can’t be too sick.\u003c/p>\n\u003cp>“This can’t be something where it’s so complicated that you are monitoring a patient, worried that they could crash and need to be in the ICU within minutes,” she said.\u003c/p>\n\u003cp>But for moderate COVID-19 and dozens of other conditions, at-home hospital care programs now offered in 30 states are likely to become a more common option as more health systems adopt the program and even more diseases are added to those now eligible for at-home care.\u003c/p>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>",
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"content": "\u003cp>California officials gave a nod to Kaiser Permanente’s reputation for efficiency when they \u003ca href=\"https://calmatters.org/wp-content/uploads/2021/02/Letter-of-Intent-with-Kaiser.pdf?_gl=1*18hxzr7*_ga*NzI4NDMzNTEuMTU4MjA0NjY1NQ..\" target=\"_blank\" rel=\"noopener noreferrer\">recently selected\u003c/a> it to help speed vaccine rollout. But a review of worker safety citations shows Kaiser has had its own pandemic troubles, failing to adequately protect its employees early on.\u003c/p>\n\u003cp>Kaiser Permanente has on multiple occasions failed to provide hospital employees the gear or training needed to protect them from COVID-19, \u003ca href=\"https://www.dir.ca.gov/dosh/COVID19citations.html\" target=\"_blank\" rel=\"noopener noreferrer\">according to 12 citations\u003c/a> issued by California’s enforcer of workplace safety laws, Cal/OSHA.\u003c/p>\n\u003cp>The agency has issued more citations against Kaiser than any other health care employer in California, fining it almost $500,000. In addition, Santa Clara County has separately penalized the hospital for not immediately reporting an outbreak in December.\u003c/p>\n\u003cp>Kaiser is appealing all 12 of the state’s citations, as well as the county-issued fine.\u003c/p>\n\u003cp>“It’s misleading to interpret these citations to signal any ongoing serious infractions of current public health guidelines at Kaiser Permanente,” Marc Brown, a Kaiser spokesman, said in an emailed statement. “In fact, these citations stem mainly from allegations much earlier in the pandemic, as health care systems including ours grappled with national shortages and evolving public health guidance.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Kaiser’s medical centers, he added, are a safe place to work and receive care.\u003c/p>\n\u003cp>CalMatters \u003ca href=\"https://calmatters.org/health/2020/10/kaiser-cal-osha-citation-failing-to-treat-covid-airborne/\" target=\"_blank\" rel=\"noopener noreferrer\">first reported\u003c/a> an incoming wave of citations for Kaiser in October, following the first fine issued to its psychiatric hospital in Santa Clara.\u003c/p>\n\u003cp>The state imposed the largest penalty, $87,500, on Kaiser’s San Leandro Medical Center for not immediately reporting to Cal/OSHA when one employee was hospitalized in May and for not limiting the reuse of N95 respirators, among several other violations.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" src=\"https://e.infogram.com/9b5ce597-4fd5-43f5-bce6-57f47e20af6d?src=embed\" title=\"kaiser citations\" width=\"800\" height=\"712\" scrolling=\"no\" frameborder=\"0\" style=\"border:none;\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>Cal/OSHA began citing Kaiser facilities in October, months after receiving complaints. The short-staffed agency has been inundated with COVID-related complaints. Between February and September of last year, it conducted \u003ca href=\"https://calmatters.org/california-divide/2020/10/cal-osha-response-covid-complaints/\" target=\"_blank\" rel=\"noopener noreferrer\">on-site inspections for only 5%\u003c/a> of almost 7,000 pandemic complaints.\u003c/p>\n\u003cp>Almost half of Cal/OSHA’s citations to hospitals are directed at Kaiser. But it’s difficult to know for sure why Kaiser has been disciplined the most, said Laura Stock, director of the Labor Occupational Health Program at UC Berkeley. It could be its practices, but also its size, and its employees may be more willing to speak up about hazards, Stock said.\u003c/p>\n\u003cp>“If there is a citation it’s probably because someone filed an OSHA complaint,” Stock said. “Kaiser is a unionized workplace and there are workers who are educated on these issues and really on top of these things.”\u003c/p>\n\u003cp>One violation labeled as “serious” in Cal/OSHA’s citation to Oakland Medical Center, for example, found that the hospital did not provide employees from an oncology unit with N95 respirators when they entered an area with patients confirmed or suspected of having COVID-19. The hospital also failed to ensure each employee passed a “fit test” to ensure employees’ respirators fit properly, \u003ca href=\"https://www.dir.ca.gov/dosh/coronavirus/citations/11.06.2020_Kaiser-Permanente-Oakland-Medical-Center_1474630.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">according to the citation.\u003c/a>\u003c/p>\n\u003cp>Cal/OSHA also found that Kaiser’s Redwood City Medical Center did not inform and train employees that surgical masks do not protect against inhalation of infectious aerosols — N95 respirators are needed instead.\u003c/p>\n\u003cp>Kaiser’s San Jose Medical Center failed to notify employees “with significant exposures in a reasonable timeframe” and didn’t provide a medical evaluation to those exposed, \u003ca href=\"https://www.dir.ca.gov/dosh/coronavirus/citations/11.23.2020-Kaiser-Foundation-Hospital-DBA-Kaiser-San-Jose-Medical-Center_1476073.pdf\">according to the citation\u003c/a>.\u003c/p>\n\u003cp>For a later and separate incident, Santa Clara County fined the San Jose hospital $43,000 for not immediately reporting an outbreak in its emergency department on Christmas Day. \u003ca href=\"https://www.mercurynews.com/2021/01/07/kaiser-san-jose-fined-43000-as-investigation-into-christmas-costume-covid-outbreak-continues/\">That incident\u003c/a> has been linked to an employee dressed in an air-powered inflatable tree costume, who was COVID positive but unaware of that. Kaiser is appealing that fine, too.\u003c/p>\n\u003cp>[aside tag=\"kaiser, kaiser permanente, health\" label=\"Related Stories\"]Federal health guidance about COVID-19 safety has evolved throughout the pandemic. Yet California already had strict workplace safety rules in place for hospitals and other health settings that should have protected employees from the very beginning, even when little was known about the virus, experts say.\u003c/p>\n\u003cp>In spring 2009, California adopted the Aerosol Transmissible Diseases (ATD) standard. Under development for several years, it was \u003ca href=\"https://www.dir.ca.gov/title8/5199.html\">unanimously approved\u003c/a> by the Cal/OSHA Standards Board soon after the first cases of the H1N1 virus were detected in the state. According to this \u003ca href=\"https://www.dir.ca.gov/title8/5199.html\">ATD standard\u003c/a>, any novel or unknown pathogen is to be handled as if it could be transmitted by aerosols until proven otherwise.\u003c/p>\n\u003cp>California is the only state in the country with this standard. And experts say this standard has helped Cal/OSHA hold health employers accountable during the pandemic.\u003c/p>\n\u003cp>The state’s aerosol standard requires employers to provide personal protective equipment that protects against aerosols, train employees about this type of transmission and notify them of any possible exposure. This state standard went beyond early pandemic guidance from the Centers for Disease Control and Prevention, which didn’t formally acknowledge the \u003ca href=\"https://www.cdc.gov/coronavirus/2019-ncov/more/scientific-brief-sars-cov-2.html\">airborne transmission\u003c/a> of coronavirus until October. For months, the federal agency focused on droplet transmission.\u003c/p>\n\u003cp>Special protection is required to protect against viruses that can transmit via smaller aerosolized particles. For example, in Cal/OSHA’s citation to Kaiser San Francisco, the agency notes that the hospital did not require employees to use \u003ca href=\"https://www.cdc.gov/coronavirus/2019-ncov/images/hcp/N95-infographic-What-Are-APR-508.png?noicon\">powered air-purifying respirators\u003c/a> during “high hazard” procedures that generate aerosols, like intubations. According to the ATD standard, N95 masks are not enough protection for those types of procedures.\u003c/p>\n\u003cp>At the San Leandro location, employees who were given powered air-purifying respirators were handed defective units held together by tape, \u003ca href=\"https://www.dir.ca.gov/dosh/coronavirus/citations/01.04.2021-Kaiser-Foundation-KaiserPermanenteSanLeandro_1479549.pdf\">according to the citation\u003c/a>. That same hospital also failed to investigate exposure incidents between May and August, the citation reads.\u003c/p>\n\u003cp>Throughout most of last year, nurses and other health workers organized rallies and protests demanding more protection from Kaiser and other hospitals. Amy Arlund, an intensive care nurse at Kaiser Fresno Medical Center and member of the California Nurses Association, said nurses aren’t as interested in fines as they are in enforcement and improvement.\u003c/p>\n\u003cp>She alleged that at her hospital, for example, when their battery-operated respirators break down, it’s hard to get replacements.\u003c/p>\n\u003cp>“A lot of nurses are carrying around their own rolls of duct tape to put these things back together when they’re falling apart,” Arlund told CalMatters in November. “We use what we have way beyond its usage.”\u003c/p>\n\u003cp>Employees at Kaiser Fresno have filed several complaints. Arlund said Cal/OSHA inspectors have visited her hospital, but as of Friday, no citations had been issued against Kaiser’s Fresno hospital.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>CalMatters COVID-19 coverage, translation and distribution is supported by generous grants from the Blue Shield of California Foundation, the California Wellness Foundation and the California Health Care Foundation.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California officials gave a nod to Kaiser Permanente’s reputation for efficiency when they \u003ca href=\"https://calmatters.org/wp-content/uploads/2021/02/Letter-of-Intent-with-Kaiser.pdf?_gl=1*18hxzr7*_ga*NzI4NDMzNTEuMTU4MjA0NjY1NQ..\" target=\"_blank\" rel=\"noopener noreferrer\">recently selected\u003c/a> it to help speed vaccine rollout. But a review of worker safety citations shows Kaiser has had its own pandemic troubles, failing to adequately protect its employees early on.\u003c/p>\n\u003cp>Kaiser Permanente has on multiple occasions failed to provide hospital employees the gear or training needed to protect them from COVID-19, \u003ca href=\"https://www.dir.ca.gov/dosh/COVID19citations.html\" target=\"_blank\" rel=\"noopener noreferrer\">according to 12 citations\u003c/a> issued by California’s enforcer of workplace safety laws, Cal/OSHA.\u003c/p>\n\u003cp>The agency has issued more citations against Kaiser than any other health care employer in California, fining it almost $500,000. In addition, Santa Clara County has separately penalized the hospital for not immediately reporting an outbreak in December.\u003c/p>\n\u003cp>Kaiser is appealing all 12 of the state’s citations, as well as the county-issued fine.\u003c/p>\n\u003cp>“It’s misleading to interpret these citations to signal any ongoing serious infractions of current public health guidelines at Kaiser Permanente,” Marc Brown, a Kaiser spokesman, said in an emailed statement. “In fact, these citations stem mainly from allegations much earlier in the pandemic, as health care systems including ours grappled with national shortages and evolving public health guidance.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Kaiser’s medical centers, he added, are a safe place to work and receive care.\u003c/p>\n\u003cp>CalMatters \u003ca href=\"https://calmatters.org/health/2020/10/kaiser-cal-osha-citation-failing-to-treat-covid-airborne/\" target=\"_blank\" rel=\"noopener noreferrer\">first reported\u003c/a> an incoming wave of citations for Kaiser in October, following the first fine issued to its psychiatric hospital in Santa Clara.\u003c/p>\n\u003cp>The state imposed the largest penalty, $87,500, on Kaiser’s San Leandro Medical Center for not immediately reporting to Cal/OSHA when one employee was hospitalized in May and for not limiting the reuse of N95 respirators, among several other violations.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" src=\"https://e.infogram.com/9b5ce597-4fd5-43f5-bce6-57f47e20af6d?src=embed\" title=\"kaiser citations\" width=\"800\" height=\"712\" scrolling=\"no\" frameborder=\"0\" style=\"border:none;\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>Cal/OSHA began citing Kaiser facilities in October, months after receiving complaints. The short-staffed agency has been inundated with COVID-related complaints. Between February and September of last year, it conducted \u003ca href=\"https://calmatters.org/california-divide/2020/10/cal-osha-response-covid-complaints/\" target=\"_blank\" rel=\"noopener noreferrer\">on-site inspections for only 5%\u003c/a> of almost 7,000 pandemic complaints.\u003c/p>\n\u003cp>Almost half of Cal/OSHA’s citations to hospitals are directed at Kaiser. But it’s difficult to know for sure why Kaiser has been disciplined the most, said Laura Stock, director of the Labor Occupational Health Program at UC Berkeley. It could be its practices, but also its size, and its employees may be more willing to speak up about hazards, Stock said.\u003c/p>\n\u003cp>“If there is a citation it’s probably because someone filed an OSHA complaint,” Stock said. “Kaiser is a unionized workplace and there are workers who are educated on these issues and really on top of these things.”\u003c/p>\n\u003cp>One violation labeled as “serious” in Cal/OSHA’s citation to Oakland Medical Center, for example, found that the hospital did not provide employees from an oncology unit with N95 respirators when they entered an area with patients confirmed or suspected of having COVID-19. The hospital also failed to ensure each employee passed a “fit test” to ensure employees’ respirators fit properly, \u003ca href=\"https://www.dir.ca.gov/dosh/coronavirus/citations/11.06.2020_Kaiser-Permanente-Oakland-Medical-Center_1474630.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">according to the citation.\u003c/a>\u003c/p>\n\u003cp>Cal/OSHA also found that Kaiser’s Redwood City Medical Center did not inform and train employees that surgical masks do not protect against inhalation of infectious aerosols — N95 respirators are needed instead.\u003c/p>\n\u003cp>Kaiser’s San Jose Medical Center failed to notify employees “with significant exposures in a reasonable timeframe” and didn’t provide a medical evaluation to those exposed, \u003ca href=\"https://www.dir.ca.gov/dosh/coronavirus/citations/11.23.2020-Kaiser-Foundation-Hospital-DBA-Kaiser-San-Jose-Medical-Center_1476073.pdf\">according to the citation\u003c/a>.\u003c/p>\n\u003cp>For a later and separate incident, Santa Clara County fined the San Jose hospital $43,000 for not immediately reporting an outbreak in its emergency department on Christmas Day. \u003ca href=\"https://www.mercurynews.com/2021/01/07/kaiser-san-jose-fined-43000-as-investigation-into-christmas-costume-covid-outbreak-continues/\">That incident\u003c/a> has been linked to an employee dressed in an air-powered inflatable tree costume, who was COVID positive but unaware of that. Kaiser is appealing that fine, too.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Federal health guidance about COVID-19 safety has evolved throughout the pandemic. Yet California already had strict workplace safety rules in place for hospitals and other health settings that should have protected employees from the very beginning, even when little was known about the virus, experts say.\u003c/p>\n\u003cp>In spring 2009, California adopted the Aerosol Transmissible Diseases (ATD) standard. Under development for several years, it was \u003ca href=\"https://www.dir.ca.gov/title8/5199.html\">unanimously approved\u003c/a> by the Cal/OSHA Standards Board soon after the first cases of the H1N1 virus were detected in the state. According to this \u003ca href=\"https://www.dir.ca.gov/title8/5199.html\">ATD standard\u003c/a>, any novel or unknown pathogen is to be handled as if it could be transmitted by aerosols until proven otherwise.\u003c/p>\n\u003cp>California is the only state in the country with this standard. And experts say this standard has helped Cal/OSHA hold health employers accountable during the pandemic.\u003c/p>\n\u003cp>The state’s aerosol standard requires employers to provide personal protective equipment that protects against aerosols, train employees about this type of transmission and notify them of any possible exposure. This state standard went beyond early pandemic guidance from the Centers for Disease Control and Prevention, which didn’t formally acknowledge the \u003ca href=\"https://www.cdc.gov/coronavirus/2019-ncov/more/scientific-brief-sars-cov-2.html\">airborne transmission\u003c/a> of coronavirus until October. For months, the federal agency focused on droplet transmission.\u003c/p>\n\u003cp>Special protection is required to protect against viruses that can transmit via smaller aerosolized particles. For example, in Cal/OSHA’s citation to Kaiser San Francisco, the agency notes that the hospital did not require employees to use \u003ca href=\"https://www.cdc.gov/coronavirus/2019-ncov/images/hcp/N95-infographic-What-Are-APR-508.png?noicon\">powered air-purifying respirators\u003c/a> during “high hazard” procedures that generate aerosols, like intubations. According to the ATD standard, N95 masks are not enough protection for those types of procedures.\u003c/p>\n\u003cp>At the San Leandro location, employees who were given powered air-purifying respirators were handed defective units held together by tape, \u003ca href=\"https://www.dir.ca.gov/dosh/coronavirus/citations/01.04.2021-Kaiser-Foundation-KaiserPermanenteSanLeandro_1479549.pdf\">according to the citation\u003c/a>. That same hospital also failed to investigate exposure incidents between May and August, the citation reads.\u003c/p>\n\u003cp>Throughout most of last year, nurses and other health workers organized rallies and protests demanding more protection from Kaiser and other hospitals. Amy Arlund, an intensive care nurse at Kaiser Fresno Medical Center and member of the California Nurses Association, said nurses aren’t as interested in fines as they are in enforcement and improvement.\u003c/p>\n\u003cp>She alleged that at her hospital, for example, when their battery-operated respirators break down, it’s hard to get replacements.\u003c/p>\n\u003cp>“A lot of nurses are carrying around their own rolls of duct tape to put these things back together when they’re falling apart,” Arlund told CalMatters in November. “We use what we have way beyond its usage.”\u003c/p>\n\u003cp>Employees at Kaiser Fresno have filed several complaints. Arlund said Cal/OSHA inspectors have visited her hospital, but as of Friday, no citations had been issued against Kaiser’s Fresno hospital.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "These Sites Offer Free COVID-19 Tests for the Uninsured. So Why Are So Many Insured Kaiser Patients Using Them?",
"title": "These Sites Offer Free COVID-19 Tests for the Uninsured. So Why Are So Many Insured Kaiser Patients Using Them?",
"headTitle": "KQED News",
"content": "\u003cp>\u003cem>This report contains a clarification.\u003c/em>\u003c/p>\n\u003cp>Nonprofit clinics and coronavirus testing centers that don't require insurance are seeing large numbers of people \u003cem>with\u003c/em> insurance seeking tests. People running these centers say that’s taking resources away from the low-income communities they’re meant to serve.\u003c/p>\n\u003cp>And many of those insured patients are Kaiser Permanente members who already have access to testing through Kaiser, those running the free clinics say.\u003c/p>\n\u003cp>Health experts say that more and faster testing is critical to slowing the spread of the virus and ultimately \u003ca href=\"https://www.nia.nih.gov/news/why-covid-19-testing-key-getting-back-normal\" target=\"_blank\" rel=\"noopener noreferrer\">saving lives\u003c/a>.\u003c/p>\n\u003cp>That's especially key as vaccines are still limited and testing remains an important tool to keep the pandemic in check, Santa Clara County's health department wrote in a \u003ca href=\"https://www.sccgov.org/sites/covid19/Pages/press-release-01-30-2021-COVID-19-tests-remain-most-important-tool.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">statement\u003c/a>, Saturday. \u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"Dr. Kim Rhoads, UCSF\"]'This is the community scrambling for resources ... so it raises the question, why is it so hard to get a test at Kaiser?'[/pullquote]Kaiser says it's following state guidelines on testing. The \u003ca href=\"https://www.dmhc.ca.gov/\" target=\"_blank\" rel=\"noopener noreferrer\">California Department of Managed Health Care\u003c/a> (DMHC) and the \u003ca href=\"https://www.cdph.ca.gov/\" target=\"_blank\" rel=\"noopener noreferrer\">California Department of Public Health\u003c/a> requires that health plans provide tests within 48 hours to a health plan enrollee who has symptoms, has known or suspected exposure or is an essential worker. The DMHC says Kaiser is currently meeting these requirements.\u003c/p>\n\u003cp>DMHC also says there is no requirement for individuals to be tested by their health plan. And if health plan enrollees are tested outside of their health plan, the health plan must reimburse the out-of-network providers for the cost of the test.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But providers tell KQED that actually getting some of those reimbursements is difficult, even as insured patients continue to flock to free clinics.\u003c/p>\n\u003ch3>Insured People Flocking to Nonprofits\u003c/h3>\n\u003cp>\u003ca href=\"https://rootsclinic.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Roots Community Health Center\u003c/a> serves patients in Oakland who are impacted by systemic inequities and poverty. The clinic was founded with the goal to serve the uninsured and low-income residents of East Oakland.\u003c/p>\n\u003cp>But Dr. Noha Aboelata, Roots' chief executive officer, says she's seen a lot of insured people coming through Roots, especially from Kaiser. She says roughly 25% of insured people are Kaiser members.\u003c/p>\n\u003cp>Aboelata says she's heard her Kaiser patients say that they were either denied getting a test at Kaiser or that the appointment date was too far out and they wanted to get tested right away.\u003c/p>\n\u003cp>When that happens, they come to Roots instead. And Roots isn't alone.[aside postID=\"news_11818312\" label=\"MAP: Free COVID-19 Public Testing Sites in the Bay Area\"]\u003c/p>\n\u003cp>Dr. Kim Rhoads, an epidemiologist and biostatistician at the University of California San Francisco,\u003ca href=\"https://www.kqed.org/news/11852147/ucsf-doctor-challenges-reports-of-high-covid-rates-in-black-community\" target=\"_blank\" rel=\"noopener noreferrer\"> hosted several pop-up COVID-19 testing sites\u003c/a> throughout Oakland last fall with the mission to test the Black community and African Americans specifically. She says of the thousand people tested at her pop-up sites, roughly 36% had Kaiser insurance.\u003c/p>\n\u003cp>“This is the community scrambling for resources,” Rhoads says, “So it raises the question, why is it so hard to get a test at Kaiser?”\u003c/p>\n\u003cp>Aboelata, at Roots, says the number of Kaiser patients they've seen has been pretty consistent since the start of the pandemic and, as of Saturday, they've tested about 5,500 Kaiser patients.\u003c/p>\n\u003cp>For now, they’ve been fortunate to have enough tests to serve everyone coming through their doors, but resources are limited. She thinks \u003cem>every\u003c/em> health care provider should make testing fast and easy, and small clinics like Roots shouldn’t be picking up the slack for larger institutions.\u003c/p>\n\u003ch3>Why Are Some Kaiser Members Not Going to Kaiser?\u003c/h3>\n\u003cp>Andy Hsu, a tech worker who lives in San Francisco’s SoMa neighborhood, has Kaiser insurance but mostly goes to \u003ca href=\"https://sf.gov/find-out-about-your-covid-19-testing-options\" target=\"_blank\" rel=\"noopener noreferrer\">city-run testing sites, or CityTestSF.\u003c/a>\u003c/p>\n\u003cp>“I would definitely take a lot more tests with City,” he says. “One because, I think, going through Kaiser's app, it's just kind of a pain in general, like there's just a lot of steps involved.”\u003c/p>\n\u003cp>And secondly, the city’s test result turnaround time is a \u003cem>lot\u003c/em> faster.\u003c/p>\n\u003cp>“I've definitely gotten test results within 24 hours\" from the city, \"whereas for Kaiser, there's been times when it would take them a little bit more than two days,\" he says.\u003c/p>\n\u003cp>\u003cem>In the Tweet below, KQED reporter Joe Fitzgerald Rodriguez, who recently got insurance through Kaiser, was similarly taken aback after getting a turnaround time estimate of five days for a COVID-19 test.\u003c/em>\u003c/p>\n\u003cp>https://twitter.com/vad3r_77/status/1355216198820974594\u003c/p>\n\u003cp>Hsu says the city of San Francisco, which isn’t even a health care institution, is setting up testing sites that are more efficient than Kaiser’s, the health care giant.\u003c/p>\n\u003cp>“Kaiser has such a big footprint in the Bay Area, I would expect things to be a little bit more like figured out by now,” he says.\u003c/p>\n\u003cp>Asked about turnaround times for COVID-19 tests, a Kaiser representative told KQED by email that it's \"usually within two to three days... But timing may change based on demand and testing capacity, and whether the test is processed at [Kaiser] or at a private commercial lab, which may take longer to report results. We prioritize our lab testing and may use private lab services for asymptomatic, less urgent cases.\"\u003c/p>\n\u003cp>Kaiser did not respond to questions about its members using free sites.\u003c/p>\n\u003cp>An official with San Francisco's COVID Command Center says those with insurance are urged to get tested with their provider and reserve city-run testing sites for those who are symptomatic, have been exposed, don’t have insurance or can't get a test appointment elsewhere.\u003c/p>\n\u003cp>San Francisco's COVID Command Center says through December city test sites conducted 100,000 tests for Kaiser patients.\u003c/p>\n\u003cp>But local nonprofit community clinics have different challenges than the city-run testing sites.\u003c/p>\n\u003ch3>\u003cstrong>Recovering Community Costs\u003c/strong>\u003c/h3>\n\u003cp>While Roots and other testing sites can legally bill Kaiser for the tests taken by their members, Aboelata says there are challenges with getting reimbursed.\u003c/p>\n\u003cp>Kaiser only reimburses for tests if members fill out their information correctly. When Kaiser members make a mistake writing down their insurance information, testing sites cannot be reimbursed for those tests from Kaiser.\u003c/p>\n\u003cp>On top of that, these clinics are typically set up to serve low-income people and those who are uninsured, so when getting a COVID-19 test, filling out insurance information is optional. That means in cases where people with insurance leave the insurance information section blank, there’s no way to recoup those costs.\u003c/p>\n\u003cp>Even the CDPH admits that there are instances when collecting payment from health care plans are not feasible.\u003c/p>\n\u003cp>In an emailed statement, the CDPH says “there may be people who come in for testing who do not identify they are covered through a health plan or insurer for the provider to request reimbursement from the health plan, or scenarios where not enough information is provided or captured.”\u003c/p>\n\u003cp>And lastly, there’s the cost of administering tests. Clinics have to pay for someone to book the visits, health care professionals to give the test as well as notify people of their test results, among other administrative tasks.\u003c/p>\n\u003cp>Kaiser is supposed to pay for administrative costs, according to DMHC. But Aboelata says they’re unaware of any way to bill Kaiser for those costs.\u003c/p>\n\u003cp>While DMHC says there is a billing system in place, Kaiser has yet to confirm if they've established that system. And even if there were a billing system in place, all of these hurdles could be avoided if people with Kaiser insurance went to a Kaiser testing site for their tests.\u003c/p>\n\u003cp>“To me, it's not efficient or effective. And obviously, it's much more ideal if they would get tested at their own primary care,” Aboelata says.\u003c/p>\n\u003cfigure id=\"attachment_11852166\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-11852166\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2020/12/Umoja-8-800x533.jpg\" alt=\"Dr. Kim Rhoads is an epidemiologist and bio-statistician at UCSF. She helped start a group called Umoja with a mission to get more African Americans to get tested for the coronavirus as well as to present a more accurate picture of positivity rates in the Black population. Rhoads is pictured wearing an Umoja t-shirt at the COVID-19 pop-up testing sites hosted by Acts Full Gospel Church in East Oakland on Oct. 31, 2020.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2020/12/Umoja-8-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2020/12/Umoja-8-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2020/12/Umoja-8-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2020/12/Umoja-8-1536x1024.jpg 1536w, https://ww2.kqed.org/app/uploads/sites/10/2020/12/Umoja-8.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Kim Rhoads is an epidemiologist and biostatistician at UCSF. She helped start a group called Umoja with a mission to get more African Americans to get tested for the coronavirus as well as to present a more accurate picture of positivity rates in the Black population. Rhoads is pictured wearing an Umoja T-shirt at the COVID-19 pop-up testing sites hosted by Acts Full Gospel Church in East Oakland on Oct. 31, 2020. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Unlike Roots, Rhoads’ team at UCSF is powered by volunteers, and they managed to get funding from Kaiser after Kaiser discovered so many of their testers had their insurance.\u003c/p>\n\u003cp>Aboelata says she'd be interested in partnering with Kaiser, too.\u003c/p>\n\u003ch3>Kaiser Says They Are Following Guidelines\u003c/h3>\n\u003cp>In a statement, Kaiser told KQED they're following the direction of the CDPH and DMHC, and that they are in compliance with state orders on testing in California.\u003c/p>\n\u003cp>Kaiser serves 4.5 million people in Northern California and has 36 testing sites in the region (25 of them are in the Bay Area).\u003c/p>\n\u003cp>Kaiser says in Northern California it has the capacity to perform roughly 20,000 tests per day. But according to \u003ca href=\"https://testing.covid19.ca.gov/wp-content/uploads/sites/332/2021/01/20210123_TAT-dashboard.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">the California Department of Public Health\u003c/a>, from January 17-23 Kaiser only tested 52,797 in Northern California.\u003c/p>\n\u003cp>This pales in comparison to the 100,559 they tested in Southern California, though it's important to note the Los Angeles area has been dealing with a major surge over the past few weeks.\u003c/p>\n\u003cfigure id=\"attachment_11858047\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-11858047 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/02/Screen-Shot-2021-02-01-at-2.55.50-PM-800x69.png\" alt=\"\" width=\"800\" height=\"69\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2021/02/Screen-Shot-2021-02-01-at-2.55.50-PM-800x69.png 800w, https://ww2.kqed.org/app/uploads/sites/10/2021/02/Screen-Shot-2021-02-01-at-2.55.50-PM-1020x88.png 1020w, https://ww2.kqed.org/app/uploads/sites/10/2021/02/Screen-Shot-2021-02-01-at-2.55.50-PM-160x14.png 160w, https://ww2.kqed.org/app/uploads/sites/10/2021/02/Screen-Shot-2021-02-01-at-2.55.50-PM-1536x133.png 1536w, https://ww2.kqed.org/app/uploads/sites/10/2021/02/Screen-Shot-2021-02-01-at-2.55.50-PM.png 1644w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">A partial screen-capture from CDPH’s Turnaround Time Dashboard (PDF) which shows total tests counted by Kaiser Northern California and Kaiser Southern California from January 17, 2021 to January 23, 2021.\u003c/figcaption>\u003c/figure>\n\u003cp>Meanwhile, over the weekend, Kaiser’s CEO sent out an email to members that says Kaiser is working to ramp up its vaccination efforts.\u003c/p>\n\u003cp>Kaiser will “continue providing vaccines we receive at each of our medical office buildings . . . and in anticipation of more vaccine, we’re prepared to open additional locations and use mobile clinics,\" the statement reads. The health care company also says it's working to open up high-volume COVID-19 vaccination hubs.\u003c/p>\n\u003cp>This suggests that Kaiser has opened or will open up \u003cem>at least\u003c/em> 73 vaccination sites in the region, since it has 73 medical offices in Northern California.\u003c/p>\n\u003cp>When asked why only some Kaiser facilities offer COVID-19 testing, a spokesperson told KQED that Kaiser \"carefully selected locations that could best accommodate a drive-up testing site based on physical space, parking and where we felt we could safely accommodate the expected volume while minimizing patient contact info and supporting social distancing.\"\u003c/p>\n\u003cp>Kaiser did not offer an explanation as to why vaccinations would be available at all medical office buildings, but not COVID-19 tests.\u003c/p>\n\u003cp>\u003cem>Feb. 3: This report has been updated to clarify statements from Kaiser on COVID-19 testing turnaround times and the selection of testing sites.\u003c/em>\u003c/p>\n\u003cp>\u003cem>Disclaimer: KQED reporter Julie Chang is a Kaiser Permanente insurance member.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"excerpt": "Free COVID-19 testing clinics for the uninsured tell KQED there are high rates of insured Kaiser members using their free services instead of using Kaiser.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>This report contains a clarification.\u003c/em>\u003c/p>\n\u003cp>Nonprofit clinics and coronavirus testing centers that don't require insurance are seeing large numbers of people \u003cem>with\u003c/em> insurance seeking tests. People running these centers say that’s taking resources away from the low-income communities they’re meant to serve.\u003c/p>\n\u003cp>And many of those insured patients are Kaiser Permanente members who already have access to testing through Kaiser, those running the free clinics say.\u003c/p>\n\u003cp>Health experts say that more and faster testing is critical to slowing the spread of the virus and ultimately \u003ca href=\"https://www.nia.nih.gov/news/why-covid-19-testing-key-getting-back-normal\" target=\"_blank\" rel=\"noopener noreferrer\">saving lives\u003c/a>.\u003c/p>\n\u003cp>That's especially key as vaccines are still limited and testing remains an important tool to keep the pandemic in check, Santa Clara County's health department wrote in a \u003ca href=\"https://www.sccgov.org/sites/covid19/Pages/press-release-01-30-2021-COVID-19-tests-remain-most-important-tool.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">statement\u003c/a>, Saturday. \u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Kaiser says it's following state guidelines on testing. The \u003ca href=\"https://www.dmhc.ca.gov/\" target=\"_blank\" rel=\"noopener noreferrer\">California Department of Managed Health Care\u003c/a> (DMHC) and the \u003ca href=\"https://www.cdph.ca.gov/\" target=\"_blank\" rel=\"noopener noreferrer\">California Department of Public Health\u003c/a> requires that health plans provide tests within 48 hours to a health plan enrollee who has symptoms, has known or suspected exposure or is an essential worker. The DMHC says Kaiser is currently meeting these requirements.\u003c/p>\n\u003cp>DMHC also says there is no requirement for individuals to be tested by their health plan. And if health plan enrollees are tested outside of their health plan, the health plan must reimburse the out-of-network providers for the cost of the test.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But providers tell KQED that actually getting some of those reimbursements is difficult, even as insured patients continue to flock to free clinics.\u003c/p>\n\u003ch3>Insured People Flocking to Nonprofits\u003c/h3>\n\u003cp>\u003ca href=\"https://rootsclinic.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Roots Community Health Center\u003c/a> serves patients in Oakland who are impacted by systemic inequities and poverty. The clinic was founded with the goal to serve the uninsured and low-income residents of East Oakland.\u003c/p>\n\u003cp>But Dr. Noha Aboelata, Roots' chief executive officer, says she's seen a lot of insured people coming through Roots, especially from Kaiser. She says roughly 25% of insured people are Kaiser members.\u003c/p>\n\u003cp>Aboelata says she's heard her Kaiser patients say that they were either denied getting a test at Kaiser or that the appointment date was too far out and they wanted to get tested right away.\u003c/p>\n\u003cp>When that happens, they come to Roots instead. And Roots isn't alone.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Dr. Kim Rhoads, an epidemiologist and biostatistician at the University of California San Francisco,\u003ca href=\"https://www.kqed.org/news/11852147/ucsf-doctor-challenges-reports-of-high-covid-rates-in-black-community\" target=\"_blank\" rel=\"noopener noreferrer\"> hosted several pop-up COVID-19 testing sites\u003c/a> throughout Oakland last fall with the mission to test the Black community and African Americans specifically. She says of the thousand people tested at her pop-up sites, roughly 36% had Kaiser insurance.\u003c/p>\n\u003cp>“This is the community scrambling for resources,” Rhoads says, “So it raises the question, why is it so hard to get a test at Kaiser?”\u003c/p>\n\u003cp>Aboelata, at Roots, says the number of Kaiser patients they've seen has been pretty consistent since the start of the pandemic and, as of Saturday, they've tested about 5,500 Kaiser patients.\u003c/p>\n\u003cp>For now, they’ve been fortunate to have enough tests to serve everyone coming through their doors, but resources are limited. She thinks \u003cem>every\u003c/em> health care provider should make testing fast and easy, and small clinics like Roots shouldn’t be picking up the slack for larger institutions.\u003c/p>\n\u003ch3>Why Are Some Kaiser Members Not Going to Kaiser?\u003c/h3>\n\u003cp>Andy Hsu, a tech worker who lives in San Francisco’s SoMa neighborhood, has Kaiser insurance but mostly goes to \u003ca href=\"https://sf.gov/find-out-about-your-covid-19-testing-options\" target=\"_blank\" rel=\"noopener noreferrer\">city-run testing sites, or CityTestSF.\u003c/a>\u003c/p>\n\u003cp>“I would definitely take a lot more tests with City,” he says. “One because, I think, going through Kaiser's app, it's just kind of a pain in general, like there's just a lot of steps involved.”\u003c/p>\n\u003cp>And secondly, the city’s test result turnaround time is a \u003cem>lot\u003c/em> faster.\u003c/p>\n\u003cp>“I've definitely gotten test results within 24 hours\" from the city, \"whereas for Kaiser, there's been times when it would take them a little bit more than two days,\" he says.\u003c/p>\n\u003cp>\u003cem>In the Tweet below, KQED reporter Joe Fitzgerald Rodriguez, who recently got insurance through Kaiser, was similarly taken aback after getting a turnaround time estimate of five days for a COVID-19 test.\u003c/em>\u003c/p>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\n\u003cp>Hsu says the city of San Francisco, which isn’t even a health care institution, is setting up testing sites that are more efficient than Kaiser’s, the health care giant.\u003c/p>\n\u003cp>“Kaiser has such a big footprint in the Bay Area, I would expect things to be a little bit more like figured out by now,” he says.\u003c/p>\n\u003cp>Asked about turnaround times for COVID-19 tests, a Kaiser representative told KQED by email that it's \"usually within two to three days... But timing may change based on demand and testing capacity, and whether the test is processed at [Kaiser] or at a private commercial lab, which may take longer to report results. We prioritize our lab testing and may use private lab services for asymptomatic, less urgent cases.\"\u003c/p>\n\u003cp>Kaiser did not respond to questions about its members using free sites.\u003c/p>\n\u003cp>An official with San Francisco's COVID Command Center says those with insurance are urged to get tested with their provider and reserve city-run testing sites for those who are symptomatic, have been exposed, don’t have insurance or can't get a test appointment elsewhere.\u003c/p>\n\u003cp>San Francisco's COVID Command Center says through December city test sites conducted 100,000 tests for Kaiser patients.\u003c/p>\n\u003cp>But local nonprofit community clinics have different challenges than the city-run testing sites.\u003c/p>\n\u003ch3>\u003cstrong>Recovering Community Costs\u003c/strong>\u003c/h3>\n\u003cp>While Roots and other testing sites can legally bill Kaiser for the tests taken by their members, Aboelata says there are challenges with getting reimbursed.\u003c/p>\n\u003cp>Kaiser only reimburses for tests if members fill out their information correctly. When Kaiser members make a mistake writing down their insurance information, testing sites cannot be reimbursed for those tests from Kaiser.\u003c/p>\n\u003cp>On top of that, these clinics are typically set up to serve low-income people and those who are uninsured, so when getting a COVID-19 test, filling out insurance information is optional. That means in cases where people with insurance leave the insurance information section blank, there’s no way to recoup those costs.\u003c/p>\n\u003cp>Even the CDPH admits that there are instances when collecting payment from health care plans are not feasible.\u003c/p>\n\u003cp>In an emailed statement, the CDPH says “there may be people who come in for testing who do not identify they are covered through a health plan or insurer for the provider to request reimbursement from the health plan, or scenarios where not enough information is provided or captured.”\u003c/p>\n\u003cp>And lastly, there’s the cost of administering tests. Clinics have to pay for someone to book the visits, health care professionals to give the test as well as notify people of their test results, among other administrative tasks.\u003c/p>\n\u003cp>Kaiser is supposed to pay for administrative costs, according to DMHC. But Aboelata says they’re unaware of any way to bill Kaiser for those costs.\u003c/p>\n\u003cp>While DMHC says there is a billing system in place, Kaiser has yet to confirm if they've established that system. And even if there were a billing system in place, all of these hurdles could be avoided if people with Kaiser insurance went to a Kaiser testing site for their tests.\u003c/p>\n\u003cp>“To me, it's not efficient or effective. And obviously, it's much more ideal if they would get tested at their own primary care,” Aboelata says.\u003c/p>\n\u003cfigure id=\"attachment_11852166\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-11852166\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2020/12/Umoja-8-800x533.jpg\" alt=\"Dr. Kim Rhoads is an epidemiologist and bio-statistician at UCSF. She helped start a group called Umoja with a mission to get more African Americans to get tested for the coronavirus as well as to present a more accurate picture of positivity rates in the Black population. Rhoads is pictured wearing an Umoja t-shirt at the COVID-19 pop-up testing sites hosted by Acts Full Gospel Church in East Oakland on Oct. 31, 2020.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2020/12/Umoja-8-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2020/12/Umoja-8-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2020/12/Umoja-8-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2020/12/Umoja-8-1536x1024.jpg 1536w, https://ww2.kqed.org/app/uploads/sites/10/2020/12/Umoja-8.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Kim Rhoads is an epidemiologist and biostatistician at UCSF. She helped start a group called Umoja with a mission to get more African Americans to get tested for the coronavirus as well as to present a more accurate picture of positivity rates in the Black population. Rhoads is pictured wearing an Umoja T-shirt at the COVID-19 pop-up testing sites hosted by Acts Full Gospel Church in East Oakland on Oct. 31, 2020. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Unlike Roots, Rhoads’ team at UCSF is powered by volunteers, and they managed to get funding from Kaiser after Kaiser discovered so many of their testers had their insurance.\u003c/p>\n\u003cp>Aboelata says she'd be interested in partnering with Kaiser, too.\u003c/p>\n\u003ch3>Kaiser Says They Are Following Guidelines\u003c/h3>\n\u003cp>In a statement, Kaiser told KQED they're following the direction of the CDPH and DMHC, and that they are in compliance with state orders on testing in California.\u003c/p>\n\u003cp>Kaiser serves 4.5 million people in Northern California and has 36 testing sites in the region (25 of them are in the Bay Area).\u003c/p>\n\u003cp>Kaiser says in Northern California it has the capacity to perform roughly 20,000 tests per day. But according to \u003ca href=\"https://testing.covid19.ca.gov/wp-content/uploads/sites/332/2021/01/20210123_TAT-dashboard.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">the California Department of Public Health\u003c/a>, from January 17-23 Kaiser only tested 52,797 in Northern California.\u003c/p>\n\u003cp>This pales in comparison to the 100,559 they tested in Southern California, though it's important to note the Los Angeles area has been dealing with a major surge over the past few weeks.\u003c/p>\n\u003cfigure id=\"attachment_11858047\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-11858047 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/02/Screen-Shot-2021-02-01-at-2.55.50-PM-800x69.png\" alt=\"\" width=\"800\" height=\"69\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2021/02/Screen-Shot-2021-02-01-at-2.55.50-PM-800x69.png 800w, https://ww2.kqed.org/app/uploads/sites/10/2021/02/Screen-Shot-2021-02-01-at-2.55.50-PM-1020x88.png 1020w, https://ww2.kqed.org/app/uploads/sites/10/2021/02/Screen-Shot-2021-02-01-at-2.55.50-PM-160x14.png 160w, https://ww2.kqed.org/app/uploads/sites/10/2021/02/Screen-Shot-2021-02-01-at-2.55.50-PM-1536x133.png 1536w, https://ww2.kqed.org/app/uploads/sites/10/2021/02/Screen-Shot-2021-02-01-at-2.55.50-PM.png 1644w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">A partial screen-capture from CDPH’s Turnaround Time Dashboard (PDF) which shows total tests counted by Kaiser Northern California and Kaiser Southern California from January 17, 2021 to January 23, 2021.\u003c/figcaption>\u003c/figure>\n\u003cp>Meanwhile, over the weekend, Kaiser’s CEO sent out an email to members that says Kaiser is working to ramp up its vaccination efforts.\u003c/p>\n\u003cp>Kaiser will “continue providing vaccines we receive at each of our medical office buildings . . . and in anticipation of more vaccine, we’re prepared to open additional locations and use mobile clinics,\" the statement reads. The health care company also says it's working to open up high-volume COVID-19 vaccination hubs.\u003c/p>\n\u003cp>This suggests that Kaiser has opened or will open up \u003cem>at least\u003c/em> 73 vaccination sites in the region, since it has 73 medical offices in Northern California.\u003c/p>\n\u003cp>When asked why only some Kaiser facilities offer COVID-19 testing, a spokesperson told KQED that Kaiser \"carefully selected locations that could best accommodate a drive-up testing site based on physical space, parking and where we felt we could safely accommodate the expected volume while minimizing patient contact info and supporting social distancing.\"\u003c/p>\n\u003cp>Kaiser did not offer an explanation as to why vaccinations would be available at all medical office buildings, but not COVID-19 tests.\u003c/p>\n\u003cp>\u003cem>Feb. 3: This report has been updated to clarify statements from Kaiser on COVID-19 testing turnaround times and the selection of testing sites.\u003c/em>\u003c/p>\n\u003cp>\u003cem>Disclaimer: KQED reporter Julie Chang is a Kaiser Permanente insurance member.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "New Bay Area Parents Adapt to Changing Birth Landscape Under COVID-19",
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"content": "\u003cp>Erica Becks had it all planned out. The first-time San Mateo mom had organized an early baby shower, hired a doula and lined up all her people to be with her at the hospital for the birth.\u003c/p>\n\u003cp>\"I had this dream of having my best friend there, my partner there, my doula there and my sister there,\" Becks said in a video interview with KQED during the final days of her pregnancy. \"And now that has all been shattered.\"\u003c/p>\n\u003cp>Many activities have been canceled or put on hold during the coronavirus pandemic. But when it comes to giving birth, there’s no such thing as rescheduling, and expectant parents across the Bay Area have to adapt fast to these extraordinary times.\u003c/p>\n\u003cp>Due to the coronavirus pandemic, hospitals have been forced to change their maternity policies — like providing masks for women in labor and limiting access to delivery rooms. And as a result, pregnant mothers, like Becks, are dealing with a slew of unforeseen worries.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"I'm getting anxious about weird things that I never thought I would be thinking about, like whether or not I want medical professionals to even be touching my baby,\" Becks said. \"Or does the baby also need to wear a mask? Is that overkill?\"\u003c/p>\n\u003cp>Becks says she turned to her \u003ca href=\"https://www.facebook.com/SanMateoParentsClub/?eid=ARBs8y-0CYVd7l8hMMCO5Fus3mxc8hswzPAtZJBYIMEF_jfBjOzahPS0rkAYNV4PLRQx7GW5Mo_a3bD6\" target=\"_blank\" rel=\"noopener noreferrer\">San Mateo parents Facebook group\u003c/a> for emotional support, like when it came to the tough decision of having to choose between her partner or doula’s company in the maternity ward.\u003c/p>\n\u003cp>\"It’s hard to find other women who are in the same situation,\" Becks said. \"And so I was actually really grateful that I found the group. Because I'm like, 'OK, I'm not alone.' \"\u003c/p>\n\u003cfigure id=\"attachment_11813772\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-11813772 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2020/04/RS42884_Michele-Berrios-and-daughters-qut-800x799.jpg\" alt=\"\" width=\"800\" height=\"799\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2020/04/RS42884_Michele-Berrios-and-daughters-qut-800x799.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2020/04/RS42884_Michele-Berrios-and-daughters-qut-160x160.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2020/04/RS42884_Michele-Berrios-and-daughters-qut-1020x1019.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2020/04/RS42884_Michele-Berrios-and-daughters-qut-1472x1472.jpg 1472w, https://ww2.kqed.org/app/uploads/sites/10/2020/04/RS42884_Michele-Berrios-and-daughters-qut-1104x1104.jpg 1104w, https://ww2.kqed.org/app/uploads/sites/10/2020/04/RS42884_Michele-Berrios-and-daughters-qut-912x912.jpg 912w, https://ww2.kqed.org/app/uploads/sites/10/2020/04/RS42884_Michele-Berrios-and-daughters-qut-550x550.jpg 550w, https://ww2.kqed.org/app/uploads/sites/10/2020/04/RS42884_Michele-Berrios-and-daughters-qut-470x470.jpg 470w, https://ww2.kqed.org/app/uploads/sites/10/2020/04/RS42884_Michele-Berrios-and-daughters-qut.jpg 1797w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Michele Berrios with her two daughters, 18-month-old Chiara Nazzarena Berrios, and newborn Francesca Carolyn Berrios \u003ccite>(Courtesy of Michele Berrios)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Michele Berrios was also thrown for a loop by hospitals’ decisions to limit bedside support. The Alameda mom had been planning for a natural birth — birth without the use of pain medications — at \u003ca href=\"https://healthy.kaiserpermanente.org/northern-california/facilities/san-leandro-medical-center-301981\" target=\"_blank\" rel=\"noopener noreferrer\">Kaiser Permanente San Leandro Medical Center.\u003c/a>\u003c/p>\n\u003cp>Berrios had relied on the help of her husband to get her through the delivery of their first child, 18 months ago, also through natural birth.\u003c/p>\n\u003cp>\"I needed his support through every contraction of that 36-hour labor. He was there with me and was helping me through it,\" Berrios said. \"And I can't imagine doing it without him.\"\u003c/p>\n\u003cp>So when Berrios started hearing rumors that hospitals were restricting visitor access to the labor ward, she panicked. She even added an advance directive to her birth plan, stating that if something were to go wrong during the delivery, the hospital had to save the child first.\u003c/p>\n\u003cp>\"My husband was like, 'That's really scary.' But I said, 'It has to be done,' \" Berrios said.\u003c/p>\n\u003cp>Berrios also started to think about alternatives. She asked Kaiser Permanente about the possibility of switching to a home birth.\u003c/p>\n\u003cp>\"And they told me that if my gynecologist would deem it medically necessary and prescribe a midwife, that they would cover the home birth,\" she said.\u003c/p>\n\u003cp>Only about 1% of parents opt for home births in the United States. Most insurance policies won’t cover them, and they’re only advisable for low-risk pregnancies. But the coronavirus pandemic is fueling an interest in the time-honored tradition.\u003c/p>\n\u003cp>\"There's definitely a slight uptick in the number of home births that are happening right now,\" said Berkeley-based midwife \u003ca href=\"http://hummingbirdmidwifery.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Morgan West\u003c/a>, \"but a massive uptick in the number of people inquiring about the possibility of a home birth.\"\u003c/p>\n\u003cfigure id=\"attachment_11813880\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-full wp-image-11813880\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2020/04/DSC09920-1.jpg\" alt=\"\" width=\"640\" height=\"428\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2020/04/DSC09920-1.jpg 640w, https://ww2.kqed.org/app/uploads/sites/10/2020/04/DSC09920-1-160x107.jpg 160w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Midwife Morgan West of Berkeley-based Hummingbird Midwifery says there's currently a spike in people interested in home births. \u003ccite>(Courtesy of Morgan West)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Berrios quickly obtained letters of support from her gynecologist, found a midwife and got into gear to have her baby at home.\u003c/p>\n\u003cp>At 39 weeks and after 12 hours of labor, Berrios gave birth.\u003c/p>\n\u003cp>\"Our baby girl was born at 5:38 p.m. on Saturday, March 21,\" Berrios said. \"On my couch.\"\u003c/p>\n\u003cp>Shortly after baby Francesca was born, Berrios learned that she had been misinformed: Her health care provider does not, in fact, authorize home births. So Berrios and her husband may end up having to foot the $7,000 bill themselves.\u003c/p>\n\u003cp>Kaiser Permanente wouldn’t grant KQED an interview or comment directly on Berrios’ case.\u003c/p>\n\u003cp>But the company did issue a written statement rearticulating its no home birth policy.\u003c/p>\n\u003cp>\"Our providers and hospitals offer many patient-centered options for delivery of their babies, and we are confident that we can keep new mothers and babies safe at delivery,\" the statement said. \"We do not provide authorization for home births or other prenatal care outside of Kaiser Permanente.\"\u003c/p>\n\u003cp>[aside label=\"Related Stories\" tag=\"coronavirus\"]\u003c/p>\n\u003cp>Berrios is currently fighting the denial of service. But she is full of hope.\u003c/p>\n\u003cp>\"I feel so fortunate to not have fears and despair bogging us down,\" Berrios said. \"That could be the case, and we don't feel that way.\"\u003c/p>\n\u003cp>Meanwhile, Becks gave birth to her daughter, Emersyn Michelle, on April 14. She said despite her fears, the birth went surprisingly smoothly at \u003ca href=\"https://locations.dignityhealth.org/sequoia-hospital-redwood-city-ca?utm_source=LocalSearch&utm_medium=Facility&utm_campaign=BayArea&utm_term=SequoiaHospital\" target=\"_blank\" rel=\"noopener noreferrer\">Sequoia Hospital\u003c/a> in Redwood City with her partner by her side.\u003c/p>\n\u003cp>But there have been other complications since: Emersyn has trouble breastfeeding.\u003c/p>\n\u003cp>\"She's been crying and fussy, and she hasn't been able to eat,\" Becks said.\u003c/p>\n\u003cp>Under normal circumstances, Becks said the doctor would have seen her right away. But she said office hours for non-essential services are reduced because of COVID-19. So she’ll have to wait.\u003c/p>\n\u003cp>To complicate matters, it's been hard to track down baby formula. Becks said bottles have been flying off store shelves during the pandemic. Luckily, she got help from friends, and now has enough to get by.\u003c/p>\n\u003cp>Becks called these \"first-world problems\" and said they pale in comparison to the joy she feels as a new mom.\u003c/p>\n\u003cp>\"It's totally worth it, and I would do it all over again,\" she said. \"Even in the midst of global pandemic.\"\u003c/p>\n\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Erica Becks had it all planned out. The first-time San Mateo mom had organized an early baby shower, hired a doula and lined up all her people to be with her at the hospital for the birth.\u003c/p>\n\u003cp>\"I had this dream of having my best friend there, my partner there, my doula there and my sister there,\" Becks said in a video interview with KQED during the final days of her pregnancy. \"And now that has all been shattered.\"\u003c/p>\n\u003cp>Many activities have been canceled or put on hold during the coronavirus pandemic. But when it comes to giving birth, there’s no such thing as rescheduling, and expectant parents across the Bay Area have to adapt fast to these extraordinary times.\u003c/p>\n\u003cp>Due to the coronavirus pandemic, hospitals have been forced to change their maternity policies — like providing masks for women in labor and limiting access to delivery rooms. And as a result, pregnant mothers, like Becks, are dealing with a slew of unforeseen worries.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"I'm getting anxious about weird things that I never thought I would be thinking about, like whether or not I want medical professionals to even be touching my baby,\" Becks said. \"Or does the baby also need to wear a mask? Is that overkill?\"\u003c/p>\n\u003cp>Becks says she turned to her \u003ca href=\"https://www.facebook.com/SanMateoParentsClub/?eid=ARBs8y-0CYVd7l8hMMCO5Fus3mxc8hswzPAtZJBYIMEF_jfBjOzahPS0rkAYNV4PLRQx7GW5Mo_a3bD6\" target=\"_blank\" rel=\"noopener noreferrer\">San Mateo parents Facebook group\u003c/a> for emotional support, like when it came to the tough decision of having to choose between her partner or doula’s company in the maternity ward.\u003c/p>\n\u003cp>\"It’s hard to find other women who are in the same situation,\" Becks said. \"And so I was actually really grateful that I found the group. Because I'm like, 'OK, I'm not alone.' \"\u003c/p>\n\u003cfigure id=\"attachment_11813772\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-11813772 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2020/04/RS42884_Michele-Berrios-and-daughters-qut-800x799.jpg\" alt=\"\" width=\"800\" height=\"799\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2020/04/RS42884_Michele-Berrios-and-daughters-qut-800x799.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2020/04/RS42884_Michele-Berrios-and-daughters-qut-160x160.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2020/04/RS42884_Michele-Berrios-and-daughters-qut-1020x1019.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2020/04/RS42884_Michele-Berrios-and-daughters-qut-1472x1472.jpg 1472w, https://ww2.kqed.org/app/uploads/sites/10/2020/04/RS42884_Michele-Berrios-and-daughters-qut-1104x1104.jpg 1104w, https://ww2.kqed.org/app/uploads/sites/10/2020/04/RS42884_Michele-Berrios-and-daughters-qut-912x912.jpg 912w, https://ww2.kqed.org/app/uploads/sites/10/2020/04/RS42884_Michele-Berrios-and-daughters-qut-550x550.jpg 550w, https://ww2.kqed.org/app/uploads/sites/10/2020/04/RS42884_Michele-Berrios-and-daughters-qut-470x470.jpg 470w, https://ww2.kqed.org/app/uploads/sites/10/2020/04/RS42884_Michele-Berrios-and-daughters-qut.jpg 1797w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Michele Berrios with her two daughters, 18-month-old Chiara Nazzarena Berrios, and newborn Francesca Carolyn Berrios \u003ccite>(Courtesy of Michele Berrios)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Michele Berrios was also thrown for a loop by hospitals’ decisions to limit bedside support. The Alameda mom had been planning for a natural birth — birth without the use of pain medications — at \u003ca href=\"https://healthy.kaiserpermanente.org/northern-california/facilities/san-leandro-medical-center-301981\" target=\"_blank\" rel=\"noopener noreferrer\">Kaiser Permanente San Leandro Medical Center.\u003c/a>\u003c/p>\n\u003cp>Berrios had relied on the help of her husband to get her through the delivery of their first child, 18 months ago, also through natural birth.\u003c/p>\n\u003cp>\"I needed his support through every contraction of that 36-hour labor. He was there with me and was helping me through it,\" Berrios said. \"And I can't imagine doing it without him.\"\u003c/p>\n\u003cp>So when Berrios started hearing rumors that hospitals were restricting visitor access to the labor ward, she panicked. She even added an advance directive to her birth plan, stating that if something were to go wrong during the delivery, the hospital had to save the child first.\u003c/p>\n\u003cp>\"My husband was like, 'That's really scary.' But I said, 'It has to be done,' \" Berrios said.\u003c/p>\n\u003cp>Berrios also started to think about alternatives. She asked Kaiser Permanente about the possibility of switching to a home birth.\u003c/p>\n\u003cp>\"And they told me that if my gynecologist would deem it medically necessary and prescribe a midwife, that they would cover the home birth,\" she said.\u003c/p>\n\u003cp>Only about 1% of parents opt for home births in the United States. Most insurance policies won’t cover them, and they’re only advisable for low-risk pregnancies. But the coronavirus pandemic is fueling an interest in the time-honored tradition.\u003c/p>\n\u003cp>\"There's definitely a slight uptick in the number of home births that are happening right now,\" said Berkeley-based midwife \u003ca href=\"http://hummingbirdmidwifery.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Morgan West\u003c/a>, \"but a massive uptick in the number of people inquiring about the possibility of a home birth.\"\u003c/p>\n\u003cfigure id=\"attachment_11813880\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-full wp-image-11813880\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2020/04/DSC09920-1.jpg\" alt=\"\" width=\"640\" height=\"428\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2020/04/DSC09920-1.jpg 640w, https://ww2.kqed.org/app/uploads/sites/10/2020/04/DSC09920-1-160x107.jpg 160w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Midwife Morgan West of Berkeley-based Hummingbird Midwifery says there's currently a spike in people interested in home births. \u003ccite>(Courtesy of Morgan West)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Berrios quickly obtained letters of support from her gynecologist, found a midwife and got into gear to have her baby at home.\u003c/p>\n\u003cp>At 39 weeks and after 12 hours of labor, Berrios gave birth.\u003c/p>\n\u003cp>\"Our baby girl was born at 5:38 p.m. on Saturday, March 21,\" Berrios said. \"On my couch.\"\u003c/p>\n\u003cp>Shortly after baby Francesca was born, Berrios learned that she had been misinformed: Her health care provider does not, in fact, authorize home births. So Berrios and her husband may end up having to foot the $7,000 bill themselves.\u003c/p>\n\u003cp>Kaiser Permanente wouldn’t grant KQED an interview or comment directly on Berrios’ case.\u003c/p>\n\u003cp>But the company did issue a written statement rearticulating its no home birth policy.\u003c/p>\n\u003cp>\"Our providers and hospitals offer many patient-centered options for delivery of their babies, and we are confident that we can keep new mothers and babies safe at delivery,\" the statement said. \"We do not provide authorization for home births or other prenatal care outside of Kaiser Permanente.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Berrios is currently fighting the denial of service. But she is full of hope.\u003c/p>\n\u003cp>\"I feel so fortunate to not have fears and despair bogging us down,\" Berrios said. \"That could be the case, and we don't feel that way.\"\u003c/p>\n\u003cp>Meanwhile, Becks gave birth to her daughter, Emersyn Michelle, on April 14. She said despite her fears, the birth went surprisingly smoothly at \u003ca href=\"https://locations.dignityhealth.org/sequoia-hospital-redwood-city-ca?utm_source=LocalSearch&utm_medium=Facility&utm_campaign=BayArea&utm_term=SequoiaHospital\" target=\"_blank\" rel=\"noopener noreferrer\">Sequoia Hospital\u003c/a> in Redwood City with her partner by her side.\u003c/p>\n\u003cp>But there have been other complications since: Emersyn has trouble breastfeeding.\u003c/p>\n\u003cp>\"She's been crying and fussy, and she hasn't been able to eat,\" Becks said.\u003c/p>\n\u003cp>Under normal circumstances, Becks said the doctor would have seen her right away. But she said office hours for non-essential services are reduced because of COVID-19. So she’ll have to wait.\u003c/p>\n\u003cp>To complicate matters, it's been hard to track down baby formula. Becks said bottles have been flying off store shelves during the pandemic. Luckily, she got help from friends, and now has enough to get by.\u003c/p>\n\u003cp>Becks called these \"first-world problems\" and said they pale in comparison to the joy she feels as a new mom.\u003c/p>\n\u003cp>\"It's totally worth it, and I would do it all over again,\" she said. \"Even in the midst of global pandemic.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>",
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"content": "\u003cp>The state is facing mounting pressure to enforce \u003ca href=\"https://calmatters.org/projects/california-mental-health-care-parity/\" target=\"_blank\" rel=\"noopener noreferrer\">parity laws that are supposed to guarantee equal care for physical and mental health issues\u003c/a>— with a spotlight this week on mental health care problems at health giant Kaiser Permanente.\u003c/p>\n\u003cp>This week, Kaiser mental health clinicians are on a\u003ca href=\"https://www.kqed.org/news/11791527/kaiser-therapists-strike-again-over-long-wait-times\" target=\"_blank\" rel=\"noopener noreferrer\"> five-day strike\u003c/a>, protesting long patient wait times and strenuous working conditions for providers. They say children and adults with serious mental health needs, including schizophrenia, anxiety and severe depression, are often waiting six to eight weeks — sometimes longer — to see a therapist. And they contend that Kaiser’s behavioral health services have in many ways worsened in recent years, despite being under a corrective plan overseen by the state \u003ca href=\"http://www.dmhc.ca.gov/?referral=healthhelp.ca.gov\" target=\"_blank\" rel=\"noopener noreferrer\">Department of Managed Health Care\u003c/a>.\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"Fred Seavey, research director for the National Union of Healthcare Workers\"]‘If these were cardiac catheterization services that were not functioning, if a health plan was screwing those up, (the state) would jump on that and require those to be fixed right away. Meanwhile they’re just sitting on their hands.’[/pullquote]\u003c/p>\n\u003cp>Striking clinicians on Thursday plan to march from the Capitol to the state agency to protest what they called “the agency’s failure to enforce parity legislation.” They specifically criticized the agency for not releasing reports from an outside monitor that would show whether Kaiser is meeting mental health access benchmarks outlined in a 2017 settlement agreement.\u003c/p>\n\u003cp>“I’m very disappointed with the DMHC — it’s just stunning,” said Fred Seavey, research director for the National Union of Healthcare Workers, which organized the strike. “It’s just criminal in my mind that they’re not holding Kaiser accountable.”\u003c/p>\n\u003cp>“If these were cardiac catheterization services that were not functioning, if a health plan was screwing those up, (the state) would jump on that and require those to be fixed right away,” he said. “Meanwhile they’re just sitting on their hands. We have people who are dying in the course of this failed enforcement by the DMHC.”\u003c/p>\n\u003cp>Seavey criticized Kaiser’s “massive influence” with the department, and said the union may call an open-ended strike in early 2020 if Kaiser does not improve mental health services.\u003c/p>\n\u003cp>After the state’s agreement with Kaiser in 2017, the health plan created a process to ensure that follow-up appointments are available in a timely manner, the state agency said in an emailed statement. Providers who cannot get their patients in for follow-up care are supposed to notify their managers.\u003c/p>\n\u003cp>The department fined Kaiser $4 million in 2013, but the plan did not agree to a settlement with corrective actions until 2017. That \u003ca href=\"https://wpso.dmhc.ca.gov/enfactions/docs/2895/1500394196511.pdf\">settlement agreement\u003c/a> is publicly available. But while the state department receives regular updates about the plan’s progress, it says it keeps that information confidential “in compliance with federal and state laws.”\u003c/p>\n\u003cp>Kaiser spokesman Marc Brown called the strikes “disruptive to patient access, operational care and service and…frankly irresponsible.” In an emailed statement, he said this is the union’s sixth strike this year (Seavey said most of these strikes were done at individual clinics, as opposed to statewide).\u003c/p>\n\u003cp>[aside postID=\"arts_13871243,news_11786202,news_11756742\" label=\"Mental Health Care in California\"]“We take any concern raised about our care very seriously, and always investigate and respond thoroughly,” Brown said. “However, it is inappropriate for the union to file multiple, often unwarranted complaints, and attack Kaiser Permanente’s reputation.”\u003c/p>\n\u003cp>More than a dozen complaints the union has filed with the DMHC in the past year — and sought to publicize — decry violations of network adequacy rules, timely access rules and long appointment wait times, among others. One complaint said patients in Pasadena with schizophrenia, serious major depression and bipolar disorder were waiting three or four months for an appointment. Another complaint said therapists in San Francisco were being told to keep alternative paper wait lists — or tell patients to call back later — to hide its failure to see children in a timely manner.\u003c/p>\n\u003cp>\u003ca href=\"https://calmatters.org/projects/californians-struggle-to-get-mental-health-care/\">Frustration with access to mental health services at Kaiser\u003c/a> extends beyond the HMO as well. According to a\u003ca href=\"https://www.chcf.org/publication/poll-shows-californians-health-priorities-new-governor-legislature/\"> statewide poll\u003c/a> by the Kaiser Family Foundation and the California Health Care Foundation released earlier this year, more than half of those surveyed thought that most people with mental health conditions are unable to get the services they need. A \u003ca href=\"http://www.milliman.com/bowman/\">recent analysis by healthcare consultants Milliman Inc.\u003c/a> showed that California patients were more than five times more likely to have office visits for mental health or addiction problems from providers outside their insurance plan’s network compared with their counterparts seeking medical or surgical care.\u003c/p>\n\u003cp>Concerned about these access problems, State Controller Betty Yee, who sits on the board of the California Public Employees’ Retirement System, wrote a letter to its executive officer requesting a series of hearings with its largest plans: Kaiser, Anthem, Blue Shield and United Healthcare. Kaiser, with more than 640,000 enrollees, has by far the highest membership.\u003c/p>\n\u003cp>“We negotiate contracts; we have leverage,” Yee said Tuesday, as the CalPERS board was conducting its third hearing on the subject. “To the extent that parity is not guaranteed, we need to make sure that our plans are living up to the law.”\u003c/p>\n\u003cp>State Treasurer Fiona Ma, who also sits on the board, said she’s seen firsthand how her own mother and brother have struggled to get adequate, timely care for depression. She’s been writing letters asking plans to explain the long wait times and high cost of care, and the growing numbers of people suffering from mental illnesses. Plans need to get more creative in finding solutions, she said.\u003cbr>\n[pullquote size=\"medium\" align=\"right\" citation=\"Cindy Striegel, a vice president at Kaiser\"]‘This is not an issue or an area that we can solve overnight. We can’t just throw more money at it. We can’t throw more effort at it. We’re doing the things that we feel are the most important.’[/pullquote]\u003c/p>\n\u003cp>“Kaiser is out on strike again today,” she said. “Why is that? Is it because everything is going well? No, it’s because things are not going well in the system and patients are getting sicker and sicker.”\u003c/p>\n\u003cp>Kaiser and the Department of Managed Health Care both sent representatives to speak at a November meeting of the CalPERS Pension and Benefits Committee.\u003c/p>\n\u003cp>DMHC director Shelley Rouillard told board members that day that the department takes its responsibility as a consumer protection agency very seriously, and outlined some of its offerings: a consumer help center, independent medical review process, regular monitoring of plans to ensure they have enough providers and enforcement actions against plans that violate timely access requirements. She said Kaiser has met all of the benchmarks of the 2017 settlement agreement so far.\u003c/p>\n\u003cp>But she also acknowledged that, in some cases, it takes years to correct problems with plans.\u003c/p>\n\u003cp>https://youtu.be/zDuLZ1oJR8k\u003c/p>\n\u003cp>Cindy Striegel, a vice president at Kaiser, said it has hired more than 1,200 full-time therapists or clinicians since 2015, an increase of 30 percent. At the same time, she said, membership has grown about 20 percent. Kaiser is continuing to recruit and currently has about 300 positions posted or in the hiring process.\u003c/p>\n\u003cp>“This is not an issue or an area that we can solve overnight,” she said. “We can’t just throw more money at it. We can’t throw more effort at it. We’re doing the things that we feel are the most important. They just take some time to implement.”\u003c/p>\n\u003cp>Susan Whitney, a psychiatric social worker at the Kern County Kaiser Medical Center in Bakersfield, said she has worked for Kaiser for 15 years. Since the state first cited Kaiser in 2013, she said, “access to care has definitely gotten worse.” She believes that’s because the state has focused its scrutiny on how long it takes to get patients in the door for an initial appointment.\u003c/p>\n\u003cp>“People can get in right away to be seen, but then we’re left saying we don’t have a follow-up appointment for them for 6 to 8 or 12 weeks,’” she said. Whitney, who works with children and teenagers, said those delays in follow-up care exist even for children have anxiety so bad they can’t go to school, or show signs of being suicidal. The network of community providers that Kaiser sometimes outsources care to has been “completely overwhelmed,” she said.\u003c/p>\n\u003cp>“There is no therapy treatment model where you see a provider every 6 to 8 weeks,” she said. “Therapy just doesn’t work that way.”\u003c/p>\n\u003cp>Vicki Hoskins, a psychiatric therapist at Kaiser’s Euclid Medical Offices in Anaheim, said last week she spent the day on the phone telling patients in crisis they can’t get an appointment for a therapist until March.\u003c/p>\n\u003cp>“It’s super stressful,” she said. “Everyone’s frustrated. It’s always been bad, but this is the worst it’s ever been.”\u003c/p>\n\u003cp>She attributes the problem, in part, to Kaiser adding members before they build up their base of clinicians, along with greater awareness of suicidality and depression. A reduced stigma around mental illness also has led more people to seek help.\u003c/p>\n\u003cp>“When someone finally decides to seek help and then are told they can’t get help for 3 months, it makes them feel worse,” she said.\u003c/p>\n\u003cp>[aside tag=\"kaiser-permanente\" label=\"More on Kaiser\"]Des Michel, 27, from Oakland, said they reached out to Kaiser in July of 2018 in crisis, seeking care for gender identity affirming therapy. Michel’s first appointment was at the end of October, at which point they received referrals to Beacon Health Services and then, a few months later to Magellan.\u003c/p>\n\u003cp>“It was overall, and still is, a very negative experience for my mental health,” Michel said. “It’s been a year and a half. I’m probably just going to suck it up and pay privately, but financially and ethically it wasn’t something I wanted to do because I feel strongly that Kaiser has an obligation to their patients to be providing mental health care.”\u003c/p>\n\u003cp>Jeanette Zollinger, 42, of Thousand Oaks, said she, too, ended up paying out of pocket to see an outside therapist when she was having a “pretty rough breakdown.”\u003c/p>\n\u003cp>“It was literally life-saving,” she said. “I really didn’t feel like I had an option to go through Kaiser when I really needed help. They just didn’t have the staffing.”\u003c/p>\n\u003cp>Rouillard at the state Department of Managed Health Care maintains that the state is doing its job, but it is challenging given the shortage of providers.\u003c/p>\n\u003cp>“Access to behavioral health care services is a very high priority for our governor and for the Secretary of the Health and Human Services Agency,” she said. “The department has been working hard to ensure health plans comply with all requirements regarding timely access to care and federal and state mental health law — parity laws.”\u003c/p>\n\u003cp>Critics are unconvinced. Meiram Bendat, a Los Angeles attorney and psychotherapist, won a much-touted case this spring in which a Northern California federal court found that United Behavioral Health had wrongly restricted treatment for patients with mental health and substance abuse disorders in order to cut costs.\u003c/p>\n\u003cp>Kaiser therapists “have every reason to be fed up with the DMHC, which over the years has created an illusion of public service by fining it a few million dollars – trivial penalties that have no actual deterrent effect,” he said. He said Kaiser could compensate for network inadequacies by covering out-of-network mental health treatment at billed charges\u003c/p>\n\u003cp>“If DMHC were truly committed to mental health reforms and not just to its public image, it would have insisted on such measures long ago,” he said.\u003c/p>\n\u003cp>\u003cem>Jocelyn Wiener is a CalMatters contributing writer. Her reporting is made possible by a grant from the California Health Care Foundation.\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://CalMatters.org\" target=\"_blank\" rel=\"noopener noreferrer\">CalMatters.org \u003c/a>is a nonprofit, nonpartisan media venture explaining California policies and politics.\u003c/em>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"excerpt": "Striking clinicians — spotlighting complaints that patients with serious mental illness face long waits and inadequate care — lay blame at the doorstep of the state Department of Managed Health Care.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Striking clinicians on Thursday plan to march from the Capitol to the state agency to protest what they called “the agency’s failure to enforce parity legislation.” They specifically criticized the agency for not releasing reports from an outside monitor that would show whether Kaiser is meeting mental health access benchmarks outlined in a 2017 settlement agreement.\u003c/p>\n\u003cp>“I’m very disappointed with the DMHC — it’s just stunning,” said Fred Seavey, research director for the National Union of Healthcare Workers, which organized the strike. “It’s just criminal in my mind that they’re not holding Kaiser accountable.”\u003c/p>\n\u003cp>“If these were cardiac catheterization services that were not functioning, if a health plan was screwing those up, (the state) would jump on that and require those to be fixed right away,” he said. “Meanwhile they’re just sitting on their hands. We have people who are dying in the course of this failed enforcement by the DMHC.”\u003c/p>\n\u003cp>Seavey criticized Kaiser’s “massive influence” with the department, and said the union may call an open-ended strike in early 2020 if Kaiser does not improve mental health services.\u003c/p>\n\u003cp>After the state’s agreement with Kaiser in 2017, the health plan created a process to ensure that follow-up appointments are available in a timely manner, the state agency said in an emailed statement. Providers who cannot get their patients in for follow-up care are supposed to notify their managers.\u003c/p>\n\u003cp>The department fined Kaiser $4 million in 2013, but the plan did not agree to a settlement with corrective actions until 2017. That \u003ca href=\"https://wpso.dmhc.ca.gov/enfactions/docs/2895/1500394196511.pdf\">settlement agreement\u003c/a> is publicly available. But while the state department receives regular updates about the plan’s progress, it says it keeps that information confidential “in compliance with federal and state laws.”\u003c/p>\n\u003cp>Kaiser spokesman Marc Brown called the strikes “disruptive to patient access, operational care and service and…frankly irresponsible.” In an emailed statement, he said this is the union’s sixth strike this year (Seavey said most of these strikes were done at individual clinics, as opposed to statewide).\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“We take any concern raised about our care very seriously, and always investigate and respond thoroughly,” Brown said. “However, it is inappropriate for the union to file multiple, often unwarranted complaints, and attack Kaiser Permanente’s reputation.”\u003c/p>\n\u003cp>More than a dozen complaints the union has filed with the DMHC in the past year — and sought to publicize — decry violations of network adequacy rules, timely access rules and long appointment wait times, among others. One complaint said patients in Pasadena with schizophrenia, serious major depression and bipolar disorder were waiting three or four months for an appointment. Another complaint said therapists in San Francisco were being told to keep alternative paper wait lists — or tell patients to call back later — to hide its failure to see children in a timely manner.\u003c/p>\n\u003cp>\u003ca href=\"https://calmatters.org/projects/californians-struggle-to-get-mental-health-care/\">Frustration with access to mental health services at Kaiser\u003c/a> extends beyond the HMO as well. According to a\u003ca href=\"https://www.chcf.org/publication/poll-shows-californians-health-priorities-new-governor-legislature/\"> statewide poll\u003c/a> by the Kaiser Family Foundation and the California Health Care Foundation released earlier this year, more than half of those surveyed thought that most people with mental health conditions are unable to get the services they need. A \u003ca href=\"http://www.milliman.com/bowman/\">recent analysis by healthcare consultants Milliman Inc.\u003c/a> showed that California patients were more than five times more likely to have office visits for mental health or addiction problems from providers outside their insurance plan’s network compared with their counterparts seeking medical or surgical care.\u003c/p>\n\u003cp>Concerned about these access problems, State Controller Betty Yee, who sits on the board of the California Public Employees’ Retirement System, wrote a letter to its executive officer requesting a series of hearings with its largest plans: Kaiser, Anthem, Blue Shield and United Healthcare. Kaiser, with more than 640,000 enrollees, has by far the highest membership.\u003c/p>\n\u003cp>“We negotiate contracts; we have leverage,” Yee said Tuesday, as the CalPERS board was conducting its third hearing on the subject. “To the extent that parity is not guaranteed, we need to make sure that our plans are living up to the law.”\u003c/p>\n\u003cp>State Treasurer Fiona Ma, who also sits on the board, said she’s seen firsthand how her own mother and brother have struggled to get adequate, timely care for depression. She’s been writing letters asking plans to explain the long wait times and high cost of care, and the growing numbers of people suffering from mental illnesses. Plans need to get more creative in finding solutions, she said.\u003cbr>\n\u003c/p>\u003c/div>",
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"content": "‘This is not an issue or an area that we can solve overnight. We can’t just throw more money at it. We can’t throw more effort at it. We’re doing the things that we feel are the most important.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Kaiser is out on strike again today,” she said. “Why is that? Is it because everything is going well? No, it’s because things are not going well in the system and patients are getting sicker and sicker.”\u003c/p>\n\u003cp>Kaiser and the Department of Managed Health Care both sent representatives to speak at a November meeting of the CalPERS Pension and Benefits Committee.\u003c/p>\n\u003cp>DMHC director Shelley Rouillard told board members that day that the department takes its responsibility as a consumer protection agency very seriously, and outlined some of its offerings: a consumer help center, independent medical review process, regular monitoring of plans to ensure they have enough providers and enforcement actions against plans that violate timely access requirements. She said Kaiser has met all of the benchmarks of the 2017 settlement agreement so far.\u003c/p>\n\u003cp>But she also acknowledged that, in some cases, it takes years to correct problems with plans.\u003c/p>\u003c/p>\u003cp>\u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutube'>\n \u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutubeInside'>\n \u003ciframe\n loading='lazy'\n class='utils-parseShortcode-shortcodes-__youtubeShortcode__youtubePlayer'\n type='text/html'\n src='//www.youtube.com/embed/zDuLZ1oJR8k'\n title='//www.youtube.com/embed/zDuLZ1oJR8k'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>Cindy Striegel, a vice president at Kaiser, said it has hired more than 1,200 full-time therapists or clinicians since 2015, an increase of 30 percent. At the same time, she said, membership has grown about 20 percent. Kaiser is continuing to recruit and currently has about 300 positions posted or in the hiring process.\u003c/p>\n\u003cp>“This is not an issue or an area that we can solve overnight,” she said. “We can’t just throw more money at it. We can’t throw more effort at it. We’re doing the things that we feel are the most important. They just take some time to implement.”\u003c/p>\n\u003cp>Susan Whitney, a psychiatric social worker at the Kern County Kaiser Medical Center in Bakersfield, said she has worked for Kaiser for 15 years. Since the state first cited Kaiser in 2013, she said, “access to care has definitely gotten worse.” She believes that’s because the state has focused its scrutiny on how long it takes to get patients in the door for an initial appointment.\u003c/p>\n\u003cp>“People can get in right away to be seen, but then we’re left saying we don’t have a follow-up appointment for them for 6 to 8 or 12 weeks,’” she said. Whitney, who works with children and teenagers, said those delays in follow-up care exist even for children have anxiety so bad they can’t go to school, or show signs of being suicidal. The network of community providers that Kaiser sometimes outsources care to has been “completely overwhelmed,” she said.\u003c/p>\n\u003cp>“There is no therapy treatment model where you see a provider every 6 to 8 weeks,” she said. “Therapy just doesn’t work that way.”\u003c/p>\n\u003cp>Vicki Hoskins, a psychiatric therapist at Kaiser’s Euclid Medical Offices in Anaheim, said last week she spent the day on the phone telling patients in crisis they can’t get an appointment for a therapist until March.\u003c/p>\n\u003cp>“It’s super stressful,” she said. “Everyone’s frustrated. It’s always been bad, but this is the worst it’s ever been.”\u003c/p>\n\u003cp>She attributes the problem, in part, to Kaiser adding members before they build up their base of clinicians, along with greater awareness of suicidality and depression. A reduced stigma around mental illness also has led more people to seek help.\u003c/p>\n\u003cp>“When someone finally decides to seek help and then are told they can’t get help for 3 months, it makes them feel worse,” she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Des Michel, 27, from Oakland, said they reached out to Kaiser in July of 2018 in crisis, seeking care for gender identity affirming therapy. Michel’s first appointment was at the end of October, at which point they received referrals to Beacon Health Services and then, a few months later to Magellan.\u003c/p>\n\u003cp>“It was overall, and still is, a very negative experience for my mental health,” Michel said. “It’s been a year and a half. I’m probably just going to suck it up and pay privately, but financially and ethically it wasn’t something I wanted to do because I feel strongly that Kaiser has an obligation to their patients to be providing mental health care.”\u003c/p>\n\u003cp>Jeanette Zollinger, 42, of Thousand Oaks, said she, too, ended up paying out of pocket to see an outside therapist when she was having a “pretty rough breakdown.”\u003c/p>\n\u003cp>“It was literally life-saving,” she said. “I really didn’t feel like I had an option to go through Kaiser when I really needed help. They just didn’t have the staffing.”\u003c/p>\n\u003cp>Rouillard at the state Department of Managed Health Care maintains that the state is doing its job, but it is challenging given the shortage of providers.\u003c/p>\n\u003cp>“Access to behavioral health care services is a very high priority for our governor and for the Secretary of the Health and Human Services Agency,” she said. “The department has been working hard to ensure health plans comply with all requirements regarding timely access to care and federal and state mental health law — parity laws.”\u003c/p>\n\u003cp>Critics are unconvinced. Meiram Bendat, a Los Angeles attorney and psychotherapist, won a much-touted case this spring in which a Northern California federal court found that United Behavioral Health had wrongly restricted treatment for patients with mental health and substance abuse disorders in order to cut costs.\u003c/p>\n\u003cp>Kaiser therapists “have every reason to be fed up with the DMHC, which over the years has created an illusion of public service by fining it a few million dollars – trivial penalties that have no actual deterrent effect,” he said. He said Kaiser could compensate for network inadequacies by covering out-of-network mental health treatment at billed charges\u003c/p>\n\u003cp>“If DMHC were truly committed to mental health reforms and not just to its public image, it would have insisted on such measures long ago,” he said.\u003c/p>\n\u003cp>\u003cem>Jocelyn Wiener is a CalMatters contributing writer. Her reporting is made possible by a grant from the California Health Care Foundation.\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://CalMatters.org\" target=\"_blank\" rel=\"noopener noreferrer\">CalMatters.org \u003c/a>is a nonprofit, nonpartisan media venture explaining California policies and politics.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Four thousand mental health clinicians are walking off their jobs at Kaiser Permanente today, affecting care at more than 100 clinics across the state. The week-long strike is the second in a year, as the workers’ union and Kaiser management remain deadlocked on a new contract.\u003c/p>\n\u003cp>Therapists’ main complaint is long wait times for patients. While industry best practice is to see clients every one to two weeks, the majority of Kaiser clinicians say their patients with anxiety and depression are forced to wait four to eight weeks between appointments.\u003c/p>\n\u003cp>“That is substandard care, that is unethical care and that is dangerous care,” said Mickey Fitzpatrick, a clinical psychologist at Kaiser in Pleasanton. “That increases the risk of suicide and, indeed, people have taken their lives.”\u003c/p>\n\u003cp>They're asking Kaiser to hire more therapists to reduce wait times and ease the workload on employees. They also want higher wages and more time to complete administrative tasks.\u003c/p>\n\u003cp>Under the current contract, Fitzpatrick said he sees four to five new patients every week, in addition to all his current patients. Unlike therapists in private practice, Fitzpatrick can not turn patients away or tell them he doesn’t have room to see them.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“There's no cap to my caseload,” he said. “It just grows and grows and grows.”\u003c/p>\n\u003cp>Kaiser executives say they are investing millions of dollars in new facilities and workforce development, including educational programs for new therapists to meet the increasing demand for mental health care.\u003c/p>\n\u003cp>The company says it increased its workforce by 30% in the last three years, including hiring nearly 500 new therapists last year, but patient demand has grown 23% in the same time.\u003c/p>\n\u003cp>“The good news is that the stigma has been removed and people that need care are actually coming forward to get it,” said Michelle Gaskill-Hames, senior vice president for hospital and health plan operations at Kaiser Northern California. But, “it's creating a rise in demand at a time when there is a shortage of workers.”\u003c/p>\n\u003cfigure id=\"attachment_11791582\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"https://ww2.kqed.org/news/2019/12/16/kaiser-therapists-strike-again-over-long-wait-times/img_3737/\" rel=\"attachment wp-att-11791582\">\u003cimg src=\"https://ww2.kqed.org/app/uploads/sites/10/2019/12/IMG_3737.jpg\" alt=\"\" width=\"1920\" height=\"1440\" class=\"size-full wp-image-11791582\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2019/12/IMG_3737.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/10/2019/12/IMG_3737-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2019/12/IMG_3737-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2019/12/IMG_3737-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2019/12/IMG_3737-1200x900.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/10/2019/12/IMG_3737-1832x1374.jpg 1832w, https://ww2.kqed.org/app/uploads/sites/10/2019/12/IMG_3737-1376x1032.jpg 1376w, https://ww2.kqed.org/app/uploads/sites/10/2019/12/IMG_3737-1044x783.jpg 1044w, https://ww2.kqed.org/app/uploads/sites/10/2019/12/IMG_3737-632x474.jpg 632w, https://ww2.kqed.org/app/uploads/sites/10/2019/12/IMG_3737-536x402.jpg 536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A Kaiser clinician during the previous Dec. 2018 strike. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Research shows there is a shortage of clinicians in some positions in some regions of the country, particularly for psychiatrists and adolescent psychiatrists in rural areas. But union members say that's not the case in most Kaiser locations, where graduate schools are “pumping out” masters and doctorate level mental health clinicians.\u003c/p>\n\u003cp>“The issue is that few people want to work for Kaiser,” said Fitzpatrick, “because once they’re working for Kaiser, they quickly burn out. They’re overloaded, they're overworked, and so they leave.”\u003c/p>\n\u003cp>California regulators have substantiated some of the therapists’ allegations. In 2013, the state Department of Managed Health Care fined Kaiser $4 million for long wait times for individual appointments and for forcing patients into group therapy who didn’t want it. The agency cited Kaiser again in 2015 and 2017 over wait times.\u003c/p>\n\u003cp>Kaiser executives say the company has improved since then, meeting the state’s standard for timely access 90% of the time in 2019, according to its own data.\u003c/p>\n\u003cp>But therapists say Kaiser is crunching the numbers to make the situation look better than it is on the ground. For example, one of Kaiser’s solutions to improving wait times for initial appointments, which they must provide with 48 hours for urgent needs and 10 days for non-urgent matters under state law, is to do intakes over the phone through its Connect 2 Care program.\u003c/p>\n\u003cp>[aside postID='news_11763856,news_11760375,news_11748021,news_11711317' label='Previous Kaiser Strikes']Clinicians say this means patients get quick access to an initial 30-minute phone appointment, but are still waiting weeks or a month to start therapy in earnest with a clinician who can see them on a regular basis, and are then waiting months between appointments.\u003c/p>\n\u003cp>“It’s mainly giving patients more of the run-around, of needing to talk to multiple providers before getting to their assigned therapist,” said Kirstin Quinn Siegel, a licensed marriage and family therapist at Kaiser’s Richmond clinic, who marched on the picket lines on Monday. “So right now they have improved their initial access, but it hasn't really made a dent in our return access.”\u003c/p>\n\u003cp>During the strike, emergency mental health services will be available and Kaiser is working to minimize disruption to ongoing care, but some appointments may need to be rescheduled.\u003c/p>\n\u003cp>“We have plans in place, but we're really disappointed that we haven't been able to draw this to resolution,” said Kaiser’s Gaskill-Hames. “This is the sixth time that there's been a strike called in 12 months, and each time it can be disruptive to our members.”\u003c/p>\n\u003cp>Two previous strikes were called off, once in June, after state lawmakers asked both sides to return to the bargaining table, and another time in November, after Kaiser CEO Bernard Tyson died unexpectedly.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Sara Hossaini contributed reporting.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Four thousand mental health clinicians are walking off their jobs at Kaiser Permanente today, affecting care at more than 100 clinics across the state. The week-long strike is the second in a year, as the workers’ union and Kaiser management remain deadlocked on a new contract.\u003c/p>\n\u003cp>Therapists’ main complaint is long wait times for patients. While industry best practice is to see clients every one to two weeks, the majority of Kaiser clinicians say their patients with anxiety and depression are forced to wait four to eight weeks between appointments.\u003c/p>\n\u003cp>“That is substandard care, that is unethical care and that is dangerous care,” said Mickey Fitzpatrick, a clinical psychologist at Kaiser in Pleasanton. “That increases the risk of suicide and, indeed, people have taken their lives.”\u003c/p>\n\u003cp>They're asking Kaiser to hire more therapists to reduce wait times and ease the workload on employees. They also want higher wages and more time to complete administrative tasks.\u003c/p>\n\u003cp>Under the current contract, Fitzpatrick said he sees four to five new patients every week, in addition to all his current patients. Unlike therapists in private practice, Fitzpatrick can not turn patients away or tell them he doesn’t have room to see them.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“There's no cap to my caseload,” he said. “It just grows and grows and grows.”\u003c/p>\n\u003cp>Kaiser executives say they are investing millions of dollars in new facilities and workforce development, including educational programs for new therapists to meet the increasing demand for mental health care.\u003c/p>\n\u003cp>The company says it increased its workforce by 30% in the last three years, including hiring nearly 500 new therapists last year, but patient demand has grown 23% in the same time.\u003c/p>\n\u003cp>“The good news is that the stigma has been removed and people that need care are actually coming forward to get it,” said Michelle Gaskill-Hames, senior vice president for hospital and health plan operations at Kaiser Northern California. But, “it's creating a rise in demand at a time when there is a shortage of workers.”\u003c/p>\n\u003cfigure id=\"attachment_11791582\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"https://ww2.kqed.org/news/2019/12/16/kaiser-therapists-strike-again-over-long-wait-times/img_3737/\" rel=\"attachment wp-att-11791582\">\u003cimg src=\"https://ww2.kqed.org/app/uploads/sites/10/2019/12/IMG_3737.jpg\" alt=\"\" width=\"1920\" height=\"1440\" class=\"size-full wp-image-11791582\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2019/12/IMG_3737.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/10/2019/12/IMG_3737-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2019/12/IMG_3737-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2019/12/IMG_3737-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2019/12/IMG_3737-1200x900.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/10/2019/12/IMG_3737-1832x1374.jpg 1832w, https://ww2.kqed.org/app/uploads/sites/10/2019/12/IMG_3737-1376x1032.jpg 1376w, https://ww2.kqed.org/app/uploads/sites/10/2019/12/IMG_3737-1044x783.jpg 1044w, https://ww2.kqed.org/app/uploads/sites/10/2019/12/IMG_3737-632x474.jpg 632w, https://ww2.kqed.org/app/uploads/sites/10/2019/12/IMG_3737-536x402.jpg 536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A Kaiser clinician during the previous Dec. 2018 strike. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Research shows there is a shortage of clinicians in some positions in some regions of the country, particularly for psychiatrists and adolescent psychiatrists in rural areas. But union members say that's not the case in most Kaiser locations, where graduate schools are “pumping out” masters and doctorate level mental health clinicians.\u003c/p>\n\u003cp>“The issue is that few people want to work for Kaiser,” said Fitzpatrick, “because once they’re working for Kaiser, they quickly burn out. They’re overloaded, they're overworked, and so they leave.”\u003c/p>\n\u003cp>California regulators have substantiated some of the therapists’ allegations. In 2013, the state Department of Managed Health Care fined Kaiser $4 million for long wait times for individual appointments and for forcing patients into group therapy who didn’t want it. The agency cited Kaiser again in 2015 and 2017 over wait times.\u003c/p>\n\u003cp>Kaiser executives say the company has improved since then, meeting the state’s standard for timely access 90% of the time in 2019, according to its own data.\u003c/p>\n\u003cp>But therapists say Kaiser is crunching the numbers to make the situation look better than it is on the ground. For example, one of Kaiser’s solutions to improving wait times for initial appointments, which they must provide with 48 hours for urgent needs and 10 days for non-urgent matters under state law, is to do intakes over the phone through its Connect 2 Care program.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Clinicians say this means patients get quick access to an initial 30-minute phone appointment, but are still waiting weeks or a month to start therapy in earnest with a clinician who can see them on a regular basis, and are then waiting months between appointments.\u003c/p>\n\u003cp>“It’s mainly giving patients more of the run-around, of needing to talk to multiple providers before getting to their assigned therapist,” said Kirstin Quinn Siegel, a licensed marriage and family therapist at Kaiser’s Richmond clinic, who marched on the picket lines on Monday. “So right now they have improved their initial access, but it hasn't really made a dent in our return access.”\u003c/p>\n\u003cp>During the strike, emergency mental health services will be available and Kaiser is working to minimize disruption to ongoing care, but some appointments may need to be rescheduled.\u003c/p>\n\u003cp>“We have plans in place, but we're really disappointed that we haven't been able to draw this to resolution,” said Kaiser’s Gaskill-Hames. “This is the sixth time that there's been a strike called in 12 months, and each time it can be disruptive to our members.”\u003c/p>\n\u003cp>Two previous strikes were called off, once in June, after state lawmakers asked both sides to return to the bargaining table, and another time in November, after Kaiser CEO Bernard Tyson died unexpectedly.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Sara Hossaini contributed reporting.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Kaiser Permanente and a coalition of 11 unions that represent the health care provider’s employees in several states, including California, reached a tentative contract deal on Wednesday. The four-year agreement includes wage increases, a workforce development program and stronger restrictions on outsourcing.\u003c/p>\n\u003cp>“This agreement will allow us to rebuild the worker-management partnership that has been so important to all of us in making Kaiser successful over the last 20 years,” said Georgette Bradford, an ultrasound technologist at Kaiser in Sacramento, in a union press release. “Reaching an agreement was not easy, it had lots of twists and turns, but in the end we accomplished what we set out to do — reach an agreement that is good for patients, workers and our communities.”\u003c/p>\n\u003cp>The deal comes after months of bargaining and several demonstrations by members of the Coalition of Kaiser Permanente Unions. Workers were threatening a nationwide strike in mid-October that would have involved more than 80,000 employees. The threat of this strike has now been withdrawn, according to Kaiser Permanente.\u003c/p>\n\u003cp>“We greatly respect and value our employees who deliver on our mission every day,” said Arlene Peasnall, interim chief human resources officer of Kaiser Permanente Health Plan and Hospitals, in a statement. “This agreement is a testament to the dedication, compassion, and skill those employees bring to work every day and demonstrates that Kaiser Permanente and the Coalition have a shared commitment to affordability for our members.”\u003c/p>\n\u003cp>“Kaiser Permanente has an unparalleled track record of working constructively with labor to solve problems together to improve the care and service offered to our members and patients,” Peasnall added. “We may disagree at times, but we have always been able to work through our challenges to align on common goals.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[aside label=\"related coverage\" tag=\"kaiser-permanente\"]\u003c/p>\n\u003cp>All employees covered by the contract, which spans seven states and Washington, D.C., will receive wage increases. The contract covers only Kaiser Permanente employees whose unions are part of the coalition, the bulk of whom are based in California.\u003c/p>\n\u003cp>The roughly 67,000 California-based employees included in the agreement will receive annual raises of 3% through 2023. The deal also outlines full protection of retirement benefits and a ban on subcontracting.\u003c/p>\n\u003cp>Notably, the agreement will create a $130 million program to reduce the shortage of health care workers in California.\u003c/p>\n\u003cp>“We’re not aware of a similar arrangement in a similar industry, and certainly not at this scale,” said Sean Wherley of SEIU-United Healthcare Workers West, one of the unions in the coalition. “This is something the workers have been pushing for in bargaining.”\u003c/p>\n\u003cp>The tentative agreement now goes to members of the coalition for ratification. Voting is expected to be completed by the end of October.\u003c/p>\n\u003cp>If ratified, the contract will go into effect on Oct. 1, 2019, and will cover many of Kaiser Permanente’s workers in California, Oregon, Washington, Colorado, Maryland, Virginia, Hawaii and Washington, D.C.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>KQED’s Alice Woelfle contributed to this story.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Kaiser Permanente and a coalition of 11 unions that represent the health care provider’s employees in several states, including California, reached a tentative contract deal on Wednesday. The four-year agreement includes wage increases, a workforce development program and stronger restrictions on outsourcing.\u003c/p>\n\u003cp>“This agreement will allow us to rebuild the worker-management partnership that has been so important to all of us in making Kaiser successful over the last 20 years,” said Georgette Bradford, an ultrasound technologist at Kaiser in Sacramento, in a union press release. “Reaching an agreement was not easy, it had lots of twists and turns, but in the end we accomplished what we set out to do — reach an agreement that is good for patients, workers and our communities.”\u003c/p>\n\u003cp>The deal comes after months of bargaining and several demonstrations by members of the Coalition of Kaiser Permanente Unions. Workers were threatening a nationwide strike in mid-October that would have involved more than 80,000 employees. The threat of this strike has now been withdrawn, according to Kaiser Permanente.\u003c/p>\n\u003cp>“We greatly respect and value our employees who deliver on our mission every day,” said Arlene Peasnall, interim chief human resources officer of Kaiser Permanente Health Plan and Hospitals, in a statement. “This agreement is a testament to the dedication, compassion, and skill those employees bring to work every day and demonstrates that Kaiser Permanente and the Coalition have a shared commitment to affordability for our members.”\u003c/p>\n\u003cp>“Kaiser Permanente has an unparalleled track record of working constructively with labor to solve problems together to improve the care and service offered to our members and patients,” Peasnall added. “We may disagree at times, but we have always been able to work through our challenges to align on common goals.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>All employees covered by the contract, which spans seven states and Washington, D.C., will receive wage increases. The contract covers only Kaiser Permanente employees whose unions are part of the coalition, the bulk of whom are based in California.\u003c/p>\n\u003cp>The roughly 67,000 California-based employees included in the agreement will receive annual raises of 3% through 2023. The deal also outlines full protection of retirement benefits and a ban on subcontracting.\u003c/p>\n\u003cp>Notably, the agreement will create a $130 million program to reduce the shortage of health care workers in California.\u003c/p>\n\u003cp>“We’re not aware of a similar arrangement in a similar industry, and certainly not at this scale,” said Sean Wherley of SEIU-United Healthcare Workers West, one of the unions in the coalition. “This is something the workers have been pushing for in bargaining.”\u003c/p>\n\u003cp>The tentative agreement now goes to members of the coalition for ratification. Voting is expected to be completed by the end of October.\u003c/p>\n\u003cp>If ratified, the contract will go into effect on Oct. 1, 2019, and will cover many of Kaiser Permanente’s workers in California, Oregon, Washington, Colorado, Maryland, Virginia, Hawaii and Washington, D.C.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>KQED’s Alice Woelfle contributed to this story.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"title": "What Passed? What Didn't? Catch Up With the California Legislature as Session Ends",
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"content": "\u003cp>The final day of session for the California State Legislature was disrupted late Friday afternoon when a woman in the Senate gallery \u003ca href=\"https://www.apnews.com/0ff009de977741e0abdd8568d9d80a29\" target=\"_blank\" rel=\"noopener\">tossed\u003c/a> what the California Highway Patrol said was a substance that “appeared to be blood” onto the Senate floor while yelling “That’s for the dead babies.”\u003c/p>\n\u003cp>East Bay Sen. Steve Glazer (D-Orinda) said the liquid landed on his head and splashed onto five other senators.\u003c/p>\n\u003cp>The woman, identified as 43-year-old Rebecca Dalelio of Santa Cruz County, is linked to some of the anti-vaccine protesters demonstrating in recent weeks over the passage of Senate Bills 276 and 714 aimed at tightening up medical exemptions for children’s vaccines. She was arrested and charged with assault, vandalism and disrupting the business at hand in the Senate.\u003c/p>\n\u003cp>The CHP cordoned off the Senate, forcing lawmakers, media and others to move into a committee room to finish its business hours later.\u003c/p>\n\u003cp>Below are some of the highlights from this legislative session, including bills that have already been signed into law, are awaiting signature or are in limbo until next year.\u003c/p>\n\u003ch2>Children’s Issues\u003c/h2>\n\u003cp>\u003cstrong>AB 378:\u003c/strong> In-home child care providers would be allowed to unionize under this measure. Supporters said unionizing could give child care workers a voice and encourage them to stay in the industry. The bill has made it through the Legislature. Several similar bills have either died or been vetoed by governors in the past. But supporters are hoping this measure will be signed by Governor Gavin Newsom.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>SB 337/AB 1092:\u003c/strong> Lawmakers sent Newsom two bills aimed at making sure more low-income kids in California benefit from child support payments.\u003c/p>\n\u003cp>Currently, a quarter of a million California families only receive $50 a month in child support payments, even if the non-custodial parent is paying hundreds of dollars more each month in child support. This happens when a family is also receiving government assistance, like welfare or Medi-Cal. The government takes the rest of the money to repay the public for the cost of those safety net programs.\u003c/p>\n\u003cp>And parents that fail to pay their required child support on time see huge interest added to those debts — 10% a year. In addition to the crippling debt that racks up, parents can also lose their driver’s license, or go to jail if they fall too far behind.\u003c/p>\n\u003cp>Two bills now on Newsom’s desk would change that: Oakland Sen. Nancy Skinner’s SB337 will increase the amount of child support paid to families on welfare assistance. Families with one child will get $100 a month under the bill; families with two or more kids will receive $200 a month. And AB 1092 will end the practice of adding interest to child support debt. Both bills, if signed by Newsom, will take effect in 2022.\u003c/p>\n\u003ch2>\u003cstrong>Health\u003c/strong>\u003c/h2>\n\u003cp>\u003cstrong>SB 24:\u003c/strong> State lawmakers have passed a \u003ca href=\"https://www.kqed.org/news/11772337/california-again-considers-making-abortion-pills-available-at-public-colleges\" target=\"_blank\" rel=\"noopener\">bill\u003c/a> that would require student health centers at all 34 state campuses to provide medication abortions.\u003c/p>\n\u003cp>If the measure becomes law, it will be the first of its kind in the U.S. The bill’s supporters say they want to remove the obstacles women face accessing medical abortion off campus.\u003c/p>\n\u003cp>While a consortium of women’s groups that support abortion rights has promised to pay for all the required ultrasound equipment and upfront training costs of providing the abortion pill on campus, eventually universities would likely need to dip into tax dollars or student fees for ongoing costs — which abortion opponents object to.\u003c/p>\n\u003cp>\u003cstrong>SB 276/SB 714:\u003c/strong> California Gov. Gavin Newsom signed a \u003ca href=\"https://www.kqed.org/news/11773308/anti-vaccine-protesters-swarm-capitol-as-lawmakers-pass-bill-limiting-medical-exemptions\" target=\"_blank\" rel=\"noopener\">pair of bills\u003c/a> into law earlier this week to crack down on doctors who write fraudulent medical exemptions for schoolchildren’s vaccinations.\u003c/p>\n\u003cp>The news laws would create state oversight of medical exemptions for vaccines required by most schools and day care centers in California. Under them, the state would begin collecting medical exemptions electronically by Jan. 1, 2021. But health department officials would review them only when a school’s immunization rate falls below 95% or when a doctor writes more than five medical exemptions per year (beginning in 2020).\u003c/p>\n\u003cp>The laws would also allow officials to revoke any medical exemptions written by doctors who have faced disciplinary action.\u003c/p>\n\u003cp>Since being introduced last year, hundreds of parents have protested the legislation, insisting it would disrupt confidential doctor-patient relationships and scare doctors from writing new exemptions.\u003c/p>\n\u003cp>\u003cstrong>SB 343:\u003c/strong> Under legislation signed into law last week, Kaiser Permanente will have to share more information — like other insurers do — on revenue and expenses at each of its facilities, \u003ca href=\"https://www.sacbee.com/news/local/health-and-medicine/article234806097.html#storylink=cpy\" target=\"_blank\" rel=\"noopener\">The Sacramento Bee\u003c/a> reported. The legislation was introduced on behalf of Kaiser’s largest union, the Service Employees International Union, which has been in contract negotiations for roughly a year.\u003c/p>\n\u003ch2>Housing\u003c/h2>\n\u003cp>\u003cstrong>AB 1482\u003c/strong> marks the biggest victory for California renter protections in decades. It would create a statewide limit on rent increases of 5% plus inflation, and requires that landlords provide a “just cause” when evicting tenants who have been renting for a year. The limits on rent hikes don’t go nearly as far as local rent control laws in places like San Francisco and Oakland, but it would cover millions of Californians whose units don’t already have such protections.\u003c/p>\n\u003cp>The measure exempts units under 15 years old, but it was opposed by real estate agents who argued that the legislation would discourage construction of rental housing. Newsom has committed to signing the bill, which will sunset after 10 years.\u003c/p>\n\u003cp>\u003cstrong>AB 1487\u003c/strong>, which has been sent to Newsom, would allow for a Bay Area regional ballot measure to raise money for affordable housing. Previous measures on ballots in the nine counties have raised taxes to pay for transportation and bay restoration. The executive board of the Association of Bay Area Governments (ABAG) and the Metropolitan Transportation Commission (MTC) would decide what form a potential revenue-raising measure would take.\u003c/p>\n\u003cp>\u003cstrong>SB 330\u003c/strong>, which has been sent to Newsom, would prohibit local governments from downzoning by either placing a moratorium on development or lowering the number of housing units permitted. It also would speed up the permitting process for development. The provision sunsets after five years.\u003c/p>\n\u003ch2>Law Enforcement\u003c/h2>\n\u003cp>\u003cstrong>SB 22\u003c/strong> requires prompt testing of newly collected rape kits in Califonia. Under the bill, new rape kits must be submitted for testing within 20 days and actually tested with 120 days. The bill’s author, Senator Connie Leyva (D-Chino) says the measure would help solve crimes and prevent testing backlogs.\u003c/p>\n\u003cp>“Survivors should never have to wait years or even decades for their rape kits to be tested and it is outrageous that collected evidence could ever sit on a shelf untested,” Leyva said.\u003c/p>\n\u003cp>\u003cstrong>SB 230 \u003c/strong>is meant to reduce the use of force among law enforcement agencies. Governor Newsom has signed it into law.\u003c/p>\n\u003cp>The new law requires agencies to maintain a policy providing guidelines on the use of force. That policy must also include de-escalation techniques and other alternatives to force, and specific guidelines for when deadly force can be used. In addition, the agencies’ policies must include a way to evaluate and review all use- of-force incidents.\u003c/p>\n\u003cp>\u003cstrong>SB 230\u003c/strong> is meant to be used in conjunction with \u003cstrong>AB 392\u003c/strong>, which Newsom signed into law in August. It states law enforcement can use deadly force only when “necessary,” rather than just “reasonable.”\u003c/p>\n\u003cp>\u003cstrong>AB 61\u003c/strong> would expand the scope of people able to request a gun violence restraining order against a person they believe is a danger to themselves or others. Currently, only immediate family members and police are allowed to make a request. This measure would allow employers, co-workers, schoolteachers and employees to request a restraining order as well. The legislation has been sent to Newsom for his signature.\u003c/p>\n\u003cp>\u003cstrong>AB 1215\u003c/strong> places a three-year ban on the use of facial recognition technology on body cameras by the state and local law enforcement agencies.\u003c/p>\n\u003cp>The bill was supported by the ACLU, which said the technology is not ready for prime time. To prove its point, the ACLU entered photos of all 120 state legislators into a database of mugshots. The software incorrectly identified 26 of the lawmakers as criminals.\u003c/p>\n\u003cp>San Francisco and Oakland have already passed similar legislation. The bill has been sent to Newsom for his signature.\u003c/p>\n\u003ch2>Prisons\u003c/h2>\n\u003cp>\u003cstrong>AB 32\u003c/strong> would ban the use of private for-profit prisons and detention centers in California.\u003c/p>\n\u003cp>Bill author Rob Bonta (D-Oakland) said there’s no room for the facilities in the state. “California should not be home to companies that are profiteering from the tearing of innocent children from their families. This is inhumane and goes against who we are as Californians and Americans,” Bonta said.\u003c/p>\n\u003cp>Critics say the measure would reduce the state’s options for dealing with prison overcrowding and put more pressure on local jails to hold dangerous inmates. The legislation has been sent to Newsom for his signature.\u003c/p>\n\u003cp>\u003cstrong>SB 132,\u003c/strong> which would allow transgender prisoners in the Department of Corrections and Rehabilitation (CDCR) to be housed according to their gender identity, and not their sex assigned at birth, will be carried over to the next session.\u003c/p>\n\u003cp>California would be the third state in the nation to pass such legislation.\u003c/p>\n\u003cp>The bill’s sponsor, Sen. Scott Wiener of San Francisco, said the coalition supporting the legislation had decided to make it a two-year bill so they could “come to a solution that works for” the community, CDCR and Newsom.\u003c/p>\n\u003cp>“Transgender people in our prison system are among the most marginalized people in society, and we must protect them,” he said Friday in a statement. “Over the fall recess, I will join community leaders to visit several state prisons to meet with transgender people who are incarcerated there. This listening tour will help us craft the best legislation possible.”\u003c/p>\n\u003cp>\u003cstrong>SB 136\u003c/strong> is part of a larger push in California to roll back tough on crime laws that helped pack prisons and jails to the brim and resulted in ballooning corrections spending in the Golden State.\u003c/p>\n\u003cp>The bill would end the practice of automatically adding an extra year to a defendant’s sentence if they had previously served time for a felony. Wiener said 11,000 people currently in prison have this extra year tacked on at a cost of $80,000 a year. State officials estimate that the change would save taxpayers $80 million a year. The legislation has passed the Legislature and is heading to the governor.\u003c/p>\n\u003ch2>The Environment\u003c/h2>\n\u003cp>\u003cstrong>AB 792\u003c/strong> would establish a minimum level of recycled content – 50% – in plastic bottles by 2035. On Monday, Assemblyman Phil Ting introduced another bill, \u003cstrong>AB 54\u003c/strong>, to bring temporary relief to cities feeling the bite from the sudden closure of recycling centers across the state. The bill provides $10 million for recycling centers and gives grocers a reprieve from paying some recycling fees. Both bills passed the Legislature.\u003c/p>\n\u003cp>\u003cstrong>SB 1\u003c/strong> is aimed at blunting any weakening of federal environmental laws in California by the Trump Administration. It was sent to Gov. Newsom early Saturday morning with strong backing from environmental groups, despite vigorous objections from Sen. Dianne Feinstein and some water groups who warned against creating two sets of environmental standards. If signed by the governor (or allowed to take effect without his signature) it would replace any federal environmental regulation (Clean Power Plan, Endangered Species Act, etc.) with a state alternative.\u003c/p>\n\u003cp>\u003cstrong>AB 1080 and SB 54:\u003c/strong> The legislative session ended without passage of the bills, which would have enacted the strongest plastic pollution rules in the U.S. The bills are eligible to be considered next year.\u003c/p>\n\u003cp>The plan required plastics manufacturers to take responsibility for the fate of their products — from coffee cup lids to takeout boxes to plastic packaging.\u003c/p>\n\u003cp>Businesses would have had to ensure that plastic forks, for example, are recyclable or face a potential ban. If the bill had passed, all of the state’s single-use plastic utensils would need to be recyclable or compostable by 2030, and companies must reduce waste from plastic packaging by 75%.\u003c/p>\n\u003ch2>\u003cstrong>Wildfires\u003c/strong>\u003c/h2>\n\u003cp>\u003cstrong>SB 160:\u003c/strong> This bill mandates that counties include “cultural competence” into emergency plans. It’s partially a response to elderly and non-English-speaking residents who missed emergency alerts during the state’s recent wildfires.\u003c/p>\n\u003cp>The bill, which has been sent to Newsom for his signature, calls for local communities to hold public forums that represent residents of many backgrounds when counties plan their emergency protocols.\u003c/p>\n\u003cp>\u003cstrong>SB 520\u003c/strong> would give utilities like PG&E the designation of “provider of last resort” in the areas they serve. Utilities already enjoy that privilege in practice, but the law sponsored by Sen. Robert Hertzberg would enshrine it in the law.\u003c/p>\n\u003cp>Critics say the bill could limit the options that cities and counties have to wrest control from utilities and run them municipally, and limit opportunities for community choice aggregation just as they are starting to thrive. The legislation has been sent to Newsom for his signature.\u003c/p>\n\u003ch2>Other Notable Bills\u003c/h2>\n\u003cp>\u003cstrong>SB 206:\u003c/strong> NBA icon LeBron James threw his weight behind SB 206, the “Fair Pay to Play” bill by East Bay Sen. Nancy Skinner that would allow student-athletes at all four-year colleges in California to sign endorsement deals and receive compensation for the use of their names, images or likenesses.\u003c/p>\n\u003cp>But NCAA President Mark Emmert wrote in a letter to Newsom that signing the legislation could make it “impossible to host fair national championships.” He also implied that if the bill became law, athletes at California schools could be barred from competing in NCAA national championships.\u003c/p>\n\u003cp>Nonetheless, the Senate and the Assembly passed the bill without any opposition. Now — will LeBron be there for the bill signing?\u003c/p>\n\u003cp>\u003cstrong>AB 44: \u003c/strong>Anti-fur advocates have long sought a ban on killing animals for their fur. And if Newsom signs this bill, which he said he will in a tweet, California will become the first state in the nation to ban the creation of new fur products. Republican critics said the state was once again telling Californians what they can and cannot do (the nanny state argument) and that it was disrespectful to Native Americans, whose cultures value fur. The mink, rabbit and coyote communities are no doubt pleased.\u003c/p>\n\u003cp>\u003cstrong>AB 1505\u003c/strong> seeks to more closely regulate California’s 1,300 charter schools. It would allow school districts to consider the impact to the community and the neighborhood schools when reviewing applications for new or expanded charter schools. It would require charter school teachers to be credentialed and establishes a two-year moratorium on non-classroom based charter schools. The legislation has been sent to Newsom.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cstrong>SB 313:\u003c/strong> Another victory for furry citizens of California, this bill would ban the use of wild animals in circus acts, including bears, elephants, tigers and monkeys. If signed by Newsom, California will become the third state after New Jersey and Hawaii to enact such a ban.\u003c/p>\n\n",
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"excerpt": "From crackdowns on fake medical exemptions for schoolchildren's vaccinations to reducing the use of force among law enforcement agencies, here is some of the notable legislation from lawmakers this year.",
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"title": "What Passed? What Didn't? Catch Up With the California Legislature as Session Ends | KQED",
"description": "From crackdowns on fake medical exemptions for schoolchildren's vaccinations to reducing the use of force among law enforcement agencies, here is some of the notable legislation from lawmakers this year.",
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"headline": "What Passed? What Didn't? Catch Up With the California Legislature as Session Ends",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The final day of session for the California State Legislature was disrupted late Friday afternoon when a woman in the Senate gallery \u003ca href=\"https://www.apnews.com/0ff009de977741e0abdd8568d9d80a29\" target=\"_blank\" rel=\"noopener\">tossed\u003c/a> what the California Highway Patrol said was a substance that “appeared to be blood” onto the Senate floor while yelling “That’s for the dead babies.”\u003c/p>\n\u003cp>East Bay Sen. Steve Glazer (D-Orinda) said the liquid landed on his head and splashed onto five other senators.\u003c/p>\n\u003cp>The woman, identified as 43-year-old Rebecca Dalelio of Santa Cruz County, is linked to some of the anti-vaccine protesters demonstrating in recent weeks over the passage of Senate Bills 276 and 714 aimed at tightening up medical exemptions for children’s vaccines. She was arrested and charged with assault, vandalism and disrupting the business at hand in the Senate.\u003c/p>\n\u003cp>The CHP cordoned off the Senate, forcing lawmakers, media and others to move into a committee room to finish its business hours later.\u003c/p>\n\u003cp>Below are some of the highlights from this legislative session, including bills that have already been signed into law, are awaiting signature or are in limbo until next year.\u003c/p>\n\u003ch2>Children’s Issues\u003c/h2>\n\u003cp>\u003cstrong>AB 378:\u003c/strong> In-home child care providers would be allowed to unionize under this measure. Supporters said unionizing could give child care workers a voice and encourage them to stay in the industry. The bill has made it through the Legislature. Several similar bills have either died or been vetoed by governors in the past. But supporters are hoping this measure will be signed by Governor Gavin Newsom.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>SB 337/AB 1092:\u003c/strong> Lawmakers sent Newsom two bills aimed at making sure more low-income kids in California benefit from child support payments.\u003c/p>\n\u003cp>Currently, a quarter of a million California families only receive $50 a month in child support payments, even if the non-custodial parent is paying hundreds of dollars more each month in child support. This happens when a family is also receiving government assistance, like welfare or Medi-Cal. The government takes the rest of the money to repay the public for the cost of those safety net programs.\u003c/p>\n\u003cp>And parents that fail to pay their required child support on time see huge interest added to those debts — 10% a year. In addition to the crippling debt that racks up, parents can also lose their driver’s license, or go to jail if they fall too far behind.\u003c/p>\n\u003cp>Two bills now on Newsom’s desk would change that: Oakland Sen. Nancy Skinner’s SB337 will increase the amount of child support paid to families on welfare assistance. Families with one child will get $100 a month under the bill; families with two or more kids will receive $200 a month. And AB 1092 will end the practice of adding interest to child support debt. Both bills, if signed by Newsom, will take effect in 2022.\u003c/p>\n\u003ch2>\u003cstrong>Health\u003c/strong>\u003c/h2>\n\u003cp>\u003cstrong>SB 24:\u003c/strong> State lawmakers have passed a \u003ca href=\"https://www.kqed.org/news/11772337/california-again-considers-making-abortion-pills-available-at-public-colleges\" target=\"_blank\" rel=\"noopener\">bill\u003c/a> that would require student health centers at all 34 state campuses to provide medication abortions.\u003c/p>\n\u003cp>If the measure becomes law, it will be the first of its kind in the U.S. The bill’s supporters say they want to remove the obstacles women face accessing medical abortion off campus.\u003c/p>\n\u003cp>While a consortium of women’s groups that support abortion rights has promised to pay for all the required ultrasound equipment and upfront training costs of providing the abortion pill on campus, eventually universities would likely need to dip into tax dollars or student fees for ongoing costs — which abortion opponents object to.\u003c/p>\n\u003cp>\u003cstrong>SB 276/SB 714:\u003c/strong> California Gov. Gavin Newsom signed a \u003ca href=\"https://www.kqed.org/news/11773308/anti-vaccine-protesters-swarm-capitol-as-lawmakers-pass-bill-limiting-medical-exemptions\" target=\"_blank\" rel=\"noopener\">pair of bills\u003c/a> into law earlier this week to crack down on doctors who write fraudulent medical exemptions for schoolchildren’s vaccinations.\u003c/p>\n\u003cp>The news laws would create state oversight of medical exemptions for vaccines required by most schools and day care centers in California. Under them, the state would begin collecting medical exemptions electronically by Jan. 1, 2021. But health department officials would review them only when a school’s immunization rate falls below 95% or when a doctor writes more than five medical exemptions per year (beginning in 2020).\u003c/p>\n\u003cp>The laws would also allow officials to revoke any medical exemptions written by doctors who have faced disciplinary action.\u003c/p>\n\u003cp>Since being introduced last year, hundreds of parents have protested the legislation, insisting it would disrupt confidential doctor-patient relationships and scare doctors from writing new exemptions.\u003c/p>\n\u003cp>\u003cstrong>SB 343:\u003c/strong> Under legislation signed into law last week, Kaiser Permanente will have to share more information — like other insurers do — on revenue and expenses at each of its facilities, \u003ca href=\"https://www.sacbee.com/news/local/health-and-medicine/article234806097.html#storylink=cpy\" target=\"_blank\" rel=\"noopener\">The Sacramento Bee\u003c/a> reported. The legislation was introduced on behalf of Kaiser’s largest union, the Service Employees International Union, which has been in contract negotiations for roughly a year.\u003c/p>\n\u003ch2>Housing\u003c/h2>\n\u003cp>\u003cstrong>AB 1482\u003c/strong> marks the biggest victory for California renter protections in decades. It would create a statewide limit on rent increases of 5% plus inflation, and requires that landlords provide a “just cause” when evicting tenants who have been renting for a year. The limits on rent hikes don’t go nearly as far as local rent control laws in places like San Francisco and Oakland, but it would cover millions of Californians whose units don’t already have such protections.\u003c/p>\n\u003cp>The measure exempts units under 15 years old, but it was opposed by real estate agents who argued that the legislation would discourage construction of rental housing. Newsom has committed to signing the bill, which will sunset after 10 years.\u003c/p>\n\u003cp>\u003cstrong>AB 1487\u003c/strong>, which has been sent to Newsom, would allow for a Bay Area regional ballot measure to raise money for affordable housing. Previous measures on ballots in the nine counties have raised taxes to pay for transportation and bay restoration. The executive board of the Association of Bay Area Governments (ABAG) and the Metropolitan Transportation Commission (MTC) would decide what form a potential revenue-raising measure would take.\u003c/p>\n\u003cp>\u003cstrong>SB 330\u003c/strong>, which has been sent to Newsom, would prohibit local governments from downzoning by either placing a moratorium on development or lowering the number of housing units permitted. It also would speed up the permitting process for development. The provision sunsets after five years.\u003c/p>\n\u003ch2>Law Enforcement\u003c/h2>\n\u003cp>\u003cstrong>SB 22\u003c/strong> requires prompt testing of newly collected rape kits in Califonia. Under the bill, new rape kits must be submitted for testing within 20 days and actually tested with 120 days. The bill’s author, Senator Connie Leyva (D-Chino) says the measure would help solve crimes and prevent testing backlogs.\u003c/p>\n\u003cp>“Survivors should never have to wait years or even decades for their rape kits to be tested and it is outrageous that collected evidence could ever sit on a shelf untested,” Leyva said.\u003c/p>\n\u003cp>\u003cstrong>SB 230 \u003c/strong>is meant to reduce the use of force among law enforcement agencies. Governor Newsom has signed it into law.\u003c/p>\n\u003cp>The new law requires agencies to maintain a policy providing guidelines on the use of force. That policy must also include de-escalation techniques and other alternatives to force, and specific guidelines for when deadly force can be used. In addition, the agencies’ policies must include a way to evaluate and review all use- of-force incidents.\u003c/p>\n\u003cp>\u003cstrong>SB 230\u003c/strong> is meant to be used in conjunction with \u003cstrong>AB 392\u003c/strong>, which Newsom signed into law in August. It states law enforcement can use deadly force only when “necessary,” rather than just “reasonable.”\u003c/p>\n\u003cp>\u003cstrong>AB 61\u003c/strong> would expand the scope of people able to request a gun violence restraining order against a person they believe is a danger to themselves or others. Currently, only immediate family members and police are allowed to make a request. This measure would allow employers, co-workers, schoolteachers and employees to request a restraining order as well. The legislation has been sent to Newsom for his signature.\u003c/p>\n\u003cp>\u003cstrong>AB 1215\u003c/strong> places a three-year ban on the use of facial recognition technology on body cameras by the state and local law enforcement agencies.\u003c/p>\n\u003cp>The bill was supported by the ACLU, which said the technology is not ready for prime time. To prove its point, the ACLU entered photos of all 120 state legislators into a database of mugshots. The software incorrectly identified 26 of the lawmakers as criminals.\u003c/p>\n\u003cp>San Francisco and Oakland have already passed similar legislation. The bill has been sent to Newsom for his signature.\u003c/p>\n\u003ch2>Prisons\u003c/h2>\n\u003cp>\u003cstrong>AB 32\u003c/strong> would ban the use of private for-profit prisons and detention centers in California.\u003c/p>\n\u003cp>Bill author Rob Bonta (D-Oakland) said there’s no room for the facilities in the state. “California should not be home to companies that are profiteering from the tearing of innocent children from their families. This is inhumane and goes against who we are as Californians and Americans,” Bonta said.\u003c/p>\n\u003cp>Critics say the measure would reduce the state’s options for dealing with prison overcrowding and put more pressure on local jails to hold dangerous inmates. The legislation has been sent to Newsom for his signature.\u003c/p>\n\u003cp>\u003cstrong>SB 132,\u003c/strong> which would allow transgender prisoners in the Department of Corrections and Rehabilitation (CDCR) to be housed according to their gender identity, and not their sex assigned at birth, will be carried over to the next session.\u003c/p>\n\u003cp>California would be the third state in the nation to pass such legislation.\u003c/p>\n\u003cp>The bill’s sponsor, Sen. Scott Wiener of San Francisco, said the coalition supporting the legislation had decided to make it a two-year bill so they could “come to a solution that works for” the community, CDCR and Newsom.\u003c/p>\n\u003cp>“Transgender people in our prison system are among the most marginalized people in society, and we must protect them,” he said Friday in a statement. “Over the fall recess, I will join community leaders to visit several state prisons to meet with transgender people who are incarcerated there. This listening tour will help us craft the best legislation possible.”\u003c/p>\n\u003cp>\u003cstrong>SB 136\u003c/strong> is part of a larger push in California to roll back tough on crime laws that helped pack prisons and jails to the brim and resulted in ballooning corrections spending in the Golden State.\u003c/p>\n\u003cp>The bill would end the practice of automatically adding an extra year to a defendant’s sentence if they had previously served time for a felony. Wiener said 11,000 people currently in prison have this extra year tacked on at a cost of $80,000 a year. State officials estimate that the change would save taxpayers $80 million a year. The legislation has passed the Legislature and is heading to the governor.\u003c/p>\n\u003ch2>The Environment\u003c/h2>\n\u003cp>\u003cstrong>AB 792\u003c/strong> would establish a minimum level of recycled content – 50% – in plastic bottles by 2035. On Monday, Assemblyman Phil Ting introduced another bill, \u003cstrong>AB 54\u003c/strong>, to bring temporary relief to cities feeling the bite from the sudden closure of recycling centers across the state. The bill provides $10 million for recycling centers and gives grocers a reprieve from paying some recycling fees. Both bills passed the Legislature.\u003c/p>\n\u003cp>\u003cstrong>SB 1\u003c/strong> is aimed at blunting any weakening of federal environmental laws in California by the Trump Administration. It was sent to Gov. Newsom early Saturday morning with strong backing from environmental groups, despite vigorous objections from Sen. Dianne Feinstein and some water groups who warned against creating two sets of environmental standards. If signed by the governor (or allowed to take effect without his signature) it would replace any federal environmental regulation (Clean Power Plan, Endangered Species Act, etc.) with a state alternative.\u003c/p>\n\u003cp>\u003cstrong>AB 1080 and SB 54:\u003c/strong> The legislative session ended without passage of the bills, which would have enacted the strongest plastic pollution rules in the U.S. The bills are eligible to be considered next year.\u003c/p>\n\u003cp>The plan required plastics manufacturers to take responsibility for the fate of their products — from coffee cup lids to takeout boxes to plastic packaging.\u003c/p>\n\u003cp>Businesses would have had to ensure that plastic forks, for example, are recyclable or face a potential ban. If the bill had passed, all of the state’s single-use plastic utensils would need to be recyclable or compostable by 2030, and companies must reduce waste from plastic packaging by 75%.\u003c/p>\n\u003ch2>\u003cstrong>Wildfires\u003c/strong>\u003c/h2>\n\u003cp>\u003cstrong>SB 160:\u003c/strong> This bill mandates that counties include “cultural competence” into emergency plans. It’s partially a response to elderly and non-English-speaking residents who missed emergency alerts during the state’s recent wildfires.\u003c/p>\n\u003cp>The bill, which has been sent to Newsom for his signature, calls for local communities to hold public forums that represent residents of many backgrounds when counties plan their emergency protocols.\u003c/p>\n\u003cp>\u003cstrong>SB 520\u003c/strong> would give utilities like PG&E the designation of “provider of last resort” in the areas they serve. Utilities already enjoy that privilege in practice, but the law sponsored by Sen. Robert Hertzberg would enshrine it in the law.\u003c/p>\n\u003cp>Critics say the bill could limit the options that cities and counties have to wrest control from utilities and run them municipally, and limit opportunities for community choice aggregation just as they are starting to thrive. The legislation has been sent to Newsom for his signature.\u003c/p>\n\u003ch2>Other Notable Bills\u003c/h2>\n\u003cp>\u003cstrong>SB 206:\u003c/strong> NBA icon LeBron James threw his weight behind SB 206, the “Fair Pay to Play” bill by East Bay Sen. Nancy Skinner that would allow student-athletes at all four-year colleges in California to sign endorsement deals and receive compensation for the use of their names, images or likenesses.\u003c/p>\n\u003cp>But NCAA President Mark Emmert wrote in a letter to Newsom that signing the legislation could make it “impossible to host fair national championships.” He also implied that if the bill became law, athletes at California schools could be barred from competing in NCAA national championships.\u003c/p>\n\u003cp>Nonetheless, the Senate and the Assembly passed the bill without any opposition. Now — will LeBron be there for the bill signing?\u003c/p>\n\u003cp>\u003cstrong>AB 44: \u003c/strong>Anti-fur advocates have long sought a ban on killing animals for their fur. And if Newsom signs this bill, which he said he will in a tweet, California will become the first state in the nation to ban the creation of new fur products. Republican critics said the state was once again telling Californians what they can and cannot do (the nanny state argument) and that it was disrespectful to Native Americans, whose cultures value fur. The mink, rabbit and coyote communities are no doubt pleased.\u003c/p>\n\u003cp>\u003cstrong>AB 1505\u003c/strong> seeks to more closely regulate California’s 1,300 charter schools. It would allow school districts to consider the impact to the community and the neighborhood schools when reviewing applications for new or expanded charter schools. It would require charter school teachers to be credentialed and establishes a two-year moratorium on non-classroom based charter schools. The legislation has been sent to Newsom.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>SB 313:\u003c/strong> Another victory for furry citizens of California, this bill would ban the use of wild animals in circus acts, including bears, elephants, tigers and monkeys. If signed by Newsom, California will become the third state after New Jersey and Hawaii to enact such a ban.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>About 1,000 health care workers protested in Oakland Monday to show Kaiser Permanente they’re serious about a potential strike in October, after negotiations for a new contract stalled.\u003c/p>\n\u003cp>Kaiser Permanente employees and their families rallied at Mosswood Park in Oakland and then marched to Kaiser’s Oakland Medical Center. The streets surrounding the hospital, at West MacArthur Boulevard and Broadway, shut down as protesters peacefully blocked traffic.\u003c/p>\n\u003cp>Employees represented by the Coalition of Kaiser Permanente Unions have been without a contract since September of last year. They said Kaiser is not bargaining fairly with them and is outsourcing jobs that would otherwise go to union members.\u003c/p>\n\u003cp>This impacts patient care, union members said. Sonya Allen-Smith is a radiology technician at the hospital. She has worked for Kaiser for 10 years and says things have changed recently.\u003c/p>\n\u003cp>“We see the change in higher patient wait times in the hospital, less time that we can give to patients at times,” she said.\u003c/p>\n\u003cp>https://twitter.com/lauraklivans/status/1168575047180541957\u003c/p>\n\u003cp>Wearing a SEIU-United Healthcare Workers West T-shirt, Union President Dave Regan told the crowd during the rally that the workers’ fight is simple.\u003c/p>\n\u003cp>“Are you with the workers? Are you with the people? Are you with the community? Are you with the caregivers? Or are you with the millionaires?” Regan said.\u003c/p>\n\u003cp>https://twitter.com/lauraklivans/status/1168574674369859585\u003c/p>\n\u003cp>Edmund Chan, Kaiser Permanente’s senior vice president, said the health care organization is also committed to patient care and working with unions.\u003c/p>\n\u003cp>“Our latest proposal is creating competitive wages and we are maintaining strong benefits for our employees,” said Chan. “We’ve put across-the-table guaranteed wage increases over the life of the next contract through 2022.”\u003c/p>\n\u003cp>https://twitter.com/lauraklivans/status/1168585228983492609\u003c/p>\n\u003cp>The unions and representatives from Kaiser Permanente will sit down again to bargain on Sept. 16. If no agreement is reached, the Coalition of Kaiser Permanente Unions said they will strike at the start of October.\u003c/p>\n\u003cp>Employees say Kaiser has been increasing its use of outsourcing. Allen-Smith, the radiology technician, said that impacts local communities.\u003c/p>\n\u003cp>“Right now people can’t even afford to live in the Bay Area,” said Allen-Smith. “So now we talking outsourcing jobs — where are these people gonna come from? Are they gonna work two or three jobs? Are they commuting from a larger distance to take care of our members? It’s not right.”\u003c/p>\n\u003cp>The unions said Kaiser made more than $5 billion in profits in the last two quarters. Among the workers, there’s a feeling that Kaiser Permanente, which is a nonprofit, has gone astray and is too focused on profit.\u003c/p>\n\u003cp>Chan called Monday’s protest a “publicity stunt.”\u003c/p>\n\u003cp>“It’s unfortunate that today’s being used by some of our unions to stage a planned civil disobedience, and quite frankly a publicity stunt, that’s taking away city and police resources,” he said. “We remain committed to meeting and being at the bargaining table to create a contract for our employees that makes sense for all parties.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\n\u003cp>The unions and representatives from Kaiser Permanente will sit down again to bargain on Sept. 16. If no agreement is reached, the Coalition of Kaiser Permanente Unions said they will strike at the start of October.\u003c/p>\n\u003cp>Employees say Kaiser has been increasing its use of outsourcing. Allen-Smith, the radiology technician, said that impacts local communities.\u003c/p>\n\u003cp>“Right now people can’t even afford to live in the Bay Area,” said Allen-Smith. “So now we talking outsourcing jobs — where are these people gonna come from? Are they gonna work two or three jobs? Are they commuting from a larger distance to take care of our members? It’s not right.”\u003c/p>\n\u003cp>The unions said Kaiser made more than $5 billion in profits in the last two quarters. Among the workers, there’s a feeling that Kaiser Permanente, which is a nonprofit, has gone astray and is too focused on profit.\u003c/p>\n\u003cp>Chan called Monday’s protest a “publicity stunt.”\u003c/p>\n\u003cp>“It’s unfortunate that today’s being used by some of our unions to stage a planned civil disobedience, and quite frankly a publicity stunt, that’s taking away city and police resources,” he said. “We remain committed to meeting and being at the bargaining table to create a contract for our employees that makes sense for all parties.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Kaiser Permanente workers will begin voting Monday on whether to \u003ca href=\"http://go.seiu-uhw.org/StrikeVote\" target=\"_blank\" rel=\"noopener\">authorize\u003c/a> a massive strike that would affect Kaiser facilities nationwide, according to the Service Employees International Union, one of the unions representing Kaiser workers.\u003c/p>\n\u003cp>Workers at Kaiser Permanente Medical Center in Oakland will vote on Monday. Voting will go on for more than a month as Kaiser workers in California, Oregon, Washington, Colorado, Virginia and Washington, D.C. cast ballots.\u003c/p>\n\u003cp>If authorized, the strike will begin in early October. If approved, the union said it would be the biggest strike in 20 years. According to the union, Kaiser workers have been without a contract since Sept. 30 and talks stalled on July 12.\u003c/p>\n\u003cp>The union is accusing Kaiser of unfair labor practices, saying that the healthcare company is paying its executives exorbitant salaries while not providing adequate resources to workers and patients.\u003c/p>\n\u003cp>A spokesperson for Kaiser did not immediately return a request for comment.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Many Kaiser workers have been outspoken about their issues with the company in recent months. Earlier this month, Kaiser mental health care workers in San Francisco staged a \u003ca href=\"https://www.kqed.org/news/11760375/kaiser-permanente-therapists-hold-one-day-strike-in-san-francisco-over-staffing-shortages\" target=\"_blank\" rel=\"noopener\">one-day strike\u003c/a>, saying that staffing reductions have led to severe cutbacks and long delays in service for serious mental health conditions.\u003c/p>\n\u003cp>At a recent Oakland City Council meeting, many Kaiser workers spoke in opposition to the council selling a city-owned parcel to a developer for a massive project on Telegraph Avenue that would eventually serve as Kaiser's new headquarters.\u003c/p>\n\u003cp>While councilmembers encouraged Kaiser to reach a resolution with its workers, the council approved the land sale.\u003c/p>\n\u003cp>Sonia Allen Smith, a radiology technologist at Kaiser's Oakland medical center, said in a statement that Kaiser \"has abandoned its mission to serve communities in favor of earning massive profits and enriching top executives.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Kaiser's executives \"are thriving as Kaiser raises prices for patients, undermines quality healthcare, refuses to bargain in good faith and attacks the frontline healthcare workers who have made it successful,\" Smith said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Many Kaiser workers have been outspoken about their issues with the company in recent months. Earlier this month, Kaiser mental health care workers in San Francisco staged a \u003ca href=\"https://www.kqed.org/news/11760375/kaiser-permanente-therapists-hold-one-day-strike-in-san-francisco-over-staffing-shortages\" target=\"_blank\" rel=\"noopener\">one-day strike\u003c/a>, saying that staffing reductions have led to severe cutbacks and long delays in service for serious mental health conditions.\u003c/p>\n\u003cp>At a recent Oakland City Council meeting, many Kaiser workers spoke in opposition to the council selling a city-owned parcel to a developer for a massive project on Telegraph Avenue that would eventually serve as Kaiser's new headquarters.\u003c/p>\n\u003cp>While councilmembers encouraged Kaiser to reach a resolution with its workers, the council approved the land sale.\u003c/p>\n\u003cp>Sonia Allen Smith, a radiology technologist at Kaiser's Oakland medical center, said in a statement that Kaiser \"has abandoned its mission to serve communities in favor of earning massive profits and enriching top executives.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Kaiser's executives \"are thriving as Kaiser raises prices for patients, undermines quality healthcare, refuses to bargain in good faith and attacks the frontline healthcare workers who have made it successful,\" Smith said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"title": "The California Report Magazine",
"tagline": "Your state, your stories",
"info": "Every week, The California Report Magazine takes you on a road trip for the ears: to visit the places and meet the people who make California unique. The in-depth storytelling podcast from the California Report.",
"airtime": "FRI 4:30pm-5pm, 6:30pm-7pm, 11pm-11:30pm",
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"officialWebsiteLink": "/californiareportmagazine",
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"order": 10
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM3NjkwNjk1OTAz",
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},
"city-arts": {
"id": "city-arts",
"title": "City Arts & Lectures",
"info": "A one-hour radio program to hear celebrated writers, artists and thinkers address contemporary ideas and values, often discussing the creative process. Please note: tapes or transcripts are not available",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/05/cityartsandlecture-300x300.jpg",
"officialWebsiteLink": "https://www.cityarts.net/",
"airtime": "SUN 1pm-2pm, TUE 10pm, WED 1am",
"meta": {
"site": "news",
"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
"subscribe": {
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"rss": "https://www.cityarts.net/feed/"
}
},
"closealltabs": {
"id": "closealltabs",
"title": "Close All Tabs",
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"info": "Close All Tabs breaks down how digital culture shapes our world through thoughtful insights and irreverent humor.",
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"officialWebsiteLink": "/podcasts/closealltabs",
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"source": "kqed",
"order": 1
},
"link": "/podcasts/closealltabs",
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"rss": "https://feeds.megaphone.fm/KQINC6993880386",
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"id": "code-switch-life-kit",
"title": "Code Switch / Life Kit",
"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"meta": {
"site": "radio",
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"link": "/radio/program/code-switch-life-kit",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy",
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
"airtime": "THU 10pm, FRI 1am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.commonwealthclub.org/podcasts",
"meta": {
"site": "news",
"source": "Commonwealth Club of California"
},
"link": "/radio/program/commonwealth-club",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/commonwealth-club-of-california-podcast/id976334034?mt=2",
"google": "https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw",
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}
},
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"id": "forum",
"title": "Forum",
"tagline": "The conversation starts here",
"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
"airtime": "MON-FRI 9am-11am, 10pm-11pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Forum with Mina Kim and Alexis Madrigal",
"officialWebsiteLink": "/forum",
"meta": {
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"source": "kqed",
"order": 9
},
"link": "/forum",
"subscribe": {
"apple": "https://podcasts.apple.com/us/podcast/kqeds-forum/id73329719",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz",
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"rss": "https://feeds.megaphone.fm/KQINC9557381633"
}
},
"freakonomics-radio": {
"id": "freakonomics-radio",
"title": "Freakonomics Radio",
"info": "Freakonomics Radio is a one-hour award-winning podcast and public-radio project hosted by Stephen Dubner, with co-author Steve Levitt as a regular guest. It is produced in partnership with WNYC.",
"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/freakonomicsRadio.png",
"officialWebsiteLink": "http://freakonomics.com/",
"airtime": "SUN 1am-2am, SAT 3pm-4pm",
"meta": {
"site": "radio",
"source": "WNYC"
},
"link": "/radio/program/freakonomics-radio",
"subscribe": {
"npr": "https://rpb3r.app.goo.gl/4s8b",
"apple": "https://itunes.apple.com/us/podcast/freakonomics-radio/id354668519",
"tuneIn": "https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/",
"rss": "https://feeds.feedburner.com/freakonomicsradio"
}
},
"fresh-air": {
"id": "fresh-air",
"title": "Fresh Air",
"info": "Hosted by Terry Gross, \u003cem>Fresh Air from WHYY\u003c/em> is the Peabody Award-winning weekday magazine of contemporary arts and issues. One of public radio's most popular programs, Fresh Air features intimate conversations with today's biggest luminaries.",
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"meta": {
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"link": "/radio/program/fresh-air",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=214089682&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/381444908/podcast.xml"
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"here-and-now": {
"id": "here-and-now",
"title": "Here & Now",
"info": "A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.",
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"rss": "https://feeds.npr.org/510051/podcast.xml"
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},
"hidden-brain": {
"id": "hidden-brain",
"title": "Hidden Brain",
"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/05/hiddenbrain.jpg",
"officialWebsiteLink": "https://www.npr.org/series/423302056/hidden-brain",
"airtime": "SUN 7pm-8pm",
"meta": {
"site": "news",
"source": "NPR"
},
"link": "/radio/program/hidden-brain",
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"apple": "https://itunes.apple.com/us/podcast/hidden-brain/id1028908750?mt=2",
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"rss": "https://feeds.npr.org/510308/podcast.xml"
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},
"how-i-built-this": {
"id": "how-i-built-this",
"title": "How I Built This with Guy Raz",
"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/howIBuiltThis.png",
"officialWebsiteLink": "https://www.npr.org/podcasts/510313/how-i-built-this",
"airtime": "SUN 7:30pm-8pm",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/how-i-built-this",
"subscribe": {
"npr": "https://rpb3r.app.goo.gl/3zxy",
"apple": "https://itunes.apple.com/us/podcast/how-i-built-this-with-guy-raz/id1150510297?mt=2",
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"rss": "https://feeds.npr.org/510313/podcast.xml"
}
},
"hyphenacion": {
"id": "hyphenacion",
"title": "Hyphenación",
"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/03/Hyphenacion_FinalAssets_PodcastTile.png",
"imageAlt": "KQED Hyphenación",
"officialWebsiteLink": "/podcasts/hyphenacion",
"meta": {
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"source": "kqed",
"order": 15
},
"link": "/podcasts/hyphenacion",
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"spotify": "https://open.spotify.com/show/2p3Fifq96nw9BPcmFdIq0o?si=39209f7b25774f38",
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"amazon": "https://music.amazon.com/podcasts/6c3dd23c-93fb-4aab-97ba-1725fa6315f1/hyphenaci%C3%B3n",
"rss": "https://feeds.megaphone.fm/KQINC2275451163"
}
},
"jerrybrown": {
"id": "jerrybrown",
"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Political-Mind-of-Jerry-Brown-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/podcasts/jerrybrown",
"meta": {
"site": "news",
"source": "kqed",
"order": 18
},
"link": "/podcasts/jerrybrown",
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"apple": "https://itunes.apple.com/us/podcast/id1492194549",
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}
},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
"meta": {
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"source": "npr"
},
"link": "/radio/program/latino-usa",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
}
},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"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.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
"site": "news",
"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
}
},
"masters-of-scale": {
"id": "masters-of-scale",
"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
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"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
"site": "radio",
"source": "WaitWhat"
},
"link": "/radio/program/masters-of-scale",
"subscribe": {
"apple": "http://mastersofscale.app.link/",
"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"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>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
"officialWebsiteLink": "/mindshift/",
"meta": {
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"source": "kqed",
"order": 12
},
"link": "/podcasts/mindshift",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
"npr": "https://www.npr.org/podcasts/464615685/mind-shift-podcast",
"stitcher": "https://www.stitcher.com/podcast/kqed/stories-teachers-share",
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}
},
"morning-edition": {
"id": "morning-edition",
"title": "Morning Edition",
"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
"airtime": "MON-FRI 3am-9am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/morning-edition/",
"meta": {
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"link": "/radio/program/morning-edition"
},
"onourwatch": {
"id": "onourwatch",
"title": "On Our Watch",
"tagline": "Deeply-reported investigative journalism",
"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?",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/On-Our-Watch-Podcast-Tile-703x703-1.jpg",
"imageAlt": "On Our Watch from NPR and KQED",
"officialWebsiteLink": "/podcasts/onourwatch",
"meta": {
"site": "news",
"source": "kqed",
"order": 11
},
"link": "/podcasts/onourwatch",
"subscribe": {
"apple": "https://podcasts.apple.com/podcast/id1567098962",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw",
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"stitcher": "https://www.stitcher.com/show/on-our-watch",
"rss": "https://feeds.npr.org/510360/podcast.xml"
}
},
"on-the-media": {
"id": "on-the-media",
"title": "On The Media",
"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",
"airtime": "SUN 2pm-3pm, MON 12am-1am",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/onTheMedia.png",
"officialWebsiteLink": "https://www.wnycstudios.org/shows/otm",
"meta": {
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"source": "wnyc"
},
"link": "/radio/program/on-the-media",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/on-the-media/id73330715?mt=2",
"tuneIn": "https://tunein.com/radio/On-the-Media-p69/",
"rss": "http://feeds.wnyc.org/onthemedia"
}
},
"pbs-newshour": {
"id": "pbs-newshour",
"title": "PBS NewsHour",
"info": "Analysis, background reports and updates from the PBS NewsHour putting today's news in context.",
"airtime": "MON-FRI 3pm-4pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/PBS-News-Hour-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.pbs.org/newshour/",
"meta": {
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"source": "pbs"
},
"link": "/radio/program/pbs-newshour",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/pbs-newshour-full-show/id394432287?mt=2",
"tuneIn": "https://tunein.com/radio/PBS-NewsHour---Full-Show-p425698/",
"rss": "https://www.pbs.org/newshour/feeds/rss/podcasts/show"
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